WISCONSIN
MEDICAL JOURNAL
ILLEGE OF PHYSICI^
OF PHILADELPHIA;
FEB 12 1985
4 CHILD ABUSei ):
1 ^
1 1 Diagnostic
1 9
[ 1 1 and
' / 1 Treatment .
H im§
, 1 Guidelines |
WISCONSIN
MEDICAL JOURNAL
CONTENTS
January 1985
ISSN 0043-6542 /Established 1903
Owned and published by
State Medical Society of Wisconsin
SPECIAL FEATURES
67 Let these guides help you
Medical Editor
Victor S Falk MD, Edgerton
Editorial Board
Victor S Falk MD, Edgerton Chairman
Melvin F Fluth MD. Baraboo
M C F Lindert MD, Milwaukee
Wayne J Boulanger MD, Milwaukee
Richard D Sautter MD, Marshfield
Dean M Connors MD, Madison
George W Kindschi MD, Monroe
Charles H Raine AID, Racine
Darrell L Witt MD, Wausau
Garrett A Cooper MD, Madison Emeritus
Editorial Director
Wayne J Boulanger MD, Milwaukee
Editorial Associates
John P Mullooly MD, Milwaukee
Russell F Lewis MD, Marshfield
Raymond A McCormick MD, Green Bay
Victor S Falk MD, Edgerton
Medical Editor
Staff
Earl R Thayer, Madison
Secretary-General Manager
State Medical Society of Wisconsin
H B Maroney II, Madison
Assistant Secretary -Corporate Counsel
State Medical Society of Wisconsin
Mrs Mary Angell, Madison
Managing Editor
Mrs Alarjorie Stafford, Madison
Publications Assistant
Mrs Diane Upton, Madison
Editorial Assistant
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COPYRIGHT 1985
State Medical Society of Wisconsin
4 President's Page: The patient is
our first consideration, by
Timothy T Flaherty, MD, Neenah
6 Editorials: In search of accuracy,
by Wayne J Boulanger, MD, Mil-
waukee . . .-Social Security Dis-
ability Insurance Program in
Wisconsin . . . Three thousand
surgeries . . . Farewell . . . Ele-
vated blood pressure, by Victor
S Falk, MD, Edgerton
7 Letters: Be aware, by Beth Foster,
MD, Wauwatosa
1 1 Special: Child abuse and neglect
16 Special: Documentation needs of
the Social Security Administra-
tion Disability Programs, by
George H Handy, MD, Madison
48 Public health: Hospital prepared-
ness in treating radiation accident
victims concerns SMS EOH
Committee . . . Committee seeks
ways to improve organ procure-
ment system . . . Report on
school health problems available
. . . SMS leaders discuss health
issues of the elderly with Coali-
tion of Aging . . . How they han-
dle drunk drivers in other coun-
tries
50 Socioeconomics: Legislative com-
mittee backs cap on attorney fees
. . . DHSS proposes 3.5% in-
crease in physician reimburse-
ment . . . Medicare assignment
sign-up reaches 36% of MDs and
DOs . . . WISPAC membership
shows 50% increase . . .
WHCLIP rate may increase 75%
. . . Health Policy Council to look
at CON regs
68 News you can use: Interim rec-
ommendations issued on DPT
shortage . . . Chelation therapy
. . . Physicians must report child
abuse and neglect
AMA Brief Reports
14 Poison-warning stickers may not
work . . . Poor predictability ma-
jor radial keratotomy problem
. . . Cyclosporine controls herpes
eye infection
20 Abdominal symptoms one sign of
Rocky Mountain fever . . . Cigar-
ettes fire-death hazard in hospital
26 Nifedipine offers rapid hyper-
tension treatment
33 AMA book wins award . . . Lin-
guistics offers study tool for aging
AMA News Report
30 Tissue abnormalities twice as
likely for DES-exposed women
SCIENTIFIC MEDICINE
19 A case of listeriosis in Bayfield
County, by Eugenia H Parker,
MD and Joseph B Gerwood, RN,
BS, Washburn
21 Henoch-Schoenlein purpura:
Association with unusual vesicu-
lar lesions, by Jeffrey S Garland,
MD and Michael J Chusid, MD,
Milwaukee
WISCONSIN MEDICAL JOURNAL (ISSN 0043-6542) is the official publication of the State Medical
Society of Wisconsin, devoted to the interests of the medical profession and health care in Wisconsin.
Its affairs are handled by the Editorial Board, subject to policy direction of the Society's Board of
Directors. The Managing Editor is responsible for the production, business operation, and coor-
dination of contents as well as the final responsibility of the entire publication. The Editorial Director
IS responsible for Editorials. Unsigned Editorials express views consistent with the policies of the
State Medical Society of Wisconsin. Signed Editorials express personal views of the author for which
the Society takes no responsibility. Neither the Editors nor the State Medical Society will accept
responsibility for statements made or opinions expressed in the pages of the Journal. Indexed in
"Index Medicus," 'Hospital Literature Index," and "Cambridge Scientific Abstracts."
A.
Vol. 84, No. 1
CONTENTS
23 Lithium and Wisconsin— A medi-
cinal trip through history, by
Beverly Redmann, BS and James
W Jefferson, MD, Madison
27 Epidemic typhus acquired in
Wisconsin, by William A Agger,
MD and Vanee Songsiridej, MD,
La Crosse
29 COMMENTARY: Epidemic typhus
in Wisconsin, by Jeffrey P Davis,
MD, Madison
31 Is high too low? A commentary
by the Wisconsin State High
Blood Pressure Advisory Com-
mittee, by Frank D Gutmann,
MD, Milwaukee
ORGANIZATIONAL
37 Highlights of AMA House of
Delegates Meeting, Dec 2-5
39 Milwaukee's Weinshel named
1985 "Physician-Citizen of the
Year"
40 Annual Meeting resolution dead-
line . . . Patient handouts avail-
able on Medicare assignment
44 Doctor Landis nominated for
President-elect of SMS
44 Membership Directory— Update
52 Membership facts
54 CES FOUNDATION: Contributions
for November 1984
DEPARTMENTS
10 Publication information
53 County societies: Milwaukee—
Malpractice focus of Milwaukee
county society meeting . . . Lin-
coln . . . Jefferson . . . Kenosha
54 Physician briefs
59 Specialty societies: Wisconsin
chapter of the American College
of Physicians . . . Wisconsin
Chapter, American College of
Physicians
59 News HIGHLIGHTS
60 OBITUARIES:
Richard D Kennedy, MD
Eau Claire
Albert M Cohen, MD
Fox Point (Milwaukee)
Alphonsus M Rauch, MD
West Bend (Kenosha and
Lake Geneva)
Robert B Andrew, MD
Madison
Christian Fredrik Midelfort, MD
La Crosse
61 Medical Yellow Pages: Physi-
cians exchange . . . Medical facil-
ities . . . Announcements . . .
Advertisers . . . Books received
. . . Medical meetings— Continu-
ing medical education ■
THE STATE MEDICAL SOCIETY OF WISCONSIN, created by the Territorial Legislature in 1841,
represents over 5600 member physicians in Wisconsin, comprising 55 county medical societies
and 25 medical specialty sections. The purpose of the Society is to "bring together the physicians
of the State of Wisconsin to advance the science and art of medicine and the better health of the
people of Wisconsin, and to secure the enactment and enforcement of just medical laws." The major
activities of the Society include continuing medical education, peer review, legislation, community
health education, scientific affairs, socioeconomics, health planning, services for physicians, opera-
tion of a Charitable, Educational and Scientific Foundation, and publication of the Wisconsin Medical
Journal.
S
Officers
President: Timothy T Flaherty, MD
Neenah
President-Elect: John K Scott, MD
Madison
Secretary-General Manager:
Earl R Thayer, Madison
Treasurer: John J Foley, MD
Menomonee Falls
Board of Directors
Chairman: Darold A Treffert, MD
Fond du Lac
Vice Chairman: Roger L
von Heimburg, MD, Green Bay
First District
John P Mullooly, MD, Milwaukee
Jerome W Fans Jr, MD, Cudahy
Carl S Eisenberg, MD, Milwaukee
Thomas A Hofbauer, MD,
Menomonee Falls
Wayne H Konetzki, MD, Waukesha
Fredrick Wood Jr, MD, Kenosha
William L Treacy, MD, Milwaukee
Charles W Landis, MD, Milwaukee
Richard D Fritz, MD, Milwaukee
William J Listwan, MD, West Bend
Second District
J D Kabler, MD, Madison
Cyril M Hetsko, MD, Madison
James J Tydrich, MD, Richland Center
Allen O Tuftee, MD, Beloit
Alwin E Schultz, MD, Madison
Third District
Pauline M Jackson, MD, La Crosse
Fourth District
John J Kief, MD, Rhinelander
Jung K Park, MD, Wisconsin Rapids
W George Locher, MD, Wausau
Fifth District
Darold A Treffert, MD, Fond du Lac
Kenneth M Viste Jr, MD, Oshkosh
C William Freeby, MD, Appleton
Sixth District
Roger L von Heimburg, MD, Green Bay
Vacancy
Seventh District
Marwood E Wegner, MD, St Croix Falls
Eighth District
Joseph M Jauquet, MD, Ashland
1 President: Doctor Flaherty
President-Elect: Doctor Scott
Past President: Chesley P Erwin, MD,
Milwaukee
Speaker: Duane W Taebel, MD,
La Crosse
Vice Speaker: Vernon M Griffin, MD,
Mauston
A,
y
[presidents page
The patient is our first consideration
There are many who say that we have ' 'progressed" to the point where the issue is not what's best for the
patient, but how to limit access, decrease demand, and ration care. I reject that notion. The patient is,
and always must be, our first consideration. If our patients canijot count on us to carry out this simple pledge,
both they and we are lost.
I met just before Christmas with some forty over-65ers who make up the Board of Coalition of Wiscon-
sin Aging Groups. Many of them realize that the federal government has broken its 1965 Medicare promises.
They perceive that Medicare is paying for minimal services and not for compassion. They are scared. I don't
blame them. In a sense, we physicians stand between them and a feeling of hopelessness.
Yes, there are lots of pressures to abandon the patient; lots of frustrating regulation and fudging on political
promises that wear on every doctor's self-esteem and tempt us to breach ethical standards. The more we yield,
the more we decrease the public's confidence in our profession.
I join AMA President Joseph Boyle, MD in his belief that we can regain the public's confidence, the patient's
esteem, and our own belief in ourselves only if we accept the task of leading; making known to the public
that what we do truly is on behalf of the patient.
We— SMS and SMS members— have already come quite a way:
• Two years ago we made it possible for Sharecare to provide primary medical services to 15,000 unem-
ployed individuals and truly needy mothers and children by donating our professional services in full for
patient care under this Wisconsin program, unique in the nation.
• Just two months ago we pledged to the needy of all ages that they should not go without necessary
medical care for lack of money— and we're now dedicated to making that pledge work throughout Wiscon-
sin. So far as we know, no other State Medical Society has publicly made such a commitment to patient
care for the needy.
• We have a nationally recognized model program for impaired physicians— not only to rescue and
rehabilitate our deserving colleagues but also primarily to carry out our obligation to assure safe and proper
patient care.
• We have not succumbed to FTC and antitrust pressures to limit our peer review committee's overview
of the medically incompetent or aberrant practitioners. Unfortunately we have been forced as a Medical
Society to cease imposing strong sanctions on such persons. And worse, the State Medical Examining Board
faces several legal obstacles in its attempts to discipline the incompetent. Yet, we will continue our efforts
to make this part of the system work to our patients' best interests.
• We contributed mightily to the Wisconsin Clean Indoor Air Act; we fought for and won more stringent
formulas for the use of formaldehyde in mobile home construction; we have implemented better prepared-
ness by hospitals and doctors to deal with radiation accidents in Wisconsin; we have invited a delegation
of visiting Russian physicians to come and talk with us about the hazards of nuclear armaments; all of
these are important to the care and well-being of our patients.
This is but part of our story; and we should tell it with pride. For my part, I intend to go on pointing out
that we will help contain cost, but that limiting access or rationing care can be hazardous to your health.
I intend to go on saying that "gatekeeper" systems may sound good to the planners; they can also deprive
some people of useful and necessary medical services.
I intend to go on telling the people of our state that we are interested in our patients and the kind of care
they receive; that we are eager to know how they feel they are being treated by the doctors, and if they are
being mistreated, we will help them.
That's what it means when we say the patient is our first consideration. What we say will have meaning
only if we make it work. ■
4
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EDITORIALS
V
Wayne J Boulanger, MD, Editorial Director
Unsigned editorials express views consistent with the policies of the State Medical Society of Wisconsin.
Signed editorials express personal views of the author for which the Society takes no responsibility.
In search of accuracy
The WiPRO contract with HCFA
continues to rankle a bit as we fall
into the routine of seeking permis-
sion to arrange elective Medicare
hospital admissions. But as it
becomes more routine it also be-
comes a habit, and we'll probably
soon forget this yet another
freedom we have lost.
The "Quality Review Objec-
tives" in the contract aren't as
easy to forget, however. Wiscon-
sin surgeons, (who seem to bear
the brunt of the WiPRO thrust),
under the leadership of the Wis-
consin Chapter of the American
College of Surgeons and the Coun-
cil of the Wisconsin Surgical
Society, have analyzed the con-
tract for accuracy and practicality.
Eventually, constructive criticism
will be offered with an eye toward
improving the quality of surgical
practice in Wisconsin. Unfor-
tunately, the accuracy of the data
presented in the contract is by no
means certain; and without ac-
curate data, remedial actions can-
not even be proven necessary, let
alone planned.
At issue, of course, is the dam-
aging statement brought out in Re-
quired Quality Objective 3A: "(To
Reduce by 50% the Rate of Mor-
tality Among Medicare Patients
Electively Hospitalized and
Undergoing a Class I Surgical Pro-
cedure)" "Rationale: WiPRO
physicians have identified an in-
cidence of potentially avoidable
mortalities among Medicare pa-
tients electively undergoing a
Class I surgical procedure. The
combined data bases of WisPRO
and FMCE suggest that 291 of
1332 deaths within this patient
group were potentially untimely
or premature." That amounts to
an avoidable death rate of 22 per-
cent! If it is correct, then remedial
action is indeed necessary.
However, it is our understand-
ing that the 291 avoidable deaths'
figure was not developed through
individual case studies, but is
merely an estimate based on what
may be erroneous premises. If
that is true, then Wisconsin
surgery has been delivered a low
blow by people who should know
better.
Our course is clear. The 1332
deaths must be scrutinized indi-
vidually if an accurate "avoidable
death" incidence for that group is
to be determined. The Wisconsin
Chapter of the American College
of Surgeons and the Wisconsin
Surgical Society have offered to do
this. Perhaps by the time this goes
to press, the review will already
be under way.
— Wayne J Boulanger, MD, Milwaukee
In this issue is an important arti-
cle by Dr George Handy, formerly
State Health Officer and now
Chief Medical Consultant for the
State Bureau of Social Security
Disability Insurance. His office
processes about 900 applications
for disability each week. Even-
tually about 40% are allowed.
Doctor Handy emphasizes the
necessity of submitting detailed
information beginning with the
date of onset. A common mis-
understanding for both patients
and physicians pertains to the
definition of disability— in this
Editorial Board comment: Doc-
tor Boulanger shows commendable
restraint, for they have planned to
desecrate the sanctuary of those who
seek care and to pollute the dwelling
place of those who provide it. We
agree there is a glaring absence of
verifiable information re quality of
care issues, and that far-reaching
decisions are being made on the basis
of hopelessly inadequate data. For
example, one of the prized "facts" in-
dicting medical practice standards in
this country is the variation found in
length of stay in different parts of the
country. Yet in an important study
reported in the November 1984 issue
of Medical Care, substantial
regional differences in LOS all but
disappeared when socioeconomic
conditions fie, entirely nonmedically
determined factors) were taken into
account. Doctor Boulanger is ab-
solutely correct in pointing out the
need for having credible data before
massive efforts are mobilized to cor-
rect minor or even nonexisting prob-
lems. Why forget Don Quixote in
these times?
situation it is the inability to
engage in any substantial gainful
activity.
Since the ultimate determina-
tion is based on evidence from
medical sources, physicians must
submit accurate, detailed reports
if they are to be of help to their pa-
tients. This is becoming more im-
portant with our increasing aging
population and with such mili-
tant, potent organizations as the
American Association of Retired
Persons turning on the heat in
Washington.
— Victor S Falk, MD, Edgerton
Social Security Disability Insurance
Program in Wisconsin
6
WISCONSIN MEDICAL JOURNAL, JANUARY 1985:VOL. 84
EDITORIALS
Three thousand
surgeries
Medical marketing is now a
way of life, but the high-priced
hucksters would do well to seek
medical advice as well as a basic
course in the English language.
Recently we have been informed
repeatedly by a wide-ranging
commercial aired from a Chicago
radio station that the Chicago area
hospitals of a religious group have
performed "3,000 orthopedic sur-
geries" in the past year.
First of all, it is obvious that the
hospitals did not perform any
operations. In addition the usual
concept of a surgery is that it is the
site where surgical procedures are
carried out.
It's a small matter, but if we
have to be assailed with this type
of salesmanship, the medical
marketers should tidy up their
act.
—Victor S Falk, MD, Edgerton
Farewell
Since November 1949, the bot-
tom half of the cover of the Wis-
consin Medical Journal has pre-
sented an ad from Eli Lilly & Co.
Over the years this has been an
important source of income, but it
also has been a point of criticism
by journalism experts during
critique sessions at the annual
medical journal conferences. We
have appreciated the revenue but
not the barbs. We are one of the
very last journals to drop the front
cover advertisement. The last ad
appeared on our December 1984
issue. In bidding farewell to the
front cover Lilly ad, the Journal
wishes to thank the Lilly company
for its continuous support of more
than three decades.
We do not plan to present
works of art on the cover in com-
petition with JAMA. However, We
may occasionally exhibit the pic-
ture of a new society president,
the honoree of a festschrift, or
some theme appropriate to a
special issue.
In any event, we will maintain
our color scheme and will still be
referred to as the "red journal."
— Victor S Falk, MD, Edgerton
Elevated blood
pressure
In this issue of the Wisconsin
Medical Journal there appears a
commentary by the Wisconsin
State High Blood Pressure Ad-
visory Committee. This is a sequel
to an article published exactly five
years ago. The Advisory Commit-
tee has made changes in the
guidelines for use at screening
sites, and it is essential that Wis-
consin physicians familiarize
themselves with the new criteria.
It is anticipated that there will
be an increase in referrals to
physicians. Also there may be dif-
ferences in opinions relative to the
program, and comments are wel-
come.
— Victor S Falk, MD, Edgerton ■
\
LETTERS
V
The Editors would like to encourage physicians to contribute to the LETTERS section where they can ventilate their frustrations as well as opinions. This feature
is intended to be lively and spirited as well as informative and educational. As with other material which is submitted for publication, all letters will be subject
to the usual editing. Address correspondence to: The Editor, Wisconsin Medical Journal, Box 1109, Madison, Wis 53701.
Be aware
To THE EDITOR: My congratula-
tions to Doctor Schoenwetter for
his very nice article [WMJ:
November 1984) regarding the
"gray area" child.
He points out some very impor-
tant and relevant issues for the
physician who is helping a family
in meeting their child's educa-
tional needs.
The law protecting the educa-
tional needs of the moderately and
severely involved child meet their
needs very well. It is unfortunate
how many children "fall between
the cracks" in the public educa-
tional system.
The message to the practicing
physician is clear. An M-team can-
not be used as an educational,
psychological, and speech evalua-
tion.
When families come to us with
a concern about school failure, we
need to be aware of what our
community can offer in terms of
testing and rehabilitative and
educational support for these
children.
—Beth Foster, MD
Pediatrician
9001 Watertown Plank Road
Wauwatosa, Wisconsin 53226 ■
WISCONSIN MEDICAL JOURNAL, JANUARY 1985: VOL. 84
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No longer do doctors have to deny patients the
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Winthrop-Breon Laboratories has met a nagging
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equivalent to 0.5 mg base. The reformulated
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The oririnal formulation had been subject to a
form of misuse among street abusers known as
“Ts and Blues.” TALWIN 50 and PBZf an anti-
histamine, would be ground up together, put into
solution, and injected intravenously. The combi-
nation produced a heroin-like high. Because
naloxone is a narcotic antagonist when injected
intravenously, it acts to nullify any high a “T’s and
Blues” addict might expect from the pentazocine
in a combination of TALWIN Nx and PBZ. When
taken as directed orally, the naloxone component
of TALWIN Nx is inactive. Thus, TALWIN Nx
continues to be a safe, effective, oral analgesic for
the relief of moderate to severe pain, now provid-
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The reformulation of Talwin 50 to Talwin Nx
involved the addition of 0.5 mg naloxone to
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Please see following page for Brief Summary.
Each tablet contains pentazocine HCI, USR equivalent to
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Analgesic for Oral Use Only
Contraindications: Hypersensitivity to either pentazocine or
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TALWIN^ Nx IS intended for oral use only Severe, potentially
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analgesics, respiratory depressant effects of the drug may elevate
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sure Can obscure the clinical course of patients with head injuries:
in such patients, use with extreme caution and only It deemed
essential Usage with Alcohol Due to potential for increased CNS
depressant effects, alcohol should be used with caution Patients
Receiving Narcotics Rentazocine is a mild narcotic antagonist
Withdrawal symptoms have occurred in patients previously given
narcotics, including methadone Certain Respiratory Conditions
Should be administered with caution in respiratory depression from
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Precautions: CNS Effect Use cautiously in patients prone to
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sive liver disease may predispose to accentuation of side effects, it
should be administered with caution in renal or hepatic impairment
In long-term use. precautions should be taken to avoid increases in
dose by the patient Biliary Surgery Some evidence suggests that
unlike other narcotics pentazocine causes little or no elevation in
biliary tract pressures, the clinical significance of these findings is
not yet known Information for Patients Since sedation, dizziness,
and occasional euphoria have been noted, ambulatory patients
should be warned not to operate machinery drive cars, or unneces-
sarily expose themselves to hazards May cause physical and
psychological dependence taken alone and may have additive CNS
depressant properties in combination with alcohol or other CNS
depressants Myocardial Infarction. Use with caution in patients
with myocardial infarction who have nausea or vomiting. Drug
Interactions Usage with Alcohol See Warnings. Carc/oogen-
esis. Mutagenesis. Impairment of Fertility. No long-term studies
in animals to test for carcinogenesis have been performed. Preg-
nancy Category C Should be given to pregnant women only if
clearly needed Labor and Delivery Use with caution in women
delivering premature infants. Effect on mother and fetus, duration of
labor or delivery need for forceps delivery or other intervention or
resuscitation of newborn, or later growth, development, and
functional maturation of the child is unknown Nursing Mothers
Caution should be exercised when administered to a nursing
woman Pediatric Use Safety and effectiveness in children below
the age of 12 years have not been established
Adverse Reactions: Cardiovascular Hypotension, tachycar-
dia, syncope. Respiratory Rarely, respiratory depression CNS
Acute CNS Manifestations: In rare instances, hallucinations
(usually visual), disorientation, and confusion which have cleared
spontaneously within a period of hours, may recur if drug is
reiostituted. Other CNS Effects: Dizziness, lightheadedness, seda-
tion, euphoria, disturbed dreams, hallucinations, irritability excite-
ment, tinnitus, tremor. Gastrointestinal Nausea, vomiting, con-
stipation, diarrhea, anorexia, rarely abdominal distress Allergic
Edema of the face, dermatitis, including pruritus, flushed skin, includ-
ing plethora Ophthalmic: Visual blurring and focusing difficulty
Hematologic Depression of white blood cells (especiafly granulo-
cytes). which is usually reversible, moderate transient eosinophilia
Other Headache, chills, insomnia, weakness, urinary retention.
Drug Abuse and Dependence: Controlled Substance.
TALWIN Nx IS a Schedule IV controlled substance
Dependence and withdrawal symptoms have been reported with
orally administered pentazocine Patients with a history of drug
dependence should be under close supervision. Rossible abstinence
syndromes in newborns after prolonged use of pentazocine during
pregnancy have been reported In prescribing for chronic use, the
physician should take precautions to avoid increases in dose by the
patient Tolerance to the analgesic effect is rarely reported, there is
no long-term experience with oral use of TALWIN Nx
The amount of naloxone present (Q 5 mg per tablet) has no action
when taken orally and will not interfere with the pharmacologic
actioo of pentazocine, however, this amount of naloxone given oy
injection has profound antagonistic action to narcotic analgesics
TALWIN Nx has a lower potential for parenteral misuse than the
previous oral pentazocine formulation, but is still subject to patient
misuse and abuse by the oral route
Severe, even lethal, consequences may result from misuse of tablets
by injection either alone or in combination with other substances,
such as pulmonary emboli, vascular occlusion, ulceration and absces-
ses, and withdrawal symptoms in narcotic dependent individuals
Overdosage: Treatment: Dxygen, intravenous fluids, vasopres-
sors, and other supportive measures should be employed as indi-
cated. Assisted or controlled ventilation should also be considered
For respiratory depression, parenteral naloxone (Narcab', available
through Endo Laboratories! is a specific and effective antagonist
Please consult full product information before prescribing
\^/7f^rotpBreo/7
Winthrop-Breon Laboratories
Division of Sterling Drug Inc
New York, NY 10016
PUBLICATION INFORMATION
MANUSCRIPTS. Manuscripts will be accepted for con-
sideration with the understanding that they are original,
have never before been published, and are contributed
solely to the Wisconsin Medical Journal. The Editorial Board
reserves the right to limit manuscripts to two printed pages,
with additional pages to be subsidized by the author(s) on
the basis of $ 100 per page. A maximum of four illustrations
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charged to author(s) at cost. Address manuscripts to Medical
Editor, Wisconsin Medical Journal, Box 1109, Madison, Wis
53701.
Rejected manuscripts are returned by regular mail. Ac-
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are not returned. Submit one original and two photocopies.
Author should retain one photocopy. Format and style
should follow that of the AMA Style Book and Editorial
Manual. Manuscripts are subject to editorial modification
and such revisions as bring them into conformity with
Journal style.
Contributors will be sent a copy of their article after it has
been edited and set in type for final approval before publica-
tion. A form for ordering reprints will accompany the
article.
Under ordinary circumstances manuscripts are published
about four months following acceptance, and in the order
in which they are received.
COPYRIGHT. Material that is published in the Wisconsin
Medical Journal is protected by copyright and may not be
reproduced without written permission of both the author
and the Journal. However, most state and regional medical
journals owned by state medical societies have granted each
other continuing copyright permission to copy or quote with
proper credit. Copyright permission is not granted to com-
mercial or privately owned publications.
RESPONSIBILITY. Publication of the Wisconsin Medical
Journal is under the direction of the Editorial Board whose
policies are approved by the Board of Directors of the State
Medical Society of Wisconsin. The Medical Editor is chair-
man of the Editorial Board. The Editorial Director is respon-
sible for Editorials. Unsigned Editorials express views con-
sistent with the policies of the State Medical Society of
Wisconsin. Signed Editorials express personal views of the
author for which the Society takes no responsibility. The
Managing Editor is responsible for the production and
business operation of the Journal, as well as final respon-
sibility of the entire publication.
Neither the Editors nor the State Medical Society will
accept responsibility for statements made or opinions ex-
pressed by any contributor in any article or feature pub-
lished in the pages of the Journal.
ADVERTISEMENTS. The acceptance of advertising in the
Wisconsin Medical Journal is predicated on the basis that the
advertised product or service meets the ethical principles
established by the Board of Directors of the State Medical
Society of Wisconsin. The Journal reserves the right to ac-
cept or reject advertising copy for any reason. Advertising
rates will be furnished upon request.
CIRCULATION. Members of the State Medical Society of
Wisconsin receive the Wisconsin Medical Journal each
month. The cost of the Journal for members ($12.50 per
year) is included in dues. Nonmembers may subscribe at
the following rates: $25.00, one year; $2.00, single copy;
$3.00, previous years. SPECIAL RATES: Foreign and
Canada, $30.00. Blue Book issue, $8,00. Green Book issue
(Membership Directory), $15.00. The Journal reserves the
right to control its circulation.
INDEXING. The Wisconsin Medical Journal is indexed in
“Index Medicus,” “Hospital Literature Index," and “Cam-
bridge Scientific Abstracts." ■
WIN 4-41415F
special]
k.
Child abuse and neglect
a»buse (a-byoos|n. 1. a misuse. 2. an unjust or corrupt practice. 3. abusive words,
insults, abuse (a-byooz| v. (a«bused, a*bus*ing) 1. to make a bad or wrong use of,
abuse one's authority. 2. to treat badly. 3. to attack in words, to utter insults to or
about.
[Oxford American Dictionary, Oxford University Press, Inc 1980, p 6]
TT HE NEW LAW relating to report-
ing of child abuse and neglect
(1983 Wisconsin Act 172) [Wiscon-
sin Statutes 48.981) has created
concern, not to mention contro-
versy, within the medical, social
services, and enforcement com-
munities.
The Act changed the reporting
and investigation of child abuse
and neglect cases in this state by;
( 1 ) Expanding the list of persons
required to report suspected
abuse or neglect;
(2) Expanding the definition of
child abuse to include sexual
exploitation of children and
emotional damage to chil-
dren;
(3) Eliminating some of the pro-
cedural requirements appli-
cable to reporting and docu-
mentation of specific inci-
dents of abuse or neglect and
determining the guilt or in-
nocence of persons sus-
pected of child abuse or
neglect; and
(4) Establishing new procedures
for providing services to chil-
dren and families where
child abuse or neglect has
occurred or is threatened.
Individuals whose employment
brings them into regular contact
with children are required by law
to immediately report suspected
abuse or neglect. Included as
mandated reporters under Wis-
consin law are:
• physicians
• coroners
• medical
examiners
• nurses
• dentists
• chiropractors
• optometrists
• law enforce-
ment officers
• other medical and mental health
professionals
• social workers
• public assistance workers
• child care workers
• school teachers, counselors, and
administrators.
Under the current Act, any per-
son who wilfully fails to file a re-
quired report carries a penalty of
a fine not more than $100 or im-
prisonment for not more than six
months, or both, to a fine of not
more than $ 1000 or imprisonment
for not more than six months, or
both.
Any person or institution parti-
cipating in good faith in reporting
suspected cases of abuse or neg-
lect is immune from any liability,
civil or criminal, that results by
reason of the action.
In 1981, 1482 Wisconsin chil-
dren were positively determined
to be abused or neglected, and in
eight of these cases, the children
died. In 1982, 1754 Wisconsin
children (up 1.9 percent over the
previous year) were determined to
be abused or neglected; of this
number, nine died. Reported
cases of child abuse and neglect
have increased 13 percent in the
past four years.
Child sexual abuse, a highly
complex problem, during the
same period, has emerged as the
most rapidly increasing type of
reported abuse. Reports from
1979 showed 318 reports and ris-
ing to 1471 in 1982. Between 1981
and 1982, the reports of child sex-
ual abuse increased 21 percent.
The American Medical Associa-
tion has made child abuse and
Front cover artwork courtesy
of Iowa Medicine
neglect a top priority. A report of
the AMA Council on Scientific Af-
fairs entitled "Diagnostic and
Treatment Guidelines for Child
Abuse and Neglect" reflects the
views of scientific experts and
reports in the scientific literature
as of December 1984.
Hopefully, these guidelines will
help physicians improve their
child abuse diagnostic and treat-
ment skills. A complete copy of
the Guidelines is available upon
request to the SMS.
[This report is not intended to be
construed as a standard of medical
care. Standards of medical care
are determined on the basis of all
of the facts and circumstances in-
volved in an individual case and
are subject to change as scientific
knowledge and technology ad-
vance and patterns of practice
evolve.]
Introduction. Every year, more
than a million children in the
United States are seriously abused
by their parents, guardians, or
others, and between 2000 and
5000 children die as a result of
their injuries. Although child
1 1
WISCONSIN MEDICAL JOURNAL, JANUARY 1985: VOL. 84
SPECIAL
CHILD ABUSE
abuse may have been identified as
a social problem in the last cen-
tury, it took almost 100 years for
violence toward children to be
considered a major national prob-
lem.
In the 1940s, through the use of
diagnostic x-ray technology, phy-
sicians began to notice in young
children patterns of healed frac-
tures that could have resulted
only from repeated blows. It was
not until C Henry Kempe and his
associates published "The Bat-
tered Child Syndrome" in the
Journal of the American Medical
Association in 1962, that battering
and abuse became a focal point of
public attention. By the end of the
1960s, all 50 states had passed
laws requiring the reporting of
child abuse and neglect and had
initiated efforts to treat abused
children and their families.
Facts about child abuse and
neglect. Child maltreatment is
serious and life-threatening, a
phenomenon that affects not only
children but also families and
society. The causes of abuse and
neglect are complex and variable,
but it is most useful to understand
that they may be symptoms of a
dysfunctional family.
Correlations between child mal-
treatment and family characteris-
tics that have been identified in-
clude some of the following;
Families who are or have:
• low-income;
• socially isolated;
• where husbands and wives
resort to violence to one
another;
• where parental expectations
are inconsistent with the
child's developmental
abilities;
• stressors such as alcohol and
drug misuse.
Children who are or have:
• premature birth;
• adolescent parents;
• congenital deficiencies.
The etiology of child abuse and
neglect is an interactional one.
The primary care physician must
take into account social, familial,
psychological, and physical fac-
tors in developing a treatment
plan for the abused or neglected
child.
Diagnosis. A complete physical
examination, including develop-
mental testing, on any child who
may be a victim of abuse, must be
conducted. Laboratory studies are
useful in delineating the nature
and extent of current trauma and
in defining the presence of pre-
vious trauma.
The physician should also:
• understand and assess the
plausibility of historical and
medical antecedents;
• determine the dimensions of
continued risk;
• obtain the medical history.
Signs of physical abuse. It is esti-
mated that more than 125,000
new cases of physical abuse occur
annually in the United States.
Nonaccidental trauma is the most
easily identified type of abuse and
most commonly seen by physi-
cians. Characteristically, the in-
juries are more severe than those
that could reasonably be attri-
buted to the claimed cause.
Physical signs:
• bruises and welts;
• burns;
• fractures;
• lacerations or abrasions;
• abdominal injuries;
• central nervous system
injuries.
Behavioral signs: The abused
child is likely to have behavioral
problems. The following signs
may be seen as either provoking
or resulting from abuse:
The child may:
• be less compliant than
average;
• exhibit signs of negativism;
• appear to be unhappy;
• be angry, isolated,
destructive;
• display abusive behavior
toward others;
• have difficulty developing
relationships;
• display either excessive or
complete absence of anxiety
about separation from
parents;
• display inappropriate care-
taking behavior toward
parents;
• constantly be in search of
attention, favors, etc;
• evidence a variety of
developmental displays.
Signs of physical neglect. Physi-
cal neglect appears to be more
common than physical abuse.
Neglect tends to be chronic in
nature and is defined as the failure
of a parent or other person legally
responsible for a child's welfare to
provide for the child's basic needs
and an adequate level of care.
Physical signs:
• malnutrition;
• repeated episodes of pica;
• constant fatigue or
listlessness;
• poor hygiene;
• inadequate clothing for
circumstances.
Behavioral signs:
• lack of appropriate adult
supervision;
• repeated ingestions of
harmful substances;
• poor school attendance;
• exploitation;
• "role reversal;"
• drug or alcohol use.
Signs of medical neglect:
• failure to receive adequate
medical attention;
—absence of necessary
immunizations and
medications;
—absence of dental care;
—absence of necessary
prosthetics including
eyeglasses, hearing aids,
etc.
2
WISCONSIN MEDICAL JOURNAL, JANUARY 1985: VOL. 84
CHILD ABUSE
SPECIAL
Signs of sexual abuse. Child sex-
ual abuse is the exploitation of a
child for the gratification or profit
of an adult. It can range from ex-
hibitionism to intercourse or use
of a child in the production of por-
nographic materials. Sexual abuse
generally is perpetrated by some-
one known to the child and fre-
quently continues over a pro-
longed period. The incidence is
estimated at 100,000 to 250,000
cases per year; however, this type
of abuse is difficult to detect and
confirm.
Physical signs:
• difficulty in walking or sitting;
• thickening and/or hyper-
pigmentation of labial skin
(especially when it resolves
during out-of-home place-
ment);
• horizontal diameter of vaginal
opening that exceeds 4 mm
in prepubescent girls;
• torn, stained, or bloody
underclothing;
• bruises or bleeding of the
genitalia, perineum or
perianal area;
• vaginal discharge and/or
pruritis;
• recurrent urinary tract
infections;
• gonococcal infection;
• syphilis;
• genital herpes;
• trichomonas;
• chlamydial infection when
present beyond first six
months of life;
• lymphogranuloma venereum;
• nonspecific vaginitis;
• candidiasis;
• pregnancy;
• sperm or acid phosphatase
on body or clothes; sperm
in the urine of female child;
• lax rectal tone.
Behavioral signs: These are
dependent upon the age of the
child, emotional maturity, nature
of the incident, duration of sexual
abuse, and the child's relationship
to the offender.
The child may:
• confide in a relative, friend,
or teacher; the disclosure may
be either overt or subtle and
indirect;
• become withdrawn and day-
dream excessively;
• evidence poor self-esteem;
• appear frightened or phobic,
especially of adults;
• experience distortion of body
image;
• express general feelings of
guilt or shame;
• exhibit a sudden deterioration
in academic performance;
• show pseudomature person-
ality development toward
offender;
• display regressive behavior;
• attempt suicide;
• exhibit a positive relationship
toward offender;
• display eneresis and/or
encopresis;
• engage in excessive
masturbation;
• engage in highly sexualized
play;
• become sexually
promiscuous;
• have a sexually abused
sibling.
Signs of emotional maltreat-
ment. Parents or caretakers who
maltreat children emotionally are
frequently unable or unwilling to
provide the emotional attention
and nurturance necessary for nor-
mal growth and development.
Physical signs:
• delay in physical develop-
ment;
• failure to thrive.
Behavioral signs: The child may
exhibit:
• distinct emotional symptoms
and/or functional limitations
that can be causally linked to
parental management;
• deteriorating conduct;
• increased anxiety;
• apathy or depression;
• developmental lags.
[The Guidelines enumerate do's
and don'ts pertaining to the inter-
viewing process relating both to
children and parents, and will not
be listed here.]
Management objectives. Major
management objectives for the
physician include the following:
• identify the child;
• take emergency measures
needed to prevent further
injury;
• provide medical evaluation
and treatment;
• provide an accurate and
complete medical evaluation
with documentation to
include:
—brief description of the
nature and extent of the
injuries and medical
condition of the child;
—all relevant behavior and
statements;
—complete medical and brief
social history;
—results of all laboratory
and diagnostic procedures;
—color photographs and
x-rays if applicable.
• remain objective and non-
judgmental;
• attempt to establish or main-
tain a therapeutic alliance
with the family;
• attempt to secure medical
evaluation of other children
in the household;
• report all suspected cases.
Reporting requirements. Al-
though child abuse and neglect
laws vary among jurisdictions, all
statutes include:
(1) quick identification,
(2) designation of an agency,
and
(3) provision for treatment
services.
In its February issue. The Child
Abuse Law-Explanation and Impli-
cations will be published by the
Wisconsin Medical Journal. The
report will address what the law
WISCONSIN MEDICAL JOURNAL, JANUARY 1985: VOL. 84
13
SPECIAL
CHILD ABUSE
requires; potential resolutions of
legal problems and requirements,
along with formal and informal
guidelines.
Trends in treatment and pre-
vention. The physician's role in
the treatment of child abuse and
neglect historically has been one
of detection, medical diagnosis,
and treatment or referral. Physi-
cians can now participate in the
primary prevention as well as
work with local child protection
agencies to develop a followup
mechanism for reported cases.
Comprehensive prevention stra-
tegies should attempt to reduce
the burden of child care, family
isolation, and long-term conse-
quences of poor parenting. In-
creased access to health and social
services for all family members is
another goal of any prevention
effort.
Future WMJ articles will detail
what happens once the report is
made and the aftermath— dealing
with the victim and family back in
the community setting.
— Prepared by Deb Powers, Policy Analyst, SMS Physicians Alliance Division ■
AMA Brief Reports
Poison-warning stickers may not work
Toddlers may not be deterred from manipulating containers that are labeled with poison-warning
(Mr Yuk) stickers, according to Katherine Vernberg, MPH, and colleagues from the University of
Virginia School of Medicine in Charlottesville. They examined the behavior of 20 children ages 12
to 30 months before and after education on labeling and poison. Before instruction, toddlers played
with labeled and unlabeled containers without statistical preference. After instruction, they showed
a touch preference for the poison-warning labeled containers. The report appears in the November
1984 American Journal of Diseases of Children, m
Poor predictability major radial keratotomy problem
Poor predictability with variable results is the major problem with radial keratotomy today, says Perry
S Binder, MD, of La Jolla, Calif, in the November 1984 Archives of Ophthalmology. He says the National
Eye Institute has now completed the second year of its multicenter study of the procedure and that
expertise is growing. "The procedure is capable of correcting approximately 4 to 5 diopters of myopia,"
he says. "Ophthalmologists must discuss the variability of the procedure with their patients, explain
the potential and reported complications, and present the alternatives of continuous or daily wear
contact lenses." ■
Cyclosporine controls herpes eye infection
Using experimental animal models, Helene M Boisjoly, MD of Harvard Medical School, and colleagues
demonstrated significant decrease in herpetic stromal keratitis (inflammation of the cornea caused
by herpes simplex virus) by applying a 1% solution of cyclosporine to the affected eye. Such infec-
tions now are treated with topical corticosteroids, which may be associated with several corneal com-
plications, the researchers say. "Our finding of a beneficial prophylactic effect of topical cyclosporine
in experimental herpetic stromal keratitis (HSK) opens new possibilities for the treatment of HSK,"
they say in the December 1984 Archives of Ophthalmology. Cyclosporine is a powerful immunosup-
pressant drug. ■
14
WISCONSIN MEDICAL JOURNAL, JANUARY 1985: VOL. 84
who is number 1
in medical
olFice computer
systems in
Wisconsin?
HDX Clinical Hanagenent Systen
6) Appointnent Scheduling
7) Hedical History
H^TI
III
1) Financial Accounting
2) Insurance Clain Tracking
Not IBM nor Apple nor any other nationally-known
computer name. The answer is Advanced Technology
Associates. Number 1 means the most complete systems; the
most logical match of hardware, software and services. ATA is
the source for total packages — computers, terminals, printers,
special medical programs, careful installation, training for
your people and after-sale support.
Considering the scope of our Wisconsin experience, it
should not surprise you that ATA is endorsed by the State
Medical Society.
May we send you information listing your benefits from
a strictly medical office computer system? Call or write.
Advanced Technology Associates
4710 W. North Avenue, Milwaukee, Wl 53208
(414) 445-4280
In Wisconsin call toll free 1-800-242-4280.
Endorsed by SMS Services, Inc For members of the State Medical Society of Wisconsin.
SPECIAL
Documentation needs of the
Social Security Administration
Disability Programs
George H Handy, MD, Madison, Wisconsin
The Social Security Disability
Program is undergoing changes in
terms of policy and eligibility cri-
teria at the federal level. This pro-
gram has been with us since 1935,
and it affects all citizens. The sys-
tem may change, but its applica-
tion must be fair and equitable to
all. In Wisconsin this has been the
goal, and the method has been the
informed involvement of the
medical system.
In the United States nearly 5
million disabled persons are re-
ceiving cash benefits each month.
In Fiscal Year 1983, the Social
Security Administration (SSA)
processed over 1.25 million
claims. Over $22 billion in actual
cash benefits are paid to disabled
persons and their families under
the Social Security Disability Pro-
gram and Supplemental Security
Income Program. Also, in FY
1983, SSA paid out over $200 mil-
lion for medical evidence, includ-
ing $175 million for consultative
examinations. The Administration
has over 1200 physicians on duty
(part-time and full-time) in the
Disability Determination service.
In Wisconsin, the Bureau of
Social Security Disability Insur-
Doctor Handy is Chief Medical Consul-
tant, Bureau of Social Security Disability
Insurance in the Division of Community
Services of the State Department of Health
and Social Services, PO Box 7623, Madi-
son, Wis 53707 (phone: 608/ 266-6608] .
Reprint requests to Doctor Handy at the
above address. Copyright 1985 by the
State Medical Society of Wisconsin.
ance receives about 900 applica-
tions a week from Wisconsin citi-
zens. These have been screened
by the local Social Security agen-
cies for nonmedical eligibility. Of
this number about 15% are for re-
view of previously allowed dis-
ability claims. The remainder are
new or appealed claims.
Disability is defined as the in-
ability to engage in any substantial
gainful activity by reason of any
medically determinable mental or
physical impairment which can
be expected to result in death, or
which has lasted or can be ex-
pected to last for a continuous
period of not less than 12 months.
The determination must be
based on evidence from medical
sources.
About half of the cases are re-
viewed and adjudicated from evi-
dence from treating physicians'
records and records from hospi-
tals, clinics, sanitoriums, mental
institutions, or other healthcare
facilities. The remaining cases re-
quire consultative examinations
which, in Wisconsin, are physical
examinations purchased from
practicing physicians on a fixed-
fee basis.
A panel of about 1800 physi-
cians who are willing to schedule
and examine these claimants has
been established. This panel in-
cludes licensed physicians, li-
censed osteopaths, licensed or cer-
tified psychologists, and licensed
optometrists for measurement of
visual acuity and visual fields.
Some states depend primarily on
key provider groups who only
supply services to SSA for the ex-
aminations. The consultative ex-
aminations put about $250,000
monthly into the medical eco-
nomy of Wisconsin.
The medical evidence obtained,
whether from records or examina-
tions, must be of sufficient detail
in documentation so that a physi-
cian who has never seen the
claimant can make an indepen-
dent evaluation, based on objec-
tive findings, to determine the
nature of the claimant's medical
condition and also rate the sever-
ity of the impairment as the resi-
dual functional capacity. The
medical evidence must detail the
symptoms, signs, and laboratory
findings which indicate that a
claimant has a medical condition
which limits the ability to work.
The standards for the disability
evaluation are listed in "A Hand-
book For Physicians" which is
available and is supplied to all ex-
amining physicians. Many of
these standards are being revised
and updated.
If a person has only one impair-
ment and the medical evidence
documents no others, all pertinent
information concerning that im-
pairment must be supplied. For
example, if the claimant has a con-
dition involving the musculoskel-
etal system, the pertinent infor-
mation could include medical and
surgical notes describing range of
motion and functional restric-
tions, initial and subsequent x-ray
reports, laboratory reports, oper-
ative procedure reports, physio-
therapy reports showing range of
motion in degrees, and even elec-
tromyograms and nerve conduc-
tion study results.
16
WISCONSIN MEDICAL JOURNAL, JANUARY 1985:VOL. 84
SSA DISABILITY PROGRAMS-Handy
SPECIAL
Sometimes a claimant believes
that he or she is disabled only in
one body system, and the SSA
only requests information related
to that one body system. How-
ever, unknown to the claimant
and the SSA, medical evidence
may exist which points to other
serious impairments of one or
more body systems. The SSA
relies on local treating physicians
to help discover this information.
It is critical that all the additional
medical material be included in
the reports, because it may make
the difference between allowing
or denying the claim.
In one example, a claim for
benefits was filed for a heart con-
dition which was not severe, but
the medical reports show that the
person was also missing both legs
and used prostheses. This impair-
ment was not reported, because it
had occurred at a young age and
the claimant had adjusted to it.
Without the complete medical re-
ports in this case, the SSA would
have denied the claim. With
them, an allowance was made
immediately.
Multiple alleged impairments
must all be documented regard-
less of the basis.
Many people in hospitals' and
doctors' offices who send records
may believe that the SSA only re-
quires the latest information from
the records; that is, the hospital
discharge summary. This is not
necessarily true. (Dne of the big-
gest problems is deciding the date
on which the claimant became
disabled, or the "onset" date. This
is the date upon which the claim-
ant's impairment or combination
of impairments became suffi-
ciently disabling to prevent work
and the basis for onset of payment
and may allow retroactive pay-
ments. Sometimes this is clear-
cut, as in the case of a traumatic
event such as a motorcycle acci-
dent. But with long-standing im-
pairments, often with multiple
hospital admissions or repeated
physician visits, it is important to
review admission records, inter-
mediate records, findings in the
discharge summary in order to
pinpoint the onset date.
The continuous medical record
has another valuable purpose.
The onset date and current condi-
tion may be known, but what
about the months and years in be-
tween? In order to grant the claim-
ant a continuous period of dis-
ability, SSA must know what hap-
pened in the period between onset
and the present time. This is par-
ticularly important in document-
ing the history of individuals with
mental impairments, but it is im-
portant for physical conditions as
well.
In 1980, Congress directed the
SSA to review the claims of all dis-
abled persons at least once every
three years or less often if the im-
pairment is permanent. The medi-
cal evidence forms a basis for any
decision as to whether the bene-
ficiaries continue to receive bene-
fits. Local treating physicians can
help the Social Security Adjudica-
tor make the correct decision in
every case by providing copies of
all medical evidence. Also, it is im-
portant that all copies of medical
records be as legible as possible. It
is equally important that the copy
be complete. It is sometimes very
difficult to determine whether a
page was missing from a lengthy
medical report, and the missing
page may contain evidence that
makes a difference between an
allowance and a denial of the
claim.
The importance of accurate and
complete information cannot be
over emphasized. The SSA deci-
sion-making process is rendered
helpless without it. The work of
local treating physicians in supply-
ing aU pertinent medical records is
instrumental in making fair, uni-
form, correct, and equitable dis-
ability determinations. It is of the
utmost importance to millions of
individuals who file applications
for disability benefits. The con-
tinued prompt and thorough
response to SSA information re-
quests is what makes the system
work, and work fairly.
The Bureau of Social Security
Disability Insurance is constantly
attempting to add consultative ex-
aminers to the panel. This is par-
ticularly true in the outlying and
northern parts of the state which
have a very small number of
specialists to perform the exami-
nations in the fields of ortho-
pedics, neurology, and ophthal-
mology.
There also is opportunity for
physicians to be employed in the
Central Office in Madison to re-
view and provide expert advice to
the lay adjudicators who are re-
sponsible for the determinations
of disability and to call local treat-
ing physicians for additional
medical information.
If the Bureau can supply any ad-
ditional information, please call
George H Handy, MD, Chief
Medical Consultant, Bureau of
Social Security Disability Insur-
ance, Box 7623, Madison, Wis
53707; telephone (608) 266-
6608. ■
WISCONSIN MEDICAL JOCRNAL, JANUARY 1985: VOL. 84
17
A voice of one
whispers...
A voice of many
influences.
Physicians and their spouses concerned with the
future of medicine in Wisconsin make up the
strong, influentiafpolitical voice called WISPAC.
Their individual participation has brought a high
degree of success to the efforts of WISPAC. In the
last several election cycles alone, over eighty per-
cent of the candidates for political office chosen to
receive financial and technical support were
elected, thus strengthening medicine’s position in
the legislative forum.
Physicians control WISPAC— responsible physi-
cians like yourself; physicians who realize that their
political involvement at the local level, and their
support of WISPAC through membership and
financial contribution, is essential to continuing the
influential political voice of medicine in Wisconsin.
In 1984 WISPAC membership reached an all-time
high, but much more needs to be done, beginning
today, to ensure success in the future.
Political action must not end with the elections.
The 1985 legislative session begins in January and
promises to be most challenging. WISPAC will
continue to play an important role during the ses-
sion coordinating fundraising efforts, other local
political activities, and most importantly, physician-
legislator contacts.
In order to be effective, WISPAC needs your voice,
and your support. Join with those who realize that
medicine is a constituency. Join WISPAC!
a small price to pay for political effectiveness
.wispac]
P.O. BOX 2595, MADISON, Wl 53701
(608) 257-6781
Wisconsin Physicians Political Action Committee
WISPAC and AMPAC political contributions are voluntary and not tax-deductible. If your practice is incorporated, WISPAC and AMPAC dues should be written on a PERSONAL check.
Copies of the WISPAC reports are filed with the Wisconsin State Elections Board. AMPAC reports are available for purchase from the Federal Election Commission, Washington, D C. 20463.
Victor S Falk, MD, Medical Editor
SCIENTIFIC MEDICINE
A case of listeriosis
in Bayfield County
Eugenia H Parker, MD and Joseph B Gerwood, RN, BS
Washburn, Wisconsin
Abstract. While still considered an
uncommon disease, Listeria mono-
cytogenes infections are becoming
more prevalent in humans. This re-
port details the course of a previously
healthy, elderly woman from Wash-
burn, in northern Bayfield County,
Wisconsin, who contracted Listeria
infection. Although few data are
available, listeriosis is a rare condi-
tion at both Bayfield County Memor-
ial Hospital in Washburn and Mem-
orial Medical Center in Ashland.
Key WORDS: Listeriosis, Listeria mono-
cytogenes, Listeria meningitis
\jISTERIA MONOCYTOGENES infec-
tions are increasing in occurrence,
and in adults the form the disease
takes is usually meningitis.* Both
man and animal can contract lis-
teriosis and most humans are
usually exposed to this Gram-
positive rod sometime, but if a
person is immunocompromised,
this generally mild pathogen can
be fatal. 2 However, even healthy
people may succumb to this ill-
ness.^ If patients are to survive, it
is vitally important that early
diagnosis and treatment be insti-
tuted.^ Besides those who are
Doctor Parker is hospital pathologist and
both Doctor Parker and Mr Gerwood are
members of the Infection Control Com-
mittee. Reprint requests to: Joseph B Ger-
wood, RN, Route 1, Box 19-A3, Wash-
burn, Wis 54891 (phone: 715/373-2904).
Copyright 1985 by the State Medical
Society of Wisconsin.
immunocompromised, listeriosis
mainly affects newborns, preg-
nant women, and the elderly.'*
Case report. A 77-year-old lady
was admitted to the hospital with
complaints of fever, chills, peri-
orbital headache, vague abdomi-
nal tenderness, and generalized
aching. Also, she had been dizzy,
short of breath with a dry cough,
and had had a syncopal spell in
her bathtub the previous night.
Her medical history was basically
negative except for essential
hypertension under control with
hydrochlorothiazide. The admit-
ting diagnosis was cephalgia with
questionable syncopal episode,
presenting as probably a viral ill-
ness.
On admission she was acutely
ill. Her pupils were equal and
reactive to light and accommoda-
tion. There was some discomfort
on neck flexion but no nuchal
rigidity. The heart and lungs were
normal. Mild abdominal tender-
ness on palpation was apparent as
was general tenderness of the
musculature of her extremities
and unsteadiness on her feet.
Blood pressure was 110/60 mm
Hg, pulse rate 82, respirations 16,
and oral temperature 38.9 C,
rising later on the day of admis-
sion to 39.4 C.
Initial laboratory evaluation
was essentially negative except for
elevation of the blood sedimenta-
tion rate at 37 mm /hr and slight
elevation of the white blood cell
count, 13,400 per cu mm. The dif-
ferential leukocyte count was 66%
segmented neutrophils, 17% stab
forms, 10% lymphocytes, 6%
monocytes, and 1% eosinophils. A
repeat white blood cell count on
the third hospital day was 8600
per cu mm with 61% segmented
neutrophils and 4% stab forms.
On the sixth hospital day the
white blood cell count was 1 1,700
per cu mm with 66% segmented
neutrophils and 12% stab forms.
The patient followed a febrile
course, temperature rising to
38.3 C to 38.9 C daily, and con-
tinued to complain of dizziness,
chills, and headache. On the sixth
hospital day a blood culture was
obtained; this subsequently
showed no growth. On the sev-
enth hospital day a spinal tap was
performed, yielding cerebrospinal
fluid which appeared clear but
had a cell count of 308 per cu mm,
70% of the cells neutrophils. The
spinal fluid protein was elevated
at 165 mg/ 100 ml, the sugar de-
pressed at 32 mg/ 100 ml. The
cerebrospinal fluid culture grew
L. monocytogenes.
The day following lumbar punc-
ture the patient was started on
chloramphenicol sodium succin-
ate 750 mg intravenously every
six hours and ampicillin sodium
1.5 Gm intravenously every six
hours. When the cerebrospinal
fluid culture was reported, chlor-
amphenicol was discontinued and
ampicillin increased to 1.0 Gm
intravenously every two hours.
She continued on this treatment
for 15 days. At discharge she was
afebrile and felt well, ambulating
without difficulty. There were no
neurologic deficits. A followup
clinic visit was uneventful.
Discussion. Human infections
with Listeria usually show a poly-
morphonuclear response in peri-
pheral blood, cerebrospinal fluid,
and tissues.® The patient des-
WISCONSIN MEDICAL JOURNAL, JANUARY 1985:VOL. 84
19
SCIENTIFIC MEDICINE
LISTERIOSIS— Parker and Gerwood
cribed in this article is typical. The
polymorphonuclear leukocytes
(PMNs) in her blood were slightly
high but the cerebrospinal fluid
showed a marked elevation of the
PMNs. Nieman and Lorber^ re-
port in their review of the litera-
ture that an underlying malig-
nancy occurred in 25% of pa-
tients, that meningitis was present
in 30% of apparently healthy indi-
viduals and that fever was re-
ported in almost all cases. Our
lady had no malignancy and was
healthy for her age. She was
febrile during much of her hos-
pitalization.
Nieman and Lorber's report
covered 186 cases of adult listerio-
sis collected from the medical lit-
erature between 1968 and 1978.
They found that 55% of these pa-
tients had listeria meningitis.
Fever was an important finding in
all cases and the cerebrospinal
fluid showed the typical features
of bacterial meningitis, as in the
presently reported patient. Blood
cultures were positive for L. mono-
cytogenes in 75% of the cases. The
overall mortality rate among these
meningitis cases was 30%. Better
survivals occurred, however,
among patients who had no seri-
ous underlying disorder, such as
malignancy or immunosuppres-
sion.
In the 102 cases of Listeria men-
ingitis reviewed in this article,
60% of the patients had malig-
nancy and an additional 28%
were receiving corticosteroids or
other immunosuppressive ther-
apy. Another 2 1 % had a variety of
significant chronic diseases, in-
cluding sarcoidosis, alcoholism,
diabetes, cirrhosis, and splenec-
tomy. Only 13% of the meningitis
patients had no known underly-
ing disease. The present patient
falls into that minority of cases.
The initial bacteriologic diagno-
sis of L. monocytogenes at the
Bayfield County Memorial Hos-
pital laboratory was subsequently
confirmed by the State Laboratory
of Hygiene in Madison. The State
Laboratory reports that it identi-
fied seven cases of Listeria infec-
tion in 1983, two in 1982, and ten
in 1981. These data probably
underestimate the number of .
cases in Wisconsin, since some
laboratories may not submit Lis-
teria isolates to the state facility for
confirmation.
The present patient is the only
case of Listeria meningitis seen in
the past ten years at either Bay-
field County Memorial Hospital in
Washburn or at Memorial Medi-
cal Center in Ashland.
Acknowledgment: The authors wish to
thank James E Zanto, CLS and Kathleen
E Kinney, CLS for their assistance in prep-
aration of this manuscript.
REFERENCES
1. Nieman RE, Lorber B: Listeriosis in adults: a
changing pattern; report of eight cases and
review of the literature, 1968-1978. Rev Infect
Dis 1980:2:207-227.
2. Larsson S, Cronberg S, Winblad S: Clinical
aspects of 64 cases of juvenile and adult lis-
teriosis in Sweden, Acta Med Scand 1978;204:
503-508.
3. Katz Rl, McGlamery ME, Levy R: CNS lister-
iosis. Rhomboencephalitis in a healthy,
immunocompetent person. Arch Neurol
1979:36:513-514.
4. Iwarson S, Larsson S: Outcome of Listeria
monocytogenes infection in compromised and
nonconipromised adults; comparative study
of 72 cases. Infection 1979;7:54-56.
5. Shackelford PG, Feigin RD: Listeria revisited.
Am J Dis Child 1977;131:391-392. ■
AMA Brief Reports
Abdominal symptoms one sign of Rocky Mountain fever
The rash associated with Rocky Mountain spotted fever (RMSF) usually appears between the second
and fifth day of the sometimes fatal (3% to 10% of patients) illness, but abdominal symptoms often
appear earlier and should be recognized, write Milton B Randall, MD and David H Walker, MD in
the December 1984 Archives of Pathology and Laboratory Medicine. Their autopsies of 28 fatal cases
showed that 91% had rickettsial lesions in tissue from the pancreas, stomach, small intestine and colon.
In these cases, severe abdominal symptoms were noted in 72% of the patients, but were not associated
with the spotted fever. "To reduce the mortality of RMSF, these clinical manifestations must achieve
wider recognition," say the researchers, from the University of North Carolina School of Medicine
in Chapel Hill. ■
Cigarettes fire-death hazard in hospital
Five of eight patients burned in hospital fires started by cigarettes died, according to a report in the
Letters section of the November 23, 1984 Journal of the American Medical Association. "Their mor-
tality is almost five times greater than that for community-acquired flame burns (started from cigaret-
tes)," say Frederic S Bongard, MD, and associates from the University of California, San Francisco.
Fires in both homes and hospitals occur when cigarettes fall into bedding, but hospital patients are
less able to respond appropriately, the authors say. ■
20
WISCONSIN .VIEDIC.ALJOl RNAl., JANCARV I985:\OL. 84
SCIENTIFIC MEDICINE
Henoch-Schoenlein purpura:
Association with unusual
vesicular lesions
Jeffery S Garland, MD and Michael ] Chusid, MD
Milwaukee, Wisconsin
Abstract. The characteristic der-
matologic manifestations of Henoch-
Schoenlein purpura (HSP) have been
well-described. This report presents
a 5-year-old male with HSP who
developed atypical vesicular lesions
in association with HSP. Vesicular
eruptions occasionally can be a part
of the polymorphous rash of HSP.
Key WORDS: Henoch-Schoenlein pur-
pura, Vesicular lesions. Polymor-
phous rash
Pi ENOCH-SCHOENLEIN purpura
(HSP) is an acquired disorder of
unknown etiology that is charac-
terized by variable visceral and
joint abnormalities and a typical
nonthrombocytopenic purpuric
rash having a characteristic ap-
pearance and distribution.' 2 3.4
The rash, which classically pre-
sents as crops of pale pink mac-
ular or urticarial lesions, is most
often located in gravity-depen-
dent areas. Petechiae develop in
the distribution of the lesions and
may become confluent. As the
eruption fades to a brownish hue,
new crops of lesions may occur,
giving the rash a polymorphous
From the Department of Pediatrics, Mil-
waukee Children's Hospital, and the
Medical College of Wisconsin, Milwau-
kee, Wisconsin. Reprint requests to;
Jeffery S Garland, MD, Milwaukee Chil-
dren's Hospital, 1700 West Wisconsin
Ave, Milwaukee, Wis 53233. Copyright
1985 by the State Medical Society of
Wisconsin.
appearance. The rash may persist
for weeks or be transient only to
recur. 2
Occasionally patients with HSP
present unusual dermatologic
findings, posing a diagnostic chal-
lenge to the clinician.^ ® Recently
we cared for a 5-year-old patient
with HSP who exhibited an atypi-
cal vesicular rash. While several
texts mention the occurrence of
vesicular lesions in patients with
HSP, these statements are poorly
referenced.'’ ®
Case report. Two weeks after
the onset of upper respiratory
symptoms a 5-year-old white
male developed swelling of his
left ankle, a petechial rash over
his lower extremities, and inter-
mittent cramping abdominal
pain. The following day, bilateral
knee-swelling developed. Radio-
graphs of his knees were normal.
An SMA-12 and sedimentation
rate were normal. Microscopic
hematuria was present. His
symptoms improved with several
days of bedrest.
Following an increase in am-
bulation, his rash became vesicu-
lar to bullous in character. The
vesicles were filled with serous or
hemorrhagic fluid and had spread
to involve the extensor surfaces
of his elbows, thighs, buttocks,
and perioral region. Truncal
lesions were absent. The patient
passed a guaiac-positive stool and
again complained of cramping
abdominal pain. At this time he
was admitted to the hospital. He
had no known allergies.
Physical examination revealed
an anxious child with normal
vital signs. His skin was covered
with erythematous lesions lo-
cated particularly over his ankles,
lower legs, buttocks, elbows,
arms, and the perioral region.
The lesions varied from discrete
petechial eruptions to bullae, and
ranged in size from 2-3 mm to 2
cm. Serous or hemorrhagic fluid
was present in many of the
lesions (Fig 1). Diffuse abdominal
tenderness was present. His joint
examination was significant for a
decreased range of motion and
fullness in his knees and right
ankle.
A complete blood cell count
and sedimentation rate were nor-
mal. Bacterial and viral cultures
of vesicular fluid were negative.
A Tzanck preparation of a lesion
was not suggestive of a herpes
virus infection. Several blood
cultures were negative. Group A
beta hemolytic Streptococcus was
isolated from a throat culture, but
anti-streptolysin O and anti-
hyaluronidase titers were nor-
mal. C3, C4, and IgA were all
elevated at 180(86-166 mg/dl
Nl), 37(13-22 mg/dl Nl) and
214(22-137 mg/dl Nl) respec-
tively. Febrile agglutinins were
negative. Convalescent serologies
for adenovirus. Influenza A and
B, Mycoplasma pneumoniae,
Herpes simplex, varicella zoster,
measles, and Coxsackie virus
were all less than 1:8. A urinalysis
on admission revealed micro-
scopic hematuria.
The patient's symptoms re-
solved with bedrest, only to
recur, along with new petechial
lesions (Fig 2) when he was al-
lowed to ambulate. The lesions
became purpuric before they dis-
appeared. His symptoms re-
solved with further bedrest and
WISCONSIN .VIEDICAI, JOIRNAI, JANIARV 198S:VOI,. 84
21
SCIENTIFIC MEDICINE
VESICULAR LESIONS— Garland and Chusid
further exacerbations did not
occur.
Discussion. Except for his vesi-
cular rash, our patient presented
with clinical findings and a
course compatible with Henoch-
Schoenlein purpura (HSP).*^
Laboratory data including posi-
tive guaiac tests, elevated C3, C4,
and IgA, and an abnormal urin-
alysis, were all consistent with
HSP.48,9 Furthermore, labora-
tory data gathered from our pa-
tient ruled out other likely causes
of vesicular eruptions.
The hemorrhagic, serous bul-
lae, and superficial erosions evi-
denced in our patient have been
uncommon in HSP.^® Atypical
dermatological manifestations of
HSP have been reported by sev-
eral authors. Ulcerated lesions,
occasionally progressing to gang-
rene, have been described in
HSP.^® None of these reports
mention vesicular lesions as a
part of the syndrome. Occa-
sionally, lesions may take on the
appearance of erythema multi-
forme with central necrosis and
bullae formation.’’® Although
bullae occurred in our patient,
erythema multiforme was absent.
Ruiter and Hadders^° reported
vesicular lesions in a 38-year-old
woman as a part of arteriolitis
allergica cutis, of which HSP was
classified as a subgroup. Path-
ology of these lesions showed
findings compatible with HSP."
Visceral and joint involvement
were lacking, and it is difficult to
determine from this report
whether this represents a true
case of Henoch-Schoenlein pur-
pura. Winkelmann reviewed 38
cases of small vessel vasculitis or
leukocytoclastic angiitis, under
which he classifies HSP.^^ He re-
ports either hemorrhagic vesicles
or bullae occurring in at least
eight cases. However, of these 38
patients, only one was a child and
this patient's case report is not
discussed.
Our patient's rash did not have
the classical appearance of HSP,
yet the distribution, course, and
appearance of several crops of
lesions were typical of this diag-
nosis. Even though skin manifes-
tations of HSP may be extremely
variable, the occurrence of
clear vesicular eruptions as part
of the dermatologic manifesta-
tions of HSP has rarely been dis-
cussed. This case report is pre-
sented to alert clinicians to this
atypical presentation of Henoch-
Schoenlein purpura.
Acknowledgment; The authors wish to
thank Archebald R Pequet, MD and
Donald L Wood, MD for permitting them
to report this case.
References
1. Silber DL: Henoch-Schoenlein syndrome.
Pediatr Clin North Am 1972:19:1061-1070.
2. Hurwitz S: Clinical Pediatric Dermatology.
Philadelphia: WB Saunders Co, 1981.
3. Allen DM, Diamon LK, Howell DA: Ana-
phylactoid purpura in children (Schoenlein-
Figure 1— Initial presentation of vesicular eruption. Note the paucity of classical
petechial lesions found in HSP patients.
Figure 2— Recurrence of rash, showing new and healing vesicular lesions, and
petechial eruptions.
€
22
WISCONSIN MEmCAL JOCRNAL, JANI ARV 1985; VOL. 84
VESICULAR LESIONS— Garland and Chusid
SCIENTIFIC MEDICINE
Henoch Syndrome). Am J Dis Child 1960, -99:
147-168.
4. Smith CH, Miller DR: Blood Diseases of In-
fancy and Childhood, Ed 3. St Louis: CV
Mosby Company, 1972,
5. Halle CJ: Henoch-Schoenlein after chicken
pox. Arch Dis Child 1979;54:166.
6. KiskerCT, Glueck H, Kauder E: Anaphylac-
toid purpura progressing to gangrene and its
treatment with heparin./ Pediatr 1968;73:
748-751.
7. Lever WF, Schaunberg-Lever G: Histopath-
ology of the Skin, Ed 6. Philadelphia: JB Lip-
pincott Co, 1983.
8. Rook A, Wilkinson DS, Ebling FJ: Textbook
of Dermatology, Vol 1. Philadelphia: FA
Davis Co, 1968.
9. Trygstacl CW, Stiehmer ER: Elevated serum
IgA globulin in anaphylactoid purpura.
Pediatrics 1971;47:1023-1028.
10. Ruiter M, Hadder HN: Predominantly
cutaneous forms of necrotizing angiitis. /
Path Bact 1959;77:71-78.
11. Vernier RL: Anaphylactoid purpura; 1.
Pathology of the skin and kidney and fre-
quency of streptococcal infection. Pediatrics
1961;27:181-193.
12. Winkelman RK, Ditto WB: Cutaneous and
visceral syndromes of necrotizing or "aller-
gic" angiitis; study of 38 cases. Medicine
1964;43;59-89. ■
Lithium and
A medicinal
history
Wisconsin—
trip through
Beverly Redmann, BS
James W Jefferson, MD
Madison, Wisconsin
Abstract. Lithium is now well
established as the drug of choice for
treating manic-depressive disorder.
Its history in medicine extends back
into the 19th century when it was
used for a wide variety of ailments.
Over the years Wisconsin has played
a prominent role in various aspects
of lithium therapy, beginning with
the widespread use of mineral spring
lithia waters, especially in the Wau-
kesha area in the late 1800s. Lithia
beer was brewed in West Bend until
From the Department of Psychiatry and
Lithium Information Center, University
of Wisconsin Center for Health Sciences,
Madison, Wisconsin. Ms Redmann is a
second-year medical student at the
University of Wisconsin and was a 1984
Summer Fellow in Psychiatry. Doctor Jef-
ferson is Professor of Psychiatry, Director
of the Center for Affective Disorders, and
Codirector of the Lithium Information
Center. Support for this project was pro-
vided by the National Library of Medicine
(LM03713), the Lithium Corporation of
America and Mrs Pierre F Goodrich.
Reprint requests to: James W Jefferson,
MD, Lithium Information Center, UW-
Madison Center for Health Sciences, 600
Highland Ave, Madison, Wis 53792
(phone: 608/263-6078). Copyright 1985 by
the State Medical Society of Wisconsin.
the early 1970s and even now a com-
memorative beer, Lithia Christmas
Beer, is made in Eau Claire.
In 1949 lithium temporarily fell into
medical disrepute in this country due
to the occurrence of many cases of
severe intoxication, one of which was
published that year in the Wiscon-
sin Medical Journal by Dr Henry
Peters of the University of Wiscon-
sin Hospital.
More recently, Wisconsin has be-
come the world's leading source of
medically related lithium informa-
tion following the establishment of
the Lithium Information Center in
the Department of Psychiatry at the
University of Wisconsin Medical
Center in Madison. In addition to
providing answers to lithium-related
questions, the Lithium Information
Center is also actively involved in
research, the development of educa-
tional programs, and publishing in
both professional and nonprofes-
sional journals.
Key WORDS: Lithium; Mineral waters; Salt-
substitutes; Lithia water; History; Lithium
Information Center
Lithium, the lightest of all solid
elements, has a wide and diverse
distribution in nature. It can be
detected in sparse amounts in
plants and animal tissues, in many
minerals and mineral springs, and
in the sea. Lithium, a constituent
of the igneous rock which makes
up the Earth's crust, has been
present since the dawn of time. It
was not until early in the last cen-
tury, however, that this element
was discovered and named.
In 1817, Johan August Arfved-
son, a diligent Swedish chemistry
student, was busy identifying the
components of a newly discov-
ered mineral, petalite. He isolated
an alkali-like substance which had
some, but not all, the characteris-
tics of sodium and potassium, the
other known alkalis of the time.
He named this element lithium,
after lithos, the Greek word for
stone. 1
Lithium in 19th Century Medi-
cine. It was not until 1855 that
lithium could be easily separated
from its salts, thereby enabling
scientists to obtain sufficient
quantities of the element to study.
Predictably, not long after this,
lithium was introduced into medi-
cine. In the mid-1800s, drawing
upon the ideas of Lipowitz and
Ure, Garrod conducted experi-
ments in vitro showing the re-
markable dissolution of uric acid
deposits on cartilage by lithium
carbonate. Garrod erroneously
concluded that lithium carbonate
could dissolve uric acid concre-
tions in vivo as well as in vitro and,
therefore, would be suitable for
the treatment of gout.
Later, Garrod extended his view
of uric acid and its role in the cau-
sation of disease. According to
Garrod, excess uric acid in the
blood led not only to anemia and
gout but also to other afflictions
such as renal calcuh, rheumatism,
and mood disturbances. Garrod
grouped all of these under the
descriptive phrase "uric acid
diathesis.
WISCONSIN MEDICAL JOURNAL, JANUARY 1985: VOL. 84
23
SCIENTIFIC MEDICINE
LITHIUM— Redmann and Jefferson
Garrod's uric acid diathesis was
widely embraced by the medical
community in the late 1800s. Ac-
cordingly, because lithium urate is
the most soluble of all the urates,
in vitro, lithium administration
was thought to be a godsend for
the treatment of uric acid dis-
orders.
The heyday of uric acid diathe-
sis came at the turn of the century
when a prominent physician,
Alexander Haig, published. Uric
Acid as a Factor in the Causation of
Disease. Although Haig differed
with Garrod on the mechanism of
lithium's action on uric acid in the
body, he wholeheartedly sup-
ported the uric acid diathesis con-
cept and the use of lithium for its
treatment. 3 Uric acid diathesis
was so popular in the late 1800s
that although there were some
who expressed doubts about its
validity, all attacks were rebuffed
or ignored and uric acid diathesis
survived well into the 1900s.
Wisconsin lithia waters. The
upsurge of the uric acid theory of
disease and the consequent use of
lithium in its treatment opened
the way for medicinal proprietors
to flood the market with products
containing lithium. Especially
popular were the waters of hun-
dreds of mineral spring resorts
which dotted the country. Many
of them, including some in Wis-
consin, extolled their lithium con-
tent as a selling point.
The curative value of these
mineral waters was conveniently
played upon in the suggestive
advertising of the resorts and
thousands of visitors flocked to
the waters in the summer months
hoping that the healing water
would benefit them. Describing
the various summer resorts
around the country in 1889,
Harper's Weekly recommended
one in particular. The magazine
lauded upon the "sumptuous
hotels" and other luxurious ac-
commodations which were avail-
able. In addition, its "beauties of
nature” and "salubrious climate"
were features that made this place
attractive to even the most fin-
nicky or sickly of visitors. The
fame of its mineral springs and the
healing waters which flowed from
them were known worldwide.
The restorative waters were bot-
tled and shipments made to every
part of the United States and to
Europe, India, Australia, and
China.
Unbelievably to most people to-
day, the place Harper's Weekly
was commending was Waukesha,
Wisconsin. More recently the re-
nowned mineral springs and the
glamour and glitter that they
brought to Waukesha has faded.
But then, Waukesha was known
as the Saratoga of the West (after
Saratoga Springs in New York),
and the Waukesha newspapers
celebrated the town's good for-
tune. In March 1869, the Wauke-
sha Freeman printed,
"There has gurgled forth a fount of
God's elixir of life and the afflicted
of every country will look here for
a revival of lost hopes," the paper
said, "What Saratoga is to the East,
Waukesha is ultimately destined to
be to the rest of the world, a health-
restoring resort for suffering
humanity". 5
Before long, accommodations be-
came scarce; and during some
busy summer months, visitors
had to be turned away. Then, in
1874, the Eountain Spring House
was opened. It was the largest and
most prestigious hotel in Wiscon-
sin with 800 guest rooms and a
lavish formal dining room which
seated 500 people. The manage-
ment of this extravagant hotel
realizing that money came from
healthy as well as ill guests, of-
fered every kind of amusement
that a wealthy 19th century visitor
could desire. So Waukesha, in ad-
dition to becoming a mecca for the
afflicted, became a mecca for
society.®
One of the largest companies in
Waukesha which specifically ad-
vertised the lithium content of its
water was White Rock Mineral
Spring Company. The company
was prosperous, and as late as
1920 it was bottling 120,000 bot-
tles of lithia water per day. Al-
though lithia water is no longer
among their products, the White
Rock Corporation still has nation-
wide distribution and their trade-
mark, the scantily clad nymph.
Psyche, is widely recognized.^
Other Waukesha companies
which exploited the presumed
beneficial lithium content of their
waters were the Waukesha Water
Company which bottled Boro
lithia water, the Waukesha Lithia
Spring Company, and the Burr
Lithia Springs. In 1892 Waukesha
spring water came into national
prominence when a pipeline was
built to Chicago to supply fresh
spring water to the World's Fair.
By this time, competition between
the various spring companies was
so intense that proprietors began
to mislead the public, stressing the
presumed uniqueness of each
spring's curative powers.
In the great spring era, a cure
could be found in Waukesha,
Wisconsin, for everything from
diabetes to "female weakness." In
particular, the lithia spring water
was said to cure inflammation of
the kidneys, urinary infections,
dyspepsia, Bright's disease, gout,
and rheumatism.® ®
About the same time that the
Waukesha resorts became popu-
lar, similar mineral spring resorts
and companies appeared through-
out the country. Among those pro-
moting lithiated waters were the
Buffalo Lithia Springs of Virginia,
the Sweetwater Park Hotel of
Lithia Springs, Georgia, the Lon-
donderry Lithia Spring Water
Company of New Hampshire,
and Johannis-Lithia Water of New
York.
24
UISCOWSIN .VlEDIC.\I.JOlR\Al„ JAXCARY I985:VOL. 84
LITHIUM — Redmann and Jefferson
SCIENTIFIC MEDICINE
Lithia Beer— West Bend. Lithia
spring water was not the only
product made in Wisconsin with
marketing based on its lithium
content. Just north of Waukesha,
in West Bend, Wisconsin, a small
brewery was founded in 1849 by
a German immigrant, Batthazer
Goetter. An artesian well in the
basement of the brewery supplied
the water for the beer and prior to
1911 the label read "brewed with
lithium water." The name of the
beer was shortened to Lithia Beer
in 1919. This name became
widely known. According to
Dorothy Williams in the Spirit of
West Bend,
"So popular was the name Lithia
Beer that many families in the
northern part of Washington
County use little tea or coffee, for
Lithia Beer has taken its place."*'
Prohibition nearly ruined the
small brewery; and during those
years, the company bottled a non-
alcoholic beverage called "Lithia
Be Sure." The brewery reluc-
tantly closed its doors in West
Bend in 1972. The Walter Brew-
ing Company located in Eau
Claire, Wisconsin, was the last
owner. It now bottles the com-
memorative Lithia Christmas
Beer during the holiday season.
The DECLINE OF LITHIA WATERS.
The escalating enthusiasm over
the mineral springs and lithia
waters was dampened slightly
when, before the turn of the cen-
tury, the US Bureau of Chemistry
studied the current lithia waters
on the market in the United
States. Amazingly, all of the lithia
springs, including some of the
most popular, were found to con-
tain only spectroscopic amounts
of lithium. After writing an
opinion on the Buffalo Lithia
Springs water case, the Supreme
Court of the District of Columbia
said,
"For a person to obtain a therapeu-
tic dose of lithium by drinking Buf-
falo Lithia Water he would have to
drink from 150,000 to 225,000
gallons of water per day." It was
further testified, without contradic-
tion, "that Potomac River water
contains five times as much lithium
per gallon as the water in contro-
versy. "*^
These reports led zealous pro-
prietors to begin marketing lithia
tablets and artificial lithia waters.
The various tablets were adver-
tised as being "accurate, conven-
ient and permanent," and they
were welcomed by the public. By
1907 the Merck Index listed 43 dif-
ferent medicinal compounds con-
taining lithium. Unfortunately, as
the popularity of lithia tablets and
"homemade lithia water" in-
creased, so did the risk of lithium
toxicity.*^ Both Kolipinski in 1898,
and Cleaveland in 1913, reported
cases of lithium toxicity.*^*®
These reports, for the most part,
went unheeded and did not sig-
nificantly lessen the fashionability
of lithium preparations.
Lithium as a salt-substitute-
Madison. The next important
chapter in the lithium story lasted
only about a year. In the late
1940s low-salt diets were used to
treat high blood pressure and
heart failure. To make these diets
more palatable, lithium chloride
was introduced as a salt-substi-
tute, and in 1948 several US com-
panies began marketing the prod-
uct. The Federal Food, Drug and
Cosmetic Act did not require food
products to be tested before they
went on the market, so in spite of
the fact that lithium toxicity had
been documented previously, its
use as a salt-substitute was un-
restrained. It did not take long
before cases of salt-substitute
linked lithium toxicity were rec-
ognized.*® *'’
In 1949, Dr Henry A Peters,
now a Professor of Neurology at
the University of Wisconsin Hos-
pital and Clinics in Madison, pub-
lished a paper in the Wisconsin
Medical Journal entitled "Lithium
Intoxication Producing Chorea
Athetosis with Recovery." In this
article he described a patient with
salt-substitute induced lithium
toxicity.*® In an interview with the
author (BR), Peters explained that
his diagnosis was facilitated by a
headline he happened to glance at
in the February 19, 1949, Wiscon-
sin State Journal. In bold print the
headline read "SALT-SUBSTI-
TUTE KILLS."*® Four deaths
linked to several lithium chloride
products led the Food and Drug
Administration (FDA) to with-
draw these salt-substitute prep-
arations from the market in early
1949. Such a fervor was created
by the salt-substitute calamity that
lithium was not accepted by the
US medical community for treat-
ment of any disorder for many
years.
Lithium in modern psychiatry.
Ironically, in 1949 on the other
side of the globe, an Australian
psychiatrist, John Cade, reported
the successful use of lithium in the
treatment of mania. His findings
were subsequently confirmed in
Europe, and over the years lith-
ium has become one of the most
dramatically effective treatments
available to psychiatry.*
The United States, however,
was not interested in exploring
lithium's potential for use in psy-
chiatry in 1949. In fact, it was not
until 1970 that the FDA approved
the labeling of lithium carbonate
‘Lithium was actually used to treat men-
tal illness many years earlier. Haig, in
1900, interlaced manic-depressive dis-
order with the theory of uric acid diathesis
and, consequently, used lithium in its
treatment. 2* Furthermore, a Danish physi-
cian, Carl Lange, published a paper in
1886 describing what he termed periodic
depressions. Lange noticed peculiar
urinary sediments excreted by his
depressed patients which he incorrectly
believed to be deposits of uric acid. Believ-
ing this, Lange prescribed lithium pro-
phylaxis for this condition. Lange's work
received initial acknowledgment but was
quickly forgotten. It was not until 1949
that Cade introduced lithium into psy-
chiatry once again, really beginning the
modern era of psychopharmacology
WISCONSIN MEDICAL JOCRNAI , JANUARY 1985: VOL. 84
23
SCIENTIFIC MEHICINE
LITHIUM— Redmann and Jefferson
for the treatment of manic epi-
sodes of bipolar (manic-depres-
sive) disorder. Four years later,
the FDA approved lithium for
maintenance therapy of bipolar
disorder. Now, based on informa-
tion from lithium clinics around
the world, it is estimated that
1-2/ 1000 of people with access to
proper medical care are being
treated with lithium. Its poten-
tial for use in other areas such as
depression, alcoholism, premen-
strual syndrome, aggression, and
schizophrenia are being investi-
gated.
Lithium Information Center-
Madison. Because of the growing
need for knowledge and easy ac-
cess to information regarding lith-
ium and its uses in medicine, the
Lithium Information Center was
established in 1975 at the Univer-
sity of Wisconsin Medical School
in Madison. Over the years, the
Center has become the world's
leading resource for medically-
related lithium information, an-
swering well over 1000 requests
yearly. Located in the Department
of Psychiatry at the University of
Wisconsin Center for Health Sci-
ences, the Center is actively in-
volved in acquiring and cata-
loging all publications dealing
with lithium and medicine (well
over 12,000 and growing at a rate
of over 1000 per year). These arti-
cles are accessible through a com-
puterized data base so that re-
quests for information can be
handled efficiently, rapidly, and
comprehensively. The staff of the
Lithium Information Center also
is actively involved in research,
development of educational pro-
grams, and publishing both pro-
fessional and nonprofessional ar-
ticles on the subject.
Summary. Over the last 100 years
lithium usage has gone through a
metamorphosis. A once myster-
ious, miraculous, and presumed
beneficial component of beer and
mineral spring waters, lithium is
2(1
now part of the modern age of
psychopharmacology. Wisconsin,
once a center for the "medicinal"
uses of 19th century lithia prep-
arations, is now internationally
recognized as a leader in the
modern applications of lithium in
medicine.
REFERENCES
1 . Lithium in the Treatment of Mood Disorders.
Rockville, Md: National Institute of Mental
Health, 1974, p 5.
2. Johnson FN, Amdisen A; The first era of
lithium in medicine; an historical note,
Pharmacopsychiatria 1983;16:61-63.
3. Haig A: Uric Acid as a Factor in the Causation
of Disease, 5th ed. Philadelphia: P Blakiston,
1900.
4. Some Western Summer Resorts. Harper's
Weekly, Sept 28, 1889, p 26.
5. A Great Discovery. Waukesha Freeman, Mar
4, 1869, p 1.
6. Wisconsin Then and Now. Madison, Wis:
State Historical Society of Wisconsin, 1973;
12:4-5.
7. Former Popular Summer Resort Becomes
Live Industrial Center. The Milwaukee
Journal, Sept 5, 1920.
8. Williamson jW: Buffalo lithia waters for
uraemia, albuminuria of pregnancy, sup-
pression of urine in yellow fever, menstrual
disorders, and uric acid diathesis. Virginia
Medical Monthly 1878-79:5:898-899.
9. Morse WH: A contribution to the study of
the therapy of lithia water. The Medical Age
1887;5:433-434.
10. James FL: Lithium in mineral waters, St
Louis Medical and Surgical Journal 1889;57:
24-30.
11. Williams D: The Spirit of West Bend.
Madison, Wis: Straus Printing Co, 1980, pp
213-217.
12. American Medical Association: Propaganda
for Reform in Proprietary Medicines. Chicago:
1922, pp 467-469.
13. The Merck Index, 3rded, New York: Merck
& Co, Inc, 1907, pp 258-260.
14. Kolipinski L: Note on some toxic effects
from the use of citrate of lithium tablets.
Maryland Med J 1898;40:4-5.
15. Cleaveland SA: A case of poisoning by lith-
ium presenting some new features. /AMA
1913:60:722.
16. Aaron H: Dangerous drugs: lithium chloride
salt-substitutes. Consumer Reports 1949:14:
171-173.
17. Corcoran AC, Taylor RD, Page IH: Lithium
poisoning from the use of salt-substitutes.
JAMA 1949;139:685-688.
18. Peters HA: Lithium intoxication producing
chorea athetosis with recovery. Wisconsin
Med J 1949;48:1075-1076.
19. Salt-substitute Kills. Wisconsin State Journal,
Feb 19, 1949, p 1 .
20. Cade JFJ: Lithium salts in the treatment of
psychotic excitement. Med J Austral 1949;
36:349-352.
21. Haig A: Mental depression and the excre-
tion of uric acid. Practitioner 1888;41;
342-354.
22. Lange C: Om periodiske depressionstil-
stande og deres patogenes. Copenhagen:
Jacob Lunds Forlag, 1886.
23. Schou M: Trends in lithium treatment and
research during the last decade. Pharma-
copsychiatria 1982;15:128-130.
24. Baudhuin MG, Jefferson JW, Greist JH: The
Lithium Information Center: An Efficient
Information Service. Pharmacol Biochem
Behav (Supp 1|, in press. ■
AM A Brief Report
Nifedipine offers rapid hypertension treatment
Chewing perforated nifedipine capsules is a safe and effec-
tive way to lower blood pressure promptly without parenteral
medications, say Jacob I Haft, MD and William E bitterer III,
DO in the December 1984 Archives of Internal Medicine. Within
13 minutes, blood pressures of 42 emergency-room patients
dropped from an average of 205 over 127 to 158 over 88.
"There were no side effects and no hypotension even among
the 38 patients who had recently received other medications,"
the cardiologists from St Michael's Medical Center in Newark,
New Jersey report. Nifedipine is a calcium blocker. ■
VVI.SCONSIN MEUICAI. JOl'RNAl , jANliARV lH8.'5:VOI.. 84
SCIENTIFIC MEDICINE
Epidemic
typhus
acquired
in Wisconsin
Figure l— Flying squirrels (Glaucomys volans) at feeder in corner of cabin.
William A Agger, MD
Vanee Songsiridej, MD
La Crosse, Wisconsin
Abstract. A 50-year-old developed
a febrile illness in February 1984
characterized by a minimal erythe-
matous rash and prompt response to
oral tetracycline. During the month
prior to illness, he lived in his cabin
in southwestern Wisconsin with
multiple flying squirrels. The epi-
demiologic history and his serologi-
cal reactions established the diagno-
sis of ''sporadic” epidemic typhus.
Key WORDS: Sporadic epidemic
typhus, Rickettsia prowazekii. Flying
squirrels. Cold weather occurrence
T_Jntil recently, epidemic
typhus was considered an exclu-
sively human disease caused by
Rickettsia prowazekii and trans-
mitted by the human body louse.
Epidemics usually have occurred
in periods of social disruption
when malnutrition, crowding,
and poor human hygiene abound.
Under these conditions, the
disease is serious and has a case
fatality rate of 10% to 40%.'
While the last United States out-
break of typhus occurred in 1922,
From the Section of Infectious Disease
(WAA| and Section of Allergy and Im-
munology (VS) of the Gundersen Clinic
Ltd, La Crosse, Wisconsin. Reprint re-
quests to: William A Agger, MD, 1836
South Ave, La Crosse, Wis 54601 (phone:
608/782-7300). Copyright 1985 by the
State Medical Society of Wisconsin.
recent reports have shown that
sporadic epidemic typhus is being
acquired in the United States.^
These cases have been seen in
persons who live in close prox-
imity to flying squirrels, Glau-
comys volans in the Eastern wood-
lands, and G. sabrinus in the far
West. Most have occurred in the
Southeast, 3 but a few cases also
have been reported from other
states within the range of flying
squirrels, and include Arkansas,
Illinois, Indiana, Ohio, and Cali-
fornia. The following is a case of
epidemic typhus acquired from
exposure to flying squirrels in
southwestern Wisconsin.
Case report. In January 1984 a
50-year-old university professor
developed a dry cough, night
sweats, and fever. Over the last
eight winters he has had flying
squirrels in his log cabin which is
located in a wooded area of south-
western Wisconsin. The squirrels
have come into the cabin each
December and often remained
until late April. During the month
he became ill, he had regularly fed
up to ten flying squirrels from a
small feeder located in a corner of
the cabin (Fig 1). He recalled no
direct squirrel contact, nor was he
aware of any recent insect bites
prior to his illness.
Examination revealed a tem-
perature of 39 C, blood pressure of
130/80 mm Hg, and a pulse rate
of 96. His skin was hot and
flushed, and there were numer-
ous, small, punctate lesions on the
upper arms and shoulders. Within
two days these progressed to less
distinct, slightly erythematous,
3-4 mm roundish macules in the
same distribution. There were no
other remarkable physical find-
ings.
Laboratory testing revealed a
white blood cell count of 4800 per
cu mm with 46% segmented neu-
trophils, 24% band neutrophils,
17% lymphocytes, and 9% mono-
nucleocytes. Blood cultures were
negative and a urinalysis was
normal. The serum aspartate
aminotransferase (SCOT) was 85
lU/L, and a lactic dehydrogenase
UIS('0\SI\ .VirmCAI. jOl Ki\’AI„ JAMARY 1985: VOt,. 84
27
SCIENTIFIC MEDICINE
EPIDEMIC TYPHUS-Agger and Songsiridej
(LDH) was 248 lU/L, both slightly
elevated. A hepatitis B panel was
positive for hepatitis B core anti-
body, negative for surface anti-
gen, and negative for surface anti-
body. Other negative tests in-
cluded a Venereal Disease Re-
search Laboratory slide (VDRL),
antinuclear antigen (ANA), and
monospot.
A proteus OX-19 titer (Weil-
Felix agglutination) obtained on
day 10 of illness was positive at a
1:640 dilution, and 21 days later
the titer was 1:2560. Serum speci-
mens obtained on days 13, 27, and
76 after illness onset were sent to
Todd McPherson, Virus Serology
Laboratory, Wisconsin State
Laboratory of Hygiene. The com-
plement fixation antibody titers to
typhus group antigens were 1 :256,
1:64, and 1:16, respectively; the
indirect fluorescent antibody
(IFA) titers to typhus group anti-
gens were 1:8192, 1:4096, and
1:1024, respectively; and the IFA
titers to spotted fever group anti-
gens were 1:128, 1:64, and 1:64,
respectively. Aliquots of the three
sera were sent to the Centers for
Disease Control for specific
typhus testing; the antibody ab-
sorption technique of the IFA test
was used. The IFA titers were as
follows: to murine typhus antigen
1:1024, > 1:512, and 1:1024,
respectively; to epidemic typhus
antigen 1:1024, > 1:512, and
1:512, respectively; and to R.
Canada > 1:512 on the first speci-
men; the other two were not
tested. While a diagnosis of
typhus could be made, an antigen
specific diagnosis was not made
using the antibody absorption
technique of the IFA test.
Titers for multiple virus were
low and did not change. With the
positive OX-19, the patient was
started on tetracycline 250 mg
four times a day by mouth; and
fevers, sweats, cough, and rash
rapidly disappeared (Fig 2).
Discussion. To our knowledge,
typhus has not been previously
reported to have been acquired in
Wisconsin; and, therefore, other
infections should be considered
when attempting to rule out ric-
kettsial illness acquired in our
state. First, Brill-Zinsser disease,
or recrudescent typhus, is a mild
form of this illness, usually not
associated with elevations of Weil-
Felix titer. In the United States
this unusual illness has been seen
in Eastern Europeans who have
had typhus prior to immigrating to
this country. Recrudescence oc-
curs during times of physical
stress.*
Another possibility is Rocky
Mountain spotted fever (RMSF)
caused by Rickettsia rickettsii. This
illness, however, is extremely rare
in Wisconsin with only three re-
ported cases in the state in recent
years'* (personal communication
Jeffrey P Davis, MD, Wisconsin
State Epidemiologist). RMSF fol-
lows the bite of an infected tick
and thus usually occurs from
March to October. ^
A third consideration, endemic
or murine typhus, is caused by
Rickettsia mooseri. The vector of
this illness is the oriental rat flea,
Xenopsylla cheopis. Endemic in the
Southeast and the coastal areas of
Texas and Louisiana, in areas of
shanty housing with rats,® murine
typhus is not a disease commonly
recognized in Wisconsin.
We believe our patient had epi-
demic typhus secondary to ex-
posure to infected flying squirrels.
Characteristics of this type of
"sporadic” epidemic typhus are:
(1) occurrence out of the season
for Rocky Mountain spotted fever
[March-October]; (2) absence of a
rash (20%), or presence of a cen-
trifically spreading rash; (3) ab-
sence of a tick bite; (4) occurrence
in a locale with an extremely low
incidence of Rocky Mountain
spotted fever; and (5) the presence
of an unusual serological reaction
favoring the diagnosis of typhus
rather than Rocky Mountain spot-
ted fever. ^
This patient was typical of the
other sporadic cases of epidemic
typhus including the mild nature
of his illness. There have been no
fatalities among the more than 30
cases reported since 1976.*’ In ad-
dition, rashes have been absent in
approximately 20% of cases, and
otherwise fairly mild in most
others. Recovery has been gener-
ally rapid following the use of tet-
racycline or chloramphenicol, al-
though one patient had a stroke
Figure 2— Clinical data and serologic titers of patient.
T.T. 50y/o CT
Contact:
Dry cough
Sweats and fever
Macular rash
Rx - Tetracycline
Titers
Proteus OX- 19
1/640
1/2560
Proteus OX-K
1/80
1/20
IFA-Spotted fever Qr.
1/1?8
1/64
1/64 1/64
CF-Typhus Gr.
1/256
1/256
1/64 1/16
IFA-Typhus Gr.
1/8192
1/8192
1/4096 1/1024
JAN. FEB.f f
1 MARCH
1 APRIL I MAY
Visits -M.D. 2/7 2/10
2/24
3/24 4/13
28
WISCONSIN MEDICAL JOURNAL, JANUARY 1985:VOL. 84
EPIDEMIC TYPHUS— Agger and Songsiridej
SCIENTIFIC MEDICINE
shortly after recuperation from
this illness.^
Most cases of sporadic epidemic
typhus have been associated with
exposure to flying squirrels,
usually, Glaucomys volans. In the
early winter months these squir-
rels often enter human dwellings,
and during the winter they are
more likely to be carrying R. pro-
wazekii.^^ Potential vectors that
could transmit Rickettsia from the
flying squirrels to the human host
include a flea (Orchopeas howar-
diij, which when infected carry
only small numbers of R. prowa-
zekii but will bite humans, and a
squirrel louse (Neohaematopinus
sciuropteri), which can carry this
Rickettsia in large numbers, but
rarely bite humans
R. prowazekii strains that have
been cultured from blood and
urine of flying squirrels in the
United States have demonstrated
DNA hybridization and restrictive
endonuclease studies to be
slightly different than the R. pro-
wazekii strains from Europe (per-
sonal communication JE McDade,
Centers for Disease Control). It
has not been determined whether
R. prowazekii infections of the
squirrel population in the United
States were present before Euro-
pean immigration, or whether the
R. prowazekii organism was im-
ported to this country with subse-
quent mutation.
As long as there is no major dis-
ruption of society where malnu-
trition, crowding, and lice become
prevalent, this disease will prob-
ably remain rare. However, phy-
sicians are cautioned to consider
R. prowazekii infection when
evaluating an unexplained febrile
illness which follows exposure to
flying squirrels. No isolate from a
patient has been obtained. There-
fore, prior to antibiotic therapy, a
clot of blood and 10 ml of urine,
both on dry ice, should be referred
to a laboratory which can safely at-
tempt rickettsial cultures.
A preventive measure would be
to exclude flying squirrels from
living in human dwellings and
sealing the access ports for the
squirrels. However, our patient
was unwilling to do this; and,
therefore, we have recommended
that any future “cabin mates"
receive a typhus vaccination. In
addition, if any visitors become ill,
they will be treated with chloram-
phenicol or tetracycline which, if
begun early, is very efficacious.
Finally, Wisconsin physicians
should be aware that this infection
is present in our state, and any
suspect cases should be reported
to the Acute and Communicable
Diseases Section of the Bureau of
Community Health and Preven-
tion, Division of Health, Wiscon-
sin Department of Health and
Social Services.
Acknowledgment: The authors wish to
thank the Gundersen Medical Foundation
Ltd for its financial assistance, and Jeffrey
P Davis, MD for his helpful discussions.
References
1. Saah AJ, Hornick RB: Rickettsia prowazekii.
In: Principles and Practices of Infectious Dis-
ease. John Wiley & Sons, 1979: pp
1520-1523.
2. McDade JE, Shepard CC, Redus MA, et al:
Evidence of Rickettsia prowazekii infections
in the United States. AmSoc Trap Med 1980;
29(21:277-284.
3. Duma RJ, Sonenshine DE, Bozeman FM, et
al: Epidemic typhus in the United States
associated with flying squirrels. /AAfA 1981
(June 12);245(22):2318-2323.
4. Rocky Mountain spotted fever in Wiscon-
sin. Wis Epidemiol Bui, August 1980,2(7).
5. Hattwick MAW, O'Brien RJ, Hanson BF:
Rocky Mountain spotted fever: Epidemi-
ology of an increasing problem. Ann Int Med
1976;84:732-739.
6. Older JJ: The epidemiology of murine
typhus in Texas, 1969. JAMA 1970(Dec 14);
214(111:2011-2016.
7. Epidemic typhus associated with flying
squirrels— United States. Morbidity and Mor-
tality Weekly Report 1982;31(411:555-561.
8. Sonenshine DE, Bozeman FM, Williams
MS, et al: Epizootiology of epidemic typhus
(Rickettsia prowazekii! in flying squirrels. Am
J Trap Med Hygiene 1978;27(2):339-349.
9. Kaplan JE, McDadeJE, Newhouse VF: Sus-
pected Rocky Mountain spotted fever in the
winter— epidemic typhus? N Engl J Med
1981(Dec 311;305(27):1648.
10. Bozeman FM, Sonenshine DE, Williams
MS, et al: Experimental infection of ecto-
parasitic arthropods with Rickettsia prowa-
zekii (GvF- 16 strain) and transmission to fly-
ing squirrels. Am Soc Trap Med Hygiene
1981;30:253-263.
11. Typhus vaccine recommendations of the
Public Health Service Advisory Committee
on Immunization Practices. Morbidity and
Mortality Weekly Report 1978(June 2);27(22):
289. ■
Commentary
Epidemic typhus
in Wisconsin
Jeffrey P Davis, MD
State Epidemiologist
Bureau of Community Health and Prevention
Wisconsin Division of Health, Madison
Madison, Wisconsin
In this issue of the Wisconsin
Medical Journal, Doctors Agger
and Songsiridej report the initial
observation of transmission of ap-
parent epidemic typhus in Wis-
consin. ^ While the diagnosis of ill-
ness due to R. prowazekii, the
etiologic agent of epidemic
typhus, is highly likely in this
case, an antigen specific diagnosis
using the absorption method of
the indirect fluorescent antibody
(IFA) test could not be made. If the
antibody absorption technique is
incorporated with the IFA test,
epidemic typhus, in most in-
stances, can be differentiated
from endemic or murine typhus. ^
The etiologic agent of endemic
typhus is R. typhi. A more highly
specific toxin-neutralization test
can be used to clearly identify the
etiology of the infection. ^ Addi-
tional antigen specific testing of
this patient's sera is warranted
since transmission of epidemic
typhus has not been previously
documented in Wisconsin.
Of 30 previously reported cases
of epidemic typhus reported in the
United States since 1976, 26 have
occurred in the Eastern and
Southeastern United States and
four have occurred in the Mid-
west, two cases in Indiana and
one case each in Illinois and
Ohio.^
WISCONSIN MEDICAL JOURNAL, JANUARY 1985: VOL. 84
29
SCIENTIFIC MEDICINE
EPIDEMIC TYPHUS-Agger and Songsirdej
Epidemiologic evidence in this
case strongly supports a diagnosis
of epidemic typhus. The transmis-
sion of R. prowazekii infections
from flying squirrels to humans is
unproven; however, it is strongly
suggested by the high prevalence
of R. prowazekii and the isolation
of the agent from flying squir-
rels^ ® and by the observation that
nearly 60% of patients have
handled flying squirrels or their
nests or have reported squirrels in
their homes. The occurrence of
the current case in January is
highly consistent with the 70%
occurrence during the colder
months when flying squirrels tend
to nest in homes.
While a serologic study of other
potentially exposed individuals
was not conducted in association
with this case, a recent report of
a small community study has sug-
gested that unrecognized infection
in the vicinity of cases of epidemic
typhus is uncommon, even
among residents of homes in
which flying squirrels have been
present.^
As Doctors Agger and Songsir-
idej have noted, the Section of
Acute and Communicable Dis-
ease Epidemiology, Wisconsin
Division of Health, is interested in
reports of cases of typhus prefer-
ably made as soon as the illness is
suspected, and will be pleased to
assist in the diagnosis, attempted
isolation of rickettsiae, and any
additionally warranted evalua-
tion.
REFERENCES
1. Agger WA, Songsiridej V: Epidemic typhus
acquired in Wisconsin. Wisconsin Med J
1985;84(Jan):27-29.
2. Centers for Disease Control: Rickettsial Dis-
ease Surveillance Report No. 2. Summary: 1979,
issued May 1981, pp 10-11.
3. Duma RJ, Sonenshine DE, Bozeman FM, et
al: Epidemic typhus in the United States asso-
ciated with flying squirrels. /AMA 1981; 245:
2318-2323.
4. Centers for Disease Control: Epidemic
typhus associated with flying squirrels—
United States. Morbid Mortal Weekly Rep
1982;31:555-561.
5. Boseman FM, Masiello SA, et al: Epidemic
typhus rickettsiae isolated from flying squir-
rels. Nature 1975;255:545-547.
6. Sonenshine DE, Bozeman FM, Williams MS,
et al. Epizootiology of epidemic typhus
(Rickettsia prowazekiil in flying squirrels. Am
J Trop Med Hyg 1978;27:339-347.
7. Centers for Disease Control: Epidemic
typhus— Georgia. Morbid Mortal Weekly Rep
1984;33:618-619. ■
AMA News Report
Tissue abnormalities twice as likely
for DES-exposed women
Women prenatally exposed to diethylstilbestrol (DES) are twice
as likely to develop tissue abnormalities identified as precur-
sors to the most common forms of cervical and vaginal cancer,
according to results of a seven-year study appearing in the
December 7, 1984 Journal of the American Medical Association.
The incidence rate for dysplasia (abnormality of development)
was 15.7 cases per 1000 for exposed women compared with
7.9 cases for a control group of women not exposed, reports
the study conducted by the National Collaborative Diethylstil-
bestrol-Adenosis (DESAD) Project. Commissioned by the
National Cancer Institute in 1974, the study followed 3980
women exposed in utero to DES, and 1033 women not
exposed.
'The evidence regarding dysplasia should not be a cause for
alarm among exposed women, but rather a caution that any
exposed woman should continue to have yearly examinations
as the DESAD investigators have advised all along," said
Stanley J Robboy, MD of New Jersey Medical School, the
multi-clinic study's principal investigator. He points out that
although DES-exposed women develop dysplasia twice as fre-
quently as controls, it is not known how many will sub-
sequently develop squamous cell carcinoma, the cancer asso-
ciated with dysplasia.
"Our findings won't change the manner in which we follow
our DES-exposed patients," Robboy said. "However, it is
important that those women be followed over time by a physi-
cian who can detect changes in the cervix and vagina. All
women should have a yearly pelvic examination and PAP
smear and, if it appears necessary, a biopsy. Should any
abnormalities surface, these women should promptly go to a
physician experienced in the examination of women who have
been exposed to DES."
The DESAD study was conducted in clinics at Boston's
Massachusetts General Hospital, the Mayo Clinic in Rochester,
Minnesota, the Gundersen Clinic in La Crosse, Wisconsin,
Baylor College of Medicine in Houston, Texas, and Cedars
Sinai Medical Center in Los Angeles, California. ■
30
WISCONSIN MEDICAL JOURNAL, JANUARY 1985: VOL. 84
SCIENTIFIC MEDICINE
Is high too low? A commentary
by the Wisconsin State High
Blood Pressure Advisory Committee
Frank D Gutmann, MD, Milwaukee, Wisconsin
IVE YEARS have elapsed since
this journal published the article
entitled "Wisconsin High Blood
Pressure Control Program— in-
volving the physician."* In Jan-
uary 1985 the program will make
several important changes in light
of the publication of "The 1984
Report of the Joint National Com-
mittee on the Detection, Evalua-
tion, and Treatment of High Blood
Pressure" (hereafter referred to as
"The 1984 Report").^ This com-
munication will attempt to clarify
these changes.
The basic aim of the state pro-
gram is to coordinate existing
health resources for high blood
pressure control through local
geographic networks that incor-
porate the uniform state guide-
lines for high blood pressure de-
tection, referral, and patient edu-
cation. The program has been
highly successful, in great part
through the understanding and
cooperation of physicians state-
wide. It is essential for the con-
tinued success of the program that
physicians fully understand what
the changes in these guidelines
are, as well as the reasons for
Doctor Gutmann is Associate Professor of
Medicine, University of Wisconsin Medi-
cal School-Milwaukee Clinical Campus,
Department of Medicine, Milwaukee; and
Head, Nephrology Section, Department of
Medicine, Mount Sinai Medical Center,
Milwaukee. Reprint requests to: Frank D
Gutmann, MD, Mount Sinai Medical
Center, 950 North 12th St, PO Box 342,
Milwaukee, Wis 53201-0342 (phone: 414/
289-8130]. Copyright 1985 by the State
Medical Society of Wisconsin.
altering these guidelines which
are intended for use at screening
sites.
After a careful review the State
Advisory Committee, a technical
advisory group to the program,
adopted (with minor modification)
the new blood pressure criteria set
forth in The 1984 Report, as de-
picted in Table 1. The Advisory
Committee then concentrated its
efforts on establishing levels of
blood pressure to be used for the
purpose of rescreening and/or
referring screenees from state-
endorsed screening sites to their
physicians. The outcome of the
Committee's deliberations is sum-
marized in Figure 1.
Some of the items in Figure 1
clearly represent modifications of
the recommendations in The 1984
Report as well as changes from
the previous state guidelines.
These modifications and/or
Members and staff of the Advisory
Committee include:
Constantine Panagis, MD, Chair
Health Commissioner, City of Milwaukee-
Health Department, Milwaukee
Richard Dart, MD
Specialist in hypertension and nephrology.
Marshfield
Theodore Goodfriend, MD
Faculty, University of Wisconsin, Madison;
specialist in hypertension, VA Hospital, Madison
George Griese, MD
Pediatric cardiologist, Marshfield
Frank Gutmann, MD
Faculty, University of Wisconsin Medical
School, Milwaukee Clinical Campus: Head of
Nephrology Section. Mount Sinai Medical
Center, Milwaukee
Linda Sunstad, RD, MPH
Slate Division of Health, Madison
Marie Vick, RN, PHN
Coordinator of the Douglas County High Blood
Pressure Control Program, Superior
Mary Manering, RN
Consultant to the Wisconsin High Blood
Pressure Control Program, State Division
of Health, Madison
Thomas Schuler
Director, Wisconsin High Blood Pressure
Control Program. State Division of Health,
Madison
Table Blood pressure criteria for adults 18 and older
Systolic
Diastolic
Blood
Pressure
If
Less than
140 mmHg
and
Less than
86 mmHg*
then
Normal
If
Less than
140 mmHg
and
86 mmHg-
89 mmHg
then
High
normal
If
140 mmHg-
159 mmHg
and
Less than
90 mmHg
then
Borderline
isolated
systolic
If
160 mmHg
or higher
and
Less than
90 mmHg
then
Isolated
systolic
If
140 mmHg
or higher
and/
or
90 mmHg
or higher
then
Elevated
'These criteria differ from The 1984 Report only in that 86 mmHg replaces 85 mmHg
throughout.
WISCONSIN MEDICAL JOURNAL, JANUARY 1985:VOL. 84
3
SCIENTIFIC MEDICINE
HIGH BLOOD PRESSURE-Gutmann
changes warrant comment and
explanation:
© The Advisory Committee felt
that a recommendation to refer
persons with borderline isolated
systolic blood pressure (Table 1)
who were > 60 years of age (as
recommended by The 1984 Re-
port), might alienate some physi-
cians in the state, particularly in
underserved and/or rural areas.
Because the number of elderly
persons with a blood pressure in
this category is large and the
benefit of treatment not clearly
established, the resultant influx of
such referrals might unneces-
sarily overburden some health-
care providers. Therefore, persons
> 60 years of age with borderline
isolated systolic blood pressure
will not be referred.
As in the past, a person with a
blood pressure that meets the
criteria for referral on two of three
screenings will be referred. Every
effort will be made to remind the
referring screeners to assiduously
avoid the term "hypertension," in
favor of the term "elevated blood
pressure." The Committee felt
that nonphysicians should not use
a diagnostic label at a screening
site.
The same referral guidelines
are recommended for persons al-
ready on treatment as for those who
are not on treatment. However,
persons already on treatment, and
whose blood pressure is normal
and therefore not recommended
for referral, will be asked to have
a recheck of their blood pressure
every three months (rather than
within one or two years) to en-
courage compliance with treat-
ment.
© Rescreening for blood pressure
readings higher than normal
within 3-30 days (rather than
within two months) is recom-
mended with the hope that a
recommendation for more
prompt rechecking will enhance
compliance. Furthermore, per-
sons with either a blood pressure
of > 115 mmHg diastolic or > 200
mmHg systolic will be encour-
Figure 1
WISCONSIN HIGH BLOOD PRESSURE CONTROL PROGRAM
SCREENING FLOW CHART
* Encourage to consult health care provider within 24 hours.
** Rescreen in 3-30 days.
*** Check every 3 months if on treatment for HBP.
32
WISCONSIN MEDICAL JOURNAL, JANUARY 1985: VOL. 84
HIGH BLOOD PRESSURE-Gutmann
SCIENTIFIC MEDICINE
aged to consult their healthcare
provider immediately (within 24
hours). This advice is intended to
help convey to such persons the
urgent need for evaluation.
© All persons should have their
blood pressure checked at least
annually, regardless of their car-
diovascular risk since this risk
may not be accurately assessed at
a screening site. By contrast the
1984 Report recommends either
one or two year followup, de-
pending upon this risk.
© The most important, and
surely the most controversial
change to be made by the program
is the referral to a physician of all
adults with confirmed diastolic
blood pressure of ^ 86 mmHg,
rather than the previously em-
ployed ^ 90 mmHg. If the dias-
tolic blood pressure is > 86 mmHg
and < 90 mmHg with systolic
blood pressure below referral
threshold, the screenees are told
that their blood pressure is high
normal, and they are tracked in
the same way as those with ele-
vated diastolic blood pressure; ie,
> 90 mmHg.
There will be a significant in-
crease in the number of persons
referred to physicians from
screening sites as a consequence
of lower referral thresholds. It
clearly is not the intent of the State
Advisory Committee to dictate
therapy. It is the intent of the Ad-
visory Committee to encourage
health promotion and preventive
medicine. Most persons in the
population will benefit from
modifying their cardiovascular
risk factors. The Committee felt
that persons with high normal
blood pressure were especially
suitable candidates to be con-
sidered for nonpharmacologic at-
tempts at reducing cardiovascular
risk. In promoting such interven-
tions to their patients, physicians
throughout the state could in turn
make a major impact on lowering
or preventing a further rise in
blood pressure, modifying cardio-
vascular risk factors, or both.
The Advisory Committee sin-
cerely welcomes comments by
state physicians on this issue.
REFERENCES
1 Handy GH, Dart R, Koehn A: Wisconsin
High Blood Pressure Control Program— in-
volving the physician. Wisconsin Med J
1979;78(111:14-16.
2. The 1984 Report of the Joint National Com-
mittee on Detection, Evaluation, and Treat-
ment of High Blood Pressure. Arch Intern
Med 1984:144:1045-1057. ■
Editorial Board comment: We are aware that some physicians have little
confidence in mass screening of blood pressures. Readings are less ac-
curate in an unfamiliar or crowded surrounding, and physicians are
becoming less apt to interpret moderate systolic pressure increase as
abnormal. Blood pressures, both systolic and diastolic, may increase with
age of the person. We might ask another question: "At some point will
there be reasonable 'nonpharmacologic' therapy for elevated blood
pressure?" The greatest problem in detection seems to be related to the
precise determination of the diastolic reading; eg, (1) listening over the
artery, (2) distinction of change of sound vs absence of sound, and (3)
hearing ability of examiner.
AMA Brief Reports
AMA book wins award
The American Medical Association Guide to WomanCare will receive one of the 1984 American Health
Book awards offered by American Health Magazine. Chief editor T George Harris says, "It's not often
that an association turns out a focused piece of work like WomanCare. We were very impressed by
the book." ■
Linguistics offers study tool for aging
Linguistic analysis of language used by the aged may offer the best answer to whether aging is a natural
process, the result of a continuum of minor pathological insults, or a combination of both, says
Macdonald Critchley, MD, FRCP, of National Hospital, London, in the November 1984 Archives of
Neurology. He points out that some writers use more verbs and fewer adjectives as they age, and that
the aged often use fewer different types of words within language blocks than do young adults. He
believes linguistics can make an important contribution to the understanding of the aging process. ■
WISCONSIN MEDICAL JOURNAL, JANUARY 1985: VOL. 84
33
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HOW A STUDENT
WHO COULDN’T LEARN
TAUGHT EVERYONE
AN IMPORTANT LESSON.
Everyone thought Matthew Francisco
was failing school.
But was he really?
You see, Matthew has a learning
disability. And no matter what his par-
ents and teachers did, his problem only
seemed to worsen. (Matthew even started
running away from home to avoid school.)
Finally Matthew' s mother, Barbara,
did some homework of her own and got
in touch with the Minnesota Association
for Children and Adults with Learning
Disabilities, a United Way supported
agenc\'.
The Association helped Barbara deal
with Matthew at home and his teachers
deal with him at school.
Before long Matthew was solving prob-
lems in school instead of just being one.
And through her involvement with The
Association, Barbara now schools other
parents with learning disabled children.
This is just one of thousands of similar
stories from all over the country.
And, as the Franciscos can attest.
United Way does a lot in your
community.
Everything from day care to foster care
to care for the elderly.
And what makes it all w'ork are
generous contributions from people like
yourself.
People who realize that
without their help. United
Way simply cannot e.xist.
Matthew, his parents and
his teachers thank you.
So do we.
Unibed W^y
THANKS TD YOU IT WORKS
FOR ALL OF US
ORGANIZATIONAL
Highlights of AMA House of
Delegates Meeting, Dec 2-5
Action on topics ranging from
boxing to joint ventures occupied
the AMA House of Delegates at its
recent Interim Meeting in Hono-
lulu. A summary report of the
AMA's actions is offered by the
Wisconsin delegation to the AMA
—Henry F Twelmeyer, MD, Mil-
waukee, chairman. Details or fur-
ther information on any report or
activity of that AMA session are
available through the delegation
by contacting Joan Pyre at the
State Medical Society office.
AMA opposes risk-sharing for
DRG allowances: The AMA Judi-
cial Council evaluated the ethical
implications of risk sharing ar-
rangements whereby the attend-
ing physician would participate in
the hospital's reimbursement if an
individual Medicare patient's
costs were kept below the DRG
allowance. The physician likewise
would share in losses if DRG
allowances were exceeded. The
AMA House opposes such ar-
rangements.
Physician ownership in com-
mercial ventures: Guidelines were
adopted on issues related to poten-
tial conflict of interest involved in
physician ownership of health-
care facilities, equipment, or phar-
maceuticals. The AMA Judicial
Council concludes that physician
ownership is not in itself unethical
but identified five guidelines for
addressing potential conflicts.
Surrogate motherhood: The
Judicial Council ruled that "sur-
rogate motherhood presents many
ethical, legal, psychological,
societal, and financial concerns
and does not represent a satisfac-
tory reproductive alternative for
people who wish to become
parents."
Health insurance discrimination
against children: The AMA will
seek legislation to prevent tax
breaks for employers who do not
include prevention services and
immunization services for chil-
dren in their health benefit plans.
It will also seek state regulation of
self-insured health plans with
regard to minimum benefits, ac-
cessibility of providers, and qual-
ity of care. These are now regu-
lated only by a federal law known
as ERISA.
Relative value schedules: The
AMA Board of Trustees is vigor-
ously exploring vyith the federal
government and other agencies
the development of a relative
value scale (RVS) to be used to
assure appropriate reimburse-
ment under Medicare and other
government programs for both
cognitive and procedural types of
services. Currently, discussions
are going on with the Health Care
Financing Administration (HCFA)
concerning the use of a RVS in-
stead of a DRG system of paying
for physicians or an even less
desirable alternative of mandatory
assignment for Medicare.
Medicare reform: A special re-
port was issued analyzing the
problems associated with the
fiscal integrity of Medicare and
suggesting that a modified Medi-
care program be adopted with
changes in benefits, payment
methods, eligibility, financing.
integration with private sector
approaches and possibly the use
of vouchers. This statement will
form the basis for AMA policy in
dealing with this issue in the
coming months before Congress.
Billing for lab procedures: The
AMA will undertake an educa-
tional program for its members to
differentiate between procedural
and professional billing— drawing
of a specimen versus interpreting
laboratory test results. This is in-
creasingly necessary as Medicare
and Medicaid reimbursement
regulations restrict payments for
both of these processes.
Free choice of doctor and bene-
fit: The AMA was directed to seek
legislation mandating that em-
ployers of 25 or more persons of-
fer various types of health
delivery alternatives whenever an
HMO alternative is mandated.
Balance billing: The AMA was
directed to publish and mail to
American Association of Retired
Persons' (AARP) members a
pamphlet explaining the AMA
position on balance billing for
Medicare services. At the same
time the AMA was to publicize the
discriminatory effects of recent
laws providing sanctions for doc-
tors who do not contract with the
government under Medicare.
Medicare Participating Direc-
tory: The AMA asked state
medical societies and local physi-
cians to immediately review the
forthcoming MEDPARD (Medi-
care Participating Physician
Directory) to identify any errors or
misleading statements and to re-
port these to the State Medical
Society and to request the US
Dept of HHS to issue public cor-
rections.
continued
WISCONSIN MEDICAL JOURNAL. JANUARY 1985: VOL. 84
37
ORGANIZATIONAL
HIGHLIGHTS OF AMA HOUSE
continued
Medical liability: The Board of
Trustees of AMA issued an ex-
cellent update on medical liability
problems in the United States and
commended Chief Justice Burger
for his recommendation that the
American Bar Association penal-
ize attorneys who file frivolous
allegations of malpractice. The
AMA reports recommend concen-
trating on risk management, tort
reform, and the special problems
of obstetrics and gynecology in
medical liability.
Health and tobacco: The AMA
was directed to inform the federal
government of the inconsistency
of legislating reduction of certain
disease entities while reducing the
tax on cigarettes and increasing
subsidies to the tobacco industry.
AMA will seek increases in cigar-
ette taxes as a further means of
containing the use of tobacco.
Funding of medical education:
The AMA will support the con-
tinuation of current methods of
funding both the direct and in-
direct costs of medical education
under Medicare at least until
better methods can be found to
deal with this issue. There is a
threat that further budget cutting
will remove support for medical
education from Medicare reim-
bursement and thus undercut the
overall funding of medical educa-
tion in the US.
Joint ventures: The AMA issued
a major report (Board of Trustees
Report EE) dealing with joint ven-
tures and the incorporation of
hospital medical staffs. This is a
careful review of the legal and
ethical implications of such ven-
tures and is "must reading" for
medical staffs of hospitals, especi-
ally when considering either in-
corporation of any kind or joint
ventures with the hospital.
Maternal and child health: The
AMA adopted a series of major
recommendations in support of
the surgeon general's policies with
regard to maternal and infant
health and supported increases in
funding levels for maternal and
child health programs through the
block grant mechanism.
Scientific Affairs reports: The
AMA House received a series of
reports prepared by the Council
on Scientific Affairs. These were
adopted, filed, or referred as indi-
cated below.
—Saccharin and Aspartame; referred
for reconsideration of portion dealing
with saccharin
—Guidelines for Reporting Estimates of
Probability of Paternity; filed
—Effects of Toxic Chemicals on the
Reproductive Cycle; filed
—Guidelines for Handling Parenteral
Antineoplastics; adopted
—SI Units for Clinical Laboratory Data;
adopted
—Chelation Therapy; report referred
and policy statement adopted— see
News You Can Use section of this
issue
— Polygraphy; adopted
—Nicotine Chewing Gum for Cessation
of Smoking; filed
—Diagnostic and Treatment Guidelines
Concerning Child Abuse and Neglect;
adopted
—Current Status of Therapeutic
Plasmapheresis and Related Tech-
niques; filed
—Scientific Status of Refreshing
Recollection by the Use of Hypnosis;
adopted
—Update on Health Effects of "Agent
Orange" and Polychlorinated Dioxin
Contaminants; adopted
The adopted or filed reports are
available upon request.
Hair analysis: The AMA op-
posed the chemical analysis of
hair as a determinant of need for
medical therapy. This practice is
widely used by chiropractors but
it is spreading to other practi-
tioners as well.
Physician collective bargaining:
A 30-page report was presented to
the House of Delegates dealing
with the legal and regulatory ram-
ifications of physician collective
bargaining activities and other
strategies to promote fair repre-
sentation of MDs. It concludes
that "although physicians may be
unable to achieve complete nego-
tiating parity by participating in
certain PPO and IPA networks,
these forms of partial integration
facilitate a closer approximation of
provider and payor bargaining
positions within acceptable limits
of antitrust exposure. Moreover,
governmental processes may be
employed to promote fair repre-
sentation of physician interests
with a minimum of antitrust
risk." At the same time, the AMA
concluded that unless physicians
are truly employed as that term is
defined by the National Labor
Relations Board (NLRB), there is
no greater advantage to a physi-
cian group calling itself a "union"
than there is to obtaining repre-
sentation through a medical soci-
ety. The full report is well worth
reading.
Membership incentives: The
AMA approved a series of incen-
tives for physicians who partici-
pate in unified membership (con-
current membership in county,
state and AMA). Members of uni-
fied societies will be eligible for a
10% discount on AMA dues.
Public image: The AMA was
directed by the House to initiate
immediate programs to strength-
en the public's awareness of phy-
sicians as patient advocates and to
focus public attention on key
changes in healthcare delivery
and their impact on quality and
access. At the same time, AMA is
to work with reputable public
relations firms to develop a long-
range public relations program
and to provide assistance to state
and county medical societies in
this regard.
DRG problems: The AMA con-
tinues to seek modification of
Medicare rules to assure adequate
reimbursement for complications
and/or comorbidities which may
add significantly to a patient's re-
quirement for medical care under
the DRG system. At the same
continued
38
WISCONSIN MEDICAL JOURNAL, JANUARY 1985 : VOL. 84
HIGHLIGHTS OF AMA HOUSE
ORGANIZATIONAL
continued
time, AMA asks all physicians to
document identifiable DRG prob-
lems which result in harm or dis-
advantage to the patient.
PRO operation: The Wisconsin
Delegation introduced a resolu-
tion opposing inappropriate
methodologies for establishing
PRO programs. AMA supported
in principle the Wisconsin resolu-
tion and called upon HCFA to re-
evaluate arbitrary admission and
quality objectives.
Boxing: The House of Delegates
proposed the elimination of both
amateur and professional boxing.
Even before the end of the meet-
ing, this brought down the wrath
of sports writers and a variety of
sports interests across the
country.
Medical news in lay media:
American Medical News was
directed to present a weekly sum-
mary of articles in the lay media
concerning medical developments
especially of a scientific nature, so
that physicians can be informed at
least as early as the public gets in-
formation through this source.
Violence against medical facili-
ties: The AMA took a strong stand
in opposition to violence against
medical facilities, including abor-
tion clinics.
Beer advertising: A proposal
that alcohol warnings be included
in television advertising of beer
was debated but referred to the
Board of Trustees for further
study.
Area pathologist runs for AMA
trustee: Gerald Schenken, MD,
Nebraska, a pathologist and cur-
rently chairman of the AMA
Council on Legislation, has an-
nounced his candidacy for a seat
on the AMA Board of Trustees.
Doctor Schenken is supported in
his bid for office by the Wisconsin
Delegation and other members of
the North Central Medical Con-
ference of which Wisconsin is a
part. Any physician knowing Doc-
tor Schenken is asked to call or
write the State Medical Society to
offer assistance in his campaign
by writing or otherwise contacting
members of the AMA House of
Delegates. Your support will be
appreciated. Contact Joan Pyre,
SMS headquarters.
The Wisconsin delegation
during the AMA meeting met
with representatives of the North
Central Medical Conference (Min-
nesota, North and South Dakota,
Iowa, and Nebraska) to jointly
undertake manpower studies
Leo R Weinshel, MD, Milwau-
kee, was recognized by the State
Medical Society of Wisconsin and
the Wisconsin Chamber of Com-
merce Executives Association
November 29 in Milwaukee as
"1985 Physician-Citizen of the
Year." Doctor Weinshel, who re-
ceived his award at a special
meeting of the Medical Society of
Milwaukee County, was honored
for his outstanding contributions
to his community and patients.
Among the criteria used in
selecting the award recipient was
how he contributed to the better-
ment of his community and na-
tion; to the public understanding
of the role of medicine, and to the
better health and improved qual-
ity of life for Wisconsin patients.
A general surgeon in Milwau-
kee for 47 years. Doctor Weinshel
has had many outstanding civic
and medical accomplishments.
After graduating from Mar-
quette University School of Medi-
cine in 1937, Doctor Weinshel
joined the Army Reserve Corps.
During World War II he volun-
teered for duty at the front and
spent more than a year as a
surgeon working both in evacua-
tion hospitals and in MASH units
in Germany and France— some-
dealing with the supply and dis-
tribution of physicians. It is recog-
nized that Wisconsin's supply of
physicians is primarily affected by
migration patterns between Wis-
consin and Minnesota, Iowa, Illi-
nois, and Michigan. Efforts will be
made to analyze these migration
trends and to use the information
to assist the respective state legis-
latures and medical societies in
decisions that have to do with this
issue. The chairman of this Man-
power Study Committee is Kermit
Newcomer, MD, La Crosse. ■
times only five miles from battle
lines. After the war ended in 1945,
Doctor Weinshel continued to
serve in the Army Reserve until
1973 when he retired from serv-
ice with the rank of brigadier
general.
Today, Doctor Weinshel main-
tains a medical practice in Mil-
waukee where he specializes in
preventive medicine and work-
related problems. He serves as
clinical professor in both surgery
and preventive medicine at the
Medical College of Wisconsin.
Over the years. Doctor Wein-
shel has found time to become
one of Milwaukee's most out-
standing volunteers. He has de-
voted countless hours to such
organizations as the Boy Scouts of
America, Greater Milwaukee
Chapter of the Red Cross, Mar-
quette University, the American
Legion, the Variety Club, and
Badger Boy's State.
Doctor Weinshel's leadership in
these organizations has not gone
unnoticed. He is the recipient of
the Silver Beaver Award and the
Silver Antelope Award of the Boy
Scouts, the Alumni Service Award
of Marquette University, the Man
of the Year Award from the
continued
Milwaukee's Weinshel named 1985
"Physician-Citizen of the Year"
WISCONSIN MEDICAL JOURNAL, JANUARY 1985: VOL. 84
39
ORGANIZATIONAL
MILWAUKEE'S WEINSHEL
John Mullooly , MD, president of the Medical Society of Milwaukee County; Mrs and Leo Weinshel, MD;
and Darold Treffert, MD, SMS Board of Directors' chairman
continued
Variety Club, and the Outstanding
Civilian Service Medal from the
Army.
He has served on the Board of
Directors of the Medical College
of Wisconsin; as medical director,
treasurer, and board member of
Badger Boy's State; on the execu-
Annual Meeting
resolution deadline
The 1985 House of Delegates
sessions will be held April 25-26
in La Crosse. All resolutions must
be submitted in proper form to the
Secretary's office at SMS no later
than February 25, 1985 (two
months prior to the first session of
the House). It is important that
county medical societies, specialty
sections, and members submit
resolutions early to facilitate early
distribution of materials and allow
all delegates to adequately repre-
sent their county medical society
or specialty section. If a resolution
involves expenditures, a "fiscal
note" must accompany the reso-
lution. SMS staff is available to
assist in preparation of fiscal
notes. The first session of the
House will convene on April 25
and the second and third sessions
will be on April 26, 1985. ■
tive board of the Boy Scouts of
America; on the board of directors
of the Greater Milwaukee Chap-
ter of the American Red Cross, as
medical director of the Wisconsin
American Legion, and on the
board of directors of the Mar-
quette University Alumni Asso-
ciation.
Doctor Weinshel has been an
active participant in his profession
serving as senior attending sur-
geon and chief of staff from 1962-
64 at Milwaukee County General
Hospital, and on several commit-
tees of the State Medical Society of
Wisconsin and the Medical Soci-
ety of Milwaukee County. He is a
fellow of both the American Col-
lege of Chest Physicians and the
American College of Surgeons,
and is a founding member of the
Wisconsin Chapter of the Ameri-
can College of Surgeons.
In 1939, Doctor Weinshel
started visiting the Milwaukee
County Jail and other county cor-
rectional facilities on a part-time
basis. At the time, few other doc-
tors would make the visits. He
continued until he became the
physician for both the jail and
county juvenile detention center.
He was instrumental in the certi-
fication of the Milwaukee County
Jail in 1977 from the American
Medical Association's Jail Health
Care Accreditation Program. The
State Medical Society of Wiscon-
sin was one of six original pilot
states to conduct this program to
improve the level of health and
medical care administered in jails.
In presenting the award to Doc-
tor Weinshel, SMS Board of Direc-
tors' Chairman Darold A Treffert,
MD, said: "Concern about people
and helping them has been a way
of life to Dr Leo Weinshel. Be-
cause of his example, the com-
munity cannot help but better
understand and appreciate the
role of medicine as well as the
contributions made by the medi-
cal community as a whole." ■
Patient handouts
available on
Medicare assignment
Posters and statement staffers
for both "participating" and "non-
participating" physicians in the
Medicare program are available
from the SMS Membership and
Communications Division in
Madison. In the case of the non-
participating physician, the
materials indicate that the physi-
cian is willing to continue to ac-
cept Medicare assignment on a
case-by-case basis. Both versions
of the statement staffers and
posters inform the patient of the
physician's willingness to offer
reduced fees in cases of financial
hardship. Cost of billing en-
closures is $1.50 per 100 plus
$3.00 postage and handling and
5% state sales tax. To order a
supply for your office, call or
write the SMS Membership and
Communications Division at PO
Box 1109, Madison, WI 53701, or
608/257-6781, toll-free 1-800-362-
9080. ■
40
WISCONSIN MEDICAL JOURNAL, JANUARY 1985: VOL. 84
Si Eastman Kodak Company, 1984
The KODAK EKTACHEM
DT60 Analyzer creates an
extra service for your pa-
tients without extra invest-
ment in labor. And because
it can pay for itself in three
months, it’s a timely invest-
ment in your future.
The chemistry tests
you need
With the DT60 Analyzer
you perform key chemistry
tests in your own office
instead of using an out-
side laboratory. Available
tests include glucose,
cholesterol, triglycerides,
BUN, uric acid, sodium,
and potassium, with total
hemoglobin and bilirubin
coming soon.
The time you need
Get test results in five
minutes or less; perform
up to 75 tests an hour.
Save time waiting for
results to assist in your
diagnosis, and on follow-
up phone calls.
The accuracy
you need
The DT60 Analyzer uses
proven technology and
methodology from the
KODAK EKTACHEM 400
and 700 Analyzers, which
provide millions of accurate,
precise results to clinical
laboratories nationwide.
The simplicity
you need
The DT60 Analyzer, com-
pact as a personal com-
puter, features dry slide
technology to eliminate
wet reagents. It is auto-
mated to free up your
staff, and training takes
only minutes. From the
finger-stick sample to
results printout, the DT60
Analyzer is simplicity itself.
To see what the DT60
Analyzer can do for you,
write Eastman Kodak Com-
pany, Dept. 740-B, 343 State
Street, Rochester, NY 14650,
or call 1 800 44KODAK,
Ext 423(1 800 445-6325,
Ext 423) today.
Leading the way in healthcare
technology for over 100 years.
KODAKEKTACHEM
Clinical Chant istry Products
May not be available in all areas.
ORGANIZATIONAL
Doctor Landis nominated for President-elect of SMS
The House of Delegates Nomi-
nating Committee at its Novem-
ber meeting selected the following
slate of officers for the 1985 elec-
tions to be held April 26 during
the SMS Annual Meeting in Mil-
waukee:
• Charles W Landis, MD, Mil-
waukee—President-elect for
1985-86
• John J Foley, MD, Menomonee
Falls— Treasurer for 1985-86 to
succeed himself
• Duane W Taebel, MD, La
Crosse— Speaker of the House
of Delegates, 1985-87 to suc-
ceed himself
• Henry F Twelmeyer, MD,
Wauwatosa; Richard W Ed-
wards, MD, Richland Center;
and Cornelius A Natoli, MD,
La Crosse— AMA Delegates for
calendar years 1986-87, to suc-
ceed themselves
• 7 D Kabler, MD, Madison;
Kenneth M Viste Jr, MD, Osh-
kosh; and Richard H Ulmer,
MD, Marshfield— AMA Alter-
nate Delegates for calendar
years 1986-87, to succeed them-
selves
• Timothy T Flaherty, MD,
Neenah— Additional AMA
Delegate for 1985 (In 1984 the
AMA House of Delegates
amended the Bylaws to provide
for an additional delegate for a
constituent association when
75% of its members were also
AMA members. Whether Wis-
consin will be eligible for this
additional delegate in 1985 will
depend upon the membership
count as of December 31, 1984.)
Biographical sketches and pic-
tures of the candidates will appear
in the February issue. ■
Membership Directory— Update
The following information is being provided from Member-
ship reports and from individual members for updating the
1984 Membership Directory as published in the July 1984
issue of the Wisconsin Medical Journal. Because of space limita-
tions address changes and phone numbers will not be
included in this Update; however, they will be changed in
Membership records. County transfers will be included when
processing has been completed by the Membership Depart-
ment.
New, reelected, or reinstated members
(complete information!
Changes in specialties and/or Board certification!*)
(changes only with member's name!
By county medical society
ASHLAND BAYFIELD IRON
Petry, Thomas S
206 6th Ave West
Ashland WI 54806
BROWN
Kiser, John P
2404 Santa Barbara Dr
Green Bay Wl 54303
DANE
Cary, Steve
933 W Johnson St
Madison WI 53715
Denny, John
3140 View Rd
Madison WI 53711
Farley, David R
119 E Johnson St, #1
Madison WI 53703
EM*
Pearlman, Melvyn A
202 S Park St
Madison WI 53715
Saluja, Rajit
2302 University Ave, #311
Madison WI 53705
Van De Loo, David A
2207 Woodview Ct, #12
Madison WI 53713
Wilde, James
1327 Bowen Ct
Madison WI 53715
DOOR KEWAUNEE
Kimmel, Glenn
1304 First St
Kewaunee WI 54216
FOND DU LAC
DR NR R*
Salo, Bruce C
481 E Division St
Fond du Lac WI 54935
GP GS
Smith Jr, Ernest V
481 E Division St
Fond du Lac Wl 54935
GREEN
PD*
Bancroft, John D
1515 10th St
Monroe WI 53566
IM*
Brehm, Joyce
2709 6th St
Monroe WI 53566
IM* CD
Me Cauley Jr, Charles S
1515 10th St
Monroe WI 53566
KENOSHA
Droege, Elizabeth A
3235 South Johnson St
New Berlin WI 53151
P PN*
Freund Jr, Bernard W
2818 14th Ave
Kenosha WI 53140
OBG
Schellpfeffer, Michael A
1400 75th St
Kenosha WI 53140
LA CROSSE
GS*
Cogbill, Thomas H
Rte 1 Forest Ridge
La Crosse WI 54601
AN*
Dhanak, Kalpana B
1218 North Oak Ave
Onalaska WI 54650
P PN*
Goldbloom, T Joshua
1836 South Ave
La Crosse WI 54601
PM R
Griffith, Mark D
700 West Ave South
La Crosse WI 54601
continued
44
WISCONSIN MEDICAL JOURNAL, JANUARY 1985: VOL. 84
ORGANIZATIONAL
continued
LA CROSSE
CD EM IM*
Johnson, Gordon L
504 South 28th St
La Crosse WI 54601
PS OTO*
Martin, Lynn T
1836 South Ave
La Crosse WI 54601
IM*
Norenberg, David D
1836 South Ave
La Crosse WI 54601
MILWAUKEE
Me Inerney, Gerald T
2400 South 90th St
West Allis WI 53227
RACINE
ORS
Zeman, David R
837 Main St
Racine WI 53403
ROCK
FP*
Bowers, Ronald K
2020 East Milwaukee
Janesville WI 53545
IM
Fitzgerald, William M
1905 Huebbe Parkway
Beloit WI 53511
OTO
Lee, Peter U
1905 Huebbe Parkway
Beloit WI 53511
RUSK
DR R*
Ellis, David P
1009 Shade Lane
Ladysmith WI 54848
FP
Sheller, Robert D
906 College Ave
Ladysmith WI 54848
FP*
Stienke, Emil B
906 College Ave
Ladysmith WI 54848
WAUKESHA
OTO
Beste, David J
W180 N7950 Town Hall
Menomonee Falls WI 53051
FP
Carlson, Vernette M
2542 N 124th St, #301
Wauwatosa WI 53226
FP
Googe, Sarah L
338 Lemira Ave
Waukesha WI 53186
FP*
Jayne, DorothyJ
225 Eagle Lake Ave
Mukwonago WI 53149
FP*
Jensen, Thomas R
485 Claremont Ct
Waukesha WI 53186
AN
Judge, Daniel G
1245 Indianwood Dr
Brookfield WI 53005
FP*
Kelly, John E
2109 N Peninsula Rd
Oconomowoc WI 53066
FP
Larsen, Julie N
400 Fairview Ave
Waukesha WI 53186
P PN*
Logan, MichaelJ
3610 Hickory Lane
Oconomowoc WI 53066
D
Schenck, Beth A
5570 W Roosevelt Dr
Milwaukee WI 53216
R ON
Schewe, Kevin L
8701 Watertown Plank Rd
Milwaukee WI 53226
FP
Tanel Gwendolyn
482 Orchard Ave
Waukesha WI 53186
County society transfers
BARRON WASHBURN
BURNETT
(from Marathon)
Harrison, James F
995 Campus Dr
Wausau WI 54401
DODGE
(from Sauk)
Caceres, Victor W
130 Warren St
Beaver Dam WI 53916
(from Kenosha)
Steele, lames O
Rte 1
Horicon WI 53032
MANITOWOC
(from Racine)
Gommermann, John A
919 Lawton Terr
Manitowoc WI 54220
ROCK
(from Manitowoc)
Horswill, Robert N
2020 E Milwaukee St
Janesville WI 53545
WAUKESHA
(from Dane)
Maday, Gary J
1105 Terrace Dr
Elm Grove WI 53122B
To: Wisconsin Medical Journal, Box 1109, Madison, Wisconsin 53701
Please correct my listing in the 1984 Membership Directory as follows:
COUNTY MEDICAL SOCIETY
SPECIALTY CODE
(PRIMARY)
/
(SECONDARY)
BOARD CERTIFIED IN
(PRIMARY)
(SECONDARY)
NAME
(LAST NAME)
(FIRST NAME)
ADDRESS (FOR DIRECTORY)
CITY STATE
PHONE (FOR DIRECTORY) 1 )
SIGNED DATE
(SECONDARY)
/
(SECONDARY)
(MIDDLE INITIAL)
ZIP
WISCONSIN MEDICAL JOURNAL, JANUARY 1985: VOL. 84
45
Sometimes you have to send your patients
Your patients have learned to trust your judgement. They expect you to heal them.
You always have.
But there are times when you have to send them away to help them— to a tertiary
c*are hospital that will care for them as much as you do.
The Abbott Northwestern and Minneapolis Children’s Medical Center campus has
everytii^ you look for in such a facility: clinical excellence, the full range of specialties,
alternative programs and comp^tive prices.
We serve as.a referral center for the entire region. Our perinatal center and oncology
away tD keep them.
and cardiovascular progi*ams are nationally famous.
With all of Abbott Northwestern’s expert care, you might expect high bills. But many
of our costs have actually gone down in the last year. And our innovative Accommodations
Center offers patients and visitors hotel-like rooms at rates below most budget hotels— let
alone most hospitals.
So send your patients to the physicians of Abbott Northwestern. They’ll act as
patients for a very long time. Abbott Northwestern Hospital
PUBLIC HEALTH
V
Hospital preparedness in treating
radiation accident victims
concerns SMS EOH Committee
The SMS Environmental and
Occupational Health Committee
(EOHC) is continuing to express
concern over the lack of prepared-
ness of hospitals in the state to
safely treat patients who may be-
come contaminated by radio-
active fuel due to a shipment acci-
dent. Currently the Northern
States Power Company is ship-
ping spent nuclear fuel by rail
from Monticello, Minnesota to a
nuclear storage site in Morris, Illi-
nois.
Mr Dave Speerschneider of the
Division of Emergency Govern-
ment and Larry McDonnell of the
Dept of Health and Social Serv-
ices-Section on Radiation Protec-
tion met with the Committee
November 28 to discuss what
measures have been taken to as-
sure that area hospitals along the
route are prepared to deal with
emergency decontamination in
the event of a nuclear waste acci-
dent.
Mr McDonnell pointed out that
the state has no specific charge to
assure that hospitals are indeed
equipped and prepared to deal
with nuclear contamination acci-
dents. All activities to prepare
hospitals thus far have been vol-
untary efforts between the State
Division of Emergency Govern-
ment, the DHSS Section on Radia-
tion Protection, and the Northern
States Power Company.
He pointed out that the "Hos-
pital Emergency Department
Radiation Accident Protocol,"
which was prepared by the State
Medical Society's EOHC Commit-
tee, DHSS, and the Radiation Pro-
tection Council, has been distri-
buted to hospitals along the
nuclear waste transportation
route. JCAH Accreditation Stan-
dards require a protocol for radia-
tion accident procedures. State
hospitals, as well as hospitals else-
where in the nation, have been
interested in the document.
Furthermore, the Northern
States Power Company and state
government have jointly spon-
sored several training sessions
where more than 600 hospital per-
sonnel and emergency medical
technologists have been educated
on how to treat radiation accident
victims.
Several committee members
An Advisory Committee on
Organ Procurement met at SMS
offices November 27 to review the
issues surrounding organ dona-
tion and referral in the state. The
advisory committee, which con-
sists of physicians, nurses, and
hospital representatives involved
in organ donation, has been asked
to respond to a Legislative Coun-
cil Special Committee on Bio-
ethics regarding methods to in-
crease and coordinate organ dona-
tions in the state.
According to national data,
Wisconsin has an excellent record
when it comes to organ trans-
plantation and procurement. Wis-
consin has the highest procure-
ment record in the country as well
as a very high transplant-to-pop-
ulation ratio. Moreover, good rap-
port and cooperation exists be-
tween the healthcare profes-
said they were concerned that
there appeared to be no way to in-
sure that hospitals were indeed
prepared to deal with an accident
if one should occur. Committee
Chairman Vernon N Dodson,
MD, Madison, said he feared that
small hospitals would not have
the funding to purchase the equip-
ment necessary to implement a
preparedness program. Mr Mc-
Donnell concurred and said no
specific state monies have been
appropriated to address this issue,
although Governor Earl has asked
the Division of Emergency Gov-
ernment to review the prepared-
ness of local people to respond to
nuclear waste contamination acci-
dents. Governor Earl also has
asked the Nuclear Regulatory
Commission to certify that the
trips are necessary. ■
sionals involved. The aim of the
committee is to increase the effec-
tiveness of an already successful
system.
The committee discussed sev-
eral mechanisms for improving
the organ donation and referral
process in Wisconsin. Suggestions
included:
• Establish a statewide com-
puterized listing of all persons
who have signed their driver's
license organ donor card. A state-
wide telephone number for this
listing could be used by healthcare
professionals to verify the driver's
license donation signature.
• Develop a public awareness
campaign to promote organ dona-
tion via driver's license donor
card.
• Prepare a position paper on
the entire issue of organ donations
continued
Committee seeks ways to improve
organ procurement system
48
WISCONSIN MEDICAL JOURNAL, JANUARY 1985; VOL. 84
ORGAN PROCUREMENT SYSTEM
PUBLIC HEALTH
continued
and transplantation for presenta-
tion to Legislative Committee on
Bioethics. The paper would pro-
mote the ideas mentioned pre-
viously as well as include con-
sideration of how to cope legally
with coroners' cases, potential
ways to eulogize the donor (for the
family's sake), and the role of the
hospital chaplain in this process.
• Sponsor a state-of-the-art
organ transplant conference
aimed at educating designated
hospital coordinators on the latest
issues surrounding organ trans-
plantation, procurement, and
donations. ■
Report on school
health problems
available
The Wisconsin Coalition for
School Health Education
(WCSHE), of which SMS is a
member, has recently completed
a report on "Critical Health Prob-
lems of Wisconsin's School-Aged
Youth." The first part of the docu-
ment presents the major health
problems in Wisconsin's school
children and adolescents as iden-
tified by the Coalition. The second
section focuses on the Coalition's
recommendations for reducing
the critical health problems of
Wisconsin's school-aged youth
and improving Wisconsin's school
health education delivery and
support recommendations.
'The WCSHE is composed of 32
professional and voluntary organ-
izations which support the estab-
lishment of comprehensive health
instruction programs K-12 in all
Wisconsin schools. Conrad An-
dringa, MD, Madison, and Diane
Upton of the SMS staff represent
the State Medical Society on the
Coalition. Copies of the Coalition
document are available by con-
tacting the SMS Membership and
Communications Division in
Madison. ■
SMS leaders discuss health issues
of the elderly with Coalition of Aging
SMS President Flaherty and
Secretary Thayer met for several
hours Thursday, December 13,
with the Board of Directors of the
Wisconsin Coalition of Aging
Groups. Nearly 50 over-65 leaders
of volunteer local aging groups
were represented.
Doctor Flaherty outlined the
Society's policy regarding Medi-
care assignment and its considera-
tion for all Wisconsin's low-
income citizens. He explained
physicians' worries that federal-
state regulations may compromise
the ability to provide adequate
and compassionate care for the
elderly, the hazards of the "new
rationing" plans such as DRGs
and HMO/PPOs, and the need to
look for changes in the Medicare
system. He also spoke of the mal-
practice problem and how this
contributes to increased costs.
The SMS officials offered to
assist local aging groups in dealing
with access, cost, and quality
problems and encouraged them to
work closely with local physicians
and medical societies.
The coalition adopted a resolu-
tion of appreciation for Doctor
Flaherty's visit and directed that
continuing dialogue take place be-
tween the Coalition and the State
Medical Society. ■
Persons interested in the Im-
paired Physician Program
may call 608/257-6781 or
toll-free in Wisconsin; 1-800-
362-9080 and explain their
concern to Mr John LaBis-
soniere or Mr H B Maroney
of the State Medical Society
staff. The caller's identity
will be kept in complete
confidence.
How they handle
drunk drivers
in other countries
Australia . . . The names of
the drivers are sent to the local
newspapers and are printed
under the heading "He's drunk
and in jail."
Malaya . . . The driver is
jailed, and if he's married, his
wife is jailed too.
South Africa ... A 10-year
prison sentence and the equiv-
alent of a $10,000 fine or both.
Turkey . . . Drunk drivers
are taken 20 miles from town
by the police and forced to walk
back, under escort.
Norway . . . Three weeks in
jail at hard labor, one year loss
of license. Second offense with-
in 5 years— license revoked for
life.
Finland and Switzerland
. . . Automatic jail for one year
at hard labor.
Costa Rica . . . Police re-
move plates from car.
Russia . . . License revoked
for life.
England . . . One year li-
cense suspension and $250 fine
and jail for one year.
France . . . Three year loss of
license, one year in jail and
$1,000 fine.
Poland . . . Jail and fine and
forced to attend political lec-
tures.
Bulgaria ... A second con-
viction results in execution.
El Salvador . . . Your first
offense is your last. Execution
by firing squad.
* * *
Taken from: "The Impaired
Physician Program Newsletter"
of the Medical Society of New
Jersey, November 1984. ■
WISCONSIN MEDICAL JOURNAL, JANUARY 1985: VOL. 84
49
SOCIOECONOMICS
Legislative committee backs
cap on attorney fees
The Legislative Council Special
Committee on Medical Malprac-
tice added to its list of proposed
changes in Wisconsin's medical
liability laws in December by ap-
proving a recommendation to
adopt a sliding scale for attorney
contingency fees. Under this plan,
the percentage an attorney could
charge as a contingency fee would
decrease as the amount of the
award increased. SMS supports
this concept as it preserves a
greater portion of the award for
the claimant.
The Committee has not yet
determined the actual percentage
limits but an example of the
sliding fee system would be to
allow fees up to: 33% of awards
less than $ 100,000; 25% of awards
between $100,000 and $300,000;
20% of awards between $300,000
and $500,000, or 15% of awards in
excess of $500,000.
The Committee also approved
recommendations to:
• Implement a surcharge pro-
gram within the Patients Compen-
sation Fund whereby physicians
with poor claims experience
would be charged a higher fee
than others in the same specialty.
• Require all primary insurers
and the Fund to report all paid
claims to the State Medical Exam-
ining Board.
• Modify the accounting and
reserving system of the Fund to
limit reserving for anticipated
future claims. This recommenda-
tion of SMS is directed at lessen-
ing the impact of actuarial projec-
tions of future claims on current
fee assessment.
• Allow periodic (quarterly)
payment of Fund fee assessments.
• Reduce the general statute of
limitations from 3 to 2 years.
• Provide WHCLIP and Fund
coverage for HMOs, PPOs, etc.
At a previous meeting the Com-
mittee approved a $ 1 million cap
on malpractice awards.
At a subsequent meeting on
December 19, the Committee
took the following actions:
• On the recommendation of
the Wisconsin Academy of Trial
Lawyers, voted to direct the Pa-
tients Compensation Panels to not
require expert medical testimony.
Expert testimony could be vol-
untarily presented by the plaintiff
or defendant. It was indicated
that, in the absence of expert testi-
mony, the physician members of
the panel would act as the experts
themselves. The Committee also
discussed, but delayed action on,
the State Bar's recommendation to
change the composition of formal
panels by eliminating one phy-
sician member and adding an
additional public member. In con-
junction with the preceding
recommendation, this would
yield a panel of one physician, one
attorney chairperson, and three
public members, and no require-
ment for expert testimony.
• Supported in concept the
creation of physician peer review
committees to work with
WHCLIP and all other primary
carriers, the Patients Compensa-
tion Fund, and the State Medical
Examining Board. Such commit-
tees would review paid claims in
conjunction with a surcharge sys-
tem and would prioritize cases for
review by the MEB and make
recommendations for disciplinary
actions. A specific proposal cover-
ing statutory authority, composi-
tion, and immunity from liability
will be presented to the Commit-
tee for final review.
• Voted to increase protections
from lawsuits for peer review
committees and their individual
members, by extending Patients
Compensation Fund coverage to
these committees, with coverage
to apply in all cases except when
the Committee is found by a court
to be acting in bad faith and will-
ful and malicious intent to dis-
criminate. The Committee also
voted to increase the current im-
munity protection by creating a
legal presumption that peer re-
view committees are acting in
good faith and requiring a "clear
and convincing" standard of evi-
dence to rebut this presumption.
• Voted to recommend that Pa-
tients Compensation Panels pro-
ceedings be bifurcated with the
panel first considering only the
question of liability. If liability is
found, then the same panel would
proceed to consideration of
damages.
• Tabled a recommendation
that attorneys be required to file a
certificate of merit stating that a
malpractice claim has been re-
viewed by a qualified expert and
found to be meritorious.
The Committee will next meet
January 28. The agenda for the
Committee will be to discuss sta-
tutory language written by the
staff for the Committee and to
complete discussion of remaining
recommendations. ■
50
WISCONSIN MEDICAL JOURNAL, JANUARY 1985: VOL. 84
SOCIOECONOMICS
DHSS proposes 3.5% increase
in physician reimbursement
The State Department of Health
and Social Services has given the
Governor a tentative budget for
the Medicaid program which in-
cludes a 3.5% increase in physi-
cian reimbursement. In 1983 SMS
was successful in lobbying for a
3% increase in physician reim-
bursement. This occurred in a 0%
increase budget year because SMS
was able to effectively illustrate
the need for Medicaid to provide
an increase based upon escalating
practice costs by physicians.
The proposed Medicaid budget
also provides coverage for drugs
for the "medically needy." This
provision will cost $1.4 million in
fiscal year 1986 and $1.46 million
in fiscal year 1987. The Commun-
ity Options Program may be ex-
panded to all Wisconsin counties
in 1986. This would result in
Medicare assignment
sign-up reaches 36%
of MDs and DOs
WPS-Medicare reports that
3017 physicians, or 36%, of ap-
proximately 8400 Wisconsin li-
censed physicians (MDs and DOs)
have signed Medicare agree-
ments. In regard to other provider
groups, WPS-Medicare says that
41% of podiatrists, 21% of chiro-
practors, 6% of dentists, and 20%
of optometrists in the state have
signed Medicare participating
agreements.
Two directories for the Medi-
care program have been pub-
lished. One directory lists only
"participating" physicians; ie,
those physicians who accept
Medicare assignment 100% of the
time. The other directory lists all
Medicare providers along with the
percentage of time they accept
assignment. ■
spending $21 million in 1983-85
and $53 million in 1985-87.
The Governor and the Depart-
ment of Administration now are
examining the Medicaid budget
proposal and possibly will make
modifications to it before present-
ing it as part of the 1985-87 Bien-
nial Budget proposal to the Legis-
lature in early 1985. The SMS
Physicians Alliance Commission
also is reviewing the proposal. ■
WISP AC membership
shows 50% increase
Thanks to the support of physi-
cians and their spouses through-
out the state the Wisconsin Physi-
cians Political Action Committee
(WISPAC) was able to increase its
membership by more than 50% in
1984. That represents approxi-
mately 30% of the State Medical
Society's membership. WISPAC
expects an even greater increase
in 1985.
Those counties that rate special
recognition for reaching their
WISPAC membership goals in
1984 are: Calumet, Fond du Lac,
Grant, Green Lake-Waushara,
Lincoln, Manitowoc, Oconto,
Oneida-Vilas, Pierce-St Croix,
Price-Taylor, Racine, Rusk, Sauk,
Shawano, Trempealeau-Jackson-
Buffalo, and Washington. ■
WHCLIP rate may
increase 75%
Preliminary indications show
that a 75% increase in rates for the
Wisconsin Health Care Liability
Insurance Plan (WHCLIP) may be
necessary to fund next year's
claims, actuaries for the Plan told
the WHCLIP Actuarial Commit-
tee November 28. Although this is
only a preliminary report, the ac-
tuaries stated they expect little to
change between now and when
the final recommendations are
made in January.
In addition, the actuaries pro-
jected that as of December 31,
1984 WHCLIP will show a deficit
of $18 million. By comparison,
last year's premium income was
$10.7 million. The WHCLIP
Board of Directors will now have
to determine how much, if any, of
this deficit will be recouped
through next year's rates. Recoup-
ment of any or all of this deficit
could raise next year's total pre-
mium well beyond the '75%
figure. ■
Health Policy Council
to look at CON regs
The Health Policy Council
(HPC) is in the process of review-
ing a proposed change in the certi-
ficate-of-need (CON) program to
include free-standing birthing
centers under the review process.
Currently the certificate-of-need
review process only applies to
hospitals and ambulatory surgical
centers. The HPC's Acute Care
Committee, which is making the
recommendation, is arguing that
since free-standing birthing
centers are in direct competition
with hospitals, they should be
subject to the same regulations as
a hospital. ■
Persons interested in the Im-
paired Physician Program
may call 608/257-6781 or
toll-free in Wisconsin: 1-800-
362-9080 and explain their
concern to Mr John LaBis-
soniere or Mr H B Maroney
of the State Medical Society
staff. The caller's identity
will be kept in complete
confidence.
WISCONSIN MEDICAL JOURNAL, JANUARY 1985:VOL. 84
51
ORGANIZATIONAL
Membership facts
Whether you’re just starting medical school, maintaining a
full-time practice, or retiring, SMS has a membership classi-
fication to fit your individual needs. Election to membership
by the County Medical Society in which your principal place
of practice is located carries with it membership in the State
Medical Society of Wisconsin and, if you wish, the American
Medical Association. If you qualify for resident membership
at the time of your election, your membership dues are
greatly reduced. This may also qualify you for reduced dues
the first two years of your practice. Dues for regular mem-
bership in 1985 are $455 for SMS, $330 for AMA, and county
society dues vary. A more detailed listing of SMS member-
ship classifications and their corresponding dues follows;
State Medical Society of Wisconsin
DESCRIPTION OF MEMBERSHIP
CLASSIFICATIONS
Regular Member in active practice. Some are regular mem-
bers that have reduced SMS and/or AMA dues because they
are new practitioners (first year or two out of residency).
Resident; Physician who at January 1 of dues year is in an
approved training program as a hospital resident or research
fellow who is licensed to practice medicine and surgery in
Wisconsin.
Military Service; Members who are serving in the U S. armed
forces (generally not to exceed five years).
Associate; Member whose dues are waived because of fi-
nancial hardship due to illness or disability. This classifica-
tion is temporary and is reviewed on an annual basis.
Life; Member who has held membership in a state medical
society for 50 years or is a Past President of the State Med-
ical Society of Wisconsin.
Honorary; Member who was named by the Board of Direc-
tors in recognition of long and distinguished service to Ihe
cause of medicine.
Your membership in organized medicine will help insure
the continued “safety" of your practice and quality care
for all patients. Your voice will be heard through par-
ticipation. Dues statements for 1985 membership in
the State Medical Society of Wisconsin (county medi-
cal society membership also required; AMA member-
ship optional but encouraged) are being mailed in Novem-
ber with subsequent reminder notices. For Regular,
Part-time Practice, or Over Age 70 membership classifi-
cations, dues may be paid in one lump sum or in two
equal installments: one-half of the total payable by Jan-
uary 1, the other half not later than May 15, 1985 which is
the removal date for those members who have not com-
pleted payment. You are urged to renew your membership.
Reti'-ed: Member who has completely retired from practice
(works less than 240 hours per year). All dues are waived
unless county society indicates they wish to charge county
dues.
Parl-time Practice: Physician, regardless of age, who prac-
tices 1,000 hours or less during the calendar year but does
not qualify for retired membership.
Over Age 70: Member in active practice who is over 70 years
of age as of January 1.
Candidate: Member attending a medical school in Wiscon-
sin or fulfilling a postgraduate obligation prior to eligibility
for licensure.
Scientific Fellow; The Board of Directors may by invitation
and unanimous consent confer upon any person engaged in
teaching of or research in one or more of the basic sciences
at an accredited college or university, and not holding the
degree of Doctor of Medicine or Osteopathy, the status of
Scientific Fellow.
Emeritus: Retired members who have chosen not to renew
their license.
1985 DUES AMOUNTS FOR THESE
CLASSIFICATIONS
SMS
AMA
COUNTY
Regular
$455
$330
Normal County Dues
Resident
45.50
45
Varies
Military Service
-0- 220
or 45
-0-
Associate
-0-
-0-
-0-
Life-
-0-
-0-'
-0-
Honorary
-0-
-0-'
-0-
Retired
-0-
-0-'
-0-
Part-time Practice
227.50
330'
Normal County Dues
Over Age 70
227.50
-0-*
Normal County Dues
Scientific Fellow
-0-
.-0-
Emeritus
-0-
-0-'
Candidate-
Freshman Year
Medical Student
-0-
20
Varies
Sophomore and
Succeeding Medical
Student Years
10
20
Varies
Postgraduate — One
10
45
Varies
'Physicians in the follov/ing categories may be eligible for exemption from
paying AMA dues: (1) Financial hardship and/or disability, (2) Age 65-69 and
retired from the practice of medicine, (3) Over age 70 regardless of retirement
status.
State Society dues are prorated on a monthly basis for
those elected to membership July 1 through September 30.
Those elected after September 30 have no dues payable for
the balance of the year in which they are elected. AMA dues
follow the same pattern except prorating is on a semiannual
basis rather than monthly basis.
To begin the membership process, if your practice is or will
be located in Wisconsin, or you have any questions, you may
contact your local county society or call the Membership
and Communications Division of the State Medical Society,
if in Wisconsin: 1-800-362-9080 (Madison area number:
257- 6781 ).■
52
WISCONSIN MEDICAL JOURNAL, JANUARY 1985 : VOL. 84
Staff photos by Diane Upton
COUNTY SOCIETIES
Malpractice focus of Milwaukee county society meeting
MILWAUKEE: The chances of
any one of you getting sued is be-
tween one in 10 and one in 15,
William Listwan, MD, West
Bend, told a group of physicians at
a meeting of the Medical Society
of Milwaukee County November
29.
Doctor Listwan, who is a mem-
ber of the SMS Committee on
Medical Liability, was part of a
four-member panel presentation
on the medical liability situation
in Wisconsin.
In an overview he gave of the
malpractice scene in the state,
Doctor Listwan said that deter-
rence of medical negligence is get-
ting confused with adequate com-
pensation of the patient and this is
causing a snowballing effect of
awards.
"Business and industry may be
one of our biggest allies in trying
to reform the system,” he said,
"as they begin to realize what ef-
fect the cost of malpractice is hav-
ing on their costs."
William Treacy, MD, who is
also a member of the Medical Lia-
bility Committee, outlined the
Medical Society's 19-point plan
for reform of the system in Wis-
consin. The "heart" of the SMS
plan is to establish a sanction
system for "repeat offenders."
"If peer review indicates multi-
ple cases of negligence by a par-
ticular physician, sanctions, such
as surcharges, restricted coverage
or referral to the Medical Exam-
ining Board should be imposed,"
he said.
Willidm Listwan, MD
Darold Treffert, MD
William Treacy, MD and Jerome Eons. MD John MuIIooly, MD
SMS Board member Jerome
Eons, MD, Milwaukee, explained
the new SMS-endorsed medical
liability insurance plan— PICO—
to physicians. Doctor Eons said
that the Society is represented on
claims, underwriting, and ad-
visory committees for the insur-
ance plan.
He pointed out that PICO has
agreed not to settle any claims
without physician consent. "No
other insurance company has this
as its policy," he said.
Thus far, the Milwaukee Medi-
cal Society is pleased with the
plan, and to date 700 physicians
have purchased the coverage. The
coverage is tied to membership in
the State Medical Society, Doctor
Eons said, and SMS has been criti-
cized to some degree for this. He
defended the policy by saying,
"the leadership of the State Medi-
cal Society has a responsibility to
keep our organization fiscally
strong and this plan is an attrac-
tive benefit we can offer our
members."
Brian Jensen, director of the
SMS Physicians Alliance Division
began his presentation with the
announcement that the Actuarial
Committee of the Wisconsin
Health Care Liability Insurance
continued
WISCONSIN MEDICAL JOURNAL, JANUARY 1985: VOL. 84
53
COUNTY SOCIETIES
MALPRACTICE FOCUS
continued
Plan (WHCLIP) have recom-
mended a 75% increase in rates
for 1985, and that yet to come are
increases in the assessments for
the Patients Compensation Fund.
"It is figures like these that
underscore the necessity for some
reform of the system," he said.
"Achieving reforms will not be
easy for several reasons," Jensen
explained. "The majority of the
legislators don't even realize there
is a malpractice crisis."
He urged physicians to begin
contacting their legislators on mal-
practice issues, get them familiar
with the problems. Secondly, doc-
tors should discuss the issue with
leaders in business and industry
"who have realized that profes-
sional liability is just one step
away from product liability, and
they're concerned about it,"
Jensen said. Finally, he advised
physicians to talk to their patients
about malpractice.
Perhaps the biggest thing the
medical profession can do to solve
the malpractice problem is to do
something in "real live peer re-
view," Jensen said.
"One percent of the physicians
are causing 20% of the claims. For
CES
Foundation
CONTRIBUTIONS
November 1984
The Charitable, Educational and
Scientific Foundation of the State
Medical Society is grateful to Soci-
ety members, their various friends
and associates, and other organiza-
tions interested in the aims and
purposes of the Foundation, for
their generous support. The Foun-
dation wishes to acknowledge the
following contributions for
November 1984.
Nonrestricted
Chesley P Erwin, MD; Marathon
County Medical Society Auxil-
iary; V/innebago County Medical
Society Auxiliary: Dr-Mrs Guy
Giffen; Samuel B Harper, MD;
Frances Cline, MD; AA Hol-
brook, MD; Richard H Ulmer,
MD; John H Hirschboeck, MD—
Voluntary Contributions
Restricted
Albert L Fisher, MD; RL Waffle,
MD; HJ Hansen, MD— Black Out
Drapes for SMS Board Room
Lillian E Olson; Laurene De Witt
Davidson; Ronald L Lewis; Jac-
queline P Dungar; Joseph J
Muller, MD; Thomas W Tormey
Jr, MD; Sanford R Mallin, MD—
Aesculapian Society Dues
John T McEnery, MD; Kenneth L
Day, MD; Ramona E James; SW
Hollenbeck, MD; Mrs. William
G Weber; Elsie Egan; George
Kress— Aesculapian Society Dues
(Museum of Medical Progress}
William G Wendle— Mi/senw of
Medical Progress Endowment Fund
Mrs William D Hoard, ]r— Museum
of Medical Progress (''Beaumont
500" I
Roy Selby, MD— Museum of Medi-
cal Progress ("Beaumont 500"j
Clara Joss Trust Fund— Medica/
Research
State Medical Society of Wisconsin
Auxiliary; Winnebago County
Medical Society Auxiliary;
Dodge County Medical Society
Auxiliary —Harrington- Wright
Scholarship Fund
State Medical Society of Wisconsin
Auxiliary— Wor/?s/iop on Health
Memorials
Farrell F Golden, MD— Robert B
Andrew, MD
Dr-Mrs Farrell F Golden— Dona/d
Ripple
Kristin Bjurstrom— C Appell
Dr-Mrs William ]ar\ssen— Arthur
Erwin; Alex Locke, MD
John E Dettmann, MD— Thelma
Ford
State Medical Society— Aff Her-
mann, MD; Carol D Lorton, MD;
Alphonsus M Rauch, MD; Albert
M Cohen, MD; Richard D Ken-
nedy, MD; Robert A Andrew, MD;
Christian F Midelfort, MD ■
US to believe that it is only the
lawyers that are causing the prob-
lem is not fair," he said.
John Mullooly, MD, president
of the MSMC, was moderator of
the panel.
LINCOLN; Muhammad Yusof
Ahmad, MD,* Merrill, has been
reelected president of the Lincoln
County Medical Society for 1985.
Also elected are Charles E Good-
ell, MD,* Tomahawk, vice-presi-
dent, and Gail M Amundson,
MD,* Tomahawk, secretary.
JEFFERSON: Fifteen members
and eight guests were present at
the November meeting of the
Jefferson County Medical So-
ciety. Timothy T Flaherty, MD,*
Neenah, president of the State
Medical Society, was the guest
speaker. Doctor Flaherty spoke
on the "Issues of Medicine." At
the business session of the meet-
ing, Edward J Hoy, MD,* was
elected as secretary-treasurer,
and Brigido C Calado, MD,* was
nominated for vice-president.
KENOSHA: At its October
meeting the Kenosha County
Medical Society amended Article
III— Eligibility of its Constitution
to read: "Every physician prac-
ticing medicine in Kenosha
County, who is of good moral and
professional standing and who
does not support or practice, or
claim to practice, any exclusive
system of medicine, shall be eligi-
ble to apply for election to mem-
bership, subject to such condi-
tions as may be prescribed by By-
law, and not inconsistent with the
Constitution, Bylaws, and regula-
tion of the State Medical Society.
The applicant must demonstrate
evidence of their desire to be an
integral member of the local prac-
ticing medical community. A phy-
sician retired from the practice of
medicine in Kenosha may con-
tinue as an honorary member." ■
54
WISCONSIN MEDICAL JOURNAL, JANUARY 1985 : VOL. 84
Turn of the century
trephine for cranial surgery
and tonsillotome for
removing tonsils.
We’ve been defending
doctors since
these were the
state of the art.
These instruments were the best available at
the turn of the century. So was our professional
liability coverage for doctors. In fact, we
pioneered the concept of professional
protection in 1899 and have been providing
this important service exclusively to doctors
ever since.
You can be sure we’ll always offer the most
complete professional liability coverage you
can carry. Plus the personal attention and
claims prevention assistance you deserve.
For more information about Medical
Protective coverage, contact your Medical
Protective Company general agent.
William E. Herte, Jerry E. Kronsnoble, 850 North Elm Grove Road, Elm Grove, Wisconsin 53122, 414/784-3780
PHYSICIAN BRIEFS
V
Robert W Boyle, MD, * Wauwa-
tosa, professor emeritus of physi-
cal medicine and rehabilitation
at the Medical College of Wiscon-
sin, Milwaukee, won the Ameri-
can Academy of Physical Medi-
cine and Rehabilitation's 1984
Distinguished Clinician Award.
Doctor Boyle was director of the
physical medicine and rehabilita-
tion department at the Milwaukee
County Medical Complex from
1954 to 1978, and is now a consul-
tant at the Veterans Administra-
tion Medical Center, Wood. Doc-
tor Boyle was president of the
Academy from 1961 to 1962 and
also has been its secretary.
William Sybesma, MD, * Fond
du Lac, has become associated
with the medical staff at Valley
View Medical Center, Plymouth.
Doctor Sybesma graduated from
the University of Iowa Medical
School and served his internship
at the University of Southern
California Medical Center, Los
Angeles. His residency was com-
pleted at Huntington Memorial
Hospital, Pasadena, Calif, and
Wadsworth Veterans Administra-
tion, UCLA Medical Center. He is
on the medical staff of St Agnes
Hospital in Fond du Lac.
Jules H Blank, MD, Green Bay,
has joined the medical staff of the
West Side Clinic. A graduate from
Loyola University Stritch School
of Medicine, Maywood, 111, Doc-
tor Blank completed his residency
at Southern Illinois University Af-
filiated Hospitals in Springfield,
and a fellowship in hematology
and oncology at the University of
Connecticut Health Center in
Farmington.
John P Kirchner, MD, * Marsh-
field, recently received the Dis-
tinguished Physician Award. The
award was presented during the
state convention of the American
Ex-Prisoners of War in Madison.
This was the fifth time the award
was presented since it was estab-
lished in 1968. Mr Stanley Som-
mers, Marshfield, the organiza-
tion's national medical research
chairman, said Doctor Kirchner
wrote a brief dealing with the
post-traumatic stress disorder.
The disorder is a chronic form of
anxiety affecting POWs in the
years after incarceration.
Romeo C Soriano, MD, Lan-
caster, has joined the medical staff
of Memorial Hospital of Lafayette
County. Doctor Soriano graduated
from Far Eastern University in
Manila, The Philippines, and
served his residency at Hines
Veterans Administration Hospital
in Illinois.
Beth A Schenck, MD, * Milwau-
kee, recently joined the Falls
Medical Group in the Department
of Dermatology. Doctor Schenck
graduated from the Indiana Uni-
versity School of Medicine and
completed her residency at the
Medical College of Wisconsin Af-
filiated Hospitals. Doctor Schenck
also has been appointed to the
clinical faculty of the Medical Col-
lege of Wisconsin, Milwaukee.
Michael F Finkel, MD,* Eau
Claire, has been elected vice-
president of the Wisconsin Neu-
rological Society for a one-year
term. Doctor Finkel is a member
of the medical staff of the Midel-
fort Clinic and is a member of the
medical staff at Sacred Heart and
Luther hospitals in Eau Claire.
Curtis Radford, MD, Oshkosh,
has joined the medical staff of the
McDonald Clinic in Winneconne.
Doctor Radford graduated from
the University of Wisconsin
Medical School, Madison, and
completed his residency at the
Mayo Clinic in Rochester, Minn.
Doctors Gillett and KreuI
George N Gillett, MD, * Racine
(left above), and Randolph W
Kreul, MD,* Racine (right
above), examine hand-forged iron
forceps used by 19th century doc-
tors to help deliver babies. Doc-
tors Gillett and Kreul both prac-
ticed medicine in Racine more
than 50 years. They were among
members of the Racine County
Medical Society who were helping
identify old medical instruments
stored at the Racine County His-
torical Museum. Helping catalog
the items were members of the
Racine County Medical Society
Auxiliary. The Auxiliary also
plans to do research on 19th cen-
tury medical practices in Racine
County and help the museum up-
grade its turn-of-the-century doc-
tor's office exhibit. (Photo by
Racine Shoreline Leader)
Mark Dickmeyer, MD, White-
water, has joined the medical
staff of the Whitewater Family
Practice Clinic. Doctor Dick-
meyer graduated from the In-
diana University School of Medi-
cine and completed his family
practice residency at St Michael's
Hospital in Milwaukee.
Henry C Pitot, MD, PhD,
Madison, was elected a director-
at-large of the American Cancer
56
WISCONSIN MEDICAL JOURNAL, JANUARY 1985: VOL. 84
PHYSICIAN BRIEFS
Society. Doctor Pitot is director
of the McArdle Laboratory for
Cancer Research at the Univer-
sity of Wisconsin Medical School,
Madison, and also is a professor
of oncology and pathology at the
University.
Stanley B Marshall, MD, * Hol-
landale (below), received more
than 250 guests at a final farewell
party for him. The party was
given by members of the com-
bined parishes of St Patrick's
Catholic Church and the Hollan-
dale Lutheran Church. Guests
came from all over Iowa County,
Monroe, Juda, Belleville, Green
Bay, Mt Horeb, Monticello, Madi-
son, Janesville, Beaver Dam, and
Shullsburg. He also had visitors
from Des Plaines, 111, and Du-
buque, la. Doctor Marshall retired
in 1978 but was "always there for
someone to confide in when prob-
lems or sorrows were overpower-
ing." (Photo by Jean Lewis,
Dodgeville Chronicle)
Doctor Marshall
Paul Norton, MD, has begun
his medical practice in pediatrics
in the Milwaukee suburb of
Shore wood. Doctor Norton is a
graduate of the Medical College
of Wisconsin, Milwaukee. He
completed his residency at Mil-
waukee Children's Hospital
where he also served as an as-
sistant professor.
William M Fitzgerald, MD,
retired member and founder of
the Beloit Clinic, has presented
his doll collection to the Beloit
Clinic. In 1947 when Doctor Fitz-
gerald and two friends started the
Beloit Clinic, a patient brought in
a doll and gave it to him. Pretty
soon another patient brought in
another doll from another part of
the world. Over the years the col-
lection has grown to 1 10 dolls and
Doctor Fitzgerald deemed it ap-
propriate that the Clinic should
have the dolls displayed in a
lobby showcase. Doctor Fitz-
gerald practiced in Beloit from
1947 until his retirement last
June.
George M Kroncke, MD, * Mad-
ison, University of Wisconsin
Medical School associate profes-
sor of surgery, recently was
elected to membership in the
American Association for Thor-
acic Surgery.
"WATS " LINE
FOR MEMBERS
The in-WATS (toll-free) line
can be used to contact any-
one at SMS headquarters
(330 East Lakeside Street,
Madison) from anywhere
within the State of Wiscon-
sin between the hours of
8:00 am and 4:30 pm week-
days. The number to dial is:
1-800-362-9080
Persons interested in the Im-
paired Physician Program
may call 608/257-6781 or
toll-free in Wisconsin: 1-800-
362-9080 and explain their
concern to Mr John LaBis-
soniere or Mr H B Maroney
of the State Medical Society
staff. The caller's identity
will be kept in complete
confidence.
THE NAVY SEARCH
FOR EXCELLENCE
The United States Navy Medical
Command desires physicians who
want to practice medicine . . . not
be business managers. The Navy
offers specialists quality clinical ex-
perience and professional growth,
a very comfortable lifestyle with-
out financial and administrative
worries, and the valuable time to
spend with family and friends
while planning the future.
• Flight Surgery • Orthopedic
• Anesthesiology Surgery
• Otolaryngology • General
• Neurology Surgery
• Psychiatry • Neurosurgery
LOCATIONS: 23 modern medical
facilities located along the east and
west coast, as well as nine hospitals
overseas, including those in Japan,
Spain, Italy and the Philippines.
BENEFITS: Varied clinical experi-
ence: 30 days annual vacation;
travel benefits; full malpractice,
medical /dental coverage; net start-
ing salaries from $40,000 to
$55,000; non-contributive retire-
ment package which yields approx-
imately $20,000 a year after 20
years of service, or $30,000 a year
after 30 years.
MINIMUM QUALIFICA
TIONS: State license; US citizen;
excellent professional references.
For complete details, call or send
Curriculum Vitae to: Lt Nancy Hill,
Henry S Reuss Federal Plaza, 310
W Wisconsin Ave, Suite 450, Mil-
waukee, WI 53203; 414/291-1529
(Call Collect)
WISCONSIN MEDICAL JOURNAL, JANUARY 1985: VOL. 84
57
We know you.
We've talked with you.
We have a continuing
commitment to serve you.
For professional liability insurance, the stakes are too
high to depend on anyone else.
That's why the State Pledical Society has endorsed a
professional liability plan which has been developed
especially for Wisconsin physicians.
Available only to members of the SNS— and offered
through SPIS Services, Inc.— this medical malpractice policy
has superior features including:
• Consent of the physician is required before settlement of
any claim.
• Availability of legal counsel, experienced in defendant
medical liability.
• All members of claims and underwriting committees are
Wisconsin physicians.
• Occurrence coverage provided for claims arising during
the policy period, even if claim is reported at a later
time.
for the best in professional liability coverage, contact
SMS Services, Inc. at (608) 257-6781 or toll-free 1-800-362-9080
Endorsed by the
State Medical Society
of Wisconsin
We know how vital it is to safeguard the present...
and to protect the future.
Underwritten by:
THE PROFESSIONALS
INSURANCE COMPANY
A respected leader in coverage for preferred markets.
'Physician members of Stale Medical Society of Wisconsin
SPECIALTY SOCIETIES
V
y
Internists to sponsor legislative
seminar March 1-3 in Kohler
Wisconsin Chapter of the Ameri-
can College of Physicians is spon-
soring a legislative seminar March
1-3 at the American Club, Kohler.
Internists and their spouses will
meet with members of the legisla-
tive and regulatory branches of
state government who will serve
as faculty.
Because of the ever-increasing
amount of legislation and regula-
tion and the shifting of health
states, physicians must become
more aware of and involved in
this process. Hence, this meeting
is being conducted to enable
physicians to continue to establish
avenues of communication and
develop skills necessary to work
with the legislative, executive,
and regulatory branches of gov-
ernment.
Registration is from 4:00 to 6:00
pm Friday, March 1. The seminar
will open with a reception and
dinner at 6:00 pm followed by a
brief orientation. On Saturday
there will be several simultaneous
'Physician members of Stale Medical Society of
small group sessions from 8:30 am
to 4:00 pm and again on Sunday
from 8:30 am until 10:00 am. A
plenary session between 10:30 am
and noon Sunday will close the
seminar.
The workshop sessions include
spouses and will be very informal
and unstructured. Some of the
topics expected to be discussed
include:
—How the legislative, executive,
and regulatory branches of Wis-
consin government work and
function.
—How interest groups best have
input into the government process.
—How a bill is initiated, devel-
oped, and finally brought to a vote
in the Legislature.
— How government agencies
develop and implement regula-
tions.
—Effect of shifts of responsibility
to Wisconsin state government
from the federal level.
—How legislation and regulation
can be shaped in its development.
These workshops are designed
to provide an atmosphere for free
discussion and improved under-
standing of state government.
This seminar is not intended to
be a forum for participants to pro-
mote any particular interests.
Rather, the internists' purpose is
to prove an opportunity to learn
how state government works— a
matter of vital interest to a well-
informed leadership in the medi-
cal community.
Physicians desiring to attend
should contact Edwin L Overholt,
MD, FACP, Gundersen Clinic
Ltd, 1836 South Ave, La Crosse,
Wis 54601 at 608/782-7300, ext
2281.
Wisconsin Chapter, American
College of Physicians at its
meeting in September 1984 re-
elected Edwin L Overholt, MD,*
La Crosse as its president. Other
officers are: Mahendra S Kochar,
MD,* Wood, vice president;
Thomas F Nikolai, MD,* Marsh-
field, secretary; and Terrence W
Boland, MD, Onalaska, trea-
surer. ■
Wisconsin
NEWS HIGHLIGHTS
Burlington Memorial's Hos-
pital medical staff recently
elected Gerry K Larmore, MD,*
Burlington, its chief-of-staff for
1985. Doctor Larmore succeeds
Paul F Wagner, MD,* of Burling-
ton. Doctor Larmore has been on
the medical staff of Burlington
Memorial since 1978.
St Luke's Hospital and Medical
Dental Staff, Racine, has elected
the following physicians as execu-
tive officers of its staff. Charles W
Christenson, MD,* was elected
chief-of-staff; Joseph R Wilczyn-
ski, MD,* vice chief-of-staff; Paul
L Miller, MD,* secretary; and Jose
E Reyes, MD,* treasurer. Other
elected executive medical staff
committee members are MDs
William H Stone,* medical; Den-
nis J Kontra,* surgical; David R
LeCloux,* Ob/Cyn; Stanley M
Englander,* pediatrics; Ralph E
Tomkiewicz,* psychiatry; Gerald
J Sampica,* family practice; and
Joseph R Wilczynski,* quality
assurance.
Mercy Medical Center's medi-
cal staff in Oshkosh, has elected
Eric B Wilson, MD,* as its chief-
of-staff. Doctor Wilson, who has
been director of Mercy's Medical
Imaging since 1976, served as vice
chief-of-staff this past year. A
member of the board of directors
of the Wisconsin Radiology So-
ciety since 1982, Doctor Wilson is
currently serving a three-year
term of office as secretary-treas-
urer. Also elected to the medical
staff executive committee were:
MDs James L Basiliere,* vice
chief-of-staff; Paul C O'Connor,*
secretary of staff; John B Andrew,
immediate past chief-of-staff; and
Robert J Greischar, Lance E Zern-
zach,* Warren V Hahn,* and
Michael A Duffy,* members-at-
large. ■
WISCONSIN MEDICAL JOURNAL, JANUARY 1985: VOL. 84
59
OBITUARIES
U
Richard D Kennedy, MD, 45,
Eau Claire, died Oct 24, 1984 in
Eau Claire. Born Mar 30, 1939 in
Chicago, 111, Doctor Kennedy
graduated from the University of
Minnesota School of Medicine
and served his internship at Uni-
versity of Utah Hospitals. His
residency, in orthopedic surgery,
was completed at the University
of Minnesota Hospitals. He was
a member of the Eau Claire-
Dunn-Pepin County Medical So-
ciety, the State Medical Society of
Wisconsin, and the American
Medical Association. Surviving
are his widow, Sandra; two sons,
Richard and Charles; and five
daughters, Sarah, Ann, Margaret,
Kathryn, Elizabeth; and two step-
children, Molly and Eric.
Albert M Cohen, MD, 57, Fox
Point, died Oct 26, 1984 in Mil-
waukee. Born Apr 9, 1927 in Mil-
waukee, Doctor Cohen graduated
from the Marquette University
School of Medicine in 1954 and
completed his internship at Mt
Sinai Hospital, Milwaukee. His
residency was served at the Vet-
erans Administration Hospital,
Wood. Doctor Cohen served in
the United States Army from
1945-1947. He was an associate
clinical professor of physical
medicine at the Medical College
of Wisconsin, Milwaukee. He
was a member of The Medical
Society of Milwaukee County,
the State Medical Society of Wis-
consin, and the American
Medical Association. Surviving
are his widow, Bernice; two
daughters, Mrs Simon (Sandra)
Margulius, Bayside; Marla S,
Milwaukee; three sons, Joel M
Cohen, MD, Madison; Gary A
Cohen, MD, Glendale; and David
Brian Cohen, Madison. Also sur-
viving are four grandchildren.
Alphonsus M Rauch, MD,
84, formerly of Kenosha and
Lake Geneva, died Oct 26, 1984
in West Bend. Born Jan 31, 1900
in Chilton, Doctor Rauch grad-
uated from the Marquette Uni-
versity School of Medicine and
served his internship at Mil-
waukee County General Hos-
pital. Doctor Rauch practiced
medicine in Kenosha from 1929-
1960 when he moved to Lake
Geneva. He served on the medi-
cal staff of St Catherine's and
Kenosha Memorial hospitals
and also was chief-of-staff at both
hospitals. He was chairman of
the Walworth County Nutrition
Council and also supervised the
Blood Bank in Lake Geneva for
many years. He was on the
medical staff at New York Lying-
In Hospital for six months, and
was in general practice with
J F Bennett, MD in Burlington,
Wis. He was a member of the
Walworth County Medical So-
ciety, the State Medical Society of
Wisconsin, and the American
Medical Association. Surviving
are his widow, Jane; and two
daughters, Alice Bates, West
Bend, and Janet Lee Keck of
Elmhurst, 111.
Robert B Andrew, MD, 50,
Madison, died Oct 31, 1984 in a
plane crash near North Freedom.
Born July 13, 1934 in Detroit,
Mich, Doctor Andrew graduated
from the University of Michigan
Medical School, Ann Arbor, and
served his internship at the
United States Naval Hospital
in Chelsea, Mass. His residency
was completed at Wayne State
University, Detroit, Mich. He
was a fellow of the American
Academy of Ophthalmology and
had served on the medical staffs
of Madison General, St Marys,
Methodist, Divine Savior, Port-
age, Reedsburg Memorial and St
Joseph hospitals. He served in
mission hospitals in Mungeli,
Balaspur, and in Punjab, India.
He was a member of the Dane
County Medical Society, the
State Medical Society of Wis-
consin, and the American Medi-
cal Association. Surviving are
his widow, Irmgard; three
daughters, Mrs Rebecca Spear,
Chicago; Mrs Sarah Frykenberg,
Boston, Mass; and Jennifer,
Madison; two sons. Miles and
Nathan of Madison; and two
grandchildren, Erin and Benja-
min Spear of Chicago.
Christian Fredrik Midelfort,
MD, 78, La Crosse, died Nov 4,
1984 in La Crosse. Born Oct 23,
1906 in Eau Claire, Doctor Midel-
fort graduated from Johns Hop-
kins Medical School in 1931 and
served his internships at Peter
Bent Brigham Hospital, Boston,
and at New York City Hospital.
His residency was completed
at Wisconsin General Hospital
(now UW Hospital and Clinics),
Madison, Boston City Hospital,
and Payne Whitney Psychiatric
Clinic in New York City. Doctor
Midelfort had been associated
with the Gundersen Clinic Ltd,
La Crosse, from 1944 until he
retired in 1971. After his retire-
ment, Doctor Midelfort taught
family therapy one day a week at
Lutheran General Hospital, Park
Ridge, 111, and at Lutheran Theol-
ogical Seminary in St Paul, Minn.
He had served as an assistant
professor of internal medicine at
the University of Wisconsin
Medical School, Madison, and
was a charter member of the
Family Therapy Association. He
was a member and former presi-
dent of the La Crosse County
Medical Society, a member of the
"50 Year Club" of the State Medi-
cal Society of Wisconsin, and a
member of the American Medical
Association. Surviving are his
widow, Helga, and five chil-
dren.*
60
WISCONSIN MEDICAL JOURNAL, JANUARY 1985: VOL. 84
MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
Wanted— Qualified physician to prac-
tice emergency medicine in southeastern
Wisconsin. Our group is small and flexi-
ble. Salary is negotiable. If interested, send
CV to Associated Emergency Room Phy-
sicians, SC, 1131 Sherwood Lane, Cale-
donia, Wis 53108; ph 414/835-4489.
pl-3/85
General Internist or Family Practice
physician needed to join well established
solo internist /family practitioner in a
beautiful lake area community of 21,000.
Offering competitive salary with fringe
benefits. Send CV to R C Maniquiz, MD,
600 Bay St, Chippewa Falls, Wis 54729 or
call 715/723-0211. ltfn/85
Academic Internist to join expanding
dynamic young Ambulatory Care Group
at the Milwaukee Regional Medical
Center. Responsibilities to include; pri-
mary patient care, resident /physician
education, and employee health. Oppor-
tunities for program development, ad-
ministration, research, and advancement
in clinical faculty track. Send inquiries to
Kenneth E Smith, MD, Director, Primary
Care Clinic, Medical College of Wiscon-
sin, 8700 West Wisconsin Ave, Milwau-
kee, Wis 53226. Equal opportunity /affir-
mative action employer M/F/H. 1-3/85
Internist / Gastroenterologist, Board
eligible, Boston-trained specialist seeking
practice opportunity anywhere in Wiscon-
sin. Contact Dept 551 in care of the Jour-
nal. pl/85
Internal Medicine— Board certified or
eligible, to join 17-physician multi-
specialty clinic with 7-physician internal
medicine department. Located in beauti-
ful Wisconsin lakeshore community of
35,000. Competitive salary, complete
fringe benefits, generous vacation time.
Send CV to: Administrator, Manitowoc
Clinic, SC, PO Box 3008, Manitowoc, WI
54220. 1-5/85
RATES: 50« per word, with a minimum
charge of $20.00 per ad. BOXED AD
RATES: $25.00 per column inch.
DEADLINE: Copy must be received by the
1 5th of the month preceding month of issue;
e.g., copy for the August issue is due July 1 5.
Send copy to: Wisconsin Medical Journal,
Box 1109, Madison, Wisconsin 53701; or
phone (area code 608) 257-6781; or toll-free
in Wisconsin: 800/362-9080.
Madison, Wisconsin. Experienced phy-
sician for ambulatory care center. Medic-
East, first and only independent ACC in
Madison. Now well established. Located
in heart of Eastside of Madison. Appli-
cants BC/BE demonstrated experience in
primary care, well-developed com-
munication skills. Competitive salary, ex-
cellent benefits, attractive practice setting.
Contact David A Goodman, MD, Medic-
East, 2810 E Washington, Madison, WI
53704; ph 608/244-1213. ltfn/85
Family Practitioner, General Surgeon,
Neurologist and Pediatrician /Central
Wisconsin. Excellent opportunity for
Board certified /eligible physician to join
26-physician multispecialty group.
180-bed modern hospitd. Plentiful recrea-
tional, cultural, and educational oppor-
tunities. Unique, attractive financial ar-
rangements. Contact: Administrator, Rice
Clinic, 2501 Main St, Stevens Point, WI
54481; ph 715/344-4120. ltfn/85
Internists— BC / BE Internist needed to
join five general internists in multi-
specialty group practice in north-central
Wisconsin. Competitive salary and bene-
fits. General medicine training required.
Cosmopolitan community and excellent
recreational area. Send CV to D K Augen-
baugh, MD, 2727 Plaza Dr, Wausau, WI
54401; or phone 715/847-3328. ltfn/85
Family Practitioner wanted to join
group of Boarded Family Practitioners,
practicing real family medicine with full
hospital privileges. HMO setting in Metro-
politan Milwaukee. Very competitive
salary and benefits. Please reply: James
Chaillet, MD, Medical Director, Family
Health Plan, 12500 W Bluemound Rd,
Elm Grove, WI 53122; ph 414/786-3338,
ext 451. 1-2/85
Primary Care— Union Grove Oppor-
tunity. Physician with background in
general practice, pediatrics or internal
medicine sought for full-time position
with Department of Health and Social
Services at Southern Wisconsin Center.
This State facility, 20 miles south of Mil-
waukee, is engaged in the care of the
developmentally disabled. Contact John
F Brown, MD, Medical Director, c/o
Southern Wisconsin Center, 21425 Spring
St, Union Grove, WI 53182; ph 414/878-
2411, ext 362. ll-12/84;l/85
Family Practice physician MD or DO
Board eligible or certified. Contact Leon
Gilman, 4957 West Fond du Lac Ave, Mil-
waukee, Wi 53216 or call 414/871-7900.
1-3/85
Family Practice opportunities exist with
several expanding Marshfield Clinic,
hospital-affiliated satellites in north cen-
tral Wisconsin. The Board certified /Board
eligible candidate will share the philos-
ophy of oriented care with a preventive
focus, enjoy the support of over 200 phy-
sician and surgeon specialists, and live at
the doorstep of year-round recreational ac-
tivities. Marshfield Clinic offers an excel-
lent salary and benefit program including
a liberal vacation and education leave.
Please send curriculum vitae to: John P
Folz, Assistant Director, 1000 North Oak,
Marshfield, Wisconsin 54449.
12/84;2/85
Pediatrician needed by Marshfield
Clinic to join primary care satellite in
Ladysmith, Wisconsin. Current Lady-
smith staff includes five family practition-
ers, four internists, one general surgeon,
and a radiologist. An obstetrician will be
joining the group in 1985. Clinic adjoins
41-bed JCAH-accredited hospital. Rural
location in beautiful northern Wisconsin.
Must be Board eligible or certified. Send
curriculum vitae to Dr John Ziemer, 906
College Avenue West, Ladysmith, Wis-
consin 54848, or call 715/532-6651.
1-2/85
Family Practice position available at
Stanley, Wisconsin. This physician would
join an existing family practitioner in a
hospital-affiliated satellite center of
Marshfield Clinic, a major multispecialty
referral center. The ideed candidate would
enjoy practicing a full medical spectrum
including obstetrics and pediatrics, would
enjoy working in a modern clinic facility
that is physically attached to a 41 -bed
community hospital, and would enjoy liv-
ing in a small rural community only 30
minutes from Wisconsin's fastest growing
metropolitan area that contains a major
University of Wisconsin campus. This op-
portunity offers a $63 thousand starting
salary plus an extensive fringe benefit pro-
gram. Please send curriculum vitae with
first letter to: John P Folz, Assistant Direc-
tor, 1000 North Oak, Marshfield, Wiscon-
sin 54449. l/85;3/85
Obstetrician-Gynecologist, Board cer-
tified or eligible, to join 17-physician
multispecialty clinic with two physician
OB/GYN department. Located in a
beautiful Wisconsin lakeshore commun-
ity of 35,000. Competitive salary, com-
plete fringe benefits, generous vacation
time. Send CV to: Administrator, Mani-
towoc Clinic, SC, PO Box 3008, Mani-
towoc, WI 54220. 6-12/84;l-5/85
WISCONSIN MEDICAL JOURNAL, JANUARY 1985: VOL. 84
61
MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
continued
Internal Medicine— Hospital-based pri-
vate practice in small community near
Eau Claire, Wisconsin. Involves critical
care management. Hospital less than 20
years old, 86-bed nursing home attached.
Call-sharing and guarantees provided. Af-
filiation with Marshfield Clinic. Two-hour
drive to Minneapolis. Charles Nelson, Fox
Hill Associates, 250 Regency Court, Wau-
kesha, W1 53186; ph 414/785-6500.
pl-2/85
Physicians needed full or part-time to
perform light physicals. Milwaukee area.
Professional liability provided. Phone
414/344-2100, Ms Jenkins. lOtfn/84
The Racine Medical Clinic, a progres-
sive cluster corporation of 31 physicians
is currently seeking an Obstetrician /Gyn-
ecologist physician. Full benefits, un-
limited earnings and a full and exciting
practice are offered. Please contact: Roger
D Lacock, Administrator, Racine Medical
Clinic, 5625 Washington Ave, Racine, W1
53406; ph 4 14 / 886-5000. 12tfn / 84
US Air Force Medical Corps cur-
rently is accepting applicants for phy-
sicians in the following specialties:
Orthopedic; Ear, Nose and Throat;
Obstetrics/ Gynecology; General Sur-
geons; Family Practitioners; Internal
Medicine and Pediatrics. For more in-
formation, call collect Capt Robb
Sealey, 414/258-2430. 12/84;l/85
General Surgery Residency Pro-
gram Director needed by 210 physi-
cian multispecialty private group prac-
tice in central Wisconsin. Board certi-
fied general surgeon with subspecialty
training and interest in peripheral
vascular surgery plus strong academic
interests are being considered. This
surgeon would join a seven-member
General Surgery Section with sub-
specialty expertise and experience. A
clinical appointment through the Uni-
versity of Wisconsin Medical School is
available as are research opportunities.
Please call Gail H Williams, MD, Sur-
gery Department Chairman, or Sidney
E Johnson, MD, Medical Director col-
lect at (715) 387-5609 and (715) 387-
5253 respectively or send curriculum
vitae to: Gail H Williams, MD, Chair-
man, Department of Surgery, Marsh-
field Clinic, Marshfield, WI 54449.
ll-12/84;l/85
Family Practice Oconto Falls, Wiscon-
sin. Thirty miles northwest of Green Bay.
Established practitioner needs associate to
share fully-equipped clinic adjacent to
50-bed hospital. Income guaranteed by
hospital. No ER call required. Abundant
hunting, fishing, recreational opportuni-
ties. Contact Brett Wilson, DO, 835 S Main
St, Oconto Falls, Wisconsin 54154 or call
1 -800 / 242-44 1 4, ext 278 or 4 1 4 / 846-2287.
lltfn/84
The Racine Medical Clinic, a progres-
sive cluster corporation of 31 physicians
is currently seeking an Internist -Infectious
Disease physician. Full benefits, un-
limited earnings and a full and exciting
practice are offered. Please contact: Roger
D Lacock, Administrator, Racine Medical
Clinic, 5625 Washington Ave, Racine, WI
53406; ph 414/886-5000. 12tfn/84
14 MD multispecialty clinic wishes to
add third OB/GYN 7/1/85. Three pro-
gressive hospitals (regional referral center
for Maternal High Risk); ultrasound, of-
fice cytoscopy, colposcopy, laser, hys-
teroscopy, etc; no abortions. Competitive
salary and benefits leading to partnership
in two years. Excellent family commun-
ity with multiple recreational and cultural
activities available. Send CV to T E Flood,
Administrator, Beaumont Clinic, Ltd,
1821 S Webster Ave, Green Bay, WI
54301. pl2/84;l-3/85
Medical Director. Opportunity for
physician with experience in medical
group practice administration to join
established HMO in Madison, Wiscon-
sin. Group Health serves 29,000 pa-
tients with its staff of 20 physicians and
total staff of 180. Excellent salary and
benefit program. This represents a re-
warding opportunity to develop or pro-
gress your career in medical admin-
istration. Contact: John Mueller,
Group Health Cooperative, 1 South
Park St, Madison, WI 53715; ph 608/
251-4156. 6tfn/84
Family Practice. Rapidly expanding
staff model HMO in Madison, Wiscon-
sin, has opportunities for additional
family practice physicians. Competi-
tive salary with excellent benefits and
attractive practice setting. GHC is an
established, rapidly growing HMO
serving 29,000 patients. Current staff
totals 180 employees, including 20
physicians. Contact John Mueller,
Group Health Cooperative, 1 South
Park St, Madison, WI 53715; ph 608/
251-4156. 6tfn/84
Family Practitioner needed to staff a
satellite of a 38-physician multispecialty
group in Kiel, a beautiful small commun-
ity in East Central Wisconsin. Attractive
income arrangements, association mem-
bership possible after one year, pension
and profit sharing, extensive fringe bene-
fits. Contact RB Windsor, MD, 1011
North 8 St, Sheboygan, WI 53081; ph 414/
457-4461. 6tfn/84;cl0tfn/84
Family Physician, Board certified or
eligible, to join small group as third FP.
East Central Wisconsin. Salary plus pro-
duction bonus. Option for full partnership
after one year. Well established practice,
includes OB, Pediatrics, Geriatrics,.
Please contact McCullough & Devine
Clinic, SC, 105 Sheboygan St, Fond du
Lac, WI 54935; ph 414/921-8110.
10-12/84;l/85
Family Practice physician needed to join
five family practitioners and a general
surgeon. Immediate opportunity in west
central Wisconsin near La Crosse. $45,000
first year guarantee plus incentive. Excel-
lent recreational area. Community Hos-
pital. Send CV to: Jerrold L Kamp, Ad-
ministrator, PO Box 250, Sparta, WI
54656; or phone 608/269-6731. 6tfn/84
Wisconsin, Milwaukee: Immediate
opening for a full-time emergency physi-
cian in a 350-bed suburban community
hospital. Experience or residency training
required. Excellent working relationship
with administration, medical, and nursing
staff. Competitive salary with paid mal-
practice, life, health, and disability insur-
ance, plus retirement plan. Send CV to
Landy Bonelli, MD, Emergency Physi-
cians WAMH, Ltd, 10201 W Lincoln Ave,
Ste 304, West Allis, WI 53227; 414/545-
5566. 12/84;l/85
Family Practice /Sports Medicine
physician immediately needed. Excellent
compensation in rapidly growing health
group. Part-time or full-time career oppor-
tunity. Call Linda Gaioni, Racine, Wis.
Area code 414/886-5588. 12/84*
General surgeon, OB/GYN, and
internist to join seven-doctor family prac-
tice clinic in Cloquet, Minnesota, a com-
munity of 14,000 (30,000) service area,
located 20 minutes from Duluth-Superior.
Clinic facility is located one block from
modern, well-equipped, 77-bed hospital.
Cloquet enjoys a stable economy (forest
products). Additionally our community is
noted for its excellent school system. First-
year salary guarantee; paid malpractice,
health, and disability insurance; vacation
and study time. Contact John Turonie, Ad-
ministrator, Raiter Clinic Ltd, 417 Skyline
Blvd, Cloquet, Minnesota 55720. Tele-
phone 218/879-1271. *10-12/84;l/85
62
WISCONSIN MEDICAL JOURNAL, JANUARY 1985; VOL. 84
MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
continued
Family Practitioner needed to join
established Family Practice group in East
Central Wisconsin city of 50,000 on
beautiful Lake Winnebago. Competitive
salary, fringes, excellent recreation area.
Send CV to MS Knier, MD, 555 S Wash-
burn, Oshkosh, Wis 54901; 414/426-0265.
lOtfn/84
Internist or Family Practitioner to join
two Internists and General Surgeon in
growing, established, Green Bay area
practice. Send CV to John Brusky, MD,
1203 South Military Ave, Green Bay, WI
53404. 7tfn/84
Wanted Board Certified Otolaryngol-
ogist. Head and neck surgeon. Join active
one-man practice. General otolaryngol-
ogy, head and neck surgery, facial plastic
surgery, nasal allergy. Computerized of-
fice with x-ray, audiologist, and hearing
aid dispensing. Northern Wisconsin near
Apostle Islands National Lakeshore. Con-
tact James A Hamp, MD, ENT Profes-
sional Associates, SC, 2101 Beaser Ave,
Suite 1, Ashland, WI 54806; ph 715/682-
9311. 10-12/84;l-3/85
Group Health, Inc, the midwest's largest
and oldest prepaid multispecialty group,
seeks associates in Allergy, Family Practice
(urgent care), Internal Medicine, Geriatrics,
Ophthalmology, Child Psychiatry, and Ob-
stetrics/Gynecology. Must be Board certi-
fied or eligible. Excellent facilities, com-
prehensive fringe benefits, highly compe-
titive earnings. Send curriculum vitae to:
Paul J Brat, MD, Medical Director, Group
Health Inc, 2829 University Avenue
Southeast, Minneapolis, Minnesota 55414.
An equal opportunity employer.
12/84;l/85
Expanding Ambulatory Care Center
Network seeks top quality Family Prac-
tice, Internal Medicine or Primary Care
physicians. Full-time and some part-time
positions available in major cities in Ohio
and Wisconsin. Competitive salary with
excellent benefit package including mal-
practice insurance, health and life insur-
ance, paid vacations, educational and
assistance and flexible hours with no night
duty. Send CV to: Jeannine Smeltzer,
MED/ ACCESS, Suite 13, 3085 West
Market St, Akron , Ohio 443 1 3 or call 2 1 6 /
867-2192. gll-12/84;l/85
Wanted: Young Family Practitioner to
join a ten-physician group in western Wis-
consin. Contact R M Hammer, MD, River
Falls, Wisconsin 54022; ph 612/436-8809
or 715/425-6701, 8tfn/84
Internist, with or without subspecialty,
and an OB / G YN needed (Board certified
or eligible) to practice in conjunction with
a 7-member Internal Medicine Depart-
ment and a 5-member OB/GYN Depart-
ment in a 24-member multispecialty
group. The Internal Medicine Department
currently has subspecialties in gastro-
enterology, pulmonary medicine, and car-
diology. The Group is located in South-
eastern Wisconsin in a city of 100,000, be-
tween two major metropolitan areas of
greater than one million. Estimated serv-
ice area is approximately 200,000. If inter-
ested, please send CV to Stephen L
Wagner, Kurten Medical Group, 2405
Northwestern Ave, Racine, WI 53404. All
inquiries will be kept confidential and ad-
ditional information will be sent.
7tfn/84
Board eligible cardiologist interested in
establishing an invasive service in a north
central metropolitan, university-affiliated
hospital in association with an internists'
group needed. Interest in internal medi-
cine necessary. Contact Dept 546 in care
of the Journal. 10-12/84;l/85
Family Practitioners, Pediatricians,
Orthopedic Surgeons, and OB/GYNs.
Looking for qualified people in these areas
of medicine. Located in a prosperous com-
munity in SE Wisconsin close to Milwau-
kee, Madison, and Chicago. I can offer
pleasant surroundings, competitive salary,
benefits, and fully-staffed office all within
a newly decorated office. Write or call
Medical Consultants, SC, 137 W Chestnut,
Burlington, WI 53105; ph 414/763-3531.
12/84;l-2/85
Family Practitioner. Rural Wisconsin
community, population 3500 with service
area of 8500, seeking additional family
practitioner. Fifteen minutes from State
Capitol with readily available tertiary
medical support. Family practice depart-
ment in multispecialty clinic. Excellent
fringe benefits and salary. Attractive
working conditions and environment.
Interested parties should contact Dept 550
in care of the Journal. 12/84;l-2/85
PHYSICIANS WANTED
Full or part-time PHYSICIANS
WANTED for emergency room work
throughout Wisconsin. National
Emergency Services offers excellent
income, paid malpractice insurance,
and flexible scheduling. If you're in-
terested in exploring opportunities
with N E S and you would like addi-
tional information, call Timothy
Molyneux or James Lucas at 1-800/
537-3355. 12/ 84; 1/85
Family Practice Physician to share fully
equipped medical office in central Wis-
consin city. Opportunity for partnership
and eventual purchase of practice. Excel-
lent recreational, educational, hospital,
and civic advantages. Send curriculum
vitae to Dept 503 in care of the Journal.
6tfn/82
Wanted — Board qualified— board cer-
tified obstetrician-gynecologist as an
associate. Modern well equipped facility.
Excellent starting salary and benefits in-
cluding profit sharing plan. Please contact
Elizabeth Allen Steffen, MD, 734 Lake
Ave, Racine, Wis 54303. 9tfn/83
Wisconsin— Established FFS corpora-
tion seeking Board-prepared /certified
emergency physicians for community
hospital in southeast Wisconsin. Director-
ship available to qualified candidate. Send
CV to Emergency Physicians Group, 430
Milwaukee Ave, Prairie View, IL 60069.
Contact Ms Barbara LaPiana, 312/634-
4640. lltfn/84
Immediate opportunities for qualified
physicians who possess excellent clinical
and communication skills to join long-
standing group of Emergency Physicians.
Positions available in a popular Wiscon-
sin area bordering Illinois. If interested,
send resume to Barbara Wilczynski,
Medical Emergency, Service Associates
Wanted: Wisconsin Licensed
Physicians to assist in adjudicating
Social Security Disability claims at the
Bureau of Social Security Disability In-
surance. Work part-time (20-35 hours/
week). If interested, write or telephone
George H Handy, MD, PO Box 7623,
Madison, Wisconsin 53707; ph 608/
266-1989. ll-12/84;l/85
FAMILY PRACTITIONERS
INTERNISTS, OB/GYN
The UW Office of Rural Health is seek-
ing primary care specialists for more
than 50 communities throughout Wis-
consin. Opportunities are available
throughout Wisconsin for Board certi-
fied physicians trained in US medical
schools and residencies.
CONTACT:
Laurie Glowac or Fred Moskol
New Physicians for Wisconsin
University of Wisconsin
Department of Family Medicine
777 S Mills St, Madison, WI 53715
Phone: 608/263-4095 7/84;6/85
WISCONSIN MEDICAL JOURNAL, JANUARY 1985; VOL. 84
63
MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
continued
(MESA), SC, 15 S McHenry Road, Suite 2,
Buffalo Grove, IL 60090 or call collect
312/459-7304. 6tfn/83
MEDICAL FACILITIES
Family Practice for sale in Milwaukee.
Ideal starter or satellite office. Excellent
patient goodwill. Fully equipped and fur-
nished three examining rooms, waiting
room, and office. Approximately 900 sq
ft. Contact Greg Rodenbeck, DDS, 1200
E Oklahoma Ave, Milwaukee, Wis 53207;
414/481-8111. glOtfn/84
Family Practice for sale Waukesha area.
Completely equipped with x-ray, labora-
tory in two-person office. Very favorable
Radio
dispatched
truck fleet
for
INDUSTRY, INSTITUTIONS,
SCHOOLS, ETC.
AUTHORIZED PARTS
AND SERVICE FOR
CLEAVER- BROOKS
Throughout Wisconsin
and Upper Michigan
SALES
Boiler room accessories
O2 trims
Cleveland controls
and Car automatic bottom
blowdown systems
SERVICE-CLEANING
ON ALL MAKES
Complete Mobile Boiler Room
Rentals
Stevens Point-715/344-7310
Green Bay— 414/494-3675
Madison— 608 / 249-6604
PBBS EQUIPMENT CORP.
5401 N Park Dr
PO Box 365
Butler, WI 53007
Phone: 414/781-9620
lease. Office fully-staffed and expenses
shared with another family physician.
Retiring July 1, 1985. Crossover $200,000.
Will introduce. Contact Dept 548 in care
of the Journal. ll-12/84;l/85
Office for subleasing. Attractive, newly
decorated 1,800 square feet of office space
in a very desirable location at 811 East
Wisconsin Avenue, Milwaukee. Currently
set up for practice of Internal Medicine.
Ideal for starting a practice or satellite of-
fice. Would consider leasing furnishings
and equipment. Call 414/278-7144.
12/84:1-2/85
ANNOUNCEMENTS
Administrative Medicine. Summer in-
stitute for graduate education in adminis-
tration for physicians and other clinicians
with managerial responsibilities. June 16-
July 6, 1985. University of Wisconsin-
Madison Medical School, Department of
Preventive Medicine, 1225 Observatory
Drive, Madison, Wis 53706. Application
deadline: February 15.
The State Laboratory of Hygiene an-
nounced that a complete listing of all pro-
cedures in the clinical environmental and
industrial hygiene areas is now available
upon request. Wisconsin physicians, hos-
pitals, clinics as well as local public health
and environmental agencies may use the
Laboratory's services. Telephone (608)
262-1293 for a copy. gll/84B
house of
BIDWELL, inc.
7954 West Harwood
and Watertown Plank Road
Milwaukee, Wisconsin 53213
ORTHOTIC
AND
PROSTHETIC
SERVICES
1-414-744-6250
ADVERTISERS
Abbott Northwestern Hospital . .46, 47
Acme Laboratories 34
Advanced Technology Associates,
Inc 15
Medical Computer Systems
Centralized Billing Systems 8
Dista Products Co (Div of Eli
Lilly & Co) 5
Keflex®
House of Bidwell 64
Kodak Ektachem 41, 42, 43
Clinical Chemistry Products
Medical Protective Company 55
Navy Medical Programs 57
Offerman & Co, Inc 34
PBBS Equipment 64
Professionals Insurance
Company, The 58
Roche Laboratories 69, BC
Dalmane®
S&L Signal Company 34
St Mary's Hill Hospital 8
Upjohn Company, The 35
Motrin®
Winthrop Breon Laboratories ... .9, 10
Talwin® Nx
WISP AC 18 ■
BOOKS RECEIVED
New books received are acknowledged
in this section. From these books, selec-
tions will be made for reviews in the in-
terest of the readers and as space permits.
Reviews are written by members of the
faculty of the University of Wisconsin
Medical School and by others who are par-
ticularly qualified. Most books here listed
will be available on loan from the Medical
Library Service, 1305 Linden Drive,
Madison, Wisconsin 53706; tel. 608/262-
6594.
Learning To Live With Diabetes. Medi-
cine In the Public Interest, Inc, 65 Frank-
lin St, #304, Boston, MA 02110. 1984. Pp
87.
Report of The Council for Tobacco
Research— USA, Inc. The Council for
Tobacco Research— USA, Inc, 900 Third
Ave, New York, NY 10022. 1984. Pp 146.
Treating Type A Behavior and Your
Heart. By Meyer Friedman, MD, and
Diane Ulmer, RN, MS. Alfred A Knopf
Publishing Co, New York. 1984. Pp 285.
Price: $15.95.
Hynotherapy of Pain in Children with
Cancer. By Josephine R Hilgard & Samuel
LeBaron. William Kaufmann, Inc, 95 First
St, Los Altos, CA 94022. 1984. Pp 250.
Price: $18.95. ■
64
WISCONSIN MEDICAL JOURNAL, JANUARY 1985:VOL. 84
MEDICAL YELLOW PAGES
MEDICAL MEETINGS-
CONTINUING MEDICAL
EDUCATION
WISCONSIN
JANUARY 30-FEBRUARY 1, 1985:
15th Annual Winter Refresher Course for
Family Physicians, at Pfister Hotel and
Tower, Milwaukee. Sponsored by Depart-
ment of Family Practice, Medical College
of Wisconsin and Southeast Chapter of
Wisconsin Academy of Family Physicians.
Three-day program includes lectures and
workshops for family physicians in active
practice to provide current information on
major disciplines in medicine. Fee: $200.
Info: Mrs Susanna Raechlitz, Conference
Manager, Department of Family Practice,
1315 North 74th St, Wauwatosa, Wis
53213; ph 414/778-3820. 12/84;l/85
FEBRUARY 12-14, 1985: Telemark
Symposium and Ski Outing (22nd Annual},
Telemark Lodge, Cable, Wisconsin. Spon-
sored by the Indianhead Chapter of the
Wisconsin Academy of Family Physicians.
Info: WAFP, 850 Elm Grove Road, Elm
Grove, WI 53122; ph 414/784-3656.
12/ 84; 1/85
FEBRUARY 13-15, 1985: Midwinter
Medical Conference at Ski Brule. Sponsored
by West Side Clinic, sc, 1551 Dousman St,
Green Bay, Wis 54303. Phone 414/494-
561 1 for details. 1/85
THIS LISTING is compiled by the State
Medical Society of Wisconsin in coopera-
tion with others who wish to maintain a
centralized schedule of meetings and
courses of interest to Wisconsin physicians
and to avoid scheduhng programs in conflict
with others. Hospitals, Clinics, Specialty
Societies, and Medical Schools are par-
ticularly invited to utilize this listing service.
There is a nominal charge for listing of Con-
tinuing Medical Education courses at the
following rates: 50<t per word, with a mini-
mum charge of $20.00 per listing.
BOXED LISTINGS: $25.00 per column
inch. Listings of other scientific meetings
will be included at the discretion of the
editors.
COPY DEADLINE tor listings is 15th of the
month preceding the month of publication:
e.g., copy for the August issue is due by July
15. Address communications to: Wisconsin
Medical Journal, Box 1109, Madison, Wis-
consin 53701; or phone (area code 608)
257-6781; or toll-free in Wisconsin: 800/
362-9080.
FOR LISTING of other meetings see the
July 6, 1984 issue of the Journal of the Ameri-
can Medical Association: Continuing Educa-
tion Opportunities for Physicians for period
September 1984 through February 1985.
MARCH 1-3, 1985: Wisconsin Psychia-
tric Association at Lake Lawn Lodge,
Delavan. gll-12/84;l-2/85
APRIL 19-20, 1985: Wisconsin Urolog-
ical Society, Pfister Hotel, Milwaukee.
glltfn/84
APRIL or MAY 1985: Wisconsin Asso-
ciation of Medical Directors Annual Meet-
ing (in conjunction with the County
Homes Association), tentatively at Stevens
Point. More definite details to come.
gl2/84
MAY 9-11, 1985: Wisconsin Chapter,
American Academy of Pediatrics, Pioneer
Inn, Oshkosh. glltfn/84
JUNE 12-15, 1985: 37th Annual Scientific
Assembly of the Wisconsin Academy of
Family Physicians, Americana Resort
Hotel, Lake Geneva, Wisconsin. Info:
WAFP, 850 Elm Grove Road, Elm Grove,
WI 53122; ph 414/784-3656.
12/84;l-5/85
State Medical Society
of Wisconsin
Dates and locations of
ANNUAL MEETINGS
1985-1992
All meetings will be held in Milwau-
kee at the Milwaukee Exposition and
Convention Center and Arena
(MECCA) and the new Hyatt Regency
as the headquarters hotel with the ex-
ception of 1985, when the meeting will
be held at the La Crosse Convention
Center.
1985- April 25-27
1986- April 17-19
1987- March 26-28
1988- April 28-30
1989- April 13-15
1990- April 26-28
1991- April 18-20
1992- April 23-25
Meeting days will be Thursday and
Friday; the first session of the House
of Delegates will convene on Thurs-
day, the second and third on Friday.
Scientific programming will be on Fri-
day and Saturday.
Further information: Commission on
Continuing Medical Education, State
Medical Society of Wisconsin, Box
1109, Madison, Wis 53701. Local tele-
phone: 257-6781; toll-free in Wiscon-
sin: 1-800/362-9080.
OTHERS
MARCH 1-3, 1985 (Illinois): Midwest
Clinical Conference, sponsored by Chicago
Medical Society, at Westin Hotel, Chicago.
Info: Chicago Medical Society, 515 North
Dearborn St, Chicago, 111 60610; ph 312/
670-2550. gl-2/85
MARCFI4-15, 1985 (Florida): fVacrica/
Update for Primary Care Physicians, MEDI-
CLINICS postgraduate medical refresher
course. Fort Lauderdale. 50 Category I
credit hours. Limited one week, 25-hour
credit course available. Preregistration:
$450 (until Feb 15, 1985). Info: Medi-
clinics, 2917 South Ocean Blvd, Suite 905,
Highland Beach, Florida 33431; or phone
305/272-8973. 12/84;l/85
MARCH 20, 1985 (Illinois): Trends in
Specialization: Tomorrow's Medicine, at
Wisconsin Specialty
Society Meetings
• Wisconsin Psychiatric Association,
March 1-3, 1985, Lake Lawn
Lodge, Delevan
• Wisconsin Urological Society,
April 19-20, 1985, Pfister Hotel,
Milwaukee
• Wisconsin Chapter: American
Academy of Pediatrics, May 9-11,
1985, Pioneer Inn, Oshkosh
• Wisconsin Academy of Family
Physicians, June 12-15, 1985,
Americana Resort, Lake Geneva
* * *
Specialty Society Meetings
to be held in conjunction
with SMS Annual Meeting,
April 25-27, 1985, La Crosse
• Wisconsin Society of Anesthesiolo-
gists
• Wisconsin Dermatological Society
• Wisconsin Chapter, American Col-
lege of Emergency Physicians
• Wisconsin Academy of Family
Physicians
• Wisconsin Society of Internal
Medicine
• Wisconsin Academy of Ophthal-
mology
• Wisconsin Otolaryngological
Society
• Wisconsin Society of Pathologists
• Wisconsin Society of Physical
Medicine & Rehabilitation
• Wisconsin Society of Plastic Sur-
geons
• Wisconsin Society for Preventive
Medicine
• Wisconsin Society of Radiation
Oncologists •
• Wisconsin Surgical Society
WISCONSIN MEDICAL JOURNAL, JANUARY 1985:VOL. 84
65
MEDICAL YELLOW PAGES
MEDICAL MEETINGS-
CONTINUING MEDICAL
EDUCATION
continued
Westin Hotel O'Hare, Chicago. Jointly
sponsored by the American Board of
Medical Specialties and the Royal College
of Physicians and Surgeons of Canada.
Info; American Board of Medical Special-
ties, One American Plaza, Suite 805,
Evanston, IL 60201; phone 312/491-9091.
gl2/84;l-2/85
APRIL 10-14, 1985 (Florida): 20t/j An-
nua/ Clinical Conference at Longboat Key
Club, Longboat Key. Sponsored by the
Marquette-MCW Medical Alumni Asso-
ciation and the Medical College of Wis-
consin. Info; Marquette-MCW Medical
Alumni Association, 8701 Watertown
Plank Rd, Milwaukee, Wis 53226; ph
414/257-8367. 1-3/85
AUGUST 1-4, 1985 (Georgia): Inter-
national Doctors in Alcoholics Anonymous
Annual Meeting. Hyatt Regency Hotel,
Savannah. Reservations may be made at
a later date when specific details and in-
structions are published. For further infor-
mation contact: Information Secretary,
IDAA, 1950 Volney Road, Youngstown,
Ohio44511;ph216/782-6216.gl2tfn/84
SEPTEMBER 17-18, 1985 (Illinois):
Medical Practice and Hospital Privileges, at
Chicago Marriott O'Hare, Chicago. Info:
American Board of Medical Specialties,
One American Plaza, Suite 805, Evanston,
IL 60201; phone 312/491-9091.
gl2/84;l-8/85
1985 CME Cruise/Conferences on
Selected Medical Topics— Caribbean,
Mexican, Hawaiian, Alaskan, Medi-
terranean. 7-14 days year-round. Ap-
proved for 20-24 CME Category I credits
(AMA/PRA) & AAFP prescribed credit.
Distinguished professors. Fly roundtrip
free on Caribbean, Mexican, & Alaskan
Cruises. Excellent group fares on finest
ships. Registration limited. Prescheduled
in compliance with present IRS require-
ments. Info: International Conferences,
189 Lodge Ave, Huntington Station, NY
11746; ph 516/549-0869.
p9-ll/84;l,3,4/85
AMA
JUNE 16-20, 1985: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 8-11, 1985: Interim AMA
House of Delegates, Washington, DC.
JUNE 15-19, 1986: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 7-10, 1986: Interim AMA
House of Delegates, Las Vegas, NV.
JUNE 21-25, 1987: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 6-9, 1987: Interim AMA
House of Delegates, Atlanta, GA.
JUNE 26-30, 1988: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 4-7, 1988: Interim House
of Delegates, Dallas, TX. ■
Consensus Development
Conference
Electroconvulsive Therapy
June 10-12, 1985
Masur Auditorium, Warren Grant
Magnuson Clinical Center, National
Institutes of Health, 9000 Rockville
Pike
Bethesda, Maryland
Sponsored by the National Institute of
Mental Health and the Office of Medi-
cal Applications of Research, National
Institutes of Health
This open forum will address the use
of electroconvulsive therapy (ECT) in
the treatment of the severely mentally
ill.
During the 45 years ECT has been in
use, concern has been shown by prac-
titioners, patients, and the public
about whether, when, how, and for
whom to use ECT and about possible
long-term side effects. In recent years
scientists have conducted intensified
studies on clarifying mechanisms of
action; determining optimum mode of
administration; establishing the extent
of adverse effects, particularly on
brain functioning and memory; and
evaluating effectiveness in a variety of
mental disorders. These endeavors
have produced a substantial data base
relevant to the effectiveness and safety
of ECT.
Following V/z days of presentations by
experts in the relevant fields, a con-
sensus panel consisting of representa-
tives from psychiatry, psychology,
neurology, epidemiology, and the
public will consider the scientific evi-
dence and formulate a consensus state-
continued next column
continued
ment responding to the following key
questions:
• What is the evidence that ECT is
effective for patients with specific
mental disorders?
• What are the risks and adverse ef-
fects of ECT?
• What factors should be considered
by the physician and patient in deter-
mining if and when ECT would be
an appropriate treatment?
• How should ECT be administered to
maximize benefits and minimize
risks?
• What are the directions for future
use?
NIH consensus conferences bring to-
gether biomedical investigators, prac-
ticing physicians, consumers, and
representatives of public interest
groups to review scientific information
and evaluate the safety and effective-
ness of selected drugs, devices, and
procedures.
To register for this conference or to
obtain further information, contact:
Ms Michele Dillon, Prospect Associ-
ates, Suite 401, 2115 East Jefferson St,
Rockville, Md 20852; ph 301/468-6555.
For program information, contact:
Jack D Blaine, MD, Affective Dis-
orders Section, Pharmacologic and
Somatic Treatments Research Branch,
National Institute of Mental Health,
Parklawn Bldg, Room 10C06, 5600
Fishers Lane, Rockville, Md 20857; ph
301/443-3568.
International Childbirth
Education Association
to host 1985 Conference
in cooperation with Methodist Hos-
pital who will coordinate the local
planning committee.
in Madison, June 20-23
at the Sheraton Inn and Conference
Center
The four-day conference is expected to
draw 400 to 500 persons from across
the nation, including childbirth educa-
tors, nurses, physicians, parent advo-
cates, and others interested in the cur-
rent changes in pregnancy, birthing,
and early parenting.
Persons interested in assisting with the
conference or learning more details
can call Methodist Hospital, Madison,
at 608/258-3290.
66
WISCONSIN MEDICAL JOURNAL, JANUARY 1985 ; VOL. 84
LET THESE GUIDES HELP YOU
The following guides and manuals have been prepared or obtained at the direction of the Board of Directors and/
or commissions and committees of the State Medical Society of Wisconsin to be of direct personal assistance to the
physician or his county medical society. Each is available (some without cost, others at nominal cost) upon request to
the Communications Dept., State Medical Society of Wisconsin, Box 1 109, Madison, Wis. 53701.
• Interprofessional Code (1977 Revision) — An instrument
for better understanding between attorneys and physi-
cians with reference to medical testimony and interpro-
fessional conduct and practices.
• Communications Guide for Wisconsin Hospitals and
Physicians — Establishes a communications guide for
Wisconsin hospitals and physicians to promote coopera-
tion between the allied medical professions and those
who report medical news.
• Comments on Fee Splitting Statute, Including Chapter
82, Laws of Wisconsin, 1973 — Governing physicians and
others and authorizing employment of physicians by
hospitals and others.
• Approved Program in Continuing Medical Education —
Explains the State Medical Society of Wisconsin’s ac-
creditation program for continuing medical education in
conjunction with the American Medical Association’s
Council on Medical Education.
• Physician Guidelines: Blood-Alcohol Testing — Includes a
request/consent form for drawing blood. (Revised 1978
— Single copy 25c with order.)
• If You Have a Complaint About Medical Care — Medical
care is a personal matter between patient and physician.
Yet, sometimes misunderstandings arise about what the
physician hopes to accomplish and what the patient ex-
pects. This brochure, aimed at patients, explains the
State Medical Society’s grievance and peer review system.
• School Health Examination — A guide for physicians and
school authorities in establishing a program of school
health examinations. (Single copy $2.00 plus 5% sales tax
with order.)
• Occupational Health Guide— For medical and nursing
personnel. A practical manual covering everything from
“abnormal injuries” to “wounds,” with every item sug-
gesting steps to be taken, and providing space for specific
instructions of the plant physician. Over 70 pages of in-
structional material, with all sections provided as
separate sheets, punched to fit a ring book 10"xll‘/2".
For handy reference order ring book, with full set of in-
serts, including anatomical charts. (Complete guide in-
cluding ring binder: $11.00; complete guide without
binder: $10.00 — to accompany order.)
• Make Yours a Smokeless Pregnancy — Points out the
dangers of smoking during pregnancy and its effects on
the fetus.
• Retention and inspection of patients’ records — Ex-
plains the right of access to physician and hospital
records concerning patient care, and includes the re-
vised form, through statute amendment, of an Inter-
pretation of Chapter 301, Laws of 1959.
• Legal Responsibilities of the Physician-Patient Reiation-
ship
• Putting the UCR Fee Puzzle Together — Explains what
“usual, customary and reasonable” means, how mis-
understandings concerning it can be avoided and how
problems can be resolved when they occur. The small
size of the brochure makes it suitable for enclosure in
office statements or for placement in patient reception
areas.
• Guide to the Service Corporation Law
• Some Straight ‘Dope’ on Marijuana — Increasing evidence
appearing regularly that marijuana is hazardous to health
has led the State Medical Society of Wisconsin to declare
it to be a dangerous drug. This brochure explains what
marijuana is, who uses it, and points out some of the
psychological and physiological hazards associated with
its use.
• Rubella— Red Measles Brochure — This conveniently
sized 2'/2 "x4" sized brochure alerts women to the neces-
sity of being immunized for Rubella before they become
pregnant. The brochure also reminds parents to have
their children immunized for the red measles. Perfect for
patient billing statements or waiting rooms.
• Getting the Most Out of Your Health Care Dollar —
Explains the reasons for rising health care costs and offers
advice on what the patient can do to control them.
• Alcohol and Your Unborn Baby . . . — Warns women of
the harmful effects alcohol can have on an unborn child.
Av2iilable in both English and Spanish versions.
• To All My Patients, Partners in Good Health — Explains
the rights and responsibilities physicians and patients
have in medical care. Available in standard brochure or
smaller “statement staffer” form.
• I Want To Know What You Think — a questionnaire physi-
cians can use with patients to elicit their attitudes and
opinions regarding his/her medical practice.
• So You’ve Been Sued . . . Now What? — a brochure pre-
pared by the SMS Medical Liability Committee which
answers 12 questions physicians commonly ask about
medical malpractice lawsuits.
NEWS YOU CAN USE
Interim recommendations issued on DPT shortage. The Centers for Disease Control has announced that
a shortage of diphtheria-pertussis-tetanus (DPT) vaccine exists in the US. The shortage has occurred because
all manufacturers, except one, have stopped producing the vaccine due to prohibitive product liability costs.
That manufacturer recently experienced production difficulties and said no new vaccine lots will be available
until sometime in February 1985. Litigation costs have been high since rare, but severe reactions include brain
damage and death. After consultation with members of the Centers for Disease Control's Immunization Prac-
tices Advisory Committee and the Committee on Infectious Diseases of the American Academy of Pediatrics,
the US Surgeon General has issued the following interim recommendations:
1. Effective immediately, all healthcare providers should postpone administration of the DPT vaccine
doses usually given at 18 months and 4-6 years of age (fourth and fifth doses) until greater supplies
are available.
2. When adequate DPT vaccine becomes available, steps should be taken to recall all children under
7 years of age who miss these doses for remedial immunization.
If these recommendations are followed by all providers of DPT vaccine throughout this temporary vaccine
shortage, immunity in infants will be maintained at the best possible levels. Public healthcare providers and
professional organizations throughout the United States have been notified and are being urged to follow these
recommendations.
The American Medical Association's Ad Hoc Commission on Vaccine Injury Compensation has been monitor-
ing the shortage situation and has issued the following statement: "The Centers for Disease Control announce-
ment of a shortage of DPT vaccine underscores the vital need for federal legislation aimed at protecting vaccine
supplies." AMA Ad Hoc Commission Chairman Alan R Nelson, MD summarized the Commission's recom-
mendation as follows:
• The benefits of vaccination outweigh the risks.
• Federal legislation should provide no-fault review of injury claims. While few people are injured, those
who are should be compensated by the federal government.
Nelson added that because of concern over the supply of DPT vaccine, legislative action is needed to protect
vaccine manufacturers from product liability action. At the same time, the federal government should be
allowed to recover costs of compensation to injured patients, if negligence is proven. "In addition," Nelson
said, "we need to encourage continued research to improve the vaccine." ■
Chelation therapy: AMA policy statement. The AMA House of Delegates at its December 1984 session adopted
the following policy statement on this controversial treatment: Resolved, That AMA reports show that there
is no scientific documentation that the use of chelation therapy is effective in the treatment of cardiovascular
disease, atherosclerosis, rheumatoid arthritis, and cancer; and be it further Resolved, That if chelation therapy
is to be considered a useful medical treatment for anything other than heavy metal poisoning, hypercalcemia,
or digitalis toxicity, it is the responsibility of its proponents to (a) conduct properly controlled scientific studies,
(b) adhere to FDA guidelines for the investigation of drugs, and (c) disseminate results of scientific studies
in the usually accepted channels. ■
Physicians must report child abuse and neglect. Physicians and others dealing with children are mandated
by law to report cases of suspected child abuse. Abuse includes repeated beatings or other forms of severe abuse,
sexual exploitation, physical crippling, brain damage, or even death. Threat of injury and emotional damage
to a child also is considered abuse under the law. Child abuse is a felony punishable by a fine up to $10,000
and imprisonment up to two years. Because of current attention being focused on the problems of child abuse
in its various dimensions, the State Medical Society is preparing a series of articles for publication in the WMJ
to aid physicians in their response to situations of child abuse. The first article. Child abuse and neglect: Diagnostic
and treatment guidelines, appears in this issue. Subsequent articles will focus on the legal, societal, and ethical
issues involved in child abuse. ■
68
WISCONSIN MEDICAL JOURNAL, JANUARY 1985 : VOL. 84
COMPLETE
LABORATORY
DOCUMENTATION . . . EXTENSIVE
CLINICAL PROOF
FOR THE PITEDIQABILITY
CONFIITMED BY EXPEITIENCE
OMMANE®
flurozepom HCIMoche
THE COMPLETE HYPNOTIC
PROVIDES ALL THESE BENEFITS:
• Rapid sleep onset' "
• More total sleep time"
• Undiminished efficacy for at least
28 consecutive nights^ ■*
• Patients usually awake rested and refreshed'"
• Avoids causing early awakenings or rebound
insomnia after discontinuation of therapy' ’""^
Caution patients about driving, operating hazardous machinery or drinking
alcohol during therapy. Limit dose to 15 mg in elderly or debilitated patients.
Contraindicated during pregnancy
DALMANE's
flurozepom HCI/Poche
References: 1. Kales J et al: Clin Pharmacol Ther
72:691-697, Jul-Aug 1971. 2. Kales A et al. Clin Phar-
macol Ther 78:356-363, Sep 1975. 3. Kales A et al:
Clin Pharmacol Ther 79:576-583, May 1976 4. Kales A
et al: Clin Pharmacol Ther 32:781-788, Dec 1982.
5. Frost JD Jr, DeLucchi MR: J Am Geriatr Soc
27:541-546, Dec 1979 6. Kales A, Kales JD: J Clin
Pharmacol 3:140-150, Apr 1983. 7. Greenblatt DJ,
Allen MD, Shader Rl: Clin Pharmacol Ther 27:355-361,
Mar 1977 8. Zimmerman AM: Curr Ther Res
73:18-22, Jan 1971. 9. Amrein R et al: Drugs Exp Clin
Res 9(1):85-99, 1983 10. Monti JM: Methods Find Exp
Clin Pharmacol 3:303-326, May 1981. 11. Greenblatt DJ
et al: Sleep 5(Suppl 1):S18-S27 1982. 12. Kales A
et al: Pharmacology 26:121-137 1983.
OALMANE'^
flurazepam HCI/Roche
Before prescribing, please consult complete
product information, a summary of which follows:
Indications: Effective in all types of insomnia charac-
terized by difficulty in falling asleep, frequent nocturnal
awakenings and/or early morning awakening; in
patients with recurring insomnia or poor sleeping hab-
its; in acute or chronic medical situations requiring
restful sleep. Objective sleep laboratory data have
shown effectiveness for at least 28 consecutive nights
of administration. Since insomnia is often transient
and intermittent, prolonged administration is generally
not necessary or recommended. Repeated therapy
should only be undertaken with appropriate patient
evaluation.
Contraindications: Known hypersensitivity to fluraze-
pam HCI; pregnancy. Benzodiazepines may cause
fetal damage when administered during pregnancy.
Several studies suggest an increased risk of congeni-
tal malformations associated with benzodiazepine use
during the first trimester. Warn patients of the potential
risks to the fetus should the possibility of becoming
pregnant exist while receiving flurazepam. Instruct
patient to discontinue drug prior to becoming preg-
nant Consider the possibility of pregnancy prior to
instituting therapy
Warnings: Caution patients about possible combined
effects with alcohol and other CNS depressants. An
additive effect may occur if alcohol is consumed the
day following use for nighttime sedation. This potential
may exist for several days following discontinuation.
Caution against hazardous occupations requiring
complete mental alertness (e g., operating machinery,
driving). Potential impairment of performance of such
activities may occur the day following ingestion Not
recommend^ for use in persons under 15 years of
age Though physical and psychological dependence
have not been reported on recommended doses,
abrupt discontinuation should be avoided with gradual
tapering of dosage for those patients on medication
for a prolonged period of time. Use caution in adminis-
tering to addiction-prone individuals or those who
might increase dosage.
Precautions: In elderly and debilitated patients, it is
recommended that the dosage be limited to 15 mg to
reduce risk of oversedation, dizziness, confusion and/
or ataxia. Consider potential additive effects with other
hypnotics or CNS depressants. Employ usual precau-
tions in severely depressed patients, or in those with
latent depression or suicidal tendencies, or in those
with impaired renal or hepatic function.
Adverse Reactions: Dizziness, drowsiness, light-
headedness. staggering, ataxia and falling have
occurred, particularly in elderly or debilitated patients.
Severe sedation, lethargy, disorientation and coma,
probably indicative of drug intolerance or overdosage,
have been reported. Also reported: headache, heart-
burn, upset stomach, nausea, vomiting, diarrhea,
constipation, Gl pain, nervousness, talkativeness,
apprehension, irritability, weakness, palpitations, chest
pains, body and joint pains and GU complaints. There
have also been rare occurrences of leukopenia, gran-
ulocytopenia, sweating, flushes, difficulty in focusing,
blurred vision, burning eyes, faintness, hypotension,
shortness of breath, pruritus, skin rash, dry mouth,
bitter taste, excessive salivation, anorexia, euphoria,
depression, slurred speech, confusion, restlessness,
hallucinations, and elevated SGOT SGPT, total and
direct bilirubins, and alkaline phosphatase: and para-
doxical reactions, e g., excitement, stimulation and
hyperactivity.
Dosage: Individualize for maximum beneficial effect.
Adults: 30 mg usual dosage; 15 mg may suffice in
some patients. Elderly or debilitated patients: 15 mg
recommended initially until response is determined.
Supplied: Capsules containing 15 mg or 30 mg
flurazepam HCI.
Roche Products Inc.
Manati, Puerto Rico 00701
DOCUMENTED ^ PROVEN IN
IN THE SLEEP THE PATIENT'S
LABORATORY'’. . . HOME
WISCONSIN
MEDICAL JOURNAL
Medical alert— DES exposure. Society urges physi-
cians to take precautionary measures to help patients and their DES-
exposed offspring become aware of the need to be examined and possibly
treated for cervical or vaginal complications (see page 11).
Child abuse and neglect. An explanation and implica-
tion of the law— 1973 Wisconsin Act 172 (see page 15).
Ethical decision-making in the care of
seriously ill patients. Limitation of resources and concerns
with the quality of human life have moved the ethical decision process
into the center of medical practice (see page 25).
Nominees for SMS offices . Biographical sketches and
pictures. Election April 26 at Annual Meeting in La Crosse (see page 40).
WISCONSIN
MEDICAL JOURNAL
I T
ISSN 0043-6542 /Established 1903
Owned and published by
State Medical Society of Wisconsin
Medical Editor
Victor S Falk MD, Edgerton
Editorial Board
Victor S Falk MD, Edgerton Chairman
Melvin F Fluth MD, Baraboo
M C F Lindert MD, Milwaukee
Wayne J Boulanger MD, Milwaukee
Richard D Sautter MD, Marshfield
Dean M Connors MD, Madison
George W Kindschi MD, Monroe
Charles H Raine MD, Racine
Darrell L Witt MD, Wausau
Garrett A Cooper MD, Madison Emeritus
Editorial Director
Wayne J Boulanger MD, Milwaukee
Editorial Associates
John P Mullooly MD, Milwaukee
Russell F Lewis MD, Marshfield
Raymond A McCormick MD, Green Bay
Victor S Falk MD, Edgerton
Medical Editor
Staff
Earl R Thayer, Madison
Secretary -General Manager
State Medical Society of Wisconsin
H B Maroney II, Madison
Assistant Secretary-Corporate Counsel
State Medical Society of Wisconsin
Mrs Mary Angell, Madison
Managing Editor
Mrs Marjorie Stafford, Madison
Publications Assistant
Mrs Diane Upton, Madison
Editorial Assistant
NATIONAL ADVERTISING REPRESENTA-
TIVE; State Medical Journal Advertising
Bureau, Inc, 71 1 South Blvd, Oak Park, III
60302. Ph 312/383-8800.
LOCAL (WISCONSIN) ADVERTISING: Con-
tact. Mrs Mary Angell, Wisconsin Medical
Journal, Box 1109, Madison, Wis 53701. Ph
608/257-6781
SUBSCRIPTION RATES: Members, $12.50
per year (included in dues); nonmembers,
$25.00. Single copy: current year, $2.00; pre-
vious years, $3.00. SPECIAL RATES: Foreign
and Canada. $30.00. Blue Book issue, $8.00.
Membership Directory issue, $15.00.
SECOND CLASS POSTAGE PAID at
Madison, Wisconsin, and at additional mail-
ing offices.
PUBLISHED MONTHLY. 'Acceptance for
mailing at special rate of postage provided for
in Section 1103, Act of October 3, 1917.
Authorized August 7, 1918." Address all com-
munications to THE WISCONSIN MEDICAL
JOURNAL. Street address; 330 East Lakeside
Street. Mailing address: Box 1109, Madison,
Wis 53701.
POSTMASTER; Send address changes to
Wisconsin Medical Journal, PO Box 1109,
Madison, Wis 53701.
COPYRIGHT 1985
State Medical Society of Wisconsin
CONTENTS
February 1985
SPECIAL FEATURES
5 President's Page: Malpractice
seizures, by Timothy T Flaherty,
MD, Neenah
6 Editorials: Malpractice panels;
Are they the solution?, by Wayne
J Boulanger, MD, Milwaukee . . .
Malpractice panels: The Society's
view, by Sidney E Johnson, MD,
Marshfield. . . What's your opin-
ion? . . . DES— Forty years of fall-
out . . . Advertising, by Victor S
Falk, MD, Edgerton . . . The spit-
toon bowl, by Raymond A McCor-
mick, MD, Green Bay ... I am
sorry. Doctor, by Victor S Falk,
MD, Edgerton
1 1 Special: Diethylstilbestrol (DES)
update'— A message from the
DESAD Project (Medical alert—
DES exposure)
15 Special: Child abuse and neglect:
The law— explanation and impli-
cation (1983 Wisconsin Act 172)
50 Socioeconomics: Reform mal-
practice system to cut costs. Med-
ical Society tells Legislature . . .
Uncompensated care problem
looms on horizon, SMS President
says . . .Malpractice committee
backs SMS peer review proposal
. . . WHCLIP Fund rate increases
recommended . . . Medicare par-
ticipating physicians' directories
available . . . Legislative leader-
ship announced
53 WISPAC, by William L Treacy,
MD, Chairman, WISPAC Board
of Directors
68 Public health: New Baby Doe
rules proposed . . . SMS seeking
repeal of rule allowing chiroprac-
tors to draw blood
84 News you can use: More physi-
cians leaning towards advertising
. . . Wisconsin ranks #17 in Med-
icare sign-up rate . . . Physicians
to receive 3% increase in Medi-
caid reimbursement . . .
CHAMPUS appoints new pro-
vider field rep for Wisconsin . . .
Cancer Society launches educa-
tion campaign on colorectal
cancer
WISCONSIN MEDICAL JOURNAL (ISSN 0043-6542) is the official publication of the State Medical
Society of Wisconsin, devoted to the interests of the medical profession and health care in Wisconsin.
Its affairs are handled by the Editorial Board, subject to policy direction of the Society's Board of
Directors. The Managing Editor is responsible for the production, business operation, and coor-
dination of contents as well as the final responsibility of the entire publication. The Editorial Director
IS responsible for Editorials. Unsigned Editorials express views consistent with the policies of the
State Medical Society of Wisconsin. Signed Editorials express personal views of the author for which
the Society takes no responsibility. Neither the Editors nor the State Medical Society will accept
responsibility for statements made or opinions expressed in the pages of the Journal. Indexed in
"Index Medicus," "Hospital Literature Index,” and "Cambridge Scientific Abstracts."
V
A.
Vol. 84, No. 2
CONTENTS
SCIENTIFIC MEDICINE
25 Ethical decision-making in the
care of seriously ill patients, by
Guenther P Pohlmann, MD, Mil-
waukee
32 Malignant mesothelioma, by
Warren H De Kraay, MD,
Kenosha
33 A survey showing current status
of medical directors and long-
term care facilities in Wisconsin
(summary), by Mary Ann Zilz,
RN, Madison
ORGANIZATIONAL
39 SMS Annual Meeting approach-
ing . . . CES Foundation an-
nounces new research trust fund
40 Annual Meeting: Nominees for
SMS offices: election April 26
(biographical sketches with pic-
tures)
43 Annual Meeting: House of
Delegates 1984-85 Nominating
Committee
43 SMS needs MDs for committees,
commissions
44 County medical societies: List
of officers with addresses and
telephone numbers
47 Membership Directory— update
52 Annual Meeting resolution dead-
line
54 CES Foundation: Contributions
for December 1984
60 CES Foundation: Contributions
during 1984
DEPARTMENTS
54 Obituaries:
Plarold D Rose, MD
Wood
Ralph George Burnett, MD
Kenosha
Bernard Anthony Trimborn, MD
Milwaukee
Oscar A Stiennon, MD
Green Bay
Raul M Lagman, MD
Cuba City
77 County Societies: Brown
County residents give high
marks to area medical care . . .
Eau Claire-Dunn-Pepin . . .
Jefferson . . . Outagamie . . .
Marinette-Florence . . . Monroe
. . . Winnebago
79 Medical Yellow Pages: Physi-
cians exchange . . . Medical
facilities . . . Miscellaneous . . .
Medical meetings— Continuing
medical education . . . Adver-
tisers ■
the state medical society of Wisconsin, created by the Territorial Legislature in 1841,
represents over 5600 member physicians in Wisconsin, comprising 55 county medical societies
and 25 medical specialty sections. The purpose of the Society is to "bring together the physicians
of the State of Wisconsin to advance the science and art of medicine and the better health of the
people of Wisconsin, and to secure the enactment and enforcement of just medical laws." The major
activities of the Society include continuing medical education, peer review, legislation, community
health education, scientific affairs, socioeconomics, health planning, services for physicians, opera-
tion of a Charitable, Educational and Scientific Foundation, and publication of the Wisconsin Medical
Journal.
Officers
President: Timothy T Flaherty, MD
Neenah
President-Elect: John K Scott, MD
Madison
Secretary-General Manager:
Earl R Thayer, Madison
Treasurer: John J Foley. MD
Menomonee Falls
Board of Directors
Chairman: Darold A Treffert, MD
Fond du Lac
Vice Chairman: Roger L
von Heimburg, MD, Green Bay
First District
John P Mullooly, MD, Milwaukee
Jerome W Fons Jr, MD, Cudahy
Carl S Eisenberg, MD, Milwaukee
Thomas A Hofbauer, MD,
Menomonee Falls
Wayne FI Konetzki, MD, Waukesha
Fredrick Wood Jr, MD, Kenosha
William L Treacy, MD, Milwaukee
Charles W Landis, MD, Milwaukee
Richard D Fritz, MD, Milwaukee
William J Listwan, MD, West Bend
Second District
J D Kabler, MD, Madison
Cyril M Hetsko, MD, Madison
James J Tydrich, MD, Richland Center
Allen O Tuftee, MD, Beloit
Alwin E Schultz, MD, Madison
Third District
Pauline M Jackson, MD, La Crosse
Fourth District
John J Kief, MD, Rhinelander
Jung K Park, MD, Wisconsin Rapids
W George Locher, MD, Wausau
Fifth District
Darold A Treffert, MD, Fond du Lac
Kenneth M Viste Jr, MD, Oshkosh
C William Freeby, MD, Appleton
Sixth District
Roger L von Fleimburg, MD, Green Bay
Vacancy
Seventh District
Marvjood E Wegner, MD, St Croix Falls
Eighth District
Joseph M Jauquet, MD, Ashland
President: Doctor Flaherty
President-Elect: Doctor Scott
Past President: Chesley P Erwin, MD,
Milwaukee
Speaker: Duane W Taebel, MD,
La Crosse
Vice Speaker: Vernon M Griffin, MD,
Mauston
A,
\Me know you.
We've talked with you.
We have a continuing
commitment to serve you.
For professional liability insurance, the stakes are too
high to depend on anyone else.
That's why the State Medical Society has endorsed a
professional liability plan which has been developed
especially for Wisconsin physicians.
Available only to members of the SMS— and offered
through SMS Services, Inc.— this medical malpractice policy
has superior features including:
• Consent of the physician is required before settlement of
any claim.
• Availability of legal counsel, experienced in defendant
medical liability.
• All members of claims and underwriting committees are
Wisconsin physicians.
• Occurrence coverage provided for claims arising during
the policy period, even if claim is reported at a later
time.
Tor the best in professional liability coverage, contact
SMS Services, Inc. at (608) 257-6781 or toll-free 1-800-362-9080
Endorsed by the
State Medical Society
of Wisconsin
We know how vital it is to safeguard the present...
and to protect the future.
Underwritten by:
THE PROFESSIONALS
INSURANCE COMPANY
A respected leader in coverage for preferred markets.
PRESIDENT'S PAGE
Timothy T Flaherty, MD
Malpractice seizures
The symptoms became highly noticeable about 1975. Professional liability premiums inflated to double-
digit rates overnight. Suits for malpractice increased. Claims were being won for $100,000 or more.
Unheard of!
Insurance companies, beset with plummeting investment earnings, panicked. Some withdrew from the
marketplace; others cancelled high-risk insureds; still others rejected potential new policyholders. Unable to
buy insurance or unwilling to pay what they thought were ''exorbitant'' premiums, many physicians were
unable to enter practice. A few refused to serve hospitalized patients except in emergency. The profession
was in seizure.
Physicians, hospitals, lawyers, and insurers clamored for relief. In 1976 the Legislature acted to "reform"
the system. It created WHCLIP, a Patients Compensation Fund, and the patients compensation panel system.
The seizures subsided to an occasional twinge; but the treatment masked the basic causes of the problem.
Ten years have passed. The petit mal-practice seizures have returned, but now they exhibit grand mal
symptoms. Medical liability protection is fully available, but premium costs will go up 70-160% for 1985 and
are projected for almost 100% escalation for each of the next four years. The mathematics are frightening.
Physicians who this year will have their premiums doubled to a range of from $4,500 to $52,000 simply
cannot absorb annual increases of this nature. This is particularly so when office expense is expected to in-
crease more than 20% over 1984, medical supplies overhead up 17-19% over last year, and other profes-
sional expense increases in excess of 9.5%.
Until the Legislature, physicians, attorneys, and citizens seriously consider major changes in the tort
system, the malpractice seizures facing this state will continue.
Our Society has been working closely with a State Legislative Council Committee on a series of reforms,
but they do not represent long-term solutions to the problem. They do, however, represent a first step and
deserve prompt consideration by the Legislature.
These reforms include a $1,000,000 limit on awards per occurrence (or in the alternative, drastic limita-
tions on pain and suffering awards as well as structured payout of all settlements or awards); a more re-
strictive discounted reserving system for the Fund; installment payment of Fund premiums; an appropriate
sliding scale on contingency fees for attorneys; certificates of merit prior to filing a claim; surcharges on cer-
tain insured physicians and reporting of all paid claims and settlements to the Medical Examining Board for
investigation and review, plus an expanded system of malpractice prevention.
At the same time work must begin immediately on a more permanent solution which inevitably involves
some means of eliminating the Fund's open-ended obligation to finance future losses, an insuring mechanism
which is currently unrestricted by any responsible limit and which is perceived by lawyers and public alike
as the ultimate deep pocket.
The State Medical Society of Wisconsin is committed to a resolution of this serious problem. Please
join us.B
WISCONSIN MEDICAI, JOURNAL, FEBRUARY 1985: VOL. 84
EDITORIALS
Wayne J Boulanger, MD, Editorial Director
Unsigned editorials express views consistent with the policies of the State Medical Society of Wisconsin.
Signed editorials express personal views of the author for which the Society takes no responsibility.
Malpractice panels: Are they the solution?
There has been pressure, most of
it from the trial lawyers, to alter or
abolish the Patient Compensation
Panels. Perhaps the time has
come to go back over the nine
years of their existence and esti-
mate their worth.
In the beginning most of us
physicians looked upon them as a
major improvement, at least in
principle; and although we grum-
bled a bit, we served as panel
members when called. Perhaps
we liked them even more than
was justified because it seemed
the lawyers didn't. Certainly we
were piqued by the frequent dis-
ruptive delays and cancellations,
but we considered them a neces-
sary evil and assumed the Panels
were infinitely better than the
courts.
But are they really?
After all, why should medical
malpractice suits be treated dif-
ferently from other civil actions?
Many good lawyers think they
shouldn't be.
Do the Panels save time? Appar-
ently. On the average, it takes 391
days to institute a panel hearing,
whereas 655 days are required to
convene a malpractice action in
circuit court.
So what? Does the expenditure
of an additional nine or ten
months work to our disadvantage?
Our experts seem to think so, in
that insurance companies are
more likely to want to settle be-
cause of the inflationary effects on
awards which are increasing at a
rapid rate.
Are the awards granted by the
Panels more realistic than those
determined by a jury? It's hard to
say.
Are the Panels fair? The lawyers
think not, because of the presence
under the law of two physicians.
and want one physician replaced
by a public member. But fairness
is not easy to define; the loser
seldom believes he was dealt with
fairly.
Attorneys from both sides have^
complained that the attorney-
chairmen of the Panels are often
inept in conducting the hearings
because of lack of experience in
medical malpractice cases. When
that situation obtains, appeal is a
virtual certainty. (Ten percent of
panel cases are eventually carried
to circuit court today.) The medi-
cal society would like to see the
Panels conducted by retired
judges.
How are the doctors doing?
They win 70% of the time. But
Malpractice panels:
Any system used to decide medi-
colegal issues should be con-
stantly evaluted by physicians.
The system should be fair to pa-
tients and physicians, cost-effec-
tive, and should enhance, not
hinder, medical care. The State
Bar of Wisconsin has officially
called for the repeal of the Wis-
consin Patient Compensation
Panels system; Doctor Boulanger
and others are now apparently
asking for the same. The State
Medical Society feels it is pre-
mature to abandon a system that
has basically been working well.
Members of the State Medical So-
ciety should be channeling their
energies into improving our cur-
rent system rather than abandon-
ing a system that is working.
It is evident that the disposition
time of panel cases is shorter as
compared to jury trials. In 1983
the median disposition time for
that means they lose 30% of the
time, and that seems to be a high
figure when you consider the in-
creasing number of actions
brought each year.
Do the Panels encourage frivo-
lous suits? Possibly, because it is
easier and less expensive to bring
a case before a Panel than it is to
take it to court.
So what is the score? The State
Medical Society believes the panel
system, although in need of minor
revision, has been a positive force
in the malpractice morass these
nine years and wants to save it.
My own view is that if I'm sued,
I want to go to court and put my
fate in the hands of a judge and
jury.
—Wayne J Boulanger, MD, Milwaukee
The Society's view
panel cases was under one year;
the median disposition time for
non-auto personal injury cases
was 438 days in Milwaukee
County and 432 days for the re-
mainder of the state. I believe the
physician benefits from this
shortened period.
A malpractice suit is a serious
and devastating event in the per-
sonal and professional lives of
respondent physicians. A recent
survey of physicians’ who were
named in malpractice actions de-
scribes the psychological and phy-
sical symptoms developed by the
respondents. These include anger,
change in mood, inner tension,
depression, frustration, irritability,
insomnia, fatigue, difficulty con-
centrating, feelings of worthless-
ness, feelings of guilt, feelings of
‘Charles SC, Wiberl JR, Kennedy EC: Physi-
cians' self-reports of reactions to malpractice
litigation. Am J Psych iai 1984(Aprl:141:4.
6
W ISCONSIN MEDIC.ALJOCRNAI., FEBRUARY 198.S: VOL. 84
MALPRACTICE PANELS
EDITORIALS
low self-esteem, indecision, de-
creased appetite, gastrointestinal
symptoms, headache, and even
suicidal ideation. A psychiatric
analysis of the reported symptoms
indicated the possible presence of
a depressive disorder in 40% of
the physicians. Another 20% have
symptoms suggestive of a severe
adjustment disorder. Approxi-
mately 8% noted the onset of phy-
sical illness, including myocardial
infarction, angina pectoris, duo-
denal ulcer, hypertension, and ir-
ritable bowel syndrome. The
authors noted that the prolonged
stress, aggravated by the time-
span from filing of the suit to set-
tlement, was felt to be a major fac-
tor in physician impairment. All of
the respondents in this survey
won their cases in court. This is
good evidence that even an unjus-
tified suit causes significant stress.
Is the panel system fair to pa-
tients? If the patient loses at panel,
he/she has a right to trial by jury
at circuit court. The panel deci-
sions are in favor of the patient
30% of the time. Whether they
would do better in court is an
open question. Whether the
award is appropriate and how
much of the award the patient
receives after all expenses are
paid, including attorney con-
tingency fees, is an unknown
question. The amount finally re-
ceived by a patient in any given
case and the percentage of the
total award that goes to the patient
are data that should be developed
to help determine the fairness of
the overall system.
The number of cases submitted
to Panels has risen sharply from
12 in 1976 to 378 in 1983. Physi-
cians have been successful in de-
fending these cases 70% of the
time. I do not know if physicians
would win a greater percentage in
circuit court. In 1983 thirty-five
malpractice cases were appealed
to circuit court after being heard
at panel, and five trials were con-
ducted. I am told that a panel
hearing is cheaper than a circuit
court trial. If that is true, the panel
system is certainly cost-effective,
and it reduces the overall dollars
spent in malpractice litigation.
Overall, 80%-90% of malpractice
cases in Wisconsin are disposed at
the panel level, either by settle-
ment, dismissal, or hearing.
The panel system allows prac-
ticing physicians first-hand exper-
ience with this element of the
medicolegal system. While physi-
cians dislike time away from prac-
tice, last minute cancellations of
the panel hearing, and reimburse-
ment that does not cover the cost
What's your opinion?
Because of differing views concerning the Patients Compensation
Panel system, the following questions have been developed by the
Committee on Medical Liability in an effort to determine the opinion
of the membership. You are invited to answer the following ques-
tions and mail to: Committee on Medical Liability, State Medical
Society of Wisconsin, PO Box 1109, Madison, Wis 53701. Signature
not necessary.
YES NO
1. Have you had personal experience with the
Panels as:
a. a respondent in a suit?
b. a Panel member?
c. an expert witness?
2. Have you had personal experience with the
court system as:
a. a defendant?
b. a juror?
c. an expert witness?
3. Do you favor continuation of the Panel
system as it is now?
4. Do you favor having the Panel decision be
final subject only to judicial review
(or whether the Panel hearing was con-
ducted in a legally proper manner)?
5. Do you favor amending the Panel law to
allow direct access to circuit court if
both parties agree to waive the Panel
hearing?
7. Comments:
(Further comment may be attached)
VVISCON.SIN .UEDICAI, JOURNAL, FEBRliARY 198.5: VOL. 84
EDITORIALS
MALPRACTICE PANELS
of being away from practice, this
ever-growing collective experi-
ence of physicians gives us a
unique opportunity to be edu-
cated about medicolegal issues.
The State Medical Society might
be wise to develop a program to
collect and evaluate reports from
physicians serving on Panels that
would augment development of a
risk-control program by Wiscon-
sin physicians.
A worrisome trend may be the
use of the panel system by plain-
tiffs and their attorneys as a step-
ping stone to trial in circuit court.
The panel decision, however, is
admissible in court and the State
Medical Society should closely
analyze the outcome of those
cases heard at panel and later
decided in a court of law. While I
have no evidence at this time, it is
my impression that if a plaintiff
wins at panel, he /she is very likely
to win in court.
A special Legislative Council
committee on medical malprac-
tice is currently reviewing approx-
imately 60 proposals to modify the
current system. This committee
has drawn the ire of the trial law-
yers with its recommendations to
limit awards and limit contin-
gency fees. Let us hope that the
committee can recommend some
needed improvements in the sys-
tem that will benefit the citizens of
the State of Wisconsin, including
physicians, hospitals, and patients.
—Sidney E Johnson, MD, Marshfield
Member of the State Medical Society's
Medical Liability Committee of the Physi-
cians Alliance Division
DES— Forty years of fallout
Despite all the scientific litera-
ture, all the nationwide public
education, and all the widely
publicized litigation against
manufacturers over the last 40
years, the use of DES (diethyl-
stilbestrol) for women at risk of
miscarriage, starting in the late
1940s and officially terminated in
1971, continues as a lingering
concern for physicians and the
public.
Even though the risk of de-
velopment of clear cell cancer
in daughters of DES users is
estimated to be no more than
1.4 per 1000 and as few as 1.4
per 10,000, the possibility of
cancer among those whose
identity remains unknown is of
deep concern to the potentially
affected families. Adding to the
suspense is the fact that the long-
term effects on mothers, daugh-
ters, and sons is not firmly
known.
The article, "Diethylstilbestrol
(DES) update," in this issue is an
excellent summary of the current
status of this long-standing prob-
lem. It is further a reminder that
the fallout from the innocent and
nonnegligent use of DES at a time
when it was the drug for problem
pregnancies continues to require
diligent search for daughters and
sons of exposed women.
The State Medical Society's
recent Medical Alert on DES was
very frankly prompted by the
fears of Laila Rosen, Milwaukee
(Bayside), that her own recent
discovery of DES exposure 17
years earlier might well apply to
others. After The Milwaukee
Journal carried her story, SMS
confirmed the need for continued
vigilance with the American
Medical Association and its own
Maternal and Child Health Com-
mittee. Credit is indeed due Mrs
Rosen's determination and The
Milwaukee Journal's nose for
news; no less credit is due the
State Medical Society for ap-
propriately responding to a clear
and timely need for patient
advocacy.
Advertising
When I FiRSTjoined the Editorial
Board of the Wisconsin Medical
Journal in 1953, the chief com-
plaint of the Board members was
that the Journal was overloaded
with advertising. This contributed
handsomely to the coffers of the
State Medical Society, but it did
detract somewhat from the
Journal.
When the Kefauver legislation
became effective a few years later,
the Journal advertising dropped
off drastically. Few new products
were being introduced and many
of the old ones were eliminated. A
good many lean years followed,
and the Journal required subsidi-
zation by the Society. Some of the
weaker state journals folded.
Recently the staff of the Journal
was contacted relative to publish-
ing an ad from a Chicago heli-
copter service that would trans-
port patients from southern Wis-
consin to a Chicago hospital. Al-
though this might irritate some
Wisconsin physicians, it was felt
that the ad could not be rejected
since it might be regarded as a
restraint of trade. Subsequently
the Journal has published ads from
hospitals located in bordering
states. Since Wisconsin physicians
are regularly flooded with mail
from hospitals and clinics in that
same area, it was felt that ads in
the Journal would not result in any
conflict of interest.
At the same time, we have
learned that the national advertis-
ing for January 1985, originating
from the State Medical Journal
Advertising Bureau in Chicago, is
three times as great as it was in
January 1984. This is a very en-
couraging trend, and it's a great
way to start the new year.
—Victor S Falk, MD, Edgerton
WISCONSIN MEDICAL JOURNAL, FEBRUARY 1985: VOL. 84
EDITORIALS
The spittoon bowl
At the end of another football
season, with all of the playoff and
bowl games, it seems like an ap-
propriate time to recommend a
change in behavorial patterns for
the contestants and coaches.
Why is it that football players
invariably spit when they are
standing along the sidelines? Even
the coaches and the anonymous
folks who carry the clipboards
about on the sidelines spit when
they know they are on camera.
If the athletes are the idols of the
young folks who watch all these
games, why do they put this boor-
ish behavior on public display?
This spitting phenomenon is not
seen in other sports like basket-
ball, tennis, or bowling. Why is it
necessary to expectorate all over
the astroturf?
Incidentally, the synthetic car-
pets on which many football
games are played are not self-
sterilizing or self-replenishing like
normal turf. Therefore, the sea-
son-long accumulation of spittle
must make for a disagreeable bac-
terial sea which could complicate
minor abrasions to the players!
The NFL continues to use its
best and brightest on TV messages
for the United Way and for other
worthy projects which is admir-
able, but why do these same char-
acters feel compelled to spit along
the sidelines? This behavior un-
doubtedly influences the enor-
mous number of young kids out
there who watch these contests
but also carries over to the base-
ball season. Now baseball players,
in general, have enough obnox-
ious habits when they are picked
up by the TV camera lenses. Can't
they be prevailed upon to refrain
from spitting?
All they have to do is put a
pinch between their cheek and
gum and swallow!
—Raymond A McCormick, MD, Green Bay
Editorial Board comment: From
Contemporary Health Jour-
nal, January 1984— "Twenty-two
million people use smokeless tobacco
in the United States. Sales of snuff
and chewing tobacco are increasing
at a rate of 11% a year. Government
reports indicate that use among
teenage males is increasing by leaps
and bounds. Tobacco chewing was
once considered a dirty, unsociable,
spitting habit. The tobacco industry's
advertising campaign is now at-
tempting to attach a macho image to
what is still a dirty habit and also
damages health. Increasing pressure
to require added health warnings in
cigarette advertising seems to have
sparked a campaign to promote the
use of smokeless tobacco. Health
warnings are not required in snuff
and chewing tobacco ads. The ads
present chewing and spitting as a
healthful, attractive and macho ac-
tivity /eg, the TV athlete or cow-
boy). "
In India 47% to 73% of the popu-
lation are tobacco users, most of
those using chewing tobacco. Forty-
eight percent of the cancers in India
are found in the mouth. The journal
Cancer commented on a study of
female smokers and snuff dippers in
the southeastern United States that
showed that the risk of developing
cancer of the gums or mouth is 4.6
for smokers and 13 to 48 for snuff
dippers depending upon how long the
user had indulged in the habit. Teen-
agers are becoming attracted to a
habit that carries a risk of cancer of
the mouth. Doctor McCormick is to
be commended for writing on this
subject. The medical and dental pro-
fessions should join forces in con-
demning what appears to be an "end
run" around the health warnings of
smoking.
Most of the spitting comes from
chewing tobacco. Tobacco is addic-
tive, and chewing tobacco is becom-
ing a more serious problem in
younger people. Spitting not only is
a poor example for the young but
also it can be dangerous: A teenager
nearly died over the Christmas holi-
Smokeless Tobacco
(Advice to teammatesi
From Honus Wagner to Harvey Kuenn
and all those shortstops in between,
In the dugout, don't sit
Downwind of their spit
If you choose to stay warm,
dry, and clean.
days after a knee-"burn" incurred in
a fall on the basketball floor. Severe
infection developed attributed to
sliding into spittle. Only with ex-
treme emergency intervention was
the cause located and controlled.
Baseball players are far more of-
fensive in the expectoration depart-
ment than our football heroes— both
in volume and content.
I am sorry, Doctor
I AM SORRY, Doctor, but I can't
come to you anymore. My com-
pany just signed up with an HMO
plan and my family and I can't
come to you and we can't go to the
local hospital. We have been com-
ing to you for over 20 years and I
am sorry about the situation.
We do have a choice, though.
We may go to two clinics that are
roughly 175 miles from here, or to
another 80 miles away, or to the
nearest one which is only 30 miles
away. We do not know a single
physician in the HMO plan with
which our company is now affil-
iated. We will continue to come to
you at our own expense unless
hospitalization or something ma-
jor becomes necessary.
The patient is sorry, the physi-
cian is sorry, and it's a sorry situa-
tion!
— Victor S Falk, MD, Edgerton
Editorial Board comment: Free-
dom of choice? Not according to this!
Freedom to seek? No, according to
thisl No one likes this, even many of
those physicians practicing in
HMOs. While the above situation
may seem unrealistic, it is not. It is
happening now, and this is just the
beginning; the sorry mess will snow-
ball! m
WISCONSIN MEDICAI. JOURNAL, FEBRUARY 1985 :VOE. 84
9
Turn of the century
trephine for cranial surgery
and tonsillotome for
removing tonsils.
We’ve been defending
doctors since
these were the
state of the art.
These instruments were the best available at
the turn of the century. So was our professional
liability coverage for doctors. In fact, we
pioneered the concept of professional
protection in 1899 and have been providing
this important service exclusively to doctors
ever since.
You can be sure we’ll always offer the most
complete professional liability coverage you
can carry. Plus the personal attention and
claims prevention assistance you deserve.
For more information about Medical
Protective coverage, contact your Medical
Protective Company general agent.
William E. Herte, Jerry E. Kronsnoble, 850 North Elm Grove Road, Elm Grove, Wisconsin 53122 , 414/784-3780
SPECIAL
)
Diethylstilbestrol (DES) update^
A message from the DESAD Project
IN RECENT weeks the national
media have been reporting the
possible adverse effects to off-
spring of mothers who took the
drug, diethylstilbestrol (DES),
during pregnancy.
Despite massive nationwide
efforts to locate diethylstilbestrol
(DES)-exposed females, many
such individuals apparently con-
tinue to be unaware of the need
to be examined and possibly
treated for cervical or vaginal
complications including certain
rare forms of cancer as a conse-
quence of mothers taking DES
during pregnancy.
DES was a federally approved
drug prescribed from the late
1940s to 1971 primarily for
women at risk of miscarriage.
Research in the late 1950s began
to indicate a small percentage of
daughters and sons who suffered
adverse consequences from DES,
but it was not until 1971 that the
FDA issued formal warnings and
ordered labeling changes.
Medical alert— DES exposure
The State Medical Society and its Committee on Maternal and Child
Health, Michael H Mader, MD, La Crosse, chairman, strongly urge
physicians to take the following actions if they have not already done
so:
1. In instances where records are available, notify patients who have
been treated with DES during pregnancy so that they can in turn
notify their daughters to obtain an examination to determine
whether there has been vaginal or cervical tissue change including,
in rare cases, the development of certain rare forms of cancer.
It is recognized that since most of the DES prescribing was done
from 20 to 40 years ago, the availability of documentation may be
scant or nonexistent. An alternative method is to alert all female
patients about DES by providing educational information in person
during office visits or making posters or leaflets available in the
reception area.
2. Routinely question every female born between 1940 and 1971 as
to her mother's possible exposure to DES. When a DES-exposed
daughter is discovered, she should receive a complete gynecologic
examination.
3. Make similar inquiries of males born between 1940 and 1971.
There is evidence that a small percentage of such persons develop
reproductive and urinary system abnormalities.
The State Medical Society also calls upon women and men born in
the prime exposure years to take the initiative in talking with their
personal physicians and seeking examination if they believe they
may have been exposed through their mother's use of DES.
The State Medical Society has
received reliable reports that
there continue to be numbers of
individuals locally and nation-
wide who have not yet become
aware of the possible adverse ef-
fects of DES. There also are other
reports that are confusing. There-
fore, the Society and its Com-
mittee on Maternal and Child
Health, through its chairman,
Michael H Mader, MD, La
Crosse, strongly urge physicians
to review the following informa-
tion, which is based solely on the
best available data and does not
represent personal opinion, and
take the appropriate actions if
they have not already done so.
DES-EXPOSED DAUGHTERS
Cancer risk. The risk of de-
veloping a serious cancer of the
vagina remains low. At the pres-
ent time very few new cases of
this tumor are being reported. As
exposed women pass the age of
25 years, it appears that their im-
mediate risk of this tumor de-
creases tremendously. However,
it should be noted that in the un-
exposed women the tumor oc-
curs most frequently in 50 and
60 year-olds. Therefore, all ex-
posed women should have at
least annual examinations for
life.
It now appears that another
type of premalignant tumor is
also occurring with greater fre-
quency in exposed women than
in the general population. (Rob-
boy, et al, JAMA, Dec 7, 1984)
This type of neoplasia is called
cervical dysplasia or carcinoma
in situ. These conditions are
changes of the skin of the cervix
and vagina which, if left un-
treated, could eventually become
true cancers. Fortunately, the
Pap smear is very reliable for de-
tecting the onset of these con-
ditions; and, if they are detected
early, may often be treated suc-
cessully in the office. This is
1 1
WISCONSIN MEDICAL JOLRNAL, FEBRUARY 1985:VOL. 84
SPECIAL
DIETHYLSTILBESTRQL (DES)
another reason why all exposed
women should have frequent ex-
aminations by a gynecologist who
is thoroughly familiar with the
evaluation of DES-exposed wo-
men. However, some Pap smear
laboratories and pathologists are
not prepared to diagnose these
lesions accurately in exposed
women. If a Pap smear or a biopsy
is reported to the physician as be-
ing abnormal, we suggest that the
physician forward the sample to
one of the DES centers for further
evaluation before any treatment
is begun.
Pregnancy. While some studies
of selected patients have sug-
gested that DES is related to in-
fertility problems, controlled
studies (including DESAD [Dieth-
ylstilbestrol Adenosis] Project)
have not demonstrated problems
in the ability to become pregnant.
Although occasional problems
have been encountered, this
seems to be the exception rather
than the rule.
Unfortunately, once preg-
nancy occurs DES-exposed
women are more likely to experi-
ence unfavorable outcomes than
is the general population. Spon-
taneous abortion (miscarriage) is
the most common problem en-
countered. However, ectopic
(tubal) pregnancy and premature
delivery are also complications
which occur with some increased
frequency. As soon as a DES
woman becomes pregnant, she
should let her obstetrician know
of her exposure. DES-exposed
women need much more in-
tensive prenatal care than do
unexposed women.
The reasons for these preg-
nancy problems have not been
completely explained. It does
appear, however, that the shape
of the uterus and cervix may play
some important role. Unfor-
tunately, it is not possible to pre-
dict the pregnancy outcome
based on what is observed at the
time of the clinical examination,
and x-rays of the uterus (hystero-
salpingogram) are not advised
for routine screening. Each pa-
tient must be watched carefully
throughout the pregnancy.
Medical diseases. There are no
data at present to suggest that ex-
posed women are more likely to
develop any specific medical
disease than unexposed women.
Some physicians may have ques-
tionnaires that ask patients about
medical illnesses they may have
had. The purpose of these ques-
tionnaires is to determine, with
some certainty, whether any par-
ticular diseases (other than prob-
lems with the female organs) are
linked to DES exposure. Patients'
answers to these questions will
be most helpful to physicians.
DES EXPOSED SONS _
In general, the news for DES-
exposed sons is good. Although
initially there had been some con-
cern about the ability of exposed
males to father children, a recent
study has shown no difference
between exposed and unexposed
men. (Leary, et a\, JAMA, Dec 7,
1981) The exposed men have the
same number of children, the
same sperm counts, and the same
sexual history as unexposed
males.
Certain conditions in exposed
males must be completely eval-
uated, however. Although there
is no evidence that undescended
testes occurs more commonly in
exposed males, the patient should
seek complete evaluation from
a physician if this condition is
present.
DES-EXPOSED MOTHERS
DES-exposed mothers (the
women who actually took the
drug) have recently been re-
ported to have breast cancer
more frequently than unexposed
women in the general population.
(Greenberg, et al. New England
Journal of Medicine, Nov 6, 1984)
Several years ago there had been
some suggestion of this, but de-
tailed studies at that time failed
to detect a difference between
DES mothers and women in the
general population. Because
breast cancer occurs largely in
older women, it was not possible
to detect the small difference
until the mothers reached a more
advanced age. Now, however, it
appears that there is a true dif-
ference, but the likelihood of any
one individual developing the
disease is still quite small.
All DES mothers should per-
form monthly self-breast exam-
ination. This technique may be
learned through various services
in most communities. The Ameri-
can Cancer Society sponsors
training programs in many areas
of the United States.
Besides self-examination each
woman should see a physician at
least annually for breast exam-
ination. Mammography may be
helpful in determining whether a
cancer is present. Mammography
is useful for only certain types of
breast problems, and routine
screening in certain age groups
has been shown to be of no bene-
fit. Nonetheless, there remains a
group of women for which the
technique is very beneficial. The
DES-exposed mother should ask
her doctor about this technique
and have the test performed on
the schedule that the doctor
recommends.
EXAMINATION AND
REFERRAL OE DAUGHTERS^
The examination of a DES-
exposed female is, with some
amplification, similar to a routine
pelvic examination. The gyne-
cologic examination used in the
DESAD Project to examine DES-
exposed daughters is outlined in
Table 1. Additional techniques
found useful in performing the
examination are described. When
12
WISCONSIN MEDICAL JOCRNAL, FEBRL ARY 1985: VOL. 84
DIETHYLSTILBESTROL (DES)
SPECIAL
changes characteristic of the DES-
exposed populations are present,
the physician may wish to con-
sult a gynecologist familiar with
the details of evaluation and
followup of DES-exposed in-
dividuals.
Inspection of the vulva. Changes
in the vulva have not been as-
sociated with DES exposure. If
the hymen is unusually tight, a
topical anesthetic jelly or spray
may reduce discomfort during
the initial stages of dilation. If
the hymen permits the passage of
the index finger, the examination
may proceed. The patient should
be encouraged to use tampons
during menstrual periods as this
will facilitate the initial and
future examinations.
Palpation of the vagina. Palpa-
tion is a crucial part of the DES
examination and may provide the
only evidence of clear cell adeno-
carcinoma, especially on the rare
occasion when it is located be-
neath the mucosa. The finger
used for palpation should be
moistened with water rather
than lubricant jelly in order not to
ruin the cytologic specimens ob-
tained subsequently. The entire
length of the vagina including
the fornices should be carefully
assessed. During palpation va-
ginal ridges and structural
changes of the cervix may be
noted. Areas of thickening or in-
Table I— Order of gynecologic portion
of examination of women exposed
to DES in utero
Vulvar inspection
Vaginal and cervical
palpation (digital)
Vaginal and cervical inspection
(speculum)
Cytology (separate slides of vaginal
fornices and cervix)
Colposcopy (optional)
Iodine stain of cervix and vagina
Tissue biopsy of atypical findings
Bimanual (recto-vaginal) examination
duration should arouse suspicion
and be sampled by biopsy.
Speculum examination. After
palpation, a speculum of appro-
priate size is inserted. In virginal
females the Pederson virginal
speculum is frequently effective
when the standard virginal
speculum is too short to permit
examination of the entire length
of the vagina as well as the for-
nices. Warm water, not jelly,
should be used for lubrication
during insertion of the speculum.
Excess mucus, sometimes pres-
ent in the DES-exposed woman,
should be gently removed with a
moist cotton swab. The epithelial
surface of the vagina must be
carefully inspected. Grossly,
adenosis may appear red and
granular, while squamous meta-
plasia may be indistinguishable
from normal squamous epi-
thelium. During the course of
gross inspection, the speculum
should be gently rotated as it is
withdrawn in order to assess
properly the entire length of the
vagina.
Cytology. The secretions and
epithelium in the upper third of
the vagina should be thoroughly
sampled with a wood or plastic
spatula, as should the middle or
lower third of the vagina if
gross epithelial changes are evi-
dent there. The spatula should
be rotated along the entire cir-
cumference of the vaginal for-
nices. The vaginal material
should be promptly transferred to
a slide and immediately placed
into fixative. A second sample
from the cervix should be ob-
tained from the endocervical
canal and ectocervix. Aspiration
of the external os may be per-
formed as a method for sampling
the endocervical canal. This pro-
cedure should be followed by a
scrape of the ectocervix. When an
abnormal smear is reported, a
physician may wish to consult a
gynecologist experienced in eval-
uating DES-exposed daughters.
Colposcopy. Colposcopy, if
performed, should be done be-
fore iodine staining. The chief
benefits of colposcopy are that it
permits an accurate assessment
of the extent of epithelial changes
on the cervix and vagina and can
be used as an aid to detect those
areas most likely to disclose ab-
normalities on biopsy. Colpos-
copy has not proved to be es-
sential in the detection of clear
cell adenocarcinoma. This is
due to the lack of specific vascu-
lar changes with the clear cell
adenocarcinoma and to the fact
that some tumors may be con-
fined to an intramural location
in the vagina and cervix.
Iodine staining. Iodine staining
of the vagina and cervix confirms
the boundaries of epithelial
changes observed by colposcopy,
or indicates the boundaries when
colposcopy has not been done. If
colposcopy has been performed,
Lugol's solution at half strength is
recommended for iodine staining
(half strength is 2.5 percent
iodine with 5 percent potassium
iodide in water). Otherwise Schil-
ler's solution is recommended
(1 Gm iodine and 2 Gm potas-
sium iodide in 300 ml water).
Because the iodine stains only the
normal (highly glycogenated)
surface epithelium lining the va-
gina and cervix, this technique
cannot be relied upon for detect-
ing lesions within the wall. To
properly assess the tissues after
staining, the speculum is rotated
as it is withdrawn. After in-
spection, the speculum should
be reinserted for biopsy, if indi-
cated. Insertion may be facili-
tated by lubrication with jelly to
compensate for the dehydrating
effect of the iodine.
Indications for biopsy. Biop-
sy should be performed when-
ever the vagina or cervix is indur-
ated, granular, contains a pal-
pable nodule or larger mass, has
discrete areas that appear to be of
a different color or texture than
WISCONSIN MEDICAL JOURNAL, FEBRUARY 1985: VOL. 84
SPECIAL
DIETHYLSTILBESTROL (DES)
the surrounding tissue, or dis-
closes highly atypical colposcopic
findings. Random sampling of
nonstaining areas of the vagina
or the cervix is not recommended
since these areas rarely disclose
neoplastic or preneoplastic les-
ions. Ferrous subsulfate (Mon-
sel's solution), silver nitrate, or
Gelfoam with tampons may oc-
casionally be required to stop
bleeding after biopsy.
Bimanual examination. The
bimanual examination should in-
clude examination of the vagina
and rectum and should be per-
formed in a routine manner.
EXAMINATION SCHEDULE
Initial examination of known or
suspected DES-exposed females
should be performed after men-
arche or by the age of 14 years if
menarche has not occurred. Ex-
amination of younger girls is not
advised, unless vaginal bleeding,
spotting, or abnormal discharge
occurs and then it should be
considered mandatory. Hospitali-
zation and examination under
anesthesia are rarely necessary.
The interval for followup ex-
amination is determined on an
individual basis. For most pa-
tients with nonstaining epithelial
or structural changes in the
vagina or cervix or for micro-
scopical changes such as adeno-
sis, yearly examinations are ade-
quate. Patients with abnormal
Papanicolaou smears should be
referred to a physician experi-
enced in the evaluation of DES-
exposed women. Before a diag-
nosis of dysplasia is considered
established, all abnormal cytolo-
gic specimens should be re-
viewed by a pathologist who is
thoroughly familiar with the
changes in samples from DES-ex-
posed women since immature
squamous metaplasia is fre-
quently difficult to distinguish
from dysplasia.
Important steps at the followup
examination include palpation,
inspection, and cytology. Atten-
tion should be focused on the
changes observed since the initial
evaluation. Cervical cytology is
presently performed each year.
If there are no epithelial changes
in the vagina, smears from the
vagina can be omitted. Women
should be asked about interval
bleeding or abnormal discharge.
EDUCATION AND
COUNSELING
Knowledge of DES exposure
without sufficient information
and understanding can produce
great anxiety. DES-exposed
women have anger, guilt, and
fear about the risk of cancer and
concerns about fertility and
their sexual self-image. For this
reason, it is important that time
be allocated at the initial exami-
nation for the mother and her
daughter to receive complete and
accurate information and as-
surance.
Explanations must be given
which are appropriate to the age
of the patient and in terms she
can understand. Educational
materials, such as written des-
criptions of the examination or
drawings of the changes asso-
ciated with DES exposure can be
given to the patient when she ar-
rives for her appointment, thus
allowing her some time to pre-
pare questions.
APPEAL TO MEDIA
The State Medical Society also
is appealing to the media and
other health-related organiza-
tions to continue the campaign to
find as many DES-exposed per-
sons as possible and get them to
examination. Early discovery of
DES exposure and prompt fol-
lowup with a physician is the
key to prevention and treatment.
The State Medical Society also
is making available leaflets and
posters in an effort to find the
last remaining individuals who
have not already taken precau-
tionary measures aimed at dis-
covery and treatment of DES-
exposed conditions.
REFERENCES
1. DES Update, a message from the DESAU
Project, National Cancer Institute.
2. Robboy SJ, Noller KE, Kaufman RH, et al:
Prenatal diethylstilbestrol (DES-exposure):
Recommendations of the Diethylstilbestrol
Adenosis (DESAD) Project for the Identifica-
tion and Management of Exposed Individu-
als, Dept of Health, Education, and Wel-
fare, NIH Publication No. 81-2049, March
1981, Government Printing Office.
—Prepared by Deb Powers, Policy Analyst, SMS Physicians Alliance Division ■
Physicians who practice, preach
Physicians with better personal health habits and more positive attitudes toward offering advice
counsel a broader range of patients and counsel more aggressively, say researchers from The Rand
Corporation of Santa Monica, Calif., and from Los Angeles, in the November 23, 1984 Journal of the
American Medical Association. Kenneth B Wells, MD, MPH, and colleagues say they examined the
relation of physicians' clinical specialty, personal health habits and health-related beliefs to their prac-
tices in counseling about smoking, weight, exercise and alcohol use. Those with good habits counseled
good habits. "Surgeons counsel less than nonsurgeons, even after controlling for differences in health-
related attitudes and personal habits," they add. ■
14
WISCONSIN MEDICAL JOURNAL, FEBRLIARY 1985:\'OL. 84
SPECIAL
)
Child abuse and neglect
The law— explanation and implication
According to the specific
guidelines set forth in "Cur-
rent Opinions of the Judicial
Council of the American Medical
Association— 1984" the obliga-
tion, both legal and ethical, to
report suspected or blatant cases
of abuse is clearly defined.
Wisconsin was one of the first
states in the nation to enact a
statute that required the reporting
of suspected child abuse. In a re-
cent issue of JAMA, Marilyn
Heins, MD stated that
"[rjeporting is a mechanism to prevent
fatal child abuse or future injuries by
setting child protective services in mo-
tion . . .
The intent of all the reporting laws is
to protect the child rather than punish
the perpetrators. Therefore, most
states mandate immediate investiga-
tion of the report and appropriate
action to protect the child, ranging
from the removal of the child from the
home to ongoing social services for the
family."*
With these goals in mind, the
reporting of either a suspected or
blatant case of child abuse be-
comes a necessity in order to pro-
tect the child. The physician does
not become the accuser, but
merely a facilitator for the protec-
tion of the child. When reporting
the case, if the physician feels
comfortable in aiding the treat-
ment and followup, he may wish
to offer his services. In a majority
of the cases, the Child Protection
Services will then work with the
physician to insure ongoing treat-
ment and rehabilitation.
But reporting is only a part of
the solution to the problem of
child abuse. Greater role speci-
ficity of the many professionals in-
volved is needed. Professionals
'Heins M: The 'battered child' revisited.
1984(Jun 22/291:251 (24):3297.
also must come to grips with so-
ciety's conflicts between interven-
ing to protect the child on the one
hand and upholding the sanctity
of the family and its privacy on
the other.
Under the new law relating to
reporting of child abuse and neg-
lect (1983 Wisconsin Act 172), the
definition of child abuse was ex-
panded to include:
1. Violating s. 940.203, Stats., relating to
sexual exploitation of children;
2. Permitting or requiring a child to vio-
late s. 944. 30, Stats., relating to pros-
titution; and
3. ' Covering "emotional damage,"
which is defined to mean harm to a
child's psychological or intellectual
functioning:
(a) which is exhibited by severe
anxiety, depression, withdrawal
or a combination of those behav-
iors;
(b) which is caused by the child's
parent, guardian, legal custodian
or other person exercising tem-
porary or permanent control over
the child; and
(c) for which the child's parent, guar-
dian or legal custodian has failed
to obtain the treatment necessary
to remedy the harm.
[The new law appears in its en-
tirety following this article.]
The Act specifies that "emo-
tional damage" may be demon-
strated by a substantial and obser-
vable change in behavior, emo-
tional response or cognition that is
not within the normal range for
the child's age and state of devel-
opment.
Under prior law, those persons
required by statute to report child
abuse had to report only if they
had "reasonable cause to suspect"
that a child, seen in the course of
professional duties, had been
abused. The Act provides that per-
sons required to report must also
report situations in which they
have reason to believe that a child
Table I— Growth of reporting j 1979-19821*
Preliminary Indicated Completed % Increase
1979-8020
7123
1154
15.5
1980-8286
7737
1430
18.5
1981-8500
8230
1482
18.0
1982-9067
8822
1754
19.9
’Source: Annual Report to the Governor and the Legislature on the Wisconsin Child Abuse
& Neglect Act: Chapter 355, Laws of 1977, section 48.981 : Division of Community Services,
Dept of Health & Social Services, August 1, 1983.
Table 2— Reporting of abuse only j 1980-1982J*
Preliminary Indicated % Increase
1980- 3650 875 24.0
1981- 4149 990 23.9
1982- 4606 1154 25.1
’Source: Annual Report to the Governor and the Legislature on the Wisconsin Child Abuse
& Neglect Act: Chapter 355, Laws of 1977, section 48.981 : Division of Community Services,
Dept of Health & Social Services, August 1, 1983.
WISCONSIN MEDICAL JOCRNAL, FEBRUARY 1 985: VOL. 84
SPECIAL
CHILD ABUSE AND NEGLECT
seen, in the course of professional injury and that abuse of the child
duties, has been threatened with will occur. The inclusion of threat-
Table 3— Reporting of child neglect only (1980-1982}*
Preliminary
Indicated
% Increase
1980-4149
530
12.8
1981-3889
458
11.8
1982-4044
579
14.3
Wisconsin's rate of substantiated cases was 1.29 children per 1000 children.
However, according to the US Department of Health & Human Services, only one-
third of all abused and neglected children ever comes to the attention of the child
protective services system.
'Source: Annual Report to the Governor and the Legislature on the Wisconsin Child Abuse
& Neglect Act; Chapter 355, Laws of 1977, section 48.981 : Division of Community Services,
Dept of Health & Social Services, August 1. 1983.
"Current Opinions of the Judicial Council of the American
Medical Association— 1984"
[2.02]
Laws that require the reporting of cases of suspected abuse of
children and elderly persons often create a difficult dilemma for the
physician. The parties involved, both the suspected offenders and
the victims, will often plead with the physician that the matter be
kept confidential and not be disclosed or reported for investigation
by public authorities.
Children who have been seriously injured, apparently by their
parents, may nevertheless try to protect their parents by saying that
the injuries were caused by an accident, such as a fall. The reason
may stem from the parent-child relationship or fear of further
punishment. Even institutionalized elderly patients who have been
physically maltreated may be concerned that disclosure of what has
occurred might lead to further and more drastic maltreatment by
those responsible.
The physician who fails to comply with the laws requiring reporting of
suspected cases of abuse to children and elderly persons and others at
risk can expect that the victims could receive more severe abuse that may
result in permanent bodily or brain injury or even death, (emphasis added)
Public officials concerned with the welfare of children and elderly
persons have expressed the opinion that the incidence of physical
violence to these persons is rapidly increasing and that a very
substantial percentage of such cases is unreported by hospital per-
sonnel and physicians. An important element that is sometimes
overlooked is that a child or elderly person brought to a physician
with a suspicious injury is the patient whose interests require the
protection of law in a particular situation, even though the physi-
cian may also provide services from time to time to parents or other
members of the family.
The obligation to comply with statutory requirements is clearly
stated in the Principles of Medical Ethics. As stated at 1.02, the
ethical obligation of the physician may exceed the statutory legal re-
quirement. (I, III)
ened abuse expands the number
of situations in which a report is
required.
The issue of responsibility to
report cases of known, nonincest-
ual sexual intercourse is, at best,
a gray area. According to L Ed-
ward Stengel, the President-Elect
of the Wisconsin District Attor-
neys Association, physicians
should use their best judgment
when assessing these cases. There
is no clearcut, definitive answer to
this highly controversial issue,
and concerned and interested
physicians should work toward
the possibility of statutory clarifi-
cation and change.
The penalty for a person who
wilfully fails to file a required
report ranges from a fine of not
more than $ 100 or imprisonment
for not more than six months, or
both, to a fine of not more than
$1000 or imprisonment for not
more than six months, or both.
Table A— Type of abuse or neglect-
completed 1982 reports*
Type of Abuse or Neglect Total
Total reports of individual . . . .8803
children (not incidents)
Brain damage 2
Skull fracture 28
Subdural hemorrhage or 12
hematoma
Bone fracture 87
Dislocation /sprain/ 46
twisting/shaking
Internal injuries 25
Malnutrition 88
Failure to thrive 59
Exposure to elements 57
Locking in /out 125
Poisoning (unintentional) 6
Burns, scald 217
Cuts, bruises, welts 2621
Sexual abuse 1470
Congenital drug addiction 3
Physical neglect 2644
Medical neglect 372
Abandonment 188
Lack of supervision 2070
Other injury 547
'Source; Annual Report to the Governor
and the Legislature on the Wisconsin Child
Abuse & Neglect Act; Chapter 355, Laws of
1977, section 48.981; Division of Commun-
ity Services, Dept of Health & Social Serv-
ices, August 1, 1983.
16
WISCONSIN MEDICAL JOURNAL, FEBRUARY 1983:VOL. 84
CHILD ABUSE AND NEGLECT
SPECIAL
Under prior law, any person or
institution participating in good
faith in the making of a report,
ordering or taking of photographs,
or ordering or performing medical
examinations of a child under the
child abuse and neglect statute is
immune from any liability, civil or
criminal, that results by reason of
the action. The Act expands this
immunity provision to include
any person or institution conduct-
ing an investigation under the
child abuse and neglect statute.
Any person who makes a report
in good faith is protected in the
statute. But there is also the pro-
tection of confidentiality.
(s.48.981)(7)(a) The source of a re-
port remains confidential, except
in the very rare cases when pre-
vention and intervention prove
unsuccessful and a court hearing
requires the mandated reporter to
testify. The report is also subject
to criminal defense discovery, if
so indicated.
While mandated reporters may
remain anonymous, it is recom-
mended that they identify them-
selves, not only to authorities
when making the report but also
to the victim (to assure that the
physician is there to help).
If a physician fails to report a
suspected or blatant case of child
abuse, he not only places the child
in danger of more serious harm
but also the foundation on which
a legal case against the offender
rests becomes tenuous. Physical
evidence is generally unavailable
and the case more often than not
rests solely on the child's testi-
mony. The physician may believe
that he is helping the situation by
agreeing to not report and by at-
tempting to treat the victim and
offender, but he may in fact
diminish the ability to adequately
insure that the offender will con-
tinue therapy and/or the offense
will not happen again.
An Ad Hoc Committee on Child
Abuse was recently initiated by
the State Medical Society of Wis-
consin's Committee on Mental
Health and various specialties are
represented. Major goals of the
Committee are to:
• aid the physician, through
educational materials and lec-
ture sessions, in diagnosis, re-
porting, and followup of cases
of child abuse;
• develop a generic protocol for
physicians to follow in sus-
pected or blatant cases of
abuse occurring in children;
Table 5 — Four most frequently reported incidents of child abuse and/or neglect*
Type of Abuse /Neglect
1979
1980
1981
1982
Physical Neglect
19
34.5
32.6
30.0
Cuts / Welts / Bruises
34
30.0
29.0
29.8
Lack of Supervision
15
22.9
22.4
23.5
Sexual Abuse
27
12.4
14.8
16.9
Please note: The percentage listed above may approach or exceed 100 percent since any one
child may be a victim of several different types of abuse or neglect.
•Source: Annual Report to the Governor and the Legislature on the Wisconsin Child Abuse
& Neglect Act: Chapter 355, Laws of 1977, section 48.98 1 ; Division of Community Services,
Dept of Health & Social Services, August 1, 1983.
Table 7— Case disposition by result*
Indicated
Indicated
Indicated
Abuse &
Abuse
Neglect
Neglect
Unfounded
Total
Child at home
96
371
6
6535
7819
Disposition pending
23
11
1
24
59
Voluntary placement
63
46
2
119
230
Court-ordered placement
86
99
12
129
326
Consent to adoption
0
2
0
1
3
Child died
2
2
0
5
9
Other
73
48
0
232
353
Unreported
811
0
0
22
23
TOTAL
1154
579
21
7068
8822
%
13.1
6.6
0.2
80.1
•Source: Annual Report to the Governor and the Legislature on the Wisconsin Child Abuse &
Neglect Act; Chapter 355, Laws of 1977, section 48.98 1 ; Division of Community Services, Dept
of Health & Social Services, August 1, 1983.
Table 6— Total reports received by
mandated reporters completed 1982
investigations *
Reporter's
Occupation
Count
%
Private physician
70
0.8
Hospital-clinic
216
2.4
physician
Medical examiner
1
0.0
Nurse
325
3.7
Dentist
8
0.1
Chiropractor
1
0.0
Other hospital
295
3.3
clinic
Other medical/
253
2.9
mental health
Social or public
645
7.3
assistance
worker
School teacher
182
2.1
School
914
10.4
administrator
Child care worker
65
0.7
Police law
864
9.8
enforcement
Other
18
0.2
3857
44.0
(Healthcare
1168
30.3)
providers
•Source: Annual Report to the Governor
and the Legislature on the Wisconsin Child
Abuse & Neglect Act; Chapter 355, Laws of
1977, section 48.981; Division of Commun-
ity Services, Dept of Health & Social Serv-
ices, August 1, 1983.
WISCONSIN MEDICALJOURNAL, FEBRUARY I985:VOL. 84
17
SPECIAL
CHILD ABUSE AND NEGLECT
• develop a liaison between
social service departments,
law enforcement, and health-
care providers, to better under-
stand, identify, and work with
both victim and offender, and
aid in rehabilitation; and
• conduct an educational meet-
ing on child abuse. The session
could be done as a panel dis-
cussion with a question and
answer period. Materials and
information arising from this
meeting would be distributed
to interested individuals.
Ad Hoc Committee on Child
Abuse members are: Richard
Roberts, MD, JD, Darlington
(family practitioner / lawyer);
Richard Edwards, MD, Richland
Center (family practitioner);
Pauline Jackson, MD, La Crosse
(psychiatry); and Martin Fliegel,
MD, Madison (child psychiatry).
Specialty representatives are: June
Dobbs, MD, Child Development
Center, Milwaukee Children's
Hospital (pediatrician); and Fred
Devett, Madison (psychothera-
pist).
The March edition of the WMJ
will address "what happens after
the report is made" with services
that are provided, legal actions,
and outcomes of typical cases.
—Prepared by Deb Powers, Policy Analyst, SMS Physicians Alliance Division ■
STATE OF WISCONSIN
Date of enactment: March 22, 1984
1983 Wisconsin Act 172
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
SECTION 1. 48.207 (3) of the statutes is amended to read:
48.207 (3) A child taken into custody under s. 48.981 may be held in a hospital, foster home, relative's
home or other appropriate medical or child welfare facility which is not used primarily for the detention
of delinquent children.
SECTION 2. 48.981 (1) (a), (c) and (d) of the statutes are amended to read:
48.981 (1) (a) "Abuse" means any of the following:
1. Physical injury inflicted on a child by other than accidental means.
2. Sexual intercourse or sexual contact under s. 940.225.
(c) "County agency" means a county child welfare agency under s. 48.56 (1) or a community human
services board under s. 46.23.
(d) "Neglect" means failure, refusal or inability on the part of a parent, guardian, legal custodian
or other person exercising temporary or permanent control over a child, for reasons other than poverty,
to provide necessary care, food, clothing, medical or dental care or shelter so as to seriously endanger
the physical health of the child.
SECTION 3. 48.981 (1) (a) 3 to 5, (cm) and (e) to (h) of the statutes are created to read:
48.981 (1) (a) 3. A violation of s. 940.203.
4. Permitting or requiring a child to violate s. 944.30.
5. Emotional damage.
(cm) "Emotional damage" means harm to a child's psychological or intellectual functioning which
is exhibited by severe anxiety, depression, withdrawal or outward aggressive behavior, or a combina-
tion of those behaviors, which is caused by the child's parent, guardian, legal custodian or other person
exercising temporary or permanent control over the child and for which the child's parent, guardian
or legal custodian has failed to obtain the treatment necessary to remedy the harm. "Emotional
damage" may be demonstrated by a substantial and observable change in behavior, emotional response
continued
18
WISCONSIN MEDICAL JOURNAL, FEBRUARY 1985: VOL. 84
1983 WISCONSIN ACT 172
SPECIAL
continued
A
or cognition that is not within the normal range for the child's age and stage of development.
(e) "Physical injury" includes but is not limited to lacerations, fractured bones, internal injuries,
severe or frequent bruising or great bodily harm as defined under s. 939.22 (14).
(f) "Record" means any document relating to the investigation, assessment and disposition of a report
under this section.
(g) "Reporter" means a person who reports suspected abuse or neglect or a belief that abuse will
occur under this section.
(h) "Subject" means the child who is the victim or alleged victim of abuse or neglect, the child's
parent or any other person specified in a report or record who is alleged or determined to have abused
or neglected the child.
SECTION 4. 48.981 (2) of the statutes is amended to read:
48.981 (2) PERSONS REQUIRED TO REPORT CASES OF SUSPECTED CHILD ABUSE OR
NEGLECT. A physician, coroner, medical examiner, nurse, dentist, chiropractor, optometrist, other
medical or mental health professional, social or public assistance worker, school teacher, adminis-
trator or counselor, child care worker in a day care center or child caring institution, day care pro-
vider, alcohol or other drug abuse counselor, member of the treatment staff employed by or working
under contract with a board established under s. 46.23, 51.42 or 51.437, physical therapist, occupa-
tional therapist, speech therapist, emergency medical technician— advanced (paramedic), ambulance
attendant or police or law enforcement officer having reasonable cause to suspect that a child seen
in the course of professional duties has been abused or neglected or having reason to believe that a
child seen in the course of professional duties has been threatened with an injury and that abuse of
the child will occur shall report as provided in sub. (3) . Any other person including an attorney having
reason to suspect that a child has been abused or neglected or reason to believe that a child has been
threatened with an injury and that abuse of the child will occur may make such a report. No person
making a report under this subsection may be discharged from employment for so doing.
SECTION 5. 48.981 (3) (title), (a) and (b) 1 and 2 of the statutes are amended to read:
48.981 (3) (title) REPORTS; INVESTIGATION, (a) (title) Referral of report of suspected child abuse
or neglect. Persons required to report under sub. (2) shall immediately contact, by telephone or per-
sonally, the county agency, sheriff or city police department and, in the case of American Indian
children, the tribal government and shall inform the agency or department of the facts and circum-
stances contributing to a suspicion of child abuse or neglect or to a belief that abuse will occur. The
sheriff or police department shall within 12 hours, exclusive of Saturdays, Sundays or legal holidays,
refer to the county agency and, in the case of American Indian children, the tribal government all
cases reported to it. The county agency may require that a subsequent report be made in writing.
Each county agency shall adopt a written policy specifying the kinds of reports it will routinely report
to local law enforcement authorities.
(b) 1. Any person reporting under this section may request an immediate investigation by the sheriff
or police department if the person has reason to suspect that a child's health or safety is in immediate
danger. Upon receiving such a request, the sheriff or police department shall immediately investi-
gate to determine if there is reason to believe that the child's health or safety is in immediate danger
and take any necessary action to protect the child.
2. If the investigating officer has reason under s. 48.19 (1) (c) or (d) 5 to take a child into custody,
the investigating officer shall take the child into custody and deliver the child to the intake worker
under s. 48.20.
V
continued
WISCONSIN MEDICAL JOURNAL, FEBRUARY 1985: VOL. 84
9
SPECIAL
1983 WISCONSIN ACT 172
continued
SECTION 6. 48.981 (3) (c) 1 to 5 of the statutes are repealed and recreated to read:
48.981 (3) (c) 1. Within 24 hours after receiving a report under sub. (3) (a), the county agency shall,
in accordance with the authority granted it under s. 48.57 (1) (a), initiate a diligent investigation to
determine if the child is in need of protection or services. The investigation shall include observation
of or an interview with the child, or both, and, if possible, a visit to the child's home or usual living
quarters and an interview with the child's parents, guardian or legal custodian. At the initial visit to
the child's home or living quarters, the person making the investigation shall identify himself or herself
and the county agency involved to the child's parents, guardian or legal custodian. The county agency
may contact, observe or inter\dew the child at any location without permission from the child's parent,
guardian or legal custodian if necessary to determine if the child is in need of protection or services,
except that the person making the investigation may enter a child's home or living quarters only with
permission from the child's parent, guardian or legal custodian or after obtaining a court order to do so.
2. If the person making the investigation determines that any child in the home requires immediate
protection, he or she shall take the child into custody under s. 48.08 (2) or 48.19 (1) (c) and deliver
the child to the intake worker under s. 48.20.
3. If the county agency determines that a child, any member of the child's family or the child's
guardian or legal custodian is in need of services, the county agency shall offer to provide appropriate
services or to make arrangements for the provision of services. If the child's parent, guardian or legal
custodian refuses to accept the services, the county agency may request that a petition be filed under
s. 48.13 alleging that the child who is the subject of the report or any other child in the home is in
need of protection or services.
4. The county agency shall determine, within 60 days after receipt of a report, whether abuse or
neglect has occurred or that the child has been threatened with an injury and that abuse of the child
is likely to occur. The determination that abuse or neglect has occurred may not be based solely on
the fact that the child's parent, guardian or legal custodian in good faith selects and relies on prayer
or other religious means for treatment of disease or for remedial care of the child. In making a deter-
mination that emotional damage has occurred, the county agency shall give due regard to the culture
of the subjects and shall establish that the person alleged to be responsible for the emotional damage
is unwilling to remedy the harm. This subdivision does not prohibit a court from ordering medical
services for the child if the child's health requires it.
5. The county agency shall maintain a record of its actions in connection with each report it receives.
The record shall include a description of the services provided to any child and to the parents, guardian
or legal custodian of the child. The county agency shall update the record every 6 months.
SECTION 7. 48.981 (3) (c) 6 and 9 of the statutes are repealed.
SECTION 8. 48.981 (3) (c) 7 and 8 of the statutes are renumbered 48.981 (3) (c) 6 and 7 and amended
to read:
48.981 (3) (c) 6. The county agency shall, within 60 days after it receives a report from a person
required under sub. (2) to report, inform the reporter what action, if any, was taken to protect the
health and welfare of the child who is the subject of the report.
7. The county agency shall cooperate with law enforcement officials, courts of competent jurisdic-
tion, tribal governments and other human service agencies to prevent, identify and treat child abuse
and neglect. The county agency shall coordinate the development and provision of services to abused
and neglected children and to families where abuse or neglect has occurred or to children and families
where circumstances justify a belief that abuse will occur.
continued
20
WISCONSIN MEDICAL JOLRNAL, FEBRL ARV 1985:\OL. 84
1983 WISCONSIN ACT 172
SPECIAL
continued
SECTION 9. 48.981 (3) (c) 8 of the statutes is created to read;
48.981 (3) (c) 8. Using the format prescribed by the department, each county agency shall provide
the department with information about each report it receives and about each investigation it conducts.
This information shall be used by the department to monitor services provided by county agencies.
The department shall use nonidentifying information to maintain statewide statistics on child abuse
and neglect, and for planning and policy development.
SECTION 10. 48.981 (3) (d) of the statutes is repealed and recreated to read:
48.981 (3) (d) Independent investigation. If an agent or employee of a county agency required to
investigate under this subsection is the subject of a report, or if the county agency determines that,
because of the relationship between the county agency and the subject of a report, there is a substantial
probability that the county agency would not conduct an unbiased investigation, it shall, after taking
any action necessary to protect the child, notify the department. Upon receipt of the notice, the
department or an agency designated by it shall conduct an independent investigation. The powers
and duties of the department or other agency making an independent investigation are those given
to county agencies under sub. (3) (c). In this paragraph, "agent" includes, but is not limited to, a foster
parent or other person given custody of the child or a human service professional of a community
board established under s. 46.23, 51.42 or 51.437, if the professional is wuiking with the child under
contract with or under the supervision of the county agency.
SECTION 10m. 48.981 (4) of the statutes is amended to read:
48.981 (4) IMMUNITY FROM LIABILITY. Any person or institution participating in good faith in
the making of a report, conducting an investigation, ordering or taking . photographs or ordering
or performing medical examinations of a child under this section shali have immunity from any
liability, civil or criminal, that results by reason of the action. For the purpose of any proceeding, civil
or criminal, the good faith of any person reporting under this section shall be presumed.
SECTION 11. 48.981 (6) of the statutes is amended to read:
48.981 (6) PENALTY. Whoever wilfully violates this section by failure to report as required, may
be fined not more than $1,000 or imprisoned not more than 6 months or both.
SECTION 12. 48.981 (7) to (9) of the statutes are repealed.
SECTION 13. 48.981 (7) (a) 3 to 9 and 11 and (b) to (e) of the statutes are created to read;
48.981 (7) (a) 3. An attending physician for purposes of diagnosis and treatment.
4. A child's foster parent or other person having custody of the child.
5. A professional employe of a community board established under s. 46.23, or 51.42 or 51.437 who
is working with the child under contract with or under the supervision of the county agency.
6. A multidisciplinary child abuse and neglect team recognized by the county agency.
7. Another county agency currently investigating a report of suspected child abuse or neglect
involving the subject of the record or report.
8. A law enforcement officer or agency for purposes of investigation or prosecution.
9. A court or administrative agency for use in a proceeding relating to the licensing or regulation
of a facility regulated under this chapter.
11. The county corporation counsel or district attorney representing the interests of the public in
proceedings under subd. 10.
(b) Notwithstanding par. (a), either parent of a child may authorize the disclosure of a record for
use in a child custody proceeding under s. 767.24 when the child has been the subject of a report.
continued
WISCONSIN MEDICAL JOURNAL, FEBRUARY 1985: VOL. 84
21
SPECIAL
1983 WISCONSIN ACT 172
r.
continued
Any information that would identify a reporter shall be deleted before disclosure of a record under
this paragraph.
(c) Notwithstanding par. (a), a parent who is the subject of a report may authorize the disclosure
of a record to any other person. The authorization shall be in writing. Any information that would
identify a reporter shall be deleted before disclosure of a record under this paragraph.
(d) The department may have access to any report or record maintained by a county agency under
this section.
(e) A person to whom a report or record is disclosed under this subsection may not further disclose
it, except to the persons and for the purposes specified in this section.
SECTION 14. 48.981 (10) (title) of the statutes is renumbered 48.981 (7) (title).
SECTION 15. 48.981 (10) (a) 1. (intro.), a and b of the statutes are renumbered 48.981 (7) (a) (intro.),
1 and 2 and amended to read;
48.981 (7) (a) (intro.) All reports and records made under this section and maintained by the depart-
ment, county agencies and other persons, officials and institutions shall be confidential. Reports and
records may be disclosed only to the following persons:
1. The subject of a report, except that the person or agency maintaining the record or report may
not disclose any information that would identify the reporter;.
2. Appropriate staff of the department or a county agency.
SECTION 16. 48.981 (10) (a) 1. c and d of the statutes are renumbered 48.981 (7) (a) 10 and 12 and
amended to read;
48.981 (7) (a) 10. A court conducting proceedings related to a petition under s. 48.13 or a court
conducting dispositional proceedings under subch. VI in which abuse or neglect of the child who is
the subject of the report or record is an issue.
12. A person engaged in bona fide research, with the permission of the department. Information
identifying subjects and reporters may not be disclosed to the researcher.
SECTION 17. 48.981 (10) (a) 2 and 3 of the statutes are repealed.
SECTION 18. 48.981 (10) (b) of the statutes is renumbered 48.981 (7) (f) and amended to read:
48.98 1 (7) (f) Any person who violates this subsection, or who permits or encourages the unauthor-
ized dissemination or use of information contained in reports and records made under this section, may
be fined not more than $1,000 or imprisoned not more than 6 months or both.
SECTION 19. 48.981 (11) and (12) of the statutes are renumbered 48.981 (8) and (9), and 48.981
(9), as renumbered, is amended to read:
48.981 (9) ANNUAL REPORTS. No later than October 1 of each year the department shall prepare
and transmit to the governor and the legislature a report on the status of child abuse and neglect
programs. The report shall include a full statistical analysis of the child abuse and neglect reports made
through the last calendar year, an evaluation of services offered under this section and their effec-
tiveness, and recommendations for additional legislative and other action to fulfill the purpose of this
section. The department shall provide statistical breakdowns by county, if requested by a county.
SECTION 20. Nonstatutory provision. Six months after the effective date of this act, the department
of health and social services shall destroy all identifying records of the central child abuse registry
maintained under section 48.981 (8), 1981 stats. ■
V /
22
WISCONSIN' MFDICALJOl'RNAL. FEBRl'ARV 1985;VOL. 84
SCOUTS HONOR
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Consider the
causative organisms...
cefaclor
250-mg Pulvules” t.i.d.
offers effectiveness against
the major causes of bacteriai bronchitis
H. influenzae, H. influenzae, S. pneumoniae, S. pyogenes
(ampicillin-susceptible) (ampicillin-resistant)
Brief Summary Consult the package tileralure lor prescribing
inlormaiion
Indications and Usage Ceclor' (cefaclor. Lilly) is indicated in the
treatment of the following infections when caused by susceptible
strains of the designated microorganisms
Lower respiratory infections, including pneumonia caused by
Streptococcus pneumoniae iDiplococcus pneumoniaei. Haemoph
ilus mUueniae and 5 pyogenes (group A beia-hemolytic
streptococci)
Appropriate culture and susceptibility studies should be
performed to determine susceptibility of the causative organism
to Ceclor
Contraindication Ceclor is contraindicated in patients with known
allergy to the cephalosporin group of antibiotics
Warnings IN PENICILLIN-SENSITIVE PATIENTS. CEPHALO-
SPORIN ANTIBIOTICS SHOULD BE ADMINISTERED CAUTIOUSLY
THERE IS CLINICAL AND LABORATORY EVIDENCE OF PARTIAL
CROSS ALLERGENICITY OF THE PENICILLINS AND THE
CEPHALOSPORINS. AND THERE ARE INSTANCES IN WHICH
PATIENTS HAVE HAD REACTIONS. INCLUDING ANAPHYLAXIS.
TO BOTH DRUG CLASSES
Antibiotics, including Ceclor should be administered cautiously
10 any patient who has demonstrated some form of allergy,
particularly to drugs
Pseudomembranous colitis has been reported with virtually all
broad-spectrum antibiotics (including macrolides. semisynthetic
penicillins and cephalosporins): therefore, it is important to
consider its diagnosis in patients who develop diarrhea in
association with the use of antibiotics Such colitis may range in
seventy from mild to life-threatening
Treatment with broad spectrum antibiotics alters the normal
flora of the colon and may permit overgrowth of Clostridia Studies
indicate (hat a toxin produced by ClostnPium difficile is one
primary cause of antibiotic-associated colitis
Mild cases of pseudomembranous colitis usually respond to
drug discontinuance alone In moderate to severe cases, manage-
ment should include sigmoidoscopy, appropriate bacteriologic
studies and fluid, electrolyte, and protein supplementation
When the colitis does not improve after the drug has been
discontinued, or when it is severe, oral vancomycin is the drug
of choice tor antibiotic-associated pseudomembranous colitis
produced by C difficile Other causes of colitis should be
ruled out
Precautions General Precautions - if an allergic reaction to
Ceclor ‘ (cefaclor. Lilly) occurs, the drug should be discontinued,
and. if necessary, the patient should be treated with appropriate
agents, e g . pressor amines antihistamines, or corticosteroids
Prolonged use of Ceclor may result In the overgrowth of
nonsusceplible organisms Careful observation of the patient is
essential If superinfection occurs during therapy, appropriate
measures should be taken
Positive direct Coombs' tests have been reported during treat-
ment with the cephalosporin antibiotics In hematologic studies
or in transfusion cross-matching procedures when antiglobulin
tests are performed on the minor side or in Coombs’ testing of
newborns whose mothers have received cephalosporin antibiotics
before parturition, it should be recognized that a positive
Coombs test may be due to the drug
Ceclor should be administered with caution in the presence of
markedly impaired renal function Under such conditions, careful
clinical observation and laboratory studies should be made
because safe dosage may be lower than that usually recommended
As a result of administration of Ceclor. a false-positive reaction
tor glucose in the urine may occur This has been observed with
Benedict s and Fehling’s solutions and also with Clinitest*
tablets but not with Tes-Tape‘ (Glucose Enzymatic Test Strip.
USP. Lilly)
Broad-spectrum antibiotics should be prescribed with caution in
individuals with a history of gastrointestinal disease, particularly
colitis
Usage in Pregnancy - Pregnancy Category B - Reproduction
studies have been performed in mice and lats at doses up to 12
times the human dose and in ferrets given three times the maximum
human dose and have revealed no evidence of impaired fertility
or harm to the fetus due to Ceclor* (cefaclor, Lilly) There are.
however, no adequate and well-controlled studies in pregnant
women Because animal reproduction studies are not always
predictive of human response, this drug should be used during
pregnancy only if clearly needed
Nursing Mothers - Small amounts of Ceclor have been detected
in mother’s milk following administration of single 500-mg doses
Average levels were 0 18. 0.20. 0 21. and 0 Id mcg/ml at two.
three, four, and five hours respectively Trace amounts were
detected at one hour The effect on nursing infants is not known
Caution should be exercised when Ceclor is* administered to a
nursing woman
Usage in Children ~ Safety and effectiveness of this product for
use in infants less than one month of age have not been established
Adverse Reactions: Adverse effects considered related to therapy
with Ceclor are uncommon and are listed below
Gastrointestinal symptoms occur in about 2 5 percent of
patients and include diarrhea (1 in 70)
Symptoms of pseudomembranous colitis may appear either
during or after antibiotic treatment Nausea and vomiting have
been reported rarely
Hypersensitivity reactions have been reported in about 1 5
ercent of patients and include morbiliform eruptions (1 in 100)
ruritus. urticaria, and positive Coombs’ tests each occur in less
than 1 in 200 patients Cases of serum-sickness-like reactions
(erythema multiforme or the above skin manifestations accompanied
by arthriiis/arthralgia and. frequently, fever) have been reported
These reactions are apparently due to hypersensitivity and have
usually occurred during or following a second course of therapy
with Ceclor Such reactions have been reported more frequently
in children than in adults Signs and symptoms usually occur a few
days after initiation of therapy and subside within a few days
after cessation of therapy No serious sequelae have been reported
Antihistamines and corticosteroids appear to enhance resolution
of the syndrome
Cases of anaphylaxis have been reported, halt of which have
occurred in patients with a history of penicillin allergy
Other effects considered related to therapy included
eosinophilia (1 in 50 patients) and genital pruritus or vaginitis
(less than 1 in 100 patients)
Causal Relationship Uncertain ~ Transitory abnormalities in
clinical laboratory test results have been reported Although (hey
were of uncertain etiology, they are listed below to serve as
alerting information for the ph^ician
Hepatic - Slight elevations in SCOT. SGPT. or alkaline
phosphatase values (1 in 40)
Hematopoietic - Transient fluctuations in leukocyte count,
predominantly lymphocytosis occurring in infants and young
children (1 in 40)
Rena/ - Slight elevations in BUN or serum creatinine (less than
1 in 500) or abnormal urinalysis (less than 1 in 200)
(061782R1
Note Ceclor* (cefaclor, Lilly) is contraindicated in patients
with known allergy to the cephalosporins and should be given
cautiously to penicillin-allergic patients
Penicillin is the usual drug of choice in the treatment and
prevention of streptococcal infections, including the prophylaxis
of rheumatic fever See prescribing information
© 1984, ELI LILLY AND COMPANY
Uddifional information available to
the profession on reguesi from
Ell Lilly and Company.
Indianapolis Indiana 46285
Eli Lilly Indusiries. Inc
Carolina Puerto Rico 00630
SCIENTIFIC medicine)
V^ictor S Falk, MD, Medical Editor
c
Ethical decision-making
in the care of seriously
ill patients
Guenther P Pohlmann, MD, Milwaukee, Wisconsin
Abstract. Our limitation of resources and concerns with the quality of
human life have moved the ethical decision process into the center of medical
practice. This article reviews and discusses the legal, medical, philosophical,
and political aspects of ethical decision-making. It proposes an orderly
sequence of clinical assessment, communication with the patient and the
family, respect for their beliefs and values, and finally compassionate
guidance into the difficult choices. The appropriate documentation of this
process and the role of others involved in the care of the patient are outlined.
The role of consultants, physician peers, ethics committees, and courts in
the resolution of conflict is discussed. Finally, the article stresses the need
for a consensus among healthcare providers and the public which is generous
and flexible and not restrictive and impractical when cast into law.
Key Words: Ethical decision-making, Critical care, Medical ethics
Euthanasia has once again be-
come a burning issue. Our press is
still reverberating with comments
and reactions of public officials
concerning the extent and cost of
the care our elderly and seriously
ill receive in their last years of
life.* Once again we have entered
into the debate as to where the
wisdom is to control the new tech-
nology which our scientists and
technicians have developed for
us, a comprehensive technology
of hospitals, of human skills, of
machines and of procedures. Be-
fore I summarize and explain our
new insights, let me by contrast
recall the tragic abuse of euthana-
sia which 45 years ago occurred in
a highly civilized society.
In 1933 Hitler's government in
Reprint requests to: Guenther P Pohl-
mann, MD, 2025 East Newport Ave, Mil-
waukee, Wis 53211. Copyright 1985 by
the State Medical Society of Wisconsin.
Germany passed the "Law for the
Preservation of Offspring with
Hereditary Illnesses" which
mandated sterilization of certain
afflicted individuals. In 1935
Hitler contemplated the institu-
tion of active euthanasia to
eliminate "life unworthy of liv-
ing" but delayed it because of op-
position from the church. ^ In 1939
he issued an order authorizing a
small group of designated physi-
cians to grant mercy killing "to
certain diseased who are incur-
able by all human standards and
can be declared so on the basis of
a most critical evaluation. Ap-
proximately 100,000 patients with
intractable schizophrenia, severe
dementia, and criminal insanity
were thus eliminated. Public pro-
test by physicians, lawyers, and
courts became progressively
louder and the program had to be
halted in 1941.
These killings were not sanc-
tioned by German laws which
clearly stated that in 1944 "the
right to perform euthanasia on pa-
tients suffering from conditions
with lethal outcome cannot be
granted to physicians or any other
persons, even when the patient
desires relief from suffering.
The physicians responsible for
these mercy killings were sen-
tenced to death by the Nuremberg
War Crimes Tribunal.
These trials also brought out
that the mass extermination of
Jews and other aliens started on
German soil with the same medi-
cal selection process of "life un-
worthy of living" among the con-
centration camp inmates. This
tragedy— among the most horren-
dous of all times— thus began with
medical science and its practi-
tioners being pressed into the
service of a totalitarian ideology. ^
Active euthanasia has been a
crime since the principles of medi-
cal ethics were first formulated.
Physicians and the public should
be reminded of another old ad-
monition: "Thou shalt not kill but
needst not strive officiously to
keep alive." Therein lies the es-
sence of what we nowadays refer
to as "passive euthanasia." Can
we accept this?
An 83-year-old woman in
Phoenix, Arizona, recently re-
quested to be taken off the res-
pirator and be permitted to die.
Yet her physicians and hospital of-
ficials were afraid to comply with
her living will and sought a court
order for the protection of their
own actions.'* Two physicians in
California were recently submit-
ted to agonizing legal prosecution
because they had complied with a
family's wishes to remove feeding
tubes from a hopelessly brain-
damaged patient. Courts in New
Jersey are still struggling to decide
whether a nephew and legal guar-
dian of a severely demented but
not comatose elderly patient were
justified in requesting the with-
holding of all feeding. 5
WISCONSIN .MEDICAI.JOCRNAI., FEBRUARY 1985 :VOE. 84
25
SCIENTIFIC MEDICINE
ETHICAL DECISION-MAKING-Pohlmann
In discussing what an appropri-
ate public framework for ethical
decision-making should be,
Abram® remarked on the episodic
and fragmented nature of ad hoc
reactions by courts and legisla-
tures when conflict arises over
medical-ethical issues. He decries
the lack of a comprehensive,
orderly approach based on con-
census and fears that coercion by
government may take over if vol-
untary concensus does not suc-
ceed. Sharing these concerns I
wish to summarize here those
principles and practices of ethical
decision-making which seem to
have achieved widespread accep-
tance and to point out where con-
troversy still exists, and where col-
laborative deliberation and action
by physicians and other represen-
tative professionals may achieve a
new state of order.
Clinical decision-making is a
process which emanates from the
physician's mind and takes place
within the context of his medical
knowledge and wisdom. The con-
text of ethical decision-making,
however, entails values and prin-
ciples which may lie outside of
medicine proper and emanate
from the society and culture to
which both patient and physician
belong. The linguistic roots of the
word "ethics" lie in "customs,"
customs which are socially impor-
tant in the mutual relationships
between man and man and be-
tween man and his community. It
is, therefore, understandable that
ethical decision-making in medi-
cine has aroused public interest
and has mandated public partici-
pation. Death takes place increas-
ingly in public institutions rather
than at home as reflected in the
following statistics.’’
The incidence of dying in public
institutions in the USA
1949 1958 1977 1983
50% 61% 70% 80%
The sophisticated, new tech-
nology of patient care has been ap-
plied particularly in the care of the
critically ill and has often resulted
in the prolongation of dying rather
than the extension of useful life.
This has been coupled in the last
two decades with rising costs of
healthcare. Lately it has brought
more sharply into focus the limita-
tion of our economic resources
and other social priorities with
which healthcare expenditures
compete.
An ever-increasing share of
state and federal tax revenues
goes into the terminal care of the
elderly and others who are hope-
lessly ill. Cognizant of these wide-
spread concerns, the federal gov-
ernment has asserted its role in
the area of medical ethics in a
twofold manner: first by the crea-
tion of Institutional Review
Boards to which it delegated the
task of monitoring the use of
human subjects in experimenta-
tion and assuring the compliance
with ethical standards which
were updated in 1979;® secondly,
in the broader domain of patient
care and its ethical basis, by
assuming a directive capacity in
establishing the President's Com-
mission for the Study of Ethical
Problems in Medicine and Bio-
medical and Behavioral Research.
This commission published stan-
dards and guidelines of ethical
principles and practice which un-
questionably will have binding
effects.’’
Much can be said against the
government's meddling into the
ethics of medical practice. Medi-
cal-ethical decisions are essen-
tially private, transpire between
the physicians, the patients and
their families, are based on cul-
tural-spiritual values, and should
not be overshadowed by political
doctrine. Government involve-
ment may lead to the inappropri-
ate centralization of power, the
establishment of a rigid bureau-
cracy, and the infiltration of
medical practice by a political
morality.® On the other side,
medicine has been amiss in self-
regulation, in establishing appro-
priate standards for ethical deci-
sion-making and, more generally,
in addressing the public issues of
healthcare. 'These are: equitable
distribution of, and access to,
healthcare, and the progressive
limitation of financial resources.
Economics and ethics of health-
care intersect at the critical point
where valuable resources needed
for other programs are spent on
the needless extension of the
dying process in terminally ill pa-
tients. The definition and delinea-
tion of the term "quality of life"
transcends clinical medicine. It
encompasses moral judgment and
public values. It is central to all
deliberations on medical ethics
and has to be derived from public
consensus. Therefore, it appears
reasonable for the federal govern-
ment to assume a surrogate func-
tion for the public and catalyze
this process which ranges from
the collection of information to
the molding of values and judg-
ment. Here, as in other spheres of
its involvement, government will
become dangerous only when it
disengages from public input and
control and imposes coercion
which is not supported by con-
sensus.
The law has interposed itself in
ethical issues related to the care of
patients in various ways. As men-
tioned above, criminal prosecu-
tion of two California physicians
on charges of homicide recently
ended with their acquittal. They
had removed hydration and feed-
ing from a patient who was in an
irreversible coma due to anoxic
brain damage. Fear of similar
prosecution in the state of New
York, where there is no brain-
death law, resulted in the pro-
longed respirator support of a pa-
tient who was brain-dead from
intracranial hemorrhage despite
the family's request that all life
support be stopped."*
Apparently charges of ethical
26
WISCONSIN MEDICAL JOURNAL, FEBRUARY 1985:VOL. 84
ETHICAL DECISION-MAKING-Pohlmann
SCIENTIFIC MEDICINE
malpractice have been brought
against physicians resulting in
civil litigation, but to my knowl-
edge only one physician was
found negligent in this respect.
The case involved the discon-
tinuation of life support from a
brain-dead patient against the
wishes of the family® and is still
under appeal. Ironically litigation
against physicians could also re-
sult from the maintenance of life
support against the wishes of the
family, particularly for the re-
covery of the cost of care and on
the charge of assault and battery.’®
Uncertainty about the law,
about the appropriate process of
decision-making, and conflict be-
tween the wishes of the patient
and family on the one side, physi-
cians and hospitals on the other,
have resulted in court trials and
decisions. Among these are: the
Quinlan, Saikevicz, Brother Fox
and Storar cases, the verdicts of
which have helped to establish
clarification and precedent, but
also confusion and protest, as in
the Saikevicz case.”
State legislatures also have ad-
dressed ethical issues and passed
statutes which recognize brain
death as legal death, establish the
patient's right to a natural death
and the validity of a living will,
and delineate the powers of at-
torney of a surrogate. Wisconsin's
Natural Death Act* will be dis-
cussed below. In some states Hos-
pital Ethics or Prognosis Commit-
tees are recommended or man-
dated either as part of other legis-
lation or incidental to court deci-
sions as in the Quinlan case.
In general, government feels
obligated to assure the protection
of human life, while at the same
time guaranteeing to the patient
the constitutional right to privacy
and ensuant right to decide over
one's own health and life. It also
*1983 Wisconsin Act 202, Ch 154. Pub-
lished in toto in the June 1984 BLUE
BOOK issue of the Wisconsin Medical
Journal.
has to protect the individual from
suicidal self-destruction and pro-
tect the right of innocent third
parties such as children and other
dependents. Civil law, on the
other side, observes the abidance
by normative standards of medi-
cal and ethical practice and may
prosecute where these appear to
be violated.
The ethical decision process in-
volving congenitally deformed as
well as defective infants received
renewed attention with the recent
Baby Doe case. The government's
intrusion in these cases appears to
be premised on the patient's in-
competence and lack of self-
determination, the absence of a
"substitute judgment" approach
in contrast with adults as well as
the reliance on arguments of "best
interest" and "quality of life." As
heartbreaking and agonizing as
the decision-making may be in
these cases, they are few in num-
bers compared to the growing pro-
portion of the elderly in our pop-
ulation, every one of whom may
eventually have to decide what
type of care, and how much, to
demand before death.
Ethical decision-making in pedi-
atrics appears to have matured
into a visible system based on
established standards and experi-
ence. Ethics committees and for-
mal consultation emerged here
much earlier than in adult care.
Courts and judges also have ac-
quired a firm position in the ethi-
cal decisions process for the care
of infants and children whose
parents may be in conflict with
physicians and hospitals over
religious issues, as for instance
in the case of Jehovah's Wit-
nesses and other fundamentalist
groups.
On April 18, 1984, Governor
Earl signed into law Wisconsin's
Natural Death Statute, to take ef-
fect on October 1, 1984.’^’ It allows
a competent patient to forego life-
supportive measures and devices
in case of terminal illness and pro-
tects physicians and other provid-
ers from legal prosecution. In ad-
dition to Wisconsin, 15 other
states have similar laws: Alabama,
Arkansas, California, Delaware,
District of Columbia, Idaho, Kan-
sas, Nevada, New Mexico, North
Carolina, Oregon, Texas, Ver-
mont, Virginia, and Washington.
Most of these statutes, except
those of Arkansas, North Carolina
and Virginia, require that the pa-
tient be in a terminal condition
with death to occur regardless of
the application of special life-
support measures such as respira-
tors, vasopressor therapy, blood
transfusion, and dialysis.
In most of the statutes, includ-
ing Wisconsin's, the patient's ter-
minal condition must be certified
by consultants. In addition, in
Wisconsin the patient's death
should be imminent within 30
days. Also, under these statutes
competent patients may establish
such a "living will" anytime in
their lives, but there is no pro-
vision for the role of legal guar-
dians or surrogates to act on
behalf of incompetent patients.
Under the Arkansas and North
Carolina statutes the patient has
the right to refuse extraordinary
treatment which is "calculated to
prolong his life" (Arkansas) pro-
vided "his condition is deter-
mined to be terminal and incur-
able" (North Carolina). These two
statutes significantly digress from
the others in that the patients
covered by them have the right to
refuse treatment which violates
their concepts of quality of life.
These two statutes thus authorize
passive euthanasia while under
the others it is assumed that the
removal or withholding of life
support will not alter the patient's
inexorable progression to death.
Wisconsin's Natural Death
Statute would be applicable to pa-
tients with the following repre-
sentative conditions: A terminal
leukemia patient who is close to
death but experiences a complica-
WISCONSIN MEDICAL JOURNAL, FEBRUARY 1985: VOL. 84
27
SCIENTIFIC MEDICINE
ETHICAL DECISION-MAKING-Pohlmann
tion such as respiratory failure or
bleeding. In how many of these
patients do we not already with-
hold treatment after appropriate
consultation with the family in
order not to prolong suffering and
in order to conserve valuable re-
sources such as blood? And in
how many patients with terminal
cardiogenic shock have we al-
ready decided not to use cardio-
pulmonary resuscitation in case of
asystole or electromechanical dis-
sociation because it would be like
"whipping a dying horse?"
Just as in medicine, authorita-
tive groups assemble research and
clinical experience into compre-
hensive standards of medical care
and publicize them by presenta-
tion and publication, standards of
ethical practice have similarly
evolved. The following out-
lines the responsibilities of physi-
cians and institutional providers
in ethical decision-making.
An orderly decision process rec-
ognizes and attempts to procure
the patient's wishes and opinions.
It recognizes his constitutional
right to refuse treatment and to ac-
cept death where by common
sense and clinical experience this
appears to be appropriate. If pa-
tients are incompetent and cannot
make a decision or render an
opinion, surrogates should be ap-
pointed and to the best of their
ability decide for the patient. In-
competent patients, such as those
with Alzheimer's disease, may
still be able to understand the
need for a surgical procedure and
be able to consent to it. Thus, they
should be informed even though
the consent form may still require
the signature of their legal guar-
dians.
Surrogate decision-making may
be based on "substitute judg-
ment" which is the extrapolation
of the patient's previous known
attitudes and positions as ex-
pressed in a "living will" or other-
wise into the current clinical situ-
ation. If any previous statements
are nonexistent or unavailable as
in the case of newborn infants, the
principle of "best interest" should
prevail. What would be in the best
interest of the patient's represen-
tative situation, to be treated or
not, to live or to die?
Another important considera-
tion is that of "quality of life."
Human existence is characterized
by awareness, the ability to estab-
lish and maintain simple com-
munication and relationships, by
life-sustaining drives and reflexes
such as hunger, thirst, adequate
ventilation and airway clearance,
by a minimum of intelligence, and
by superimposed personal values
which may be highly specific and
escape normative standards.
Will the patient, with or without
treatment, continue to exist
within such a state? The physi-
cian's clinical assessment of the
patient's condition has to be in
order. This means the patient's
current condition and future prog-
nosis have to be identified as
closely as possible, if necessary
with the help of appropriate con-
sultants. Alternative therapeutic
approaches, if available, have to
be presented to patient and his
family, and their risks and bene-
fits should be discussed.
This does not mean that patient
and family are presented with a
menu of clinical options from
which they are expected to make
an agonizing choice. The physi-
cian is still in the best position to
weigh all factors and circum-
stances and to formulate a per-
sonal recommendation, better
than courts, ethics committees or
even grieving and confused family
members.*^ However, the pa-
tient's and family's acceptance of
this recommendation should be
one of full understanding and, as
much as possible, free of guilt and
shame. The presence of wit-
nesses, particularly nurses in-
volved in the care of the patient.
is highly recommended during the
conversation with the patient and
family. It will increase their in-
volvement, reduce their sense of
guilt when difficult steps will have
to be taken such as the removal of
life support, and assure the stabil-
ity of the entire decision process.
All conversations and decisions
should be documented in the pa-
tient's chart, but consenting sig-
natures are not required by the pa-
tient, family members or other
surrogates, or any witnesses.'^
Breaking bad news to the family
in itself represents clinical artistry.
It is best to use a stepwise ap-
proach in which, along with the
information about the patient's
condition, gradual insight into,
and understanding of, the disease
process is fostered. In the course
of a few days the family itself may
propose to the physician what he
or she intended to recommend
from the start. A conclusion
which results from the family's
own reasoning process is usually
accepted best. In order to achieve
it the physician should guide
rather than preempt the family
members' knowledge and think-
ing.
The way in which a family ac-
cepts the bad news of impending
death, a hopeless, terminal illness
or serious, probably permanent,
brain damage is similar to the con-
frontation of a patient with impen-
ding death. The initial disbelief
and shock is in proportion to the
unexpectedness of the illness or
accident. In place of the anger dis-
played by a dying patient the
family tends to show overt or
quiet dispair in anticipation of the
patient's loss. This may alternate
with or be displaced by realistic or
unrealistic hopes. Final accep-
tance and the ability to return to
a realistic discussion usually re-
quires another 24-48 hours. At
this point some clinical and ethical
decisions may have to be made
related to life support, organ dona-
tion, or transfer to lower levels of
28
WISCONSIN MEDICAL JOl'RNAI., FEBRUARY 1983: VOL. 84
ETHICAL DECISION-MAKING-Pohlmann
SCIENTIFIC MEDICINE
care. Ethical decision-making is
another psychological stress test
which may uncover anxiety and
guilt in the family members, but
on the other side the physician
may find them surprisingly well-
informed and prepared to tackle
the sensitive issues. I found the
latter to be the case particularly
among well-educated people and
those whose lives include strong
religious commitments.
It is my impression that the
decision to limit or terminate life
support in hopelessly ill patients is
also aided by the sensitivity and
courage of the physicians who are
responsible for the care of the pa-
tient, whether they are specialists
or responsible for the patient's
primary care. Most importantly,
the physician has to transcend the
immediate problems of the pa-
tient's organ failure, obtain an
overview of short- and long-range
prognosis and integrate it with the
patients' and families' views of
life, its values and qualities. It is
also helpful for the physicians to
have known the patients and their
families for some time. A recent
study of costs and outcomes on
the faculty and community serv-
ice of a university hospital lends
some support to this.^®
If a conflict exists such as dis-
sent between the physician, pa-
tient, and family that cannot be
overcome by the involvement of
a consultant, the next level of
referral should be a hospital ethics
committee or other appropriate
body. Beyond the ethics commit-
tee, recourse to a court will have
to be taken unless authoritative
figures in the medical community
such as a chief -of-staff or depart-
ment head could effectively arbi-
trate and enable the family or
physicians to accept the proposed
change in a care plan.
Statistics which are helpful in
estimating survival and neuro-
logic recovery are now available
for patients in traumatic and non-
traumatic coma, particularly
coma ensuing a cardiac arrest.'®
Persistent coma after three days
accompanied by evidence of
brain-stem injury is associated
with a less than 5% chance of
neurologic recovery to function-
ing state. Patients with coma due
to head injury or metabolic en-
cephalopathy may fare better be-
cause of less involvement in the
brain stem and mid-brain areas.
The limitation or termination of
life support can be entertained in
patients with coma who were ob-
served for at least three days and
whose poor prognosis is sup-
ported by the level of neurologic
damage and the course of coma.^'
Since these patients are unaware
of pain, hunger and thirst, even
food and water may be withheld
provided physicians and family
members concur in this deci-
sion.
Another dilemma is presented
by the patient in respiratory fail-
ure who requires continuous
mechanical ventilation. If alert
and competent, this patient may
request removal from the respira-
tor regardless of outcome. Physi-
cians and nursing staff can concur
in this request if all reversible
courses such as bronchopneu-
monia, excessive secretions, and
nutritional depletion are optimally
controlled. Even then the weaning
process should be gradual enough
to allow for the recovery of res-
piratory muscle function and the
necessary adjustment of acid-base
balance. A more rapid weaning
approach towards almost certain
death was recently described by
Grenvik and includes the judi-
cious use of morphine to control
the distress of dyspnea.
Multisystem failure in a patient
who is diffusely anasarcous, pro-
foundly hypoalbuminemic and
without hope of rapid nutritional
resuscitation is another situation
with almost certain lethal out-
come. Since associated cerebral
edema leaves these patients ob-
tunded and unaware of most dis-
tress, the merciful withdrawal of
the respirator, intravenous fluids,
and life-supporting medications
appears appropriate and can be
discussed with the family.
The Wisconsin Natural Death
Act requires that two physicians
certify the patient's terminal state
and that death is likely within 30
days. This attempt at prognostica-
tion can be highly inaccurate.
Nevertheless, some data have be-
come available to support progno-
sis in critical illness. Outcome in
shock is related to the level of the
blood lactate, 25 the degree of
mixed venous hypoxemia^® and
the presence or absence of an as-
sociated acute respiratory distress
syndrome. 22 It also can be pre-
dicted with close accuracy by the
computerized integration of mul-
tiple monitoring variables. 2® 29
In renal failure mortality is in-
creased by old age, coexisting car-
diac or respiratory failure, diffuse
tissue injury due to trauma or sep-
sis, and malnutrition.®® ®' 52,33
Intermittent hemodialysis for
chronic renal dialysis does not af-
fect the quality of life as much as
the dependence on a ventilator in
severe chronic respiratory failure.
Therefore, the decision to institute
assisted ventilation represents a
real, ethical dilemma.®'' Adult res-
piratory insufficiency of the non-
obstructive type covers a spec-
trum which ranges from irreversi-
ble tissue destruction and high
mortality to reversible, transuda-
tive edema and a good out-
come.®®®® ®^ Ventilatory failure as-
sociated with chronic obstructive
airway disease (GOAD) is usually
due to superimposed broncho-
pneumonia or the inspissation of
secretions, both potentially rever-
sible. Both types of respiratory
failure usually require immediate
intubation and ventilatory assist-
ance, yet many of the GOAD pa-
tients will be able to be weaned off
the ventilator after a few days and
have a 60%-70% one-year sur-
VVISCONSIN MEmCAl JOl'RNAL, FEBRUARY 1985:VOL. 84
29
SCIENTIFIC MEDICINE
ETHICAL DECISION-MAKING-Pohlmann
vival rate. On the other side, more
insiduously developing ventila-
tory failure in GOAD, at first
amenable to conservative therapy
and then followed by progressive
decompensation, reflects a higher
ratio of irreversible to reversible
disease, is associated with a higher
mortality and the risk of perma-
nent respirator dependency.
Second and third recurrences of
ventilatory failure carry a mor-
tality rate of 17%-44% per epi-
sode, and a two-year mortality
rate of 66%-70%.3S39 Therefore,
the following is a reasonable
guideline for the patient with
chronic obstructive airway dis-
ease;
1. Institute immediate ventila-
tory assistance if the patient
is in acute ventilatory failure
unless the patient or his
family have made a valid
declaration to the contrary.
2. If conservative therapy ap-
pears feasible, it should be
instituted first. If it fails,
assisted ventilation and its
risks of creating permanent
or long-term ventilator de-
pendence should be dis-
cussed with the patient-
family. It is reasonable for the
patient to reject assisted ven-
tilation particularly if it had
been used before. Previous
tracheal intubations or trach-
eostomy also increase the
risk of progressive tracheal or
subglottic stenosis.
A Massachusetts court decision
in the case of Dinnerstein af-
firmed the right of family mem-
bers to decide against resuscita-
tion in the case of an incompetent,
severely demented patient.
When deliberating such limita-
tions of care, one should specify,
however, whether cardiopul-
monary resuscitation itself is
meant or other resuscitative meas-
ures such as the use of a respirator
or vasopressor drugs with inva-
sive monitoring.
In the context of cardiopul-
monary resuscitation (CPR) a case
can be made for the distinction of
clinical vs ethical decision-
making.On clinical grounds one
may advise against CPR when a
patient is already in cardiogenic
shock, when a patient with severe
chronic obstructive pulmonary
disease could not tolerate the risk
of fractured ribs or a flail chest, or
when existing brain damage en-
tails the risk of further aggravation
by any reduction of cerebral blood
flow albeit temporary. Here a
physician may recommend
against these measures out of
clinical benefit vs risk considera-
tions similar to a surgeon refusing
to operate on a high-risk patient.
If clinical reasons against CPR are
insufficient, ethical arguments
move into the foreground and
should be handled through the
same process of ethical decision-
making outlined above.
In many of the categories exem-
plified above the patient is usually
competent and functioning until
overcome by a catastrophic illness
which requires extraordinary
means of life. support. This con-
trasts with another type of patient
who is no longer competent be-
cause of an irreversible disease
process of the brain and who has
been permanently reduced to a
less-than-human level of function
and existence.
Deliberations in courts, by the
President's Commission, by ex-
perts in medical ethics, and by
prominent clinicians have
achieved some consensus on the
ethical justification of limiting life
support in these classes of pa-
tients.Since the irreversibly
comatose patient is unaware of
any distress and no longer repre-
sents genuine human existence,
complex life support such as res-
pirators, life-saving surgery, and
blood transfusions may be with-
held, as well as simple life support
represented by food and water.
However, depriving the patient of
basic body hygiene such as skin
cleansing, care of evacuation, and
care of decubitus ulcers may be
offensive to family members and
the personnel responsible for the
patient's care, and this basic care,
therefore, should be sustained.
The demented but awake pa-
tient also could be deprived of all
resuscitative measure but should
still be afforded food, water, and
other means of comfort and basic
care. Whether to use antibiotics or
blood transfusions in such pa-
tients is controversial but could be
resolved by a more thoughtful
decision process which looks at
quality of life, prognosis, and level
Table Summary of current consensus concerning the
and demented patients
care of comatose
Life Support
For Whom?
Irreversible
Awake
comatose
demented
Complex: Respirators, invasive
monitoring, vasopressor therapy,
dialysis, transplantation
no
no > maybe
Surgery or other invasive
procedures
no
no > maybe
Noninvasive complex therapy
(tumor chemotherapy)
no
no > yes
Simple therapy
(antibiotics for infections)
no > maybe
no > yes
Simple life support
(food, water)
no > yes
yes
Basic body hygiene
yes
yes
30
WISCONSIN MEDICAL JODRNAI., FEBRUARY I985:VOL. 84
ETHICAL DECISION-MAKING-Pohlmann
SCIENTIFIC MEDICINE
of distress. Patients with incurable
malignancy, dementia, loss of
basic biological drives such as eat-
ing or coughing are less likely to
be treated than patients who are
more intact and have a better
prognostic outlook.
Table 1 summarizes the current
consensus concerning the care of
these types of patients.
The issue of administering food
and water to comatose, demented
or competent and chronically ill
patients is still controversial. The
recent decision of a California ap-
pellate court in Barber vs Superior
clearly absolved two physicians of
any wrongdoing when they
obeyed the family's wishes and
withheld food and water from a
permanently comatose patient.
This is also supported by the
President's Commission.
Recently a New York court up-
held the right of an 85-year-old
competent patient to refuse nour-
ishment because of his despon-
dency over ill health."^ This con-
trasts with the 1983 decision of a
California court in which a 26-
year-old patient with nonterminal
cerebral palsy was denied the
right to assistance by institutional
personnel in her effort to end her
life by starvation. In this latter
case it may have been the pa-
tient's youth or her nonterminal
illness which may have persuaded
the court to decide in favor of
society's obligation to preserve life
rather than the patient's right to
the privacy of a quiet death.
Under Wisconsin's Natural
Death Act food and water are ex-
cluded from the means of life sup-
port which may be withheld or
withdrawn from a terminally ill
patient who has made a valid liv-
ing will. This provision is a vari-
ance with all other natural death
laws which exclude only medica-
tion or medical procedures neces-
sary to provide comfort care or to
alleviate pain. Can one, therefore,
withhold food or water from a pa-
tient in Wisconsin? Probably so, if
the patient and family desire it, if
the patient has a hopeless or ter-
minal disease in which by all rea-
sonable standards death is prefer-
able to continued misery, and if
the patient's or the surrogate's
wishes are in accordance with the
constitutional right to privacy.
However, this decision would not
be sheltered by legal immunity.
Even though the Wisconsin
Natural Death Act includes the
statement that it "does not impair
or supersede any person's legal
right or responsibility to withhold
or withdraw life-sustaining pro-
cedures," it also implies that
physicians and other providers
who comply with requests for
withdrawal or withholding of life
support under circumstances
other than those specified in the
act could be held criminally or
civilly liable for their actions. It
appears that the Wisconsin Nat-
ural Death Act is unsatisfactory in
many aspects: (1) it covers too
small a number of clinical situa-
tions for which clinical practice
has already established adequate
standards, (2) it does not address
the majority of cases in which life
support does postpone death
albeit at the cost of significant suf-
fering and compromised quality
of life, and (3) by providing legal
immunity to physicians in a
greatly restricted number of clin-
ical situations, it may by contrast
increase their vulnerability to
legal and civil prosecution in the
other situations. This could make
physicians more reluctant to dis-
continue or withhold life support
in cases which fall outside of the
statute with the ironic result that
for these patients the psychologi-
cal and financial costs of their care
will increase.
The State of California recently
passed a durable power of attor-
ney for healthcare statute under
which competent persons may
designate a family member or en-
trusted friend to make relevant
decisions concerning their care
should they become incapaci-
tated.This decision-making by
proxy may rest on the principle of
"substitute judgment" or "best
interest" and addresses itself par-
ticularly to the issues of life sup-
port, its institution, limitation, or
withdrawal. This new law does
not impose as many clinical limi-
tations and restrictions as the
natural death acts do and seems to
allow for more interpretative deci-
sions by the physicians them-
selves. It arose out of the dissatis-
faction with California's natural
death act and seems to point the
way for us in Wisconsin as we are
also confronted with the short-
coming of our own recently en-
acted statute.
In the meantime, much of our
ethical decision-making will have
to continue to be guided by our
compassion for the patients and
their families as well as good clin-
ical judgment. Our own legal
safety will have to rest on the con-
sensus arrived at between physi-
cians, patients, and family mem-
bers as well as all others directly
involved in the care of the patients
in question. In addition, we have
to ascertain that an appropriate
process of decision-making is fol-
lowed with due recognition of
current standards of our medical
community. This would also re-
quire that more consensus is
achieved among clinicians as to
how far one should go and how
long one should treat patients
with the more common condi-
tions such as irreversible debilita-
tion, the terminal cancer patient
who may not yet die within the
next 30 days, or the patient with
severe cardiopulmonary dis-
ability. Since we are obligated to
have the patients and their fam-
ilies concur in our recommenda-
tions, we have some assurance
that this consensus of a group of
clinicians is not mistaken for a
conspiracy.
The extensive list of references is available
upon request to the author.
WISCONSIN MEDICAL JOURNAL, FEBRUARY 1985: VOL. 84
31
SCIENTIFIC MEDICINE
Malignant mesothelioma
Warren H De Kraay, MD, Kenosha, Wisconsin
Abstract. The recent publicity
regarding asbestos exposure in
public buildings, asbestos liability
suits, and increasing incidents of
mesothelioma prompted a study of
mesothelioma in Southeast Wiscon-
sin. During the past few years, an in-
crease in the reported cases of meso-
thelioma has been noted in Racine
and Kenosha counties. Certain clini-
cal and radiological findings of meso-
thelioma are emphasized in this
report to enable the physician to
make an early diagnosis so prompt
treatment can be instituted.
Key words. Mesothelioma, Asbestos
body. Pleural plaques
During the past few years
there has been a significant in-
crease in mesothelioma cases in
this area and nationally. ^ Since
mesothelioma is rare and difficult
to diagnose, physicians should be
alert regarding the diagnosis and
treatment of this disease. Asbes-
tos and mesotheliomas have been
correlated since 1960 when a
South African physician, JC Wag-
ner, MD, discovered an increas-
ing number of mesothelioma
cases in workers in a nearby
asbestos mine.^ The medical pro-
fession has taken note of this
problem; and since 1964, inten-
sive investigation regarding the
relationship between asbestos
and mesothelioma and followup
of asbestos workers has been
accomplished.
Reprint requests to: Warren H De Kraay,
MD, 3618 Eighth Ave, Suite 5, Kenosha,
Wis 53140 (phone: 414/552-7211).
Copyright 1985 by the State Medical
Society of Wisconsin.
In the years 1970 to 1980 there
were five cases of mesothelioma
diagnosed in the Racine and
Kenosha areas. Between the
years 1981 and 1982 seven cases
of mesothelioma were diagnosed
in the same two counties. During
the years of 1940 to 1980, 27
million people working in 1 1 US
occupations were exposed to
asbestos. Eighteen thousand
workers in the International
Association of Heat and Frost In-
sulation and Asbestos Workers
Union have been followed peri-
odically regarding the develop-
ment of mesothelioma,^ and it is
estimated that 7% of all asbestos
workers will eventually develop
mesothelioma between 20 to 40
years after their exposure. Since
there is a long interval between
exposure to asbestos and cancer,
a gradual increase in related
deaths will occur until 1990.
It is estimated that between
8000 and 9000 deaths, directly
related to asbestos, will occur
yearly for the next 20 years. In
nearly 80% of malignant meso-
thelioma cases, a history of an
exposure to asbestos can be ob-
tained. However, the duration of
exposure to asbestos is difficult to
correlate with the onset of meso-
thelioma. Although a definite
threshold has not been estab-
lished, it appears that the workers
in the mines or in an area where
there is heavy exposure seem to
develop the disease more readily
than a bystander-type of ex-
posure. However, family mem-
bers whose only exposure had
been to asbestos contaminated
clothes have also developed the
disease.
Asbestos fibers are highly car-
cinogenic with mesothelioma of
either the pleural or peritoneal
cavity readily induced with ex-
perimental instillation of the
fibers.'* Involvement of the peri-
toneal surface is considered to be
either secondary to direct exten-
sion from the pleural surface
through the diaphragm or secon-
dary to swallowing fibers after
the respiratory cilia has moved
the fibers from the respiratory
tract into the oral cavity.
Benign asbestos disease. Asbes-
tos fibers can result in benign vari-
ants of the asbestos related dis-
ease, such as:
1. Pleural plaques.
2. Calcification of pleural
plaques.
3. Pleural effusion.
Asbestos fibers are found in a
large percentage of patients with
pleural plaques, and pleural
plaques may be considered to be
diagnostic of asbestos exposure.
Pleural plaques usually occur on
the diaphragm or posterior lateral
chest wall and the visceral pleura
is not involved. Asbestos fibers
and asbestos bodies are often
embedded in the dense fibrous
tissue. When the asbestos fiber is
located in the respiratory tract, a
protein coating results and an
"asbestos body" is formed. This is
a yellow-brown pigmented,
beaded linear structure, which
also can be found in association
with other silicates. Pleural calci-
fication is usually considered as a
later manifestation of pleural
plaques. Pleural effusion can oc-
cur with benign disease, but it is
usually associated with malignant
mesothelioma. Ninety percent of
patients with malignant meso-
thelioma develop pleural effusion.
There is no conclusive evidence of
pleural plaques progressing to
malignant mesothelioma; but
32
WISCONSIN MEDICAI JOl’RNAI., FEBRliARV 1985:\'OE. 84
MESOTHELIOMA-De Kraay
SCIENTIFIC MEDICINE
since pleural plaques denote ex-
posure to asbestos, these patients
should be followed as prospective
candidates for the development of
malignant mesothelioma.
Case 1. A 67-year-old white male
consulted his family physician be-
cause of dyspnea and weakness.
He had worked in an asbestos
plant for four years, 25 years
previously. Physical examination
revealed a slender white male
with moderate dyspnea. A chest
x-ray film revealed a right pneu-
mothorax. A chest tube was in-
serted with gradual reexpansion
of the lung. The chest tube was
removed after five days and full
lung expansion was noted.
One week later recurrent right
pneumothorax was detected, and
reinsertion of the chest tube was
performed. An air leak persisted
for seven days, and a thoracotomy
was performed.
At thoracotomy calcified
plaques were present over the
diaphragm and the lateral chest
wall. A pleural bleb was excised
and the lung oversewn. Pleuro-
desis was performed. The excised
tissue was examined at three
medical centers, and a diagnosis
of malignant mesothelioma was
made. The patient underwent
thoracotomy at another clinic and
no obvious malignancy was
found. Partial pleurectomy was
done and a 4-mm section of the
pleura was diagnosed as malig-
nant mesothelioma. The patient
has done well postoperatively.
Obviously this represented an
unusual situation in which the
diagnosis was strictly accidental
and the clinical diagnosis unsus-
pected.
Case 2. A 62-year-old white fe-
male noted dyspnea and chest
pain on the right side for two
weeks prior to hospitalization. A
chest x-ray film revealed right
pleural effusion but no definite
masses. She had no known ex-
posure to asbestos.
A physical examination re-
vealed minimal dyspnea and de-
creased breath sounds in the chest
on the right side. Thoracentesis
yielded bloody fluid, and malig-
nant cells were found. Pleural
biopsy revealed malignant meso-
thelioma.
Since there was no gross chest
nodularity on the left side and the
right lung was clear, a Stage I
mesothelioma was diagnosed. A
pleuropneumonectomy was per-
formed with partial diaphragm
excision. No obvious spread to
mediastinal tissue was noted.
Postoperatively the patient re-
covered uneventfully. Radiation
and chemotherapy were planned,
but the patient never regained her
strength enough to tolerate ad-
junctive therapy.
Three months postoperatively a
left pleural effusion developed
which also contained malignant
cells. The patient gradually deteri-
orated and died.
Symptoms of malignant meso-
thelioma. Most patients with
mesothelioma complain of chest
pain associated with dyspnea and
weight loss of approximately six
months duration.
Laboratory work is usually un-
remarkable.
Diagnosis: Chest radiography
will reveal a pleural effusion often
associated with pleural nodularity
or pleural plaques which may or
may not be calcified.
Tissue diagnosis has been a
problem. The differentiation be-
tween metastatic adenocarcinoma
of pleura and mesothelioma has
been difficult, but has been aided
by special stains and electron
microscopy.
Pleural fluid analysis and needle
biopsy of the pleura are frequently
nondiagnostic and open lung
biopsy is often needed. In one
series of 32 patients, the diagnosis
was delayed for over two months
in seven patients because of in-
conclusive pathological findings
and delay in obtaining an open
biopsy. Both fibrous and epithelial
components are present in various
degrees in the specimen.
Grossly a thick, gray-white
mass compressing the bronchi
and lung is found.
STAGING; Staging of the tumor has
assisted in evaluation, treatment,
and prognosis;^
Stage I; Tumor confined to
pleura, lung, and pericardium.
Stage II; Invasion of the chest
wall and mediastinum.
Stage III: Penetration of the
diaphragm and lymph node
metastases.
Stage IV: Distant metastases.
The diagnosis of malignant
mesothelioma carries a dismal
prognosis with very few five-year
survivals. Several series average a
10-month to 12-month survival
after diagnosis.
Table 1— Results of surgical resection for mesothelioma
Study
Year
No. OF
Patients
Type of
Resection
% of Patients
Surviving
One
Two
Three
Year
Years
Years
Worn®
1974
186
Radical
75
34
9
62
"Palliative”
68
37
10
Butchart^
1976
29
Radical
30
10
3
Wanebo®
1976
33
Pleurectomy
NS
30
15
DeLaria®
1978
11
Radical
36
27
0
Antman'®
1980
10
Pleurectomy
70
30
10
WISCONSIN MED1CAI.JOURNAL, FEBRUARY 1985: VOL. 84
33
SCIENTIFIC MEDICINE
MESOTHELIOMA-De Kraay
Therapy. Patients with Stage I
disease are treated with either
pleurectomy or pleuropneumo-
nectomy followed by radiother-
apy and chemotherapy. A few
five-year survivals have resulted.
As noted in Table 1, an approxi-
mate 10% three-year survival was
the best that could be obtained in
the listed surgical series.
Malignant mesothelioma us-
ually spreads locally and results in
death by respiratory or cardiac
failure secondary to local invasion
rather than metastatic disease.
Mesothelioma may extend
through the diaphragm into the
peritoneal cavity with resultant
bowel obstruction.
Palliation with radiotherapy
and chemotherapy has resulted in
an increased survival as compared
to no treatment. Chemotherapy
using doxorubicin hydrochloride
(Adriamycin™) seems to be most
effective.
In 1976 asbestos fibers were
found in the drinking water in
Duluth, Minnesota, and a careful
evaluation was done to determine
if an increased evidence of gas-
trointestinal carcinoma or peri-
toneal malignancy could be
found. No evidence of increasing
carcinoma was found as com-
pared to other areas in the state. “
Current management of pa-
tients with malignant mesotheli-
oma should be in accordance with
the following protocol. Patients
without extrapulmonary disease
who are clinically suitable have
thoracotomy and extra pleuro-
pneumonectomy.
The importance of tissue type,
epithelial versus fibrous, to sur-
vival is unknown.
If extrapulmonary disease is
present, intensive radiation fol-
lowed by multiple drug chemo-
therapy using doxorubicin hydro-
chloride should be considered.
Summary. There will be an in-
creasing incidence in mesotheli-
oma during the next several years
because of the delayed onset of
malignant mesothelioma follow-
ing asbestos exposure 20 to 30
years ago.
The most frequent finding of
mesothelioma is a pleural effusion
that may evade a definite diagno-
sis.
Although surgical cures are
scarce, surgery followed by radia-
tion and chemotherapy seems to
be the best treatment at this time
for Stage I malignancies.
References
1. Selikoff IJ: Mortality experience of insula-
tion workers in the United States and
Canada, 1943-1976. Ann NY Acad Sci 1979:
330-91-116.
2. Wagner JC, SleggsCA, Marchand P: Diffuse
pleural mesothelioma and asbestos ex-
posure in the North-West Cape Province.
Brit J Industrial Med 1960;17:260-271.
3. Selikoff IJ: Asbestos-associated disease.
Public Health and Preventive Medicine, 11th
Ed, 1980, pp 568-641.
4. Smith W, et al: An experimental model for
treatment of mesothelioma. Cancer 1981:47:
658-663.
5. Antman K: Malignant mesothelioma N
Engl J Med 1980(July 24);303:200-202.
6. Wb'rn H: Mb'glickeiten und ergebnisse der
chirugishen behand des malignen pleura-
mesothelioms. Thoraxchirugie 1974;22:
391-393.
7. Butchart EG, Ashcroft T, et al: Pleuropneu-
monectomy in the management of diffuse
malignant mesothelioma of the pleura: ex-
perience with 29 patients. Thorax 1976;31:
15-24.
8. Wanebo HJ, Martini N, Melamed MR, et al:
Pleural mesothelioma. Cancer 1976;38:
2481-2488.
9. DeLaria GA, Jensik R, et al: Surgical
management of malignant mesothelioma.
Ann Thorac Surg 1978;26:375-382.
10. Antman KH, Blum RH, Greenberger JS, et
al: Multimodality therapy for malignant
mesothelioma based on a study of natural
history. Am / Med 1980;68:356-362.
11. Masson TJ: Asbestos-like fibers in Duluth
water supply. /AMA 1974|May 20);228(8):
1019. ■
A survey showing current status of medical directors
and long-term care facilities in Wisconsin
Mary Ann Zilz, RN, Madison, Wisconsin
A survey was performed to evaluate medical directors' involve-
ment in long-term care facilities to determine: (1) current activities
of the medical director as compared to standard 5 of the JCAH
Accreditation Manual for Long-term Care Facilities, (2) hours of
medical director involvement, and (3) reimbursement. Of the 315
questionnaires mailed, 42% (133) responded. Findings suggest
that the majority of medical directors state that they are comply-
ing with the activities required. There was a wide variation in
hours of work reported with an overall median of 8 hours per
month. There was no relationship between the number of hours
of work reported and reimbursement. Only 54% of the respond-
ents reported that they had written job descriptions and only
50% of the respondents who sent a copy of their job description
(1) clearly delineated accountability to the board [8 of 18] or
administration [1 of 18] and (2) clearly defined who was responsi-
ble for liability insurance coverage [9 of 18]. Recommendations
regarding job descriptions are made.
The entire article is available upon request to: Mary Ann Zilz, RN, 5126 Whit-
comb Drive, Madison, Wisconsin 5371 l.B
34
WISCONSIN MEDICAL JOLRNAL, FEBRL'ARY 1983:VOL. 84
New studies uncover
the potassium effects of
beta-2 blockade
Clinical pharmacology data
from The New England journal
of Medicine:
. .when normal young men are given
infusions of epinephrine at levels such
as those that circulate in patients with
myocardial infarction, their serum
potassium concentrations fall by about
0.8 [mmol] per liter. Hypokalemia is
prevented by selective beta-2
blockade."’
Evidence
that all be
are not created equal.
I
Once-daily INDERAL LA
(propranolol HCI) for
smooth blood pressure
control without the
potassium problems
of diuretics
Once-daily INDERAL LA (propranolol HCI)
avoids the risk of diuretic-induced ECG ab-
normalities due to hypokalemia.^ ^ In addi-
tion, INDERAL LA preserves potassium
balance without additive agents or supple-
ments while providing simple, well-tolerated
therapy with broad cardiovascular benefits.
i
Once-daily INDERAL LA
for the cardiovascular
benefits of the world's
leading beta blocker
Simply start with 80 mg once daily. Dosage
may be increased to 1 20 mg to 1 60 mg once
daily as needed to achieve additional control.
Like conventional INDERAL tablets,
INDERAL LA should not be used in the
presence of congestive heart failure, sinus
bradycardia, heart block greater than first
degree, and bronchial asthma.
80 mg 120 mg 160 mg
The appearance of these capsules
is a registered trademark
of Ayerst Laboratories.
Please see brief summary of prescribing information
on the next page for further details.
Once~daity
^'‘^■Al^^flNDERALLA
(PROPRANOLOL HCI)
LONG ACTING
CAPSULES
The appearance ol these capsules
IS a registered trademark
of Ayerst Laboratories
BRIEF SUMMARY (FOR FULL PRESCRIBING INFORMATION. SEE PACKAGE CIRCULAR )
INDERAL’ LA brahd of propranolol hydrochloride (Long Acting Capsules)
DESCRIPTION. Inderal LA is formulated to provide a sustained release of propranolol
hydrochloride Inderal LA is available as 80 mg, 120 mg. and 160 mg capsules
CLINICAL PHARMACOLOGY. INDERAL is a nonselective beta-adrenergic receptor
blocking agent possessing no other autonomic nervous system activity It specifically com-
petes with beta-adrenergic receptor stimulating agents for available receptor sites When
access to beta-receptor sites is blocked by INDERAL, the chronotropic, inotropic, and
vasodilator responses to beta-adrenergic stimulation are decreased proportionately
INDERAL LA Capsules (80, 120, and 160 mg) release propranolol HCI at a controlled and
predictable rate Peak blood levels following dosing with INDERAL LA occur at about 6 hours
and the apparent plasma half-life is about 10 hours When measured at steady slate over a 24-
hour period the areas under the propranolol plasma concentration-time curve (AUCs) lor the
capsules are approximately 60% to 65% ol the AUCs lor a comparable divided daily dose ol
INDERAL tablets The lower AUCs for the capsules are due to greater hepatic metabolism of
propranolol, resulting from the slower rate of absorption of propranolol Over a twenty-four (24)
hour period, blood levels are fairly constant for about twelve (12) hours then decline
exponentially
INDERAL LA should not be considered a simple mg lor mg substitute for conventional
propranolol and the blood levels achieved do not match (are lower than) those of two to tour
times daily dosing with the same dose Wheh changing to INDERAL LA from conventional
propranolol, a possible need lor retitration upwards should be considered especially to
maintain effectiveness at the end of the dosing interval In most clinical settings, however,
such as hypertension or angina where there is little correlation between plasma levels and
clinical effect. INDERAL LA has been therapeutically equivalent to the same mg dose of
conventional INDERAL as assessed by 24-hour effects on blood pressure and on 24-hour
exercise responses of heart rale, systolic pressure and rate pressure product INDERAL LA
can provide effective beta blockade for a 24-hour period
The mechanism of the antihypertensive effect of INDERAL has not been established
Among the factors that may be involved in contributing to the antihypertensive action are (1)
decreased cardiac output. (2) inhibition ol renin release by the kidneys, and (3) diminution of
tonic sympathetic nerve outflow from vasomotor centers in the brain Although total peripheral
resistance may increase initially, it read|usls to or below the pretrealment level with chronic
use Effects on plasma volume appear to be minor and somewhat variable INDERAL has
been shown to cause a small increase in serum potassium concentration when used in the
treatment of hypertensive patients
In angina pectoris, propranolol generally reduces the oxygen requirement of the heart at
any given level of effort by blocking the catecholamine-induced increases in the heart rate,
systolic blood pressure, and the velocity and extent ol myocardial contraction Propranolol
may increase oxygen requirements by increasing left ventricular fiber length, end diastolic
pressure and systolic election period The net physiologic effect of beta-adrenergic blockade
IS usually advantageous and is manifested during exercise by delayed onset of pain and
increased work capacity
In dosages greater than required for beta blockade, INDERAL also exerts a quinidine-like
or anesthetic-like membrane action which affects the cardiac action potential The signifi-
cance of the membrane action in the treatment of arrhythmias is uncertain
The mechanism of the antimigraine effect of propranolol has not been established Beta-
adrenergic receptors have been demonstrated in the pial vessels of the brain
Beta receptor blockade can be useful in conditions in which, because of pathologic or
functional changes, sympathetic activity is detrimental to the patient But there are also
situations in which sympathetic stimulation is vital For example, in patients with severely
damaged hearts, adequate ventricular function is maintained by virtue of sympathetic drive
which should be preserved In the presence ol AV block, greater than first degree, beta
blockade may prevent the necessary facilitating effect of sympathetic activity on conduction
Bela blockade results in bronchial constriction by interfering with adrenergic bronchodilator
activity which should be preserved in patients sub|ect to bronchospasm
Propranolol is not signilicanlly dialyzable
INDICATIONS AND USAGE. Hypertension: INDERAL LA is indicated in the manage-
ment of hypertension, it may be used alone or used in combination with other antihypertensive
agents, particularly a thiazide diuretic INDERAL LA is not indicated in the management ot
hypertensive emergencies
Angina Pectoris Due to Coronary Atherosclerosis: INDERAL LA is indicated
for the long-term management of patients with angina pectoris
Migraine: INDERAL LA is indicated for the prophylaxis of commoh migraine headache
The efficacy of propranolol in the treatment of a migraine attack that has started has not been
established and propranolol is not indicated for such use
Hypertrophic Subaortic Stenosis: INDERAL LA is useful in the management of
hypertrophic subaortic stenosis, especially lor treatment of exertional or other stress-induced
angina, palpitations, and syncope INDERAL LA also improves exercise performance The
effectiveness ol propranolol hydrochloride in this disease appears to be due to a reduction of
the elevated outflow pressure gradient which is exacerbated by beta-receptor stimulation
Clinical improvement may be temporary
CONTRAINDICATIONS. INDERAL is contraindicated in 1) cardiogenic shock, 2) sinus
bradycardia and greater than first degree block. 3) bronchial asthma. 4) congestive heart
failure (see WARNINGS) unless the failure is secondary to a tachyarrhythmia treatable with
inderal
WARNINGS. CARDIAC FAILURE Sympathetic stimulation may be a vital component sup-
porting circulatory function in patients with congestive heart failure, and its inhibition by beta
blockade may precipitate more severe failure Although beta blockers should be avoided in
overt congestive heart failure, if necessary, they can be used with close follow-up in patients
with a history of failure who are well compensated and are receiving digitalis and diuretics
Beta-adrenergic blocking agents do not abolish the inotropic action of digitalis on heart
muscle
IN PATIENTS WITHOUT A HISTORY OF HEART FAILURE, continued use ot beta blockers
can, in some cases, lead to cardiac failure Therefore, at the first sign or symptom of heart
failure, the patient should be digitalized and/or treated with diuretics, and the response
observed closely, or INDERAL should be discontinued (gradually, if possible)
IN PATIENTS WITH ANGINA PECTORIS, there have been reports of exacerbation ot
angina and. in some cases, myocardial infarction, following abrupt discontinuance of
INDERAL therapy Therefore, when discontinuance of INDERAL is planned the dosage
should be gradually reduced over at least a few weeks, and the patient should be
cautioned against interruption or cessation of therapy without the physician's advice If
INDERAL therapy is interrupted and exacerbation of angina occurs, it usually is advis-
able to reinstitute INDERAL therapy and take other measures appropriate for the man-
agement ot unstable angina pectoris Since coronary artery disease may be
unrecognized, it may be prudent to follow the above advice in patients considered at risk
ol having occult atherosclerotic heart disease who are given propranolol for other
indications
Nonailargic Bronchospasm (e.g., chronic bronchitis, emphysema) —
PATIENTS WITH BRONCHOSPASTIC DISEASES SHOULD IN GENERAL NOT RECEIVE BETA
BLOCKERS INDERAL should be administered with caution since it may block bronchodila-
tion produced by endogenous and exogenous catecholamine stimulation of beta receptors
MAJOR SURGERY The necessity or desirability of withdrawal of beta-blocking therapy
prior to major surgery is controversial It should be noted, however, that the impaired ability of
the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthe-
sia and surgical procedures
INDERAL (propranolol HCI), like other beta blockers, is a competitive inhibitor of beta-
receptor agonists and its effects can be reversed by administration ot such agents, e g ,
dobutamine or isoproterenol However, such patients may be subject to protracted severe
hypotension Difficulty in starting and maintaining the heartbeat has also been reported with
DIABETES AND HYPOGLYCEMIA Beta-adrenergic blockade may prevent the ap-
pearance of certain premonitory signs and symptoms (pulse rate and pressure changes) of
acute hypoglycemia in labile insulin-dependent diabetes In these patients, it may be more
difficult to adjust the dosage ol insulin
THYROTOXICOSIS Beta blockade may mask certain clinical signs of hyperthyroidism
Therefore, abrupt withdrawal of propranolol may be followed by an exacerbation of symptoms
of hyperthyroidism, including thyroid storm Propranolol does not distort thyroid function tests
IN PATIENTS WITH WOLFF-PARKINSON-WHITE SYNDROME, several cases have been
reported in which, alter propranolol, the tachycardia was replaced by a severe bradycardia
requiring a demand pacemaker In one case this resulted after an initial dose ol 5 mg
propranolol
PRECAUTIONS. General Propranolol should be used with caution in patients with impaired
hepatic or renal function INDERAL (propranolol HCI) is not indicated lor the treatment of
hypertensive emergencies
Bela adrenoreceptor blockade can cause reduction of intraocular pressure Patients
should be told that INDERAL may interfere with the glaucoma screening lest Withdrawal may
lead to a return of increased intraocular pressure
Clinical Laboratory Tests Elevated blood urea levels in patients with severe heart disease,
elevated serum transaminase, alkaline phosphatase, lactate dehydrogenase
DRUG INTERACTIONS Patients receiving catecholamine-depleting drugs such as reser-
pine should be closely observed if INDERAL is administered The added catecholamine-
blocking action may produce an excessive reduction ol resting sympathetic nervous activity
which may result in hypotension, marked bradycardia, vertigo, syncopal attacks, or orthostatic
hypotension
Carcinogenesis, Mutagenesis. Impairment of Fertility Long-term studies in animals have
been conducted to evaluate toxic effects and carcinogenic potential In 18-month studies in
both rats and mice, employing doses up to 150 mg/kg/day, there was no evidence of significant
drug-induced toxicity There were no drug-related tumorigenic effects at any of the dosage
levels Reproductive studies in animals did not show any impairment of fertility that was
attributable to the drug
Pregnancy Pregnancy Category C INDERAL has been shown to be embryotoxic in
animal studies at doses about 10 times greater than the maximum recommended human dose
There are no adequate and well-controlled studies in pregnant women INDERAL should
be used during pregnancy only if the potential benefit justifies the potential risk to the fetus
Nursing Mothers. INDERAL is excreted in human milk Caution should be exercised when
INDERAL IS administered to a nursing woman
Pediatric Use Safety and effectiveness in children have not been established
ADVERSE REACTIONS. Most adverse effects have been mild and transient and have
rarely required the withdrawal of therapy
Cardiovascular bradycardia, congestive heart failure, intensification ot AV block, hypo-
tension, paresthesia of hands, thrombocytopenic purpura, arterial insufficiency, usually ol the
Raynaud type
Central Nervous System lightheadedness, mental depression manifested by insomnia,
lassitude, weakness, fatigue, reversible mental depression progressing to catatonia, visual
disturbances, hallucinations, an acute reversible syndrome characterized by disorientation tor
time and place, short-term memory loss, emotional lability, slightly clouded sensorium, and
decreased performance on neuropsychomelrics
Gastrointestinal nausea, vomiting, epigastric distress, abdominal cramping, diarrhea,
constipation, mesenteric arterial thrombosis, ischemic colitis
Allergic pharyngitis and agranulocytosis, erythematous rash, fever combined with aching
and sore throat, laryngospasm and respiratory distress
Respiratory bronchospasm
Hematologic agranulocytosis, nonthrombocytopenic purpura, thrombocytopenic
purpura
Auto-Immune In extremely rare instances, systemic lupus erythematosus has been
reported
Miscellaneous, alopecia, LE-like reactions, psoriasiform rashes, dry eyes, male impo-
tence. and Peyronies disease have been reported rarely Oculomucocutaneous reactions
involving the skin, serous membranes and conjunctivae reported for a beta blocker (practolol)
have not been associated with propranolol
DOSAGE AND ADMINISTRATION. INDERAL LA provides propranolol hydrochloride in a
sustained-release capsule for administration once daily if patients are switched from INDERAL
tablets to INDERAL LA capsules, care should be taken to assure that the desired therapeutic
effect IS maintained INDERAL LA should not be considered a simple mg tor mg substitute for
INDERAL INDERAL LA has different kinetics and produces lower blood levels Retitration may
be necessary especially to maintain effectiveness at the end ot the 24-hour dosing interval
HYPERTENSION— Dosage must be individualized The usual initial dosage is 80 mg
INDERAL LA once daily, whether used alone or added to a diuretic The dosage may be
increased to 120 mg once daily or higher until adequate blood pressure control is achieved
The usual maintenance dosage is 120 to 160 mg once daily In some instances a dosage of 640
mg may be required The time needed tor lull hypertensive response to a given dosage is
variable and may range from a tew days to several weeks
ANGINA PECTORIS — Dosage must be individualized Starting with 80 mg INDERAL LA
once daily, dosage should be gradually increased at three to seven day intervals until optimum
response is obtained Although individual patients may respond at any dosage level, the
average optimum dosage appears to be 160 mg once daily In angina pectoris, the value and
safety ot dosage exceeding 320 mg per day have not been established
If treatment is to be discontinued, reduce dosage gradually over a period of a few weeks
(see WARNINGS)
MIGRAINE — Dosage must be individualized The initial oral dose is 80 mg INDERAL LA
once daily The usual effective dose range is 160-240 mg once daily The dosage may be
increased gradually to achieve optimum migraine prophylaxis If a satisfactory response is not
obtained within four to six weeks after reaching the maximum dose, INDERAL LA therapy
should be discontinued It may be advisable to withdraw the drug gradually over a period of
HYPERTROPHIC SUBAORTIC STENOSIS— 80-160 mg INDERAL LA once daily
PEDIATRIC DOSAGE— At this time the data on the use ol the drug in this age group are too
limited to permit adequate directions for use
REFERENCES
1. Epstein FH, Rosa RM Adrenergic control of serum potassium N Engl J Med 1983.
309 1450-1451 2. Holland OB, Nixon JV, Kuhnert L Diuretic-induced ventricular ectopic
activity Am J /Med 1981,70 762-768 3. Holme I, Helqeland A, Hjermann I. et al Treatment of
mild hypertension with diuretics The importance of ECG abnormalities in the Oslo study and in
MRFIT JAMA 1984,251 1298-1299
9411/1184
AYERST LABORATORIES
New York, N Y 10017
Copyright © 1984 AYERST LABORATORIES
Division of AMERICAN HOME PRODUCTS CORPORATION
Ayersfe
ORGANIZATIONAL
V —
SMS Annual Meeting approaching
Mark calendars now for the
1985 SMS Annual Meeting, April
25-27 in La Crosse. This year's
meeting will focus on "Cost-ef-
fective Care of the Geriatric
Population." Special panels will
be presented dealing with
economic and ethical consider-
ations involved in caring for the
elderly.
The Panel on Economics on
Friday, April 26, will be moder-
ated by Ralph Andreano, PhD,
chairman of the Dept of Econom-
ics, UW-Madison. Panelists in-
clude; Jeffrey Adams, PhD, As-
sociate Professor of Economics,
Beloit College; State Senator
Susan Engeleiter (R-Menomonee
Falls); State Senator Russell
Feingold (D-Middleton); Linda
Reivitz, Secretary, Wisconsin
Dept of Health and Social Ser-
vices, State Representative Peggy
Rosenzweig (R-Wauwatosa);
Edward R Winga, MD, Gunder-
sen Clinic, La Crosse; and Lou
Turner Zellner, Deputy Com-
missioner, Office of the Wiscon-
sin Commissioner of Insurance.
The Panel on Ethics and the
Elderly on April 26 will be mod-
erated by Gerald Kempthorne,
MD, Spring Green. Other panel-
ists will include: Dennis J Do-
herty, PhD, Acting Director of
the Medical College of Wisconsin
(MCW) Regional Center for the
Study of Bioethics; Norman
Post, MD, MPH, Dept of Medi-
cine, UW-Madison; Roland Her-
rington, MD, Milwaukee,
McBride Center for the Impaired
Professional, Milwaukee Psy-
chiatric Hospital; Nicholas
Owen, MD, Milwaukee, and
Kenneth M Viste Jr, MD, Osh-
kosh.
Saturday, April 27, Patricia J
Stuff, MD, Bonduel, will moder-
ate a Panel on Osteoporosis: Pre-
vention and Treatment. Joining
Doctor Stuff on the panel will be
Edmund H Duthie Jr, MD, Di-
rector of the Geriatrics Resi-
dency Program at MCW; Kay
Jewell, MD, Madison; Jenifer
Jowsey, PhD, Dept of Orthopae-
dics, University of California at
Davis; Elaine A Leventhal, MD,
PhD, Head of Geriatrics, Dept
of Medicine, UW-Madison and
Everett L Smith, PhD, Director,
Biogerontology Laboratory, UW-
Madison.
[See slate of nominees for SMS
offices on following pages.] ■
CES Foundation
announces new
research trust fund
The Charitable, Educational
and Scientific Foundation of the
SMS announces that it has re-
ceived the final distribution of a
bequest from the estate of James
and Clara M Joss. The trust,
known as the James and Clara
M Joss Memorial Research Trust,
provides funding in the amount
of $43,543.13 to the Foundation
to be used for the purpose of
grants for medical research
projects. The trust has been ad-
ministered since 1960 for the
Dane County Medical Society
Foundation for Medical Research
by the First Wisconsin National
Bank of Madison.
Grants are awarded for re-
search projects on health or
disease, including related re-
search in the biological be-
havioral sciences. In the past
grants have been awarded for
research on such topics as:
"Mechanisms for Cardiac Arrhy-
thmias during Anesthesia," "The
Study of Three Cord Care
Regimens," and "Antibody to
Extracellular Matrix Protein
Causing Autoimmune Disease."
Those interested in pursuing
applications for grants should
contact the Foundation executive
director, Kristin Bjurstrom, at
CES Foundation offices at the
State Medical Society in Madi-
son.*
THE NAVY SEARCH
FOR EXCELLENCE
The United States Navy Medical
Command desires physicians who
want to practice medicine . . . not
be business managers. The Navy
offers specialists quality clinical ex-
perience and professional growth,
a very comfortable lifestyle with-
out financial and administrative
worries, and the valuable time to
spend with family and friends
while planning the future.
• Flight Surgery • Orthopedic
• Anesthesiology Surgery
• Otolaryngology • General
• Neurology Surgery
• Psychiatry • Neurosurgery
• OB/GYN • Undersea
Medicine
LOCATIONS: 23 modern medical
facilities located along the east and
west coast, as well as nine hospitals
overseas, including those in Japan,
Spain, Italy and the Philippines.
BENEFITS: Varied clinical experi-
ence; 30 days annual vacation;
travel benefits; full malpractice,
medical /dental coverage; net start-
ing salaries from $40,000 to
$55,000; non-contributive retire-
ment package which yields approx-
imately $20,000 a year after 20
years of service, or $30,000 a year
after 30 years.
MINIMUM QUALIFICA
TIONS: State license; US citizen;
excellent professional references.
For complete details, call or send
Curriculum Vitae to: Lt Nancy Hill,
Henry S Reuss Federal Plaza, 310
W Wisconsin Ave, Suite 450, Mil-
waukee, WI 53203; 414/291-1529
(Call Collect)
WISCONSIN .MEDICALJOL'RNAL, FEBRCARY 1985; VOL. 84
39
ORGANIZATIONAL
ANNUAL MEETING
ANNUAL MEETING
Here is a slate of those candidates chosen for top State Medical Society-
offices by the Committee on Nominations of the House of Delegates.
This is the slate on which the House will vote at the Society's Annual
Meeting April 25-27 at the La Crosse Center in La Crosse. Be sure to
let your county medical society delegate know your preferences in the
next few weeks.
Nominees for SMS offices;
election April 26
Charles W Landis, MD
President-elect, SMS
(1985-86)
Graduated from Indiana University
School of Medicine, 1951, and
served internship at University of
Oregon, 1951-52. Psychiatric resi-
dency, Indiana University, 1952-56.
Certified in psychiatry by Ameri-
can Board of Psychiatry and Neu-
rology, 1958. Doctor Landis is medi-
cal director and chief-of-staff, St
Mary's Hill Hospital, Milwaukee,
and also has a private practice of psy-
chiatry. He served as president of
The Medical Society of Milwaukee
County in 1981 and has been a
member of its Board of Directors
since 1980. He has served on the
mediation, ethics, and health plan-
ning committees of the Society, and
also the Impaired Physician Program
of Milwaukee County. He has been a
member of the House of Delegates of
SMS, 1962-63 and 1982-84. He has
been a member of the Board of Di-
rectors since 1984. Also has been a
member of the Committee on
Mental Health since 1978 serving as
chairman from 1978-81. He is a
member of the Committee on Al-
coholism and Other Drug Abuse of
the State Medical Society. Has been
a delegate to the Hospital Medical
Staff Section of the AMA since 1983
and a member of the Steering Com-
mittee, First Congress on Mental
Health, 1962. Doctor Landis is a
member of the American Psychiatric
Association, Wisconsin Psychiatric
Association and served as president,
1962-63. Member and president,
1969-70/1979-80 of the Milwaukee
Neuropsychiatric Society, and a
member of the American College of
Psychiatry and Central Neuro-
psychiatric Association. Has been
associate clinical professor of psy-
chiatry, Medical College of Wiscon-
sin since 1971; associate professor of
psychiatry and chairman. Section of
Community Psychiatry, Medical
College of Wisconsin, 1968-71;
clinical professor of psychiatry and
social welfare, University of Wis-
consin-Milwaukee, 1967-70; and an
instructor in psychiatry and director,
Indiana University School of Medi-
cine Child Guidance Clinic, 1956-
58. Doctor Landis has served on
boards or as a member of a number
of civic, governmental, and profes-
sional task forces, study groups,
and health organizations. Presently
on board of directors of United
Way of Greater Milwaukee and
member of Milwaukee Rotary Club.
He received the Distinguished
Service Award, Medical Society of
Milwaukee County in 1983, re-
ceived Certificate of Commendation,
American Psychiatric Association,
Certificate of Appreciation for Lead-
Incoming President
John K Scott, MD
Madison
ership, Milwaukee County Mental
Health Association, 1963, and also
received the Milwaukee County
Executive Proclamation honoring
community service, 1983.
Duane W Taebel, MD
Speaker, House of Delegates (1985-87)
Graduate of University of Chicago
School of Medicine, 1960. Internship
at University of Chicago Hospital,
1960-61. Internal medicine resi-
dency at University of Chicago Hos-
pital, 1961-64 and was chief resident
in medicine, 1963-64. Fellow in
gastroenterology, 1964-66, and was
instructor. Dept of Medicine, Uni-
versity of Chicago Hospital. Served
in US Army Hospital, Fort Devens,
Mass, 1966-68. Received Wisconsin
license in 1966 when joined Gunder-
sen Clinic-La Crosse Lutheran Hos-
pital. Board certified in internal
medicine, 1968, and recertified in
1974. Board certified in gastroen-
terology, 1972. Member of Alpha
Omega Alpha Honor Medical Fra-
ternity, American Gastroenterology
Association, and American Society
of Gastrointestinal Endoscopy. Is
Fellow, American College of Phy-
sicians. Was chairman of the Depart-
ment of Medicine, Gundersen
Clinic, Ltd, and has served as chief-
of-staff, La Crosse Lutheran Hospital.
Was president of La Crosse County
Medical Society, 1976. Has been
delegate to State Medical Society
since 1972 and vice-speaker of the
House of Delegates in 1978. Speaker,
House of Delegates 1979 to present.
-K)
WISCONSIN MEDICAL JOURNAL, FEBRUARY 1985: VOL. 84
ANNUAL MEETING
ORGANIZATIONAL
Doctor Taebel
Doctor Foley
Doctor Edwards
Doctor Natoli
Doctor Twelmeyer
Is chairman of Task Force Work
Group on physician/hospital re-
lations.
John J Foley, MD
Treasurer (1985-86)
Born in Chicago, 111, he graduated
from Stritch School of Medicine,
Chicago, 1956. Internship and resi-
dency completed at Milwaukee
County General Hospital, 1956-57
and 1959-63. Served in the United
States Air Force, 1957-59. Licensed
to practice medicine in Wisconsin,
1959. Certified by American Board
of Surgery, and fellow of American
College of Surgeons. Is member
Wisconsin Surgical Society. Is as-
sistant clinical professor of Surgery,
Medical College of Wisconsin, Mil-
waukee. Served as SMS Councilor
(now Director) from District I, 1972-
1981, and as treasurer of SMS, 1981-
85. Serves as ex-officio member of
SMS Finance Committee of the
Board of Directors, and is also presi-
dent of Milwaukee Academy of Sur-
gery, 1983-1985. Is a member of the
Board of Directors of SMS Services,
Inc.
Richard W Edwards, MD
Delegate, AMA(1986& 1987)
Graduated from the University of
Wisconsin Medical School, Madison,
in 1960, and served a rotating intern-
ship at Saint Vincent's Hospital,
Toledo, Ohio from 1960-61. Served
in the United States Navy from 1950-
54 and has been in Family Practice
in Richland Center from 1961 to
present. Served as president of
Richland County Medical Society in
1963 and 1980 and also as delegate to
the State Medical Society of Wiscon-
sin from 1966-69. Is certified by
American Board of Family Practice
and also a member of the American
Academy of Family Physicians.
Served as chief-of-staff, Richland
Hospital, Richland Center, Wiscon-
sin in 1963 and 1980, and also was
Richland County Coroner from
1966-1978. Served as Councilor of
State Medical Society of Wisconsin
from 1969-1978 from District II and
also was vice-chairman of the SMS
Council from 1976-78. He served as
treasurer of SMS from 1979 to 1981.
He served as chairman of the Finance
Committee of SMS Council from
1972-78. From 1969-71, he was a
member of the Governor's Special
Task Force for Health Manpower for
the State of Wisconsin and from
1976-77, he was a member of the
Governor's Committee to survey
health facilities in the Wisconsin
State Prison System. He has been a
member of the State Medical So-
ciety's Commission on Peer Review
since 1969. He served as an in-
structor at the University of Wis-
consin School of Nursing Post Grad-
uate Program for Nurse Practitioners
in 1977-80, and has been a partici-
pant in the Summer Externship Pro-
gram for Freshmen Medical Stu-
dents, sponsored by Wisconsin
Academy of Family Physicians since
1970. Appointed assistant professor
of Department of Family Medicine
and Practice University of Wiscon-
sin Medical School, 1981. Elected
Family Physician of the Year 1982
by Wisconsin Academy of Family
Physicians. He was an alternate dele-
gate to AMA from 1979-1983. He
presently is a delegate to AMA from
Wisconsin, serving since 1984.
Treasurer of SMS Services, Inc,
1979 to present. Serves as vice-chair-
man of the Medicaid Medical Audit
Committee of the State Medical
Society.
Cornelius A Natoli, MD
Delegate, AMA (1986 & 1987)
Born in Utica, New York, 1930, he
received BS degree in 1952 from Nia-
gara University, and graduated in
1956 from Georgetown University
School of Medicine. Internship and
residency in surgery at Barnes Hos-
pital, St Louis, Missouri, followed by
three years of urology residency at
Barnes Hospital. Private practice in
Salt Lake City, Utah, from 1961-
1969; held offices in Utah State
Medical Association, Public Health
Committee, and Utah Urological
Society. Member of Gundersen
Clinic, Ltd, from 1969 to present.
Clinical assistant professor of sur-
gery (urology). University of Wiscon-
sin Medical School. Is past president
of La Crosse County Medical So-
ciety; member of American Urol-
ogical Association, Wisconsin Urol-
ogical Society, and American Col-
lege of Surgeons, and North Central
Section of AUA. Past chairman
La Crosse County Insurance Ad-
visory Committee; past member of
SMS House of Delegates and served
on its Reference Committee on Fi-
nance and chaired Reference Com-
mittee on Reports of Officers; mem-
ber of past SMS Commission on
Medical Care Plans, and was a mem-
ber of WPS Board of Directors;
past member of SMS House of Dele-
gates Nominating Committee; and
served as Third District Councilor of
WISCONSIN MEDICAL JOURNAL, FEBRUARY I985:VOL. 84
41
ORGANIZATIONAL
ANNUAL MEETING
SMS. Is a member of WISPAC. Also
member of Board of Directors,
Gundersen Clinic, Ltd. Has been
alternate delegate to AMA, 1979-
1982, and delegate, 1983-1985.
Henry F Twelmeyer, MD
Delegate, AMA (1986 & 1987)
Graduate of Marquette University
School of Medicine, Milwaukee. Re-
ceived internship at Milwaukee
County General Hospital, 1942 to
1943. Served residency at Mil-
waukee County General Hospital,
1946-1949. Received license to prac-
tice medicine in 1943 and began
practice of general and vascular sur-
gery in Milwaukee in 1950. Has
been SMS alternate delegate to
American Medical Association
since 1971 and delegate since 1976.
Chaired special committee of AMA
to study meeting format, 1981-82.
Was president of The Medical So-
ciety of Milwaukee County in 1971,
served as member of that county's
board of directors through 1974, and
served as delegate to State Medical
Society. Is a founding member and
past president of Milwaukee Acade-
my of Surgery, past member of
Council of Wisconsin Surgical So-
ciety, and past president of Wiscon-
sin Surgical Society. Is fellow of
American College of Surgeons, past
member of Council of Wisconsin
Chapter of the American College
of Surgeons, diplomat of American
Board of Surgery, and member of
Milwaukee Academy of Medicine. Is
past chief-of-staff at West Allis
Memorial Hospital and has been
chief of surgery at both West Allis
Memorial and Elmbrook Memorial
hospitals. Is associate clinical pro-
fessor of surgery at Medical College
of Wisconsin. Is past member of
Board of Directors of Surgical Care-
Blue Shield and past chairman of its
Operating Committee. Is also mem-
ber of Wisconsin Heart Association.
J D Kabler, MD
Alternate Delegate, AMA (1986& 1987)
Graduated from University of Kan-
sas Medical School, 1950. Served
internship and residency at Uni-
versity of Wisconsin Hospitals, 1950-
52; 1954-56. Served in United States
Navy, 1944-45; 1952-54. Board certi-
fied in internal medicine, 1958.
Chief surgeon of Wisconsin National
Guard 1967-1974. Subspecialty,
psychosomatic medicine. Member
and co-chairman. Joint Practice Com-
mittee in existence for seven years.
Member and chairman. Commission
on Governmental Affairs of State
Medical Society, 1976-1982. Mem-
ber of Board of Directors, from the
First District, State Medical Society
of Wisconsin, 1979-1985. Professor
of Medicine, University of Wiscon-
sin, Madison; director. University
Health Services. Is presently alter-
nate delegate to American Medical
Association, 1984 and 1985.
Richard Henry Ulmer, MD
Alternate Delegate, AMA (1986 & 1987)
Graduated from Stritch School of
Medicine of Loyola University,
Chicago, 1961. Rotating internship,
internal medicine residency, cardiol-
ogy fellowship at the University of
Chicago Hospitals and Clinics,
1961-69. Presently cardiologist.
Marshfield Clinic, and member of
the medical staff of St Joseph’s Hos-
pital, Marshfield. Clinical instructor,
internal medicine. University of
Wisconsin, 1969-74; clinical assist-
ant professor. University of Wiscon-
sin, 1974-80; clinical associate pro-
fessor, University of Wisconsin,
1980 to present. Captain, United
States Army, Medical Corps, 1966-
68. Board certified in Internal Medi-
cine. Member of Executive Com-
mittee, Marshfield Clinic, 1973-
1975; 1982 - present; secretary,
Marshfield Clinic, 1973-75; treas-
urer, Marshfield Clinic, 1982-pres-
ent; secretary. Dept of Internal
Medicine, Marshfield Clinic, 1972;
chief. Section of Cardiology, Marsh-
field Clinic, 1976, 1977; chief. Dept
of Cardiology, Marshfield Clinic,
1979-80. Alternate delegate from
Wood County Medical Society to
SMS, 1972-73 and delegate, 1974 to
present; member. Nominating Com-
mittee, House of Delegates, SMS,
1978-80; president. Wood County
Medical Society, 1978 and 1985.
Member of Blue Key National Honor
Fraternity; Society of Sigmi Xi;
American Heart Association, Ameri-
can Medical Association, and Ameri-
can College of Physicians.
Kenneth M Vistejr, MD
Alternate Delegate, AMA (1986& 1987)
Graduate Northwestern University
Medical School, Chicago, IL, 1966.
Rotating internship, Chicago Wesley
Memorial Hospital, 1966-1967; NIH
fellowship in neurology, 1967-1970
at Northwestern Medical School.
Licensed in Wisconsin 1967. Board
certified by American Board of Psy-
chiatry and Neurology, 1975. Medi-
cal practice in Fox Valley from 1970
to present. Member of medical staff
of St Agnes Hospital, Fond du Lac,
and Mercy Medical Center, Osh-
kosh. Member of courtesy medical
staffs of St Elizabeth and Appleton
Memorial hospitals, Appleton;
Theda-Clark Regional Medical
Center, Neenah, and St Vincent Hos-
pital, Green Bay. Teaching positions
at Northwestern University Medical
School, 1970; associate clinical pro-
fessor of neurology. University of
Wisconsin Medical School, 1972 to
present; and instructor in neurology,
Winnebago Mental Health Institute,
42
WISCONSIN MEDICAL JOURNAL, FEBRUARY 1985: VOL. 84
ANNUAL MEETING
ORGANIZATIONAL
1973 to present. Has served as presi-
dent, Wisconsin Neurological Society,
1977-78; delegate to State Medical So-
ciety, Winnebago County, 1972 to
present: alternate delegate to AMA,
1982-present; chairman. Reference
Committee on Reports of Standing
Committees, State Medical Society,
1976; chairman, Nominating Commit-
tee, 1982 and member since 1975;
chairman of the Physicians Alliance
Commission from 1978 to present;
chairman, WISPAC, 1978-1982;
member of Medical Advisory Board,
Wisconsin Epilepsy Society, 1974 to
present; chairman. Medical Advisory
Committee, Wisconsin Multiple
Sclerosis Society, 1976-1982; medical
Timothy T Flaherty, MD
(President, Stale Medical Society)
Delegate, AMA (1985)
Note: The AMA Bylaws were
amended in 1984 to provide for
an additional delegate (and alter-
nate delegate) from constituent
state associations when 75% or
more of their members are also
members of AMA. SMS is eligible
for this additional position in
1985 based upon the official
membership count as of Decem-
ber 31, 1984. The House of Dele-
gates Nominating Committee has
accepted the recommendation of
the Board of Directors that this
additional delegate (and alternate
delegate) be the president (and
president-elect) of the Society.
Continued eligibility for this ad-
ditional seat will be determined
on an annual basis by the mem-
bership count as of each Decem-
ber 31 and maintenance of the
required percentage of AMA
members. ■
director Cerebral Palsy Clinic of Win-
nebagoland, Oshkosh. Governor's ap-
pointee to State Health Policy and
Planning Council, 1974-76; member
of State Department of Transporta-
tion, Medical Review Board on
Epilepsy, 1974 to present; medical
director. Neurorehabilitation Units,
Mercy Medical Center, Oshkosh, and
St Agnes Hospital, Fond du Lac; and
member of WiNNEFOX Regional Li-
brary Board, Oshkosh, 1978 to
present. Also member of the Ameri-
can Medical Association; Winne-
bago and Fond du Lac County Medi-
cal Societies; Fellow American
Academy of Neurology; Wisconsin
Neurological Society; American
EEG Society; American Medical
EEG Society: Chicago Neurological
Society; Central Neuropsychiatric
Association; American Association for
the Study of Headache; and American
Congress of Rehabilitation Medicine.
Presently serving as an alternate
delegate to American Medical Asso-
ciation, 1984 and 1985. ■
House of Delegates
1984-
-85
Nominating Committee
District
1
Jerome W Eons, Jr, MD
Cudahy
1
Robert F Purtell, Jr, MD
Milwaukee
1
John D Riesch, MD
Menomonee Falls
1
Raymond E Skupniewicz, MD
Racine
2
Sandra Osborn, MD
Madison
2
James J Tydrich, MD
Richland Center
3
Stephen B Webster, MD
La Crosse
4
John E Thompson, MD
Nekoosa
5
Kenneth M Viste, Jr, MD
Oshkosh
6
Robert T Schmidt, Jr, MD
Green Bay
7
Merne W Asplund, MD
Bloomer
8
Joseph M Jauquet, MD
Ashland
Specialty
Sections Philip J Dougherty, MD
Menomonee Falls
SMS needs MDs
for committees,
commissions
SMS members interested in
serving on statewide committees
and commissions dealing with
current topics affecting medicine
and public health are urged to
submit their names to the SMS
Secretary's Office by March 15.
Candidates should be moti-
vated, enthusiastic, and commit-
ted to attending meetings.
Members are being sought for
the following commissions and
committees:
Commission on . . .
□ Continuing Medical Education
□ Governmental Affairs
□ Health Planning
□ Mediation and Peer Review
□ Physicians Alliance
□ Public Information
□ Editorial Board, Wisconsin Medical
Journal
Committee on . . .
□ Medical Liability
□ Aging and Extended Care Facilities
□ Alcoholism and Other Drug Abuse
□ Environmental and Occupational
Health
□ Health Care Costs Liaison
□ Maternal and Child Health
□ Medicine and Religion
□ Physician-Nurse Liaison
□ Mental Health
□ Safe Transportation
□ School Health
□ Women Physicians
□ Federal Legislation
□ Joint Practice (SMS and Wisconsin
Nurses Association
Physicians interested in serving
should check the appropriate
commission(s) or committee(s)
and return this list to the SMS
Secretary's Office at PO Box 1109,
Madison, WI 53701 by March 15.
Name
Address
City / State / Zip Code
WISCONSIN MEDICAL JOURNAL, FEBRUARY 1985: VOL. 84
43
ORGANIZATIONAL
COUNTY MEDICAL SOCIETIES
President (P) and Secretaries (S); Executive Secretaries (ES), Treasurers (T); Executive Vice Presidents (EVP);
and telephone numbers
ASHLAND BAYFIELD IRON
P— Mark K Belknap, MD
922 Second Avenue, West
Ashland, WI 54806
(7151 682-6651
S— David M Saarinen, MD
2101 Beaser Avenue, #2
Ashland, WI 54806
BARRON WASHBURN
BURNETT
P— Donald E Riemer, MD
PO Box 127
Cumberland, WI 54829
(715) 822-2231
S— Roger F Macy, MD
PO Box 127
Cumberland, WI 54829
(715) 822-2231
BROWN
P— James R Mattson, MD
501 S Military Avenue
Green Bay, WI 54303
S— Stephen D Hathway, MD
PO Box 1700
Green Bay, WI 54305
(414) 433-3653
T— Roger C Wargin, MD
613 Ridgeview Court
Green Bay, WI 54303
(414) 499-8859
CALUMET
P— Badri N Ganju, MD
451 E Brooklyn Street
Chilton, WI 53014
(414) 849-2888
S— James C Pinney, MD
507-C West Main Street
Hilbert, WI 54129
(414) 853-3534
CHIPPEWA
P— Richard C Sazama, MD
3203 Stein Blvd
Eau Claire, WI 54701
(715) 835-6548
S— Robert S Lea, MD
1 102 Dover Street
Chippewa Falls, WI 54729
CLARK
P— Frederico P Gregorio, MD
216 Sunset Place
Neillsville, WI 54456
(715) 743-3231
S— Vangala J Reddy, MD
216 Sunset Place
Neillsville, WI 54456
(715) 743-3101
COLUMBIA MARQUETTE
ADAMS
P— Donald J Taylor, MD
1015 West Pleasant Street
PO Box 387
Portage, WI 53901
(608) 742-8389
S— Paul J Slavik, MD
916 Silver Lake Drive
Portage, WI 53901
ES— Mrs Elayne Hanson
PO Box 352
Portage, WI 53901
(608) 742-2410
CRAWFORD
P— Eli M Dessloch, MD
780 South Beaumont Road
PO Box 89
Prairie du Chien, WI 53821
(608) 326-6978
S— Michael S Garrity, MD
610 East Taylor Street
Prairie du Chien, WI 53821
(608) 326-6466
DANE
P— A D Anderson, MD
5110 Manitowoc Parkway
Madison, WI 53705
(608) 238-9070
S— Donald A Bukstein, MD
1313 Fish Hatchery Road
Madison, WI 53715
DODGE
P— Gerald H Klomberg, MD
130 Warren Street
Beaver Dam, WI 53916
(414) 887-1711
S— Daniel R Erickson, MD
Rte 1, Highway 28
Horicon, WI 53032
(414) 887-7101
DOOR KEWAUNEE
P— Alfonso G Tamayo, MD
1623 Rhode Island
PO Box 107
Sturgeon Bay, WI 54235
(414) 743-3383
S— William Faller, MD
330 South 16th Place
PO Box 466
Sturgeon Bay, WI 54235
DOUGLAS
P— Robert R Mataczynski, MD
1514 Ogden Avenue
Superior, WI 54880
(715) 394-5557
S— Alfred E Lounsbury, MD
3600 Tower Avenue
Superior, WI 54880
(715) 392-8111
EAU CLAIRE DUNN PEPIN
P— Patrick W Connerly, MD
807 South Farwell Street
Eau Claire, WI 54701
(715) 839-5175
S— Stanley G Norman, MD
714 South Hamilton Avenue
Eau Claire, WI 54701
(715) 834-3448
FOND DU LAC
P— William G Sybesma, MD
80 Sheboygan Street
Fond du Lac, WI 54935
(414) 923-7400
S— Elizabeth T Sanfelippo, MD
80 Sheboygan Street
Fond du Lac, WI 54935
T— Robert H House, MD
PO Box 96
Ripon, WI 54971
(414) 748-6400
FOREST
P— Enzo F Castaldo, MD
Laona, WI 54541
(715) 674-3131
S— Burton S Rathert, MD
101 West Washington
PO Box 278
Crandon, WI 54520
(715) 478-2413
GRANT
P— John M McKichan, MD
1370 North Water Street
Platteville, WI 53818
(608) 348-2455
Robert E Stader, MD
235 North Madison Street
Lancaster, WI 53813
(608) 723-2131
GREEN
P— Carlos A Jaramillo, MD
PO Box 786
Monroe, WI 53566
(608) 328-0429
S— Jacob George, MD
1515 10th Street
Monroe, WI 53566
(608) 328-7000
GREEN LAKE WAUSHARA
P-John C Koch, MD
209 East Park Avenue
Berlin, WI 54923
(414) 361-1313
S— Michael E Tieman, MD
PO Box 266
Berlin, WI 54923
(414) 361-4306
IOWA
P— Timothy A Correll, MD
227 Commerce Street
Mineral Point, WI 53565
(608) 935-9331
S— Harold P L Breier, MD
PO Box 185
Montfort, WI 53569
(608) 943-6308
JEFFERSON
P— Alan L Detwiler, MD
500 McMillen Street
Fort Atkinson, WI 53538
(414) 563-5571
S— Edward J Hoy, MD
123 Hospital Drive, #208
Watertown, WI 53094
JUNEAU
P— D Keith Ness, MD
1040 Division Street
Mauston, WI 53948
(608) 847-5000
S— Nancy E B Ness, MD
1040 Division Street
Mauston, WI 53948
(608) 847-5000
44
WISCONSIN MEDICAL JOL'RNAL, FEBRUARY 1985:\’OL. 84
COUNTY MEDICAL SOCIETIES
ORGANIZATIONAL
KENOSHA
P— Andrew T Prziomski, MD
6530 Sheridan Road
Kenosha, WI 53140
(414) 658-2516
S— Douglas G Devan, MD
3734 7th Avenue, #26
Kenosha, WI 53140
(414) 657-3011
ES— Mr James Splitek
4109-67th Street
Kenosha, WI 53142
(414) 654-9166
LA CROSSE
P— Pauline M Jackson, MD
1836 South Avenue
La Crosse, WI 54601
(608) 782-7300
S— Thomas P Lathrop, MD
1836 South Avenue
La Crosse, WI 54601
(608) 782-7300
LAFAYETTE
P— Lyle L Olson, MD
517 Park Place
Darlington, WI 53530
(608) 776-4497
S— Richard G Roberts, MD
517 Park Place
Darlington, WI 53530
(608) 776-4497
LANGLADE
P— Theodore C Fox, MD
213 5th Avenue
Antigo, WI 54409
(715) 623-2351
S— John R Myers, MD
1 1 1 1 Langlade Road
Antigo, WI 54409
(715) 623-3761
LINCOLN
P— Muhammad Y Ahmad, MD
716 East 2nd Street
Merrill, WI 54452
(715) 536-2463
S— Gail M Amundson, MD
216 North 7th Street
Tomahawk, WI 54487
(715) 453-4700
MANITOWOC
P— John C Zeldenrust, MD
2219 Garfield Street
Two Rivers, WI 54241
(414) 293-2281
S— Henry M Katz, MD
600 York Street
Manitowoc, WI 54220
(414) 682-7124
MARATHON
P— Curt G Grauer, MD
2727 Plaza Drive
Wausau, WI 54401
(715) 847-3379
S— Leonard H Wurman, MD
425 Pine Ridge Blvd, #305
Wausau, WI 54401
(715) 845-9634
ES— Ms Lorraine W Kordas
PO Box 569
Wausau, WI 54401
(715) 845-6231
MARINETTE FLORENCE
P— James Tandias, MD
PO Box 435
Marinette, WI 54143
S— Leonard R Worden, MD
1510 Main Street
Marinette, WI 54143
(715) 735-7421
MILWAUKEE
P— Lucille B Glicklich, MD
1610 N Prospect Ave, #1202
Milwaukee, WI 53202
S— Donald P Davis, MD
2015 East Newport Avenue
Milwaukee, WI 53211
EVP— Mr William B Harlan
1020 North Broadway, #200
Milwaukee, WI 53202
MONROE
P— Jameel S Mubarak, MD
105 West Milwaukee Street
Tomah, WI 54660
(608) 372-4111
S— Jack D Brown, MD
PO Box 250
Sparta, WI 54656
(608) 269-6731
OCONTO
P— John S Honish, MD
PO Box 260
Oconto, WI 54153
S— Clyde E Siefert, MD
164 North Main Street
Oconto Falls, WI 54154
(414) 846-3671
ONEIDA VILAS
P— Stephen R Peters, MD
PO Box 549
Woodruff, WI 54568
S— Robert J Aylesworth Jr, MD
1020 Kabel Avenue
Rhinelander, WI 54501
(715) 362-5650
ES— Mrs Sally Christoffersen
1020 Kabel Avenue
Rhinelander, WI 54501
(715) 362-5650
OUTAGAMIE
P— Henry Chessin, MD
424 East Wisconsin Avenue
Appleton, WI 54911
S— Nancy J Homburg, MD
401 North Oneida Street
Appleton, WI 5491 1
(414) 739-0171
OZAUKEE
P— Thomas Wall, MD
326 West Pierre Lane
Port Washington, WI 53074
S— Peter W Messer, MD
3344 West Grace Avenue
Mequon, WI 53092
PIERCE ST CROIX
P— Terry G Domino, MD
280 Vine Street
Hudson, WI 54016
(715) 386-9381
S— Joseph E Powell, MD
441 East 7th Street
New Richmond, WI 54017
(715) 246-6846
POLK
P— William W Young, MD
104 Adams Street South
St Croix Falls, WI 54024
(715) 483-3221
S— Vacancy
PORTAGE
P— Joseph F Jarabek, MD
2501 Main Street
Stevens Point, WI 54481
(715) 344-4120
S— Roy J Dunlapp II, MD
508 Vincent Street
Stevens Point, WI 54481
(715) 341-8001
PRICE TAYLOR
P— T Bayard Frederick, MD
789 South 7th Avenue
Park Falls, WI 54552
(715) 762-3212
S— Walther W Meyer, MD
101 North Gibson Avenue
Medford, WI 54451
(715) 748-2121
RACINE
P— Richard N Odders, MD
5625 Washington Avenue
Racine, WI 53406
(414) 886-8226
S— Dennis J Kontra, MD
5802 Washington Avenue
Racine, WI 53406
T— Kenneth J Pechman, MD
2405 Northwestern Avenue
Racine, WI 53404
ES— Mr John M Bjelajac
PO Box 592
Racine, WI 53401
(414) 634-0702
RICHLAND
P— Thomas L Richardson, MD
1313 West Seminary Street
Richland Center, WI 53581
(608) 647-6161
S— Robert P Smith, MD
1313 West Seminary Street
Richland Center, WI 53581
(608) 647-6161
ROCK
P— Jovan L DJokovic, MD
630 Wexford Drive
Janesville, WI 53545
S— Daniel T Peterson, MD
580 North Washington Street
Janesville, WI 53545
RUSK
P— Joseph S Bachir, MD
906 College Avenue West
Ladysmith, WI 54848
(715) 532-6651
S— Ron M Charipar, MD
1216 East River
Ladysmith, WI 54848
SAUK
P— David E Burnett, MD
1900 North Dewey Avenue
Reedsburg, WI 53959
S— James W Clay, MD
1900 North Dewey Avenue
Reedsburg, WI 53959
SAWYER
P— Lloyd M Baertsch, MD
Rte 3, Box 3998
Hayward, WI 54843
S— Paul Strapon III, MD
Rte 3, Box 3998
Hayward, WI 54843
WISCONSIN MEmC/U. JOURNAL, FEBRUARY 1985: VOL. 84
45
ORGANIZATIONAL
COUNTY MEDICAL SOCIETIES
SHAWANO
P— William A Coan, MD
610 West Green Bay Street
Shawano, WI 54166
(715) 526-3137
S— Alois J Sebesta, MD
126‘/2 South Main Street
PO Box 360
Shawano, WI 54166
(715) 526-3313
SHEBOYGAN
P— Robert A Helminiak, MD
1011 North 8th Street
Sheboygan, WI 53081
S— Robert J Scott, MD
2809 North 7th Street
Sheboygan, WI 53081
(414) 457-5033
TREMPEALEAU JACKSON
BUFFALO
P-John H Noble, MD
1105 Harrison Street
Black River Falls, WI 54615
S— James J Dickman II, MD
610 West Adams Street
Black River Falls, WI 54615
(715) 284-4311
VERNON
P— David A Van Dyke, MD
PO Box 149
Viroqua, WI 54665
S-DeVerne W Vig, MD
PO Box 72
Viroqua, WI 54665
(608) 637-3195
WALWORTH
P— James L Knavel, MD
PO Box B
Ten Peller Road
Lake Geneva, WI 53147
(414) 248-4467
S— James V Seegers, MD
104 South Wisconsin Street
Elkhorn, WI 53121
(414) 723-6666
WASHINGTON
P— James D Froehlich, MD
7066 North Trenton Road
West Bend, WI 53095
S— Emilio B Regala, MD
1004 East Sumner Street
Hartford, WI 53027
(414) 673-5745
WAUKESHA
P— Thomas J Dougherty, MD
1 1 1 1 Delafield Street
Waukesha, WI 53186
(414) 542-9531
S-Roberf L Warth, MD
1111 Delafield Street
Waukesha, WI 53186
(414) 544-4411
T— Gerald L Harned, MD
223 Wisconsin Avenue
Waukesha, WI 53186
(414) 544-5311
ES— Mr Robert Herzog
850 Elm Grove Road, #\
Elm Grove, WI 53122
(414) 784-3747
WAUPACA
P— Leslie H Gray, MD
46 North Main Street
Clintonville, WI 54929
S— Donn D Fuhrmann, MD
1420 Algoma Street
New London, WI 54961
(414) 982-3606
WINNEBAGO
P— Paul N Gohdes, MD
130 Second Street
Neenah, WI 54956
(414) 729-3005
S— Roy E Buck, MD
555 South Washburn Avenue
Oshkosh, WI 54901
(414) 233-6000
WOOD
P— James K Jones, MD
400 Dewey Street
Wisconsin Rapids, WI 54494
(715) 421-3444
S— Michael J Kryda, MD
1000 North Oak Avenue
Marshfield, WI 54449
(715) 387-5319*
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46
WISCONSIN .MEDIC.ALJOLRNAl. FEBRL ARV 1985;VOL. 84
ORGANIZATIONAL
Membership Directory— Update
The following information is being provided from Member-
ship reports and from individual members for updating the
1984 Membership Directory as published in the July 1984
issue of the Wisconsin Medical Journal. Because of space limita-
tions address changes and phone numbers will not be
included in this Update; however, they will be changed in
Membership records. County transfers will be included when
processing has been completed by the Membership Depart-
ment.
New, reelected, or reinstated members
(complete information!
Changes in specialties and/or Board certification!*)
(changes only with member's name}
By county medical society
ASHLAND BAYFIELD
IRON
GS
Nibicr, James G
206 Sixth Ave, West
Ashland WI 54806
DANE
OTO
Bartel, Thad E
600 Highland Ave
Madison WI 53792
Dolinski, Sylna Yvonne
4833 Sheboygan Ave, #338
Madison WI 53705
Edwards, Mark L
4713Jenewein Rd, #2
Madison WI 53711
IM CD
Effron, Barry A
4 Dunraven Ct
Madison WI 53705
Hirst'll, ThoniasJ
1313 Fish Hatchery Rd
Madison WI 53715
Karlin, Elizabeth
4410 Regent St
Madison WI 53705
OPH*
Mcisekothen, William E
5003 Monona Dr
Madison WI 53716
FP*
Tumerman, Marc D
1270 West Main St
Sun Prairie WI 53590
DOOR KEWAUNEE
Gwinn, Rodney P
3936 Bay Shore
Sturgeon Bay WI 54235
EAU CLAIRE DUNN
PEPIN
AN
Cochrane, Richard N
727 Kenney Ave, Rni 207
Eau Claire WI 54701
ORS*
Leavitt, James R
836 Richard Dr
Eau Claire WI 54701
GREEN
FP*
Anderson, Eric K
2709 6th St
Monroe WI 53566
AN
Patel, Vasiidcv M
2023 Lincoln Rd
Monroe WI 53566
LA CROSSE
EM
Omans, Judson
1836 South Ave
La Crosse WI 54601
MARATHON
IM*
Rengel, Thomas N
425 Pine Ridge Blvd, #205
Wausau WI 54401
MILWAUKEE
AN*
Ansari, Shamin A
2825 North Mayfair Rd
Milwaukee WI 53222
AN
Chung, Ci II
3335 Parkside Dr
Brookfield WI 53005
IM* A
Cohen, Steven H
5810 West Oklahoma Ave
Milwaukee WI 53219
CHP
Craft, Polly H
POB 1997
Milwaukee WI 53201
OBG*
Dettmann, Frederick
5589 North Bay Ridge Ave
Milwaukee WI 53217
AN
Devine, Thomas G
1335 East Randolph Ct
Milwaukee WI 53212
PS* GS
Gingrass, Ruedi P
9800 West Bluemound Rd
Milwaukee WI 53226
AN* GS
Gondi, RaoJ
1 100 E Donges Ct
Milwaukee WI 53217
AN
Grum, Clement M
1256 Martha Washington
Milwaukee WI 53213
AN
Hernandez-Engstrand, Graciela
9102 West Dixon, #202
Milwaukee WI 53214
FP
Hussey, James J
2952 North Maryland Ave
Milwaukee WI 532 1 1
Kasner, Joseph R
620 N 19th St
Milwaukee WI 53233
PM*
Kohli, Alka
9137 North Troy Ct
Brown Deer WI 53233
R ON
l.awton, Colleen A
8700 West Wisconsin Ave
Wauwatosa WI 53226
FP*
Lesko, Gary N
7878 North 76th St
Milwaukee WI 53233
OBG
Macak, James R
2400 West Lincoln Ave
Milwaukee WI 53215
ORS*
Major, Michael R
4036 North 51st Blvd
Milwaukee WI 53216
GS
Martinez, FranciscoJ
7635 W Oklahoma Ave, #104
Milwaukee WI 53219
PTH*
Martins, Ronald R
1855 Hollyhock Lane
Elm Grove WI 53122
FP
Mateo, Raul
3821 South Howell Ave
Milwaukee WI 53207
OM FP
O'Grady, Michael G
2400 West Lincoln Ave
Milwaukee WI 53215
HS ORS*
Olson, David VV
2300 North Mayfair Rd
Milwaukee WI 53226
PH FP
Parthum, PeterJ
S63W 14899 Garden Terr
Muskego WI 53150
GS OM
Petro, Nancy B
2400 West Lincoln Ave
Milwaukee WI 53215
PD*
Rayan, Lalitha C
2388 North Lake Dr
Milwaukee WI 53216
AN
Rusch, James R
2825 North Mayfair Rd
Milwaukee WI 53222
AN
Santelle, Susan L
3103 East Hampshire St
Milwaukee WI 5321 1
continued
WISCONSIN MEDICAL JOI RNAL, FEBRUARY l985:VOL. 84
47
ORGANIZATIONAL
MEMBERSHIP DIRECTORY-UPDATE
MILWAUKEE continued
OTO
Schmidt, Frederic W
8131 Gridley Ave
Wauwatosa WI 53213
PTH*
Shah, Indu M
5703 Rochelle Dr
Greendale WI 53129
FP
Sirus, Steven R
3001 South 56th St, #3
Milwaukee WI 53219
FP
Stineman, William F
4318 South 20th St
Milwaukee WI 53221
OTO FP
Strigenz, Michael A
7802 West Livingston Ave
Wauwatosa WI 53213
GS
Tunberg, Thomas C
11121 West Lincoln Ave
Wauwatosa WI 53226
FP*
Van Cleave, Bruce L
2400 West Villard Ave
Milwaukee WI 53209
FP
V'criinden, Laurence J
3155 South 29th St
Milwaukee WI 53215
OBG
Wan, Michael
2711 West Wells St
Milwaukee WI 53208
PS HS
Yousif, NJohn
9200 West Wisconsin Ave
Milwaukee WI 53226
ORS*
Zalud, Miroslav C
SOON 19th St
Milwaukee WI 53233
OZAUKEE
OBG
Mammen, Indira
100 W Monroe St
Port Washington WI 53074
WOOD
AN
Boyle, Philip F'
1000 North Oak Ave
Marshfield WI 54449
IM
Dawson, Michael J
1701 North Chestnut
Marshfield WI 54449
IM
Egge, Paul R
1041 Hill St
Wisconsin Rapids WI 54494
PD* NPM
Goldberg, Jerry W
1000 North Oak Ave
Marshfield WI 54449
Holzberger, James A
753 West 17th St
Marshfield WI 54449
D
Kingsley, David N
1603 South Locust, #207
Marshfield WI 54449
ORS HS
Torkelson, Erik O
1000 N Oak Ave
Marshfield WI 54449B
1985 ANNUAL MEETING: APRIL 25-27, LA CROSSE
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WISCONSIN MEDICAL JOURNAL, FEBRUARY 1985:VOL. 84
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SOCIOECONOMICS
Reform malpractice system to cut costs,
Medical Society tells Legislature
Major reform of the medical
liability system in Wisconsin and
elimination of mandated benefits
in health insurance policies were
two recommendations for con-
trolling healthcare costs the Presi-
dent of the State Medical Society
gave to a special joint hearing of
the Legislature January 22.
The Assembly and Senate
Health Committees called the
meeting to hear suggestions from
key healthcare groups about
what can be done to contain
healthcare costs in Wisconsin.
"Physician premiums for
medical liability insurance have
grown to the point that some phy-
sician specialties are now re-
quired to pay in excess of $25,000
per year for insurance, and these
costs may well increase 75% to
100% this year alone," President
Timothy Flaherty, MD, Neenah,
told the legislators. "In most in-
stances these costs are passed on
to patients through higher fees."
Doctor Flaherty
Doctor Flaherty also pointed
out "that upwards of 30% of the
cost of physician services may be
attributable to the practice of
'defensive medicine,' or prescrib-
ing additional diagnostic tests
and treatment procedures in
response to the increased risk of a
liability action."
He urged the Legislature to
carefully consider the recom-
mendations the State Medical
Society has made to the Legis-
lative Council's Special Com-
mittee on Medical Malpractice to
address the malpractice problem
and the tort system in general.
Healthcare costs could also
be reduced if the Legislature
eliminated all mandated bene-
fits and provider groups from in-
surance plans sold in Wisconsin,
according to Doctor Flaherty.
"Health insurance plans should
be tailored to an individual's
needs," he said. "No one should
be required to pay for benefits
that he or she doesn't want or
need."
President Flaherty also urged
the repeal of the Wisconsin Certi-
ficate-of-Need/Capital Expendi-
ture Review Law. "While the law
was initially implemented with
the intent of preventing the dupli-
cation of healthcare services and
constraining the construction of
new healthcare facilities, studies
now question the program's
ability to contain costs," Doctor
Flaherty said noting that some
studies show that the CON pro-
gram has contributed to the cost
problem by limiting the entry of
providers into the healthcare
marketplace.
"The current competitive mar-
ketplace in healthcare and the
new hospital rate setting com-
mission eliminate any last re-
maining need for CON," he
said.
Doctor Flaherty reminded
the legislators that the physicians
in the State Medical Society in
recent months have recom-
mended no increase in fees to the
elderly and that physicians re-
duce or waive fees for low-in-
come elderly. In addition, for the
past several months Society phy-
sicians have provided thousands
of dollars in free care through
free clinics and the ShareCare
program— a statewide program
providing healthcare services to
the unemployed. The Society has
also promoted a policy of price
disclosure by physicians.
"As cost containment pres-
sures continue," Doctor Flaherty
said, "we should remain mindful
of the need to provide quality
medical care to those who lack
the financial resources to obtain
that care themselves."*
Uncompensated care problem looms on
horizon, SMS President says
Providing healthcare for the un-
insured and others who cannot
afford it is a growing problem
because of tightening reimburse-
ment to hospitals and physicians,
SMS President Timothy Flaherty,
MD said at a January 24 confer-
ence on Health Care and the
Uninsured. The conference,
sponsored by the Center for
Public Representation, was
aimed at health organizations,
business and labor groups, con-
sumer advocacy organizations,
and representatives of state
government. continued
50
WISCONSIN MEDICAL JOURNAL. FEBRUARY 1985: VOL. 84
UNCOMPENSATED CARE
SOCIOECONOMICS
continued
"New Medicare and Medicaid
payment mechanisms with an
emphasis on reducing costs,
HMO/PPO contracts, discounts
by hospitals and other cost-
cutting pressures have served to
reduce, and in some cases,
eliminate the hospital's and phy-
sician's ability to provide free or
reduced-rate care to those people
who need it," said Doctor
Flaherty.
Traditionally, hospitals have
subsidized uncompensated care
through rates charged to patients
who use hospital services, ac-
cording to Doctor Flaherty. He
compared this to "a town that is
trying to run its Fire Dept by
charging only those people who
have fires."
The Legislative Council Special
Committee on Medical Malprac-
tice continued to sift through pro-
posed revisions in medical lia-
bility laws in December and
January. In an attempt to
strengthen physician peer re-
view, the Committee December
19 approved a State Medical So-
ciety proposal to create physician
committees to work with the
Wisconsin Health Care Liability
Insurance Plan (WHCLIP), (and
all other primary insurers), the
Patients Compensation Fund,
and the Medical Examining
Board in reviewing physicians
against whom multiple awards/
settlements have been made.
Also in this regard, the Com-
mittee voted to increase pro-
tections from lawsuits for phy-
sicians serving on peer review
committees.
In addition, the Committee
voted to make the following
changes in the Patient Compen-
sation Panels;
Doctor Flaherty emphasized
that any proposed solution to
this problem must:
• Incorporate a "means test"
to insure that public dollars are
not used to subsidize the non-
poor who choose not to spend
money on healthcare;
• Retain freedom of choice in
allowing patients to select health-
care providers and institutions;
• Avoid "first-dollar" cover-
age problems by requiring some
copayment, even if only a nomin-
al amount, and
• Avoid the development of an
overly complex, bureaucratic
system which would add greatly
to the cost as well as discourage
provider and recipient partici-
pation.*
• Hold separate hearings on the
issues of liability and damages.
Only if negligence is found at
the initial hearing would the
Panel reconvene to consider
damages.
• Not require expert testimony
at panel hearings.
At its January 28 meeting the
Committee approved an SMS
recommendation that the losing
party in a panel case must post
a $10,000 bond if pursuing a
panel case in circuit court.
Also at the meeting the Com-
mittee rejected proposals:
—To require physician consent
prior to an insurance company
settling a claim; and
—To make panel findings
binding.
At previous meetings the
Committee voted to limit mal-
practice awards to $ 1 million
per occurrence and limit attorney
contingency fees.*
WHCLIP Fund
rate increases
recommended
The Actuarial Committee for
the Wisconsin Health Care Lia-
bility Insurance Plan (WHCLIP)
and the Patients Compensation
Fund are recommending a 69.6%
increase in WHCLIP rates and a
160% increase in the Patients
Compensation Fund assessment
to be effective July 1, 1985. The
recommendation was to be final-
ized by the WHCLIP Fund Board
of Governors at its meeting Feb-
ruary 13. The increase in the
Fund assessment is intended to
cover next year's claims and
recover a portion of the projected
$74.7 million deficit.
If a physician chooses to ob-
tain basic coverage from
WHCLIP, the total premium for
liability coverage (WHCLIP plus
the Fund) will range from $4,792
for a family physician to $51,773
for a neurosurgeon.
SMS actuaries opposed the
increases as being excessive. The
SMS Committee on Medical Lia-
bility and the Board of Directors
are reviewing this proposal and
formulating a plan of action.*
Medicare
participating
physicians'
directories
available
WPS-Medicare recently re-
leased the Medicare Participating
Physician Directory which pro-
vides a list by city of all MDs,
hospitals, and other services who
signed up as "participating phy-
sicians." It also issued the latest
Participation List (PARL) which
indicates the percentage of cases
continued
Malpractice committee backs
SMS peer review proposal
WISCONSIN MEDICAL JOURNAL, FEBRUARY 1985 : VOL. 84
5
SOCIOECONOMICS
MEDICARE PARTICIPATING
continued
in which each physician accepts
assignment. Persons wishing to
obtain these directories can sub-
mit their request with the appro-
priate check to: WPS-Medicare,
ATTN; Edie Laufenberg, PO
Box 1787, Madison, WI 53701.
MEDPARD (Milwaukee,
Waukesha, Racine, Kenosha,
Washington Ozaukee counties):
$4.62
MEDPARD (Balance of state):
$4.42
PARE (Entire state): $25.00
SMS is currently analyzing the
directories to determine the
actual breakdown of participating
physicians by city, specialty, and
county medical society. Accord-
ing to the SMS review, 2,691 phy-
sicians have agreed to participat-
ing status. If physicians have
specific questions about the
directory or the situation in their
county or city, they are encour-
aged to call Brian Jensen or
Michelle Scoville of the SMS
Physicians Alliance Division at
1-800-362-9080 or (608) 257-6781.
Physicians also might be inter-
ested in this comparative data
compiled by the Health Care Fi-
nancing Administration before
implementation of the Deficit
Reduction Act:
—87% of all physicians saw
Medicare patients or received
some Medicare funding.
—80% of those physicians ac-
cepted assignments some of the
time.
—20% of those physicians al-
ways accepted assignment.
—51% of all Medicare claims
were assigned. ■
Annual Meeting
resolution deadline
The 1985 House of Delegates
sessions will be held April 25-26
in La Crosse. All resolutions must
be submitted in proper form to the
Secretary's office at SMS no later
than February 25, 1985 (two
months prior to the first session of
the House). It is important that
county medical societies, specialty
sections, and members submit
resolutions early to facilitate early
distribution of materials and allow
all delegates to adequately repre-
sent their county medical society
or specialty section. If a resolution
involves expenditures, a "fiscal
note" must accompany the reso-
lution. SMS staff is available to
assist in preparation of fiscal
notes. The first session of the
House will convene on April 25
and the second and third sessions
will be on April 26, 1985. ■
Legislative leadership announced
Senate and Assembly leaders and committees have been chosen
for the 1985 Legislature. Key legislative leaders for 1985 are:
Senate Majority Leader Tim Cullen (D-Janesville); Senate Mi-
nority Leader Susan Engeleiter (R-Menomonee Falls); Assembly
Majority Leader Dismas Becker (D-Milwaukee); Assembly Mi-
nority Leader Tommy Thompson (R-Elroy); Assembly Speaker
Tom Loftus (D-Sun Prairie); and Senate President Fred Risser
(D-Madison).
Committee appointments of concern to physicians include:
Joint Committee on Finance: Representatives Schneider (D-
Wisconsin Rapids) (Chair); Metz (D-Green Bay); D Travis (D-
Madison); Jauch (D-Superior); Kunicki (D-Milwaukee); Nelson
(R-Milwaukee); Prosser (R-Appleton); Panzer (R-West Bend);
Senators George (D-Milwaukee); Norquist (D-Milwaukee);
Roshell (D-Eau Claire); Chvala (D-Monona); Helbach (D-Stevens
Point); Strohl (D-Racine); Stitt (R-Port Washington); Chilsen
(R-Wausau).
Assembly Health & Human Services: Representatives Robin-
son (D-Wausau) (Chair); Barrett (D-Milwaukee); Medinger
(D-La Crosse); M Coggs (D-Milwaukee); Bell (D-Milwaukee);
Holperin (D-Eagle River); Black (D-Madison); J Young (R-Brook-
field; Rosenzweig (R-Wauwatosa); Ourada (R-Antigo); Johnsrud
(R-Eastman).
Senate Agriculture, Health and Human Services: Senators Moen
(D-Whitehall) (Chair); Otte (D-Sheboygan); Feingold (D-Middle-
ton); Ulichny (D-Milwaukee); Norquist (D-Milwaukee); Lorman
(R-Fort Atkinson); Rude (R-Coon Valley); Harsdorf (R-Belden-
ville).
Senate Labor, Business, Veterans Affairs and Insurance:
Senators Van Sistine (D-Green Bay) (Chair); Roshell (D-Eau
Claire); Otte (D-Sheboygan); Plewa (D-Milwaukee); Leean (R-
Waupaca); Kreul (R-Platteville).B
Persons interested in the Im-
paired Physician Program
may call 608/257-6781 or
toll-free in Wisconsin: 1-800-
362-9080 and explain their
concern to Mr John LaBis-
soniere or Mr H B Maroney
of the State Medical Society
staff. The caller's identity
will be kept in complete
confidence.
32
WISCONSIN' .MEDICAL JOU RN AL, FEBRL ARV 1985: VOL. 84
SOCIOECONOMICS
What is WISPAC?
The Wisconsin Physicians
Political Action Committee is a
voluntary, nonprofit organization
whose membership consists of
physicians and their spouses. Re-
stricted from making political
contributions, the State Medical
Society created and administers
WISPAC to provide the medical
profession with an opportunity to
assume a more active role in the
political process.
Why is WISPAC necessary?
Most physicians would rather
stay out of politics but unfor-
tunately, government doesn't feel
that way about getting involved
in medicine. Medical liability,
cost and competition regulations,
as well as proposals dealing with
lay midwifery, living wills, and
mandated insurance coverages
are just a few of the issues that
the Legislature will be dealing
with during the 1985-86 session.
It's essential that physicians sup-
port those legislators who under-
stand and are responsive to medi-
cine's concerns.
Was WISPAC successful
in last year's election?
Yes. In the November election
WISPAC endorsed the eventual
winner in 86 out of 99 Assembly
races and in 14 out of 17 Senate
races. Maybe even more im-
portantly, WISPAC was able to
get off to a good start with many
new legislators. In 75 percent of
the cases where there was no in-
cumbent running, WISPAC sup-
ported the winning candidate,
thus, strengthening medicine's
position in the legislative forum.
Over 60 percent of those candi-
dates endorsed by WISPAC ac-
cepted direct financial contri-
butions while the others received
various types of assistance in
their campaigns.
What about Federal elections?
WISPAC traditionally concen-
trates on the state legislature and
cooperates with the American
Medical Political Action Commit-
tee on the national level. AMPAC
has more than 50,000 members
throughout the country and sup-
ports campaigns for the US Senate
and Congress. Wisconsin has an
extremely good record for getting
AMPAC funds back to districts in
this state.
Does WISPAC favor one
political party over another?
No, in fact, over the last three
elections, neither the Republican
nor Democratic party candidates
have received more than 52 per-
cent of the endorsements made
by WISPAC.
How does WISPAC
target its support?
Support is given to individuals
based on their voting records,
their indicated support for medi-
cine, and realistic political ap-
praisals. The final decisions are
made by the WISPAC Board of
Directors after carefully looking
at all the facts, and in many cases,
relying heavily on the recom-
mendations of physicians who
have attended local legislative
meetings.
What will WISPAC
be doing in 1985?
Political action must not end
with the elections. WISPAC will
continue to play an important
role during this year's legislative
session, coordinating fundraisers,
other local political activities,
and most importantly physician-
legislator contacts. For the first
time this year, we've asked some
key legislative leaders to offer
comments on healthcare issues
and they are being featured in a
series of Campaign Insight news-
letters. And finally, we're looking
forward to chances such as this,
to provide physicians through-
out the state with more infor-
mation about WISPAC, and
politics in Wisconsin.*
WISCONSIN MEDICAL JOURNAL, FEBRUARY 1985: VOL. 84
53
[obituaries
]
Harold D Rose, MD, Wood, died
Feb 8, 1984 in Wood. Doctor
Rose was born in 1924 and grad-
uated from George Washington
University School of Medicine
in 1948.
Ralph George Burnett, MD, 53,
Kenosha, died Aug 27, 1984 in
Kenosha. Born June 10, 1931 in
Kenosha, Doctor Burnett grad-
uated from Marquette University
School of Medicine in 1956 and
completed his internship at Cook
County Hospital in Chicago. He
served in the United States Navy
from 1957-1959. He was a mem-
ber of Kenosha County Medical
Society, the State Medical Society
of Wisconsin, and the American
Medical Association. Surviving
are his widow and six children.
Bernard Anthony Trimborn,
MD, 71, Milwaukee, died Oct 3,
1984 in Milwaukee. Born July 23,
1913 in Milwaukee, Doctor Trim-
born graduated from Marquette
University School of Medicine,
Milwaukee, in 1938 and served
his internship at St Joseph's Hos-
pital in Milwaukee. His resi-
dency was completed at St
Michael's Hospital, Milwaukee.
Doctor Trimborn was a member
of The Medical Society of Mil-
waukee County, the State Medi-
cal Society of Wisconsin, and the
American Medical Association.
Surviving is his widow.
Oscar A Stiennon, MD, 94, Green
Bay, died Dec 7, 1984 in Green
Bay. Born on Sept 19, 1890 in Bel-
gium, Doctor Stiennon graduated
from Marquette University
School of Medicine in 1918 and
served his internship at Mil-
waukee County General Hos-
pital. Doctor Stiennon had prac-
ticed medicine in Green Bay
since 1919 and was a member of
the medical staff of St Vincent's,
Beilin, and St Mary's hospitals.
He served as a delegate from
the Brown County Medical So-
ciety for twelve years and also
was a past president of Brown
County Medical Society. He was
a member of the "50 Year Club"
of the State Medical Society of
Wisconsin, and also was a mem-
ber of the American Medical As-
sociation. Surviving are two sons.
Dr O Arthur Stiennon and John
J Stiennon of Madison.
Raul M Lagman, MD, 54, Cuba
City, died Dec 19, 1984 in Cuba
City. Born Apr 15, 1930 in
Manila, The Philippines, Doctor
Lagman graduated from the Uni-
versity of Santo Tomas in 1957
and completed his internship at
Sacred Heart Hospital in Spo-
kane, Wash. His residency was
completed at the Tucson Hospital
Medical Center in Arizona.
Doctor Lagman had been asso-
ciated with the Cuba City Medical
Center since 1971. He also had
been associated with the South-
west Health Center in Platteville.
Doctor Lagman was a member of
the Grant County Medical So-
ciety, the State Medical Society of
Wisconsin, and the American
Medical Association. Surviving
are his widow, Charlotte; four
sons, Steve, Madison; Matt, Mike,
and Bruce all of Phoenix, Ariz;
two daughters, Mary and Kim,
Mesa, Ariz; and two stepchildren,
Shawn and Kami Kratochvill of
Cuba City. ■
CES Foundation
CONTRIBUTIONS-Decembcr 1984
The Charitable, Educational and Scientific Foundation of the State
Medical Society is grateful to Society members, their various friends
and associates, and other organizations interested in the aims and
purposes of the Foundation, for .their generous support. The Foun-
dation wishes to acknowledge the following contributions for
December 1 984.
Nonrcstrictcd
Frank L Myers, MD; Orvin G Glesne, MD; George Handy, MD; Jacob M Fine, MD;
Albert F Rogers, MD; Myron Schuster, MD; VA Baylon, MD; Richard C Holden,
MD; Herman J Dick, MD; Harold H Scudamore, MD— Voluntary Contributions
Ralph F Hudson, MD; Robert B Murphy; Thomas Leonard, MD; Milton Bines, MD
—Donation
Etheldred Schaefer Estate— CESF Genera/ Fund
Restricted
L Wayne Brovm— Family Physician Fund
Mrs AC Breier; Mrs William H Bennett; Constance Lotz; Robert E Durnin, MD;
Alice Senty; Harold H Scudamore, MD—Aesculapian Society Dues
W Bruce Fye, MD; DL Martalock, MD—Aesculapian Society Dues (Museum of
Medical Progress Endowment Fund)
Roy Selby, MD— Museum of Medical Progress Endowment Fund (Beaumont 500
Pledge!
Ralph F Hudson, MD— Beaumont 500
Thomas W Tormey Jr, MD—Tormey Memorial Medallion Fund
Thomas R Connell, MD— Student Loan Fund
Memorials
Dane County Medical Society— Robert B Andrew, MD
Farrell F Golden, MD— Isabel MacDonald
Eau Claire, Dunn, Pepin County Medical Auxiliary— Dr Richard D Kennedy
Mrs WR Raduchel— r/te/nra Ford
Dr-Mrs Robert T Schmidt— LFHa/ron
Dr-Mrs Robert T Schmidt— AP Magnus,' Marshall Crull; Edward L Meyer; Dr Richard
E Jensen: Mrs William Ford; Mr Robert T Meyer; Mr James Broern; John Jursich
(Brown County Loan FundjU
54
WISCONSIN MEDICAL JOURNAL, FEBRUARY 1985: VOL. 84
b
600mg1ablets
Upjohn
ti984 The Upjohn Company The Upjohn Company • Kalamazoo, Michigan 49001 USA j-4044 January 1984
I
I
!!
Aftera ntticite,
add ISOPTIN^
(verapamil HCl/Knoll)
To protect your patients, as well as their quality of life,
add Isoptin instead of a beta blocker.
first, Isoptin not only reduces myocardial oxygen demand
by reducing peripheral resistance, but also increases coro-
nary perfusion by preventing coronary vasospasm and
dilating coronary arteries — both normal and stenotic.
These are antianginal actions that no beta blocker
can provide.
Second, Isoptin spares patients the
beta-blocker side effects that may
compromise the quality of life.
With Isoptin, fatigue, bradycardia and mental
depression are rare. Unlike beta blockers,
Isoptin can safely be given to patients with
asthma, COPD, diabetes or peripheral
vascular disease. Serious adverse
reactions with Isoptin are rare
at recommended doses; the
single most common side
effect is constipation (6.3%).
Cardiovascular contra-
indications to the use of
Isoptin are similar to those
of beta blockers: severe
left ventricular dysfunction,
hypotension (systolic pres-
sure <90 mm Hg) or cardio-
genic shock, sick sinus syndrome
(if no artificial pacemaker is present)
and second- or third-degree AV block.
So, the next time a nitrate is not enough, add
Isoptin ... for more comprehensive antianginal
protection without side effects which may
cramp an active life style.
ISOPTIN. Added
antianginal protection
without beta-blocker
side effects.
Please see brief summary on following page.
ISOPHN TABICTS
iverapamil HCl/KnolO
80 mg and 120 mg !
Contraindications: Severe left ventricular dysfunction (see Warn- j
mgs), hypotension (systolic pressure <90 mm Hg) or cardiogenic I
shock, sick sinus syndrome (if no pacemaker is present), 2nd- or 3rd-
degree AV block Warnings: ISOPTIN should be avoided in patients
with severe left ventricular dysfunction (e g , ejection fraction <30%)
or moderate to severe symptoms of cardiac failure. Control milder
heart failure with optimum digitalization and or diuretics before I
ISOPTIN IS used ISOPTIN may occasionally produce hypotension '
(usually asymptomatic, orthostatic, mild, and controlled by decrease
in ISOPTIN dose) Occasional elevations of liver enzymes have been i
reported; patients receiving ISOPTIN should have liver enzymes mom- [
tored periodically Patients with atrial flutter fibrillation and an acces- ^
sory AV pathway (e,g , W-P-W or L-G-L syndromes) may develop a j
very rapid ventricular response after receiving ISOPTIN (or digitalis)
Treatment is usually D C -cardioversion AV block may occur (3rd
degree, 0.8%) Development of marked Ist-degree block or progres- j
Sion to 2nd- or 3rd-degree block requires reduction in dosage or, I
rarely, discontinuation and institution of appropriate therapy Sinus
bradycardia, 2nd-degree AV block, sinus arrest, pulmonary edema,
and'Or severe hypotension were seen in some critically ill patients
with hypertrophic cardiomyopathy who were treated with ISOPTIN
Precautions: ISOPTIN should be given cautiously to patients with
impaired hepatic function (in severe dysfunction use about 30% of
the normal dose) or impaired renal function, and patients should be
monitored for abnormal prolongation of the PR interval or other
signs of overdosage Studies in a small number of patients suggest
that concomitant use of ISOPTIN and beta blockers may be beneficial
in patients with chronic stable angina Combined therapy can also
have adverse effects on cardiac function. Therefore, until further
studies are completed, ISOPTIN should be used alone, if possible If
combined therapy is used, patients should be monitored closely
Combined therapy with ISOPTIN and propranolol should usually be
avoided in patients with AV conduction abnormalities and/or de-
pressed left ventricular function or in patients who have also recently
received methyidopa. Chronic ISOPTIN treatment increases serum
digoxin levels by 50% to 70% during the first week of therapy, which
can result n digitalis toxicity The digoxin dose should be reduced
when ISOPTIN is given, and the patient carefully monitored, ISOPTIN
may have an additive hypotensive effect in patients receiving blood-
pressure-lowering agents Disopyramide should not be given within
48 hours before or 24 hours after ISOPTIN administration Until fur-
ther data are obtained, combined ISOPTIN and quinidine therapy in
patients with hypertrophic cardiomyopathy should probably be
avoided, since significant hypotension may result Adequate animal
carcinogenicity studies have not been performed One study in rats
did not suggest a tumongenic potential, and verapamil was not
mutagenic in the Ames test Pregnancy Category C. There are no
adequate and well-controlled studies in pregnant women This drug
should be used during pregnancy, labor, and delivery only if clearly
needed It is not known whether verapamil is excreted in breast milk,
therefore, nursing should be discontinued during ISOPTIN use
Adverse Reactions: Hypotension (2 9%), peripheral edema (17%),
AV block. 3rd degree (0.8%), bradycardia HR<50/min (1 1%), CHF
or pulmonary edema (0 9%), dizziness (3 6%), headache (1 8%),
fatigue (1 1%), constipation (6 3%), nausea (1 6%). The following
reactions, reported in less than 0 5%, occurred under circumstances
where a causal relationship is not certain confusion, paresthesia,
insomnia, somnolence, equilibrium disorders, blurred vision, syncope,
muscle cramps, shakiness, claudication, hair loss, maculae, and spotty
menstruation Overall continuation rate of 94 5% in 1,166 patients
How Supplied: ISOPTIN (verapamil HCI) is supplied in 80 mg and
120 mg sugar-coated tablets. July 1982 2068
O. KNOLL PHARMACEUTICAL COMPANY
knoll 30 NORTH JEFFERSON ROAD, WHIPPANY NEW JERSEY 07981
2195
IGNORANa
IS NO
DKUSE.
America's declining
productivity is serious
business.
It's about time we all
got serious about it.
1 proauctivrty- 1 America's productivity
I TheC>'»» 1 growth rate has been
1 onUs- 1 slipping badly tor sev-
1 1 eral years now, com-
1 1 pared to that of other
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1 every one of us.
L ^ We've all seen
plants and businesses close down.
Tens of thousands of jobs lost. Prices
rising, quality deteriorating. A flood
of foreign-made products invading
our shores. It's all part of our declin-
ing productivity rate.
We've simply got to work it out —
and we've got to work together to do
it. But first, we need to know more
about the problem and the possible
solutions so we can act intelligently
and effectively.
That's why you should send for
this informative new booklet. It hasn't
got all the answers — there are no
quick and easy ways out — but it's a
very good place to start the produc-
tivity education of yourself, your
associates and your workers. It's free
for the asking — and in quantity. Mail
the coupon right away. Ignorance is
no excuse.
A public service of this publication
and the American Productivity Center
America.
Let's work together.
I National Productivity Awareness Campaign
I P.O. Bok 480, Lorton, VA 22079
Yes, I would like to improve my company's
productivity Pleose send me o free copy of
"Productivity the crisis that crept up on us "
(Quontities ovoilable ot cost from above
oddress )
Name.
Title
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I Pleose allow 4-6 weeks for delivery.
J
who is number 1
in medical
office computer
systems in
Wisconsin?
HDX Clinical Hanagenent Systen
1) Financial Accounting
2) Insurance Clam Tracking
6) Appointnent Scheduling
7) Hedical History
Not IBM nor Apple nor any other nationally-known
computer name. The answer is Advanced Technology
Associates. Number 1 means the most complete systems; the
most logical match of hardware, software and services. ATA is
the source for total packages — computers, terminals, printers,
special medical programs, careful installation, training for
your people and after-sale support.
Considering the scope of our Wisconsin experience, it
should not surprise you that ATA is endorsed by the State
Medical Society.
May we send you information listing your benefits from
a strictly medical office computer system? Call or write.
Advanced Technology Associates
4710 W. North Avenue, Milwaukee. Wl 53208
(414) 445-4280
In Wisconsin call toll free 1-800-242-4280.
Endorsed by SMS Services, Inc For members of the State Medical Society of Wisconsin.
C E S
Foundation
of the State Medical
Society of Wisconsin
The Charitable, Educational and Scientific Foundation
of the State Medical Society of Wisconsin recognizes
the generosity of the following individuals and
organizations whose contributions during 1984 have
helped make a vital and successful year.
Val D Adamski, MD
Richard D Adelman, MD
Muhammad Y Ahmad, MD
Neston C Alaborca, MD
Herbert F Allen, MD
Herbert M Allen, MD
Robin N Allin, MD
James A Alston, MD
Charles J Anderson, MD
George H Anderson, MD
Henry A Anderson, MD
Robert G Anderson, MD
Robert B Andrews, MD
Mary Angell
Thomas J Antifinger, MD
Richard E Appen, MD
Senekerim Armagan, MD
Gene F Armstrong, MD
George W Arndt, MD
Ashland-Bayfield-lron County
Medical Society Auxiliary
Benjamin W Atkinson, MD
Nerissa L Avestruz, MD
John L Babb, MD
Alan Babcock
Edward A Bachhuber, MD
Gregory J Bachhuber, MD
Max O Bachhuber, MD
Christobel G Bahzad, MD
Felicisima B Balverde, MD
James H Barbour, MD
James J Barrock, MD
LaVerne Bartel
Larry J Barthel, MD
Joseph A Bartos, MD
John E Basich, MD
Norbert G Bauch, MD
Carroll A Bauer, MD
William BAJ Bauer, MD
William Bauer, MD
Kenneth L Bauman, MD
Don P Baumblatt, MD
Lester J Bayer, MD
VA Baylon, MD
Leo E Becher, MD
Richard C Bechtel, Jr, MD
John J Beck, MD
Norman O Becker, MD
Ann C Beecher, MD
George A Behnke, MD
Joseph F Behrend, MD
Susan F Behrens, MD
James R Beix, MD
Thomas P Belson, MD
Mary Belz
A James Bennett, MD
Thomas J Beno, MD
Mary C Berg, MD
Herbert A Berkoff, MD
Harvey H Bernstein, MD
Richard H Bibler, MD
Richard W Biek, MD
James F Bigalow, MD
Milton Bines, MD
Mark R Bixby, MD
Harold A Bjork, MD
John T Bjork, MD
David P Black, MD
Samuel B Black, MD
Barry Blackwell, MD
David G Blake, MD
Steven Blatnik, MD
Donald V Blink, MD
Robert A Boedecker, MD
Robert M Boex, MD
Bruce R Bogost, MD
James T Botticelli, MD
Marshall O Boudry, MD
John S Boyle, MD
Roger V Branham, MD
Charles H Brannen, MD
William M Brennan, MD
Gordon W Brewer, MD
Frederick S Brightbili, MD
John R Brown, MD
Roland C Brown, MD
Thomas H Browning, MD
Robert G Brucker, MD
Patricia K Bruens, MD
Larry R Brunziick, MD
Richard J Bryant, MD
Robert S Bujard, Jr, MD
Kim R Burch, MD
Harvey L Burdick, MD
Donald R Burke, MD
Eugene E Burzynski, MD
Christopher J Buscaglia, MD
Ted S Buszkiewicz, MD
James J Buth, MD
Richard R Byrne, MD
Josefino B Cabaltica, MD
Donald W Caivy, MD
Robert H Caplan, MD
Eugene J Carlisle, MD
David J Carlson, MD
Guy W Carlson, MD
James L Carroll, MD
Jeffrey J Carroll, MD
Kenneth L Carter, MD
Alfred Cartes, MD
Enzo F Castaldo, MD
Hark C Chang, MD
John E Charles, MD
Sampath K Chennamaneni, MD
Henry Chessin, MD
Wook-Chin Chong, MD
Dennis D Christensen, MD
Richard H Christenson, MD
Clyde MChumbley, III, MD
Ruth E Church, MD
Douglas O Clark, MD
William E Clark, MD
Gerald P Clarke, MD
Richard W Clasen, MD
Norman M Clausen, MD
Daniel M Cline, MD
Frances A Cline, MD
Gerald L Clinton, MD
Norman E Cohen, MD
Donald F Cohill, MD
Robert L Cole, MD
Frederick W Coleman, MD
Harold L Conley, MD
John E Conway, MD
Frederick D Cook, MD
Steven D Cook, MD
Garrett A Cooper, MD
Stuart M Cooper, MD
Joihn E Cordes, MD
Robert J Corliss, MD
Howard LCorrell, MD
Arch E Cowle, MD
Michael LCummens, MD
Patrick W Cummings, Jr, MD
Dowe P Cupery, MD
John J Czajka, MD
Philip J Dahiberg, MD
Michael P Dailey, MD
Ronald J Darling, MD
William A Darling, MD
Ram Das, MD
Halil Davasligil, MD
Donald P Davis, MD
Frederick J Davis, MD
Hugh L Davis, MD
John A De Giovanni, MD
Leon F De Jongh, MD
Joel R De Koning, MD
Warren H De Kraay, MD
Hugh F De Merest, Jr, MD
E M Dessloch, MD
John E Dettmann, MD
Alan L Detwiler, MD
Herman J Dick, MD
Douglas K Diehl, MD
William S Donnell, MD
Anton S Dorn, MD
Richard K Dortzbach, MD
Philip J Dougherty, MD
Thomas J Dougherty, MD
C Thomas Dow, MD
Teresa A Dowdy, MD
Jerome J Dowling, MD
Edwin L Downing, MD
Henry D Drayer, MD
Dean M Dreblow, MD
George G Drescher, MD
Mark W Dreyer, MD
Steven D Driggers, MD
Robert E Drom, MD
Ernest M Drury, MD
David K Dunn, MD
Michael C Dussault, MD
James R Dyreby, Jr, MD
Jack D Edson, MD
Cynthia A Egan, MD
Carl S L Eisenberg, MD
Ted D Elbe, MD
Pepito M Emiano, MD
David E Enerson, MD
Stanley M Englander, MD
David E Engle, MD
Stanley A Englund, MD
Huron L Erickson, MD
Milo R Erickson, MD
Chesley P Erwin, MD
Mohammed Esmaili, MD
Michael R Evans, MD
Howard A Evert, MD
RenatoT Faylona, MD
John W Fenlon, MD
Peter A Fergus, MD
Gabriel P Ferrazzano, MD
William C Fetherston, MD
Jacob M Fine, MD
Richard C Fink, MD
Louis C Fischer, MD
William A Fischer, MD
John V Flannery, Sr, MD
Martin B Fliegel, MD
Thomas R Flygt, MD
David V Foley, MD
John J Foley, MD
JohnW Foreman, MD
Paul S Fox, MD
Theodore C Fox, MD
Joseph C Fralich, MD
Eugene B P Frank, MD
Jordon Frank, MD
Mary Franke
Raymond O Frankow, MD
Lawrence J Frazin, MD
Mark L Freeman, MD
Robert A Frisch, MD
Rudy P Froeschle, MD
Rodney B Fruth, MD
Donn D Fuhrmann, MD
Reynaldo P Gabriel, MD
Luis L Galang, MD
Ihor A Galarnyk, MD
Rocco S Galgano, MD
Thomas J Gallagher, MD
Badri N Ganju, MD
Hyman A Gantz, MD
Fema So Garay, MD
Arthur F Garcia, Jr, MD
Peter A Gardetto, MD
Gordon M Garnett, MD
James G Garnett, MD
Michael S Garrity, MD
Piero G Gasparri, MD
Howard I Gass, MD
George L Gay, Jr, MD
Irwin E Gaynon, MD
J E Geenen, MD
Francis E Gehin, MD
John V Gehring, MD
Peter T Geiss, MD
Jack E Geist, MD
Barbara Geldner, MD
Robert N Gershan, MD
Gary L Gerstner, MD
Richard D Gibson, MD
James P Gierahn, MD
Dr. and Mrs. Guy Giffen
Walters Giffin, MD
Maxine Gilbert
Alonzo R Gimenez, MD
James E Glasser, MD
Orvin G Glesne, MD
Lucille B Glicklich, MD
Orvin G Gloesne, MD
Frank E Gloss, MD
Frederick H Goetsch, MD
David N Goldstein, MD
Jyothi Gondi, MD
Caesar R Gonzaga, MD
Terry S Graves, MD
Benjamin S Greenwood, MD
Vernon M Griffin, MD
Peter J GroessI, MD
David C Grout, MD
William B Grubb, Jr, MD
Gretchen Guernsey, MD
A Erick Gunderson, MD
Thorolf E Gunderson, MD
Daniel B Gute, MD
Milton F Gutglass, MD
Jerome H Hagens, MD
Roland M Hammer, MD
George R Hammes, MD
George Handy, MD
Charles E Hansell, MD
Horace J Hansen, MD
Ervin Hansher, MD
Harold F Hardman, PhD, MD
James W Hare, MD
Stephen W Hargarten, MD
Samuel B Harper, MD
John S Harris, MD
John A Harris, MD
William C Harris, MD
Richard L Hartzell, MD
Paul S Haskins, MD
Stephen L Haug, MD
Katherines Hauser, MD
JohnW Hayden, MD
John C Heffelfinger, MD
Jack D Heiden, MD
Thomas F Heighway, MD
Robert D Heinen, MD
Glen J HeinzI, MD
Robert L Hendrickson, MD
Daniel W Herrell, MD
Roland E Herrington, MD
Sidney Herszenson, MD
Edgar O Hicks, MD
Alan C Hilgeman, MD
Glenn C Hillery, MD
James A Hinckley, MD
John S Hirschboeck, MD
John H Hirschboeck, MD
Kurt A Hoehne, MD
ArthurW Hoessel, MD
Thomas A Hofbauer, MD
Jack R Hoffman, MD
Karl M Hoffmann, MD
Frederick J Hofmeister, MD
John E Hoggatt, MD
A A Holbrook, MD
Richard C Holden, MD
Stanley W Hollenbeck, MD
Peter W Holm, MD
Charles E Holmburg, MD
John S Honish, MD
Harold J Hoops, Jr, MD
Robert H House, MD
John C Hovey, MD
Edward J Hoy, MD
Steven H Hoyme, MD
Lee H Huberty, MD
Ralph F Hudson, MD
Jewel S Huebner, MD
Willard G Huibregtse, MD
Amy L Hunter-Wilson, MD
John D Hurley, MD
Elmore P Huth, MD
Melvin F Huth, MD
Clare F Hutson, MD
Charles V Ihle, MD
Pauline M Jackson, MD
Walter H Jaeschke, MD
Charles J Jannings, III, MD
Ruth L Kramer Jansen, MD
Martin L Janssen, MD
William C Janssen, MD
Jefferson County
Medical Society Auxiliary
Lloyd F Jenk, MD
Alfhild I E Jensen, MD
Richard Jensen, MD
Robert B Johnson, Jr, MD
Howard H Johnson, MD
J Howard Johnson, MD
John W Johnson, MD
Raymond R Johnson, MD
Ronald C Johnson, MD
Samuel B Johnson, MD
Eugene R Jonas, MD
Charles L Junkerman, MD
August J Jurishica, MD
Robert N JustI, MD
Dili F Kaarakka, MD
Michael T Kademian, MD
Gerald J Kallas, MD
Albert V Kanner, MD
Edward S Kapustka, MD
Mack A Karnes, MD
Robert Kastelic, MD
Henry M Katz, MD
Henry J Katz, MD
Eugene M Kay, MD
Theodore A Keller, MD
Orville R Kelley, MD
Gerald C Kempthorne, MD
William G Kendell, MD
Janis J Kengis, MD
Ralph O Kennedy, MD
Theodore J Kern, MD
Vytas K Kerpe, MD
Charles W Keskey, MD
Nevenka T Kevich, MD
Harold J Kief, MD
Charles K Kincaid, MD
Robert R Kinde, MD
Josef A Kindwall, MD
Bruce C Kirkham, MD
Roger A Kjentvet, MD
Becky L Kleager, MD
Martin H Klein, MD
Joyce C Kline, MD
Robert E Klingbiel, MD
Douglas D Klink, MD
Willard EKIockow,MD
Ralph A Kloehn, MD
James W. Knauf, MD
Edgar L Koch, MD
Fred H Koenecke, Jr, MD
Leif H Kokvam, MD
Jane H Koll-Frazier, MD
Edward H Kolner, MD
Wayne H Konetzki, MD
Robert F Korbitz, MD
Stanley A Korducki, MD
George J Korkos, MD
Jan George Kotynek, MD
Clarence E Kozarek, MD
Bruce A Kraus, MD
Randolph WKreuI, MD
William R KreuI, MD
Robert M Krout, MD
Diana L Kruse, MD
Raymond V Kuhn, MD
Michael J Kuhn, Sr, MD
Gregory J Kuhr, MD
Vijay V Kulkarni, MD
Palmer R Kundert, MD
Esther C Kurtz, MD
Burton J Kushner, MD
S Paul Kuwayama, MD
James R Kuzdas, MD
Roger W Kwong, MD
Frederick J Lament, MD
Jean L Lang, MD
Per Langeland, MD
Mark G Langenfeld, MD
Warner Langheim, MD
John R Larsen, MD
Roy B Larsen, MD
Christopher L Larson, MD
Harry H Larson, MD
Lawrences Larson, MD
David L Lawrence, MD
Timothy E Lechmaur, MD
Emma K Ledbetter, MD
Alice M Lee, MD
Jong Man Lee, MD
Robert H Lehner, MD
Robert H Lehner, II, MD
Bradley N Lemke, MD
Thomas Leonard, MD
Loren A Leshan, MD
Marc A Letellier, MD
Jules D Levin, MD
Walter Lewinnek, MD
Russell F Lewis, MD
Roland R Liebenow, MD
R Scott LiebI, MD
Larry A Lindesmith, MD
Florentino E Lleva, MD
Roland A Locher, MD
Jack M Lockhart, MD
Paul W Loewenstein, MD
Kenneth O Loken, MD
William G Longe, MD
Basilio F Lopez, MD
William L Lorton, MD
Robert M Lotz, MD
Allan Luck, MD
Erwin P Ludwig, MD
CES FOUNDATION
CONTRIBUTIONS
continued
Thomas J Luetzow, MD
Rolf S Lulloff, MD
Robert E Lund, MD
Enrique W Luy, MD
Mary L Lyons, MD
Lloyd P Maasch, MD
Almon R Mac Ewen, MD
Ernest L Mac Vicar, Jr, MD
Robert F Madden, MD
William J Madden, MD
Frank E Maddison, MD
Michael H Mader, MD
Frederick W Madison, MD
Henry E Majeski, MD
Larry J Malewiski, MD
Aykarethu O Mammen, MD
Manitowoc County
Medical Society Auxiliary
Bradley L Manning, MD
Marathon County
Medical Society Auxiliary
Richard J Marchiando, MD
Robert W Marek, MD
Michael T G Marra, MD
Ravikant Maski, MD
Paul B Mason, MD
Johan A Mathison, MD
Kenneth L Matson, MD
James R Mattson, MD
John B Me Andrew, MD
Peter J McCanna, MD
DOnald H Me Donald, MD
James P Me Ginnis, MD
Norbert A Me Greane, MD
Josiah A Me Hale, MD
Gerald T Me Inerney, MD
John E Me Kenna, MD
Norval W Me Kittrick, MD
Robert E Me Mahon, MD
Peter J Me Namara, MD
Urquhart L Meeter, MD
Pierce J Meier, MD
Morris M Meister, MD
Cecilio T Mendoza, MD
Alan J Merkow, MD
Frank L Meyers, MD
Christian F Midelfort, MD
Charles H Miller, III, MD
David K Miller, MD
G Daniel Miller, MD
James D Miller, MD
Owen E Miller, MD
Stanley R Miller, MD
John M Mills, MD
Milwaukee County
Medical Society Auxiliary
Richard Minton, MD
Clarence B Moen, MD
James O Moermond, Jr, MD
Jane M Moir, MD
Mark D Molot, MD
Walter D Moritz, MD
David L Morris, MD
Marriott T Morrison, MD
Cecil A Morrow, MD
Kenneth A Morrow, MD
Albert J Motzel, MD
Gilbert F Mueller, Jr, MD
Mr and Mrs Robert B Murphy
James L Murphy, MD
James E Murphy, MD
Raymond J Murphy, MD
Frank L Myers, MD
George A Nadeau, MD
Moktar Najafzadeh, MD
Cornelius A Natoli, MD
Richard E Neils, MD
David L Nelson, MD
Willard H Nettles, Jr, MD
Earl J Netzow, MD
Kermit L Newcomer, MD
Julian J Newman, MD
Ligaya M I Newman, MD
Frank E Nichols, MD
George P Nichols, MD
William A Nielson, MD
John E Nilles, MD
Edwin O Niver, MD
Gilbert J Nock, Jr, MD
Eugene J Nordby, MD
Vincent W Nordholm, MD
Thomas A O'Connor, MD
Clifford A Olson, MD
Michael G O'Mara, MD
Philip B O'Neill, MD
Thomas J O’Regan, MD
Robert T Obma, MD
George E Oosterhous, MD
Richard C Oudenhoven, MD
Yon Doo Ough, MD
Outagamie County
Medical SOciety Auxiliary
Edwin L Overholt, MD
Cahit H Ozturk, MD
Roger T Pacanowski, MD
Howard J Palay, MD
Jose M Palisoc, Jr, MD
Robert A Palm, MD
James C Paimquist, MD
David E Papendick, MD
Camille A Paquette, MD
Jung Kyun Park, MD
Tai J Park, MD
John G Parrish, Mr, MD
Ando P Patel, MD
Muni H Patel, MD
Charles H Patton, MD
Raimunds Pavasars, MD
Otto V Pawlisch, MD
Ewald H Pawsat, MD
Carlyle R Pearson, MD
Kenneth J Pechman, PhD, MD
Ralph B Pelkey, MD
Philip C Pelland, MD
Russell S Pelton, MD
Karl L Pennau, Jr, MD
Thomas K Perry, MD
Henry A Peters, MD
Kenneth R Peters, MD
Marvin G Peterson, MD
Stanley E Peterson, MD
L R Pfeiffer, MD
Louis R Pfeiffer, MD
Paul W Phillips, MD
Charles J Picard, MD
Pierce-St Croix County
Medical Society Auxiliary
Joseph E Pilon, MD
L Maramon Pippin, MD
Robert B Pittelkow, MD
Michael D Plooster, MD
Louis T Plouff, MD
Bruce A Polender, MD
Leland C Pomainville, MD
George M Pope, MD
Olive Powers
William A Pruett, MD
Karver L Puestow, MD
Robert V Purtock, MD
Mohammad H A Qazi, MD
Steven R Quackenbush, MD
Russell A Quirk, MD
Abraham A Quisling, MD
Sverre Quisling, MD
Leon J Radant, MD
Douglas J Raether, MD
Henry C Rahr, MD
Robert M Railey, MD
Charles H Raine, MD
Teodoro M Ramos, MD
Emergy M Randall, MD
Veluvolu K Rao, MD
Robert J Rasmussen, MD
Cornelius J Rater, MD
John M Rathbun, MD
Alphonsus M Rauch, MD
Thomas R Rauschenberger, MD
Erling O Ravn, Jr, MD
N Hans Rechsteiner, MD
Rick R Reding, MD
Mark Reichelderfer, MD
A L Reinardy, MD
Michael J Reinardy, MD
John L Rens, MD
Paul R Rice, MD
Marcia J S Richards, MD
John E Ridley, III, MD
Anne M Riendl, MD
John D Riesch, MD
David C Riese, MD
Lee M Robak, MD
Cameron F Roberts, MD
Thomas H Roberts, MD
Kent A Robertson, MD
Generoso N Rodriguez, MD
Albert F Rogers, MD
Sion C Rogers, MD
John S Rogerson, MD
Teodoro P Romana, Jr, MD
Gordon H Rosenbrook, MD
Wilbur E Rosenkranz, MD
Harry Roth, MD
Donald M Ruch, MD
Roger L Ruehi, MD
David D Ruehiman, MD
Rusk County
Medical Society Auxiliary
Thomas J Russell, MD
William T Russell, MD
Dennis K Ryan, MD
Martin H Sahs, MD
Douglas D Salmon, MD
Michael San Dretto, MD
Herbert F Sandmire, MD
Ramakrishnan Sankaran, MD
Dennis J Saran, MD
Michael A Satchie, MD
John J Satory, MD
Chester A Sattler, MD
Kendall E Sauter, MD
Edmund W Schacht, MD
Terrance M Schmahl, MD
Carl F Schmidt, MD
Gary A Schmidt, MD
Robert D Schmidt, MD
Robert T Schmidt, MD
Jean H Schott, MD
Charles M Schroeder, MD
Irvin L Schroeder, MD
Robert W Schroeder, MD
Frank X Schuler, MD
Gert J Schuller, MD
Alwin E Schultz, MD
Myron Schuster, MD
Walter R Schwartz, MD
Clarence M Scott, MD
Robert J Scott, MD
Harold H Scudamore, MD
Roy Selby, MD
Robert L Sellers, MD
Robert H Sewell, MD
Kanak K Shah, MD
Edwin O Sheldon, Jr, MD
James J Sherry, MD
John C Shields, MD
Gowdar S Shivamurthy, MD
Philip Shovers, MD
Sultan H Siddiqi, MD
Kenneth J Siegrist, MD
David J Sievers, MD
Rahmatollan Simani, MD
Glenn A Simley, MD
Russell PSinaiko, MD
Kanwar ASingh, MD
George E Skemp, MD
Robert H Slater, MD
David A Slosky , MD
Kenneth M Smigielski, MD
Glenn A Smiley, MD
Warren G Smirl, MD
Douglas LSmith, MD
John A Smith, MD
Stephen V Somerville, MD
Moon-Won Song, MD
Charles C Sorenson, MD
David LSovine, MD
Paul N Sowka, MD
Scott R Springman, MD
Robert E Stader, MD
Helena P K Stefanowicz, MD
Elizabeth A Steffen, MD
Charles LSteidinger, MD
Carles M Steidinger, MD
Thomas E Steinmetz, MD
Ronald W Steube, MD
Bruce J Stoehr, MD
Ruth A Stoerker, MD
Dennis W Stone, MD
Richard H Strassburger, MD
Robert A Straughn, MD
Milton F Stuessy, MD
John F Sullivan, MD
Joseph Syty, MD
Alan L Taber, MD
Arthur W Tacke, MD
Yoshiro Taira, MD
Primo R Tamayo, MD
Philip J Taugher, MD
Menandro V Tavera, Jr., MD
Joel E Taxman, MD
Arthur C Taylor, MD
Benton C Taylor, MD
Alfred J Tector, Jr, MD
Regalado A Tendero, MD
Ivan Teoh, MD
Ervin Teplin, MD
Serafin B Teruel, MD
Alvin C Theiler, MD
John E Thompson, MD
Kimberly M Thompson, MD
Richard D Thompson, MD
Richard J Thurrell, MD
Paul C Todd, MD
Bonnie M Tompkins, MD
Douglas G Tompkins, MD
Clarence A Topp, MD
Joseph E Trader, MD
H Azel Trangsrud, MD
Darold A Treffert, MD
Gay D Trepanier, MD
Bernard A Trimborn, MD
Wilson J Troup, MD
Her-Lang Tu, MD
Allen O Tuftee, MD
Geoffrey LTullett, MD
Harvye A Turner, MD
Deborah M Turski, MD
Patrick A Turski, MD
Henry F Twelmeyer, MD
Lee M Tyne, MD
Richard H Ulmer, MD
Michael J Unger, MD
Hart E Van Riper, MD
Scott D Van Steen, MD
Waldo R Varberg, MD
VitoN Vitulli, MD
George H Vogt, MD
Victoria A Vollrath, MD
W Gregory Von Roenn, MD
Gilbert S Wadina, MD
Robert L Waffle, MD
Burton A Waisbren, Jr, MD
Richard J Wakefield, MD
John W Wakely, MD
Fred H Walbrun, MD
George Walcott, MD
Ernest F Wallner, Jr, MD
Walworth County
Medical Society Auxiliary
JohnEWalz, MD
William M Wanamaker, MD
Hong Chu Wang, MD
David E Warner, MD
Waukesha County
Medical Society Auxiliary
William G Weber, MD
Stephen B Webster, MD
Maxwell H S Weingarten, MD
John A Welsch, MD
Alan F Wentworth, MD
Paul A Wertsch, MD
Richard K Westphal, MD
Timothy G Wex, MD
Maurice LWhalen, MD
Rodney D Wichmann, MD
John Sperry Wier, MD
Frank C Williams, Jr, MD
Delore Williams, MD
Earl B Williams, MD
Thomas H Williams, MD
L M Williamson, MD
D Maclean Willson, MD
Thomas R Winch, MD
Winnebago County
Medical Society Auxiliary
George W Wirtanen, MD
James P Wise, MD
John H Wishart, MD
Rayond W Witt, MD
Gerhard L Witte, MD
Robert S Witte, MD
Robert G Wochos, MD
David M Woeste, MD
WaldemarW Wolfmeyer, MD
James R PWong, MD
Frederick Wood, Jr, MD
James P Wood, MD
Lewis E Wright, MD
William E Wright, MD
Nasip H Yasatan, MD
Joyce A Yerex, MD
Santiago L Yllas, MD
Calvin M Yoran, MD
Charles W Young, MD
William P Young, MD
Rizalino N Yray, MD
Carlos C Yu, MD
Kenneth H Yuska, MD
Raymond C Zastrow, M D
F Frank Zboralske, MD
John C Zeiss, MD
Clifford LZeller, MD
Clarence EZenner, MD
Richard C Zimmerman, MD
SPECIAL GIFTS
Brown Unitrust
L Wayne and Marion Brown
James and Clara Joss Trust Fund
for Medical Research
Efheldred L Schaefer Estate
AESCULAPIAN
SOCIETY
REGULAR
Henry A Anderson, MD
Hugo M Bachhuber, MD
Ann Bardeen, MD
James J Barrock, MD
Mrs William H Bennett
Richard W Biek, MD
Milton Bines, MD
Harold J Bjork, MD
Mrs A C Breier
Henry Chessin, MD
Jerome R and Asher L
Cornfield, MD
Laurene De Witt Davidson
Donald P Davis, MD
Jay S De Vote, MD
Christopher R Dix, MD
Thomas J Dougherty, MD
Jacqueline P Dungar
Roy Dunlap, II, MD
Robert E Durnin, MD
Nancy Edwards
Margaret Elliott
Victors Falk, MD
D J Freeman, MD
Barbara Geldner, MD
David N Goldstein, MD
Samuel B Harper, MD
Loren E Hart, MD
Catherine M Heyrman
Dolores M Johnston
lolyn C Koch
Roy B Larsen, MD
Ronald L Lewis
Russell F Lewis, MD
Constance Lotz
Edwin P Ludwig, MD
Patricia R Maasch
F W Madison, MD
Howard W Mahaffey, MD
Sanford R Mallin, MD
Ravikant Maski, MD
Mrs JamesW McGill
Robert E McMahon, MD
Urquhart L Meeter, MD
Mrs E A Meili
Lolita M Meisinger
William O Meyers, MD
Joseph J Muller, MD
Mrs George Nemec
Lillian E Olson
Wayman L Parker, MD
Edith Hope Pearson
Alfred G Pennings, MD
Mary Groom Pozer
June Rafiullah
Raymond J Rogers, MD
Donald M Ruch, MD
John H Russell, MD
John J Satory, MD
Frank J Scheible, MD
Jean H Schott, MD
Harold H Scudamore, MD
Alice Senty
Rita Tomkiewicz
Elaine V Torkelson
Thomas WTormey, Jr, MD
Edward Vetter, MD
Mrs Edward Vetter
George E Wahl, MD
Twila S Warner
Mrs David R Weber
Joseph Weber, MD
Timothy Wex, MD
FLWhitlark, MD
Erie Wits, MD
Mrs Bonnie Jean Wolfgram
Raymond C Zastrow, MD
GerdaZurek
SUPPORTING
Vivian Barbour
Ardeth J Bayley
D M Connors, MD
Andrew B Crummy, Jr, MD
Kenneth L Day, MD
Mrs Loren J Driscoll
Richard W Edwards, MD
Elsie Egan
William E Finlayson, MD
W Bruce Fye, MD
Lucille B Glicklich, MD
Mrs J S Hess
S W Hollenbeck, MD
Ramona E James
Gerald C Kempthorne, MD
Beverly L Levin
R R Liebenow, MD
Ardeth E Lindgren
William J Listwan, MD
Roland A Lochner, MD
Mrs Charles R Lyons
John T Me Enery, MD
Michael P Mehr, MD
Albert J Motzel, Jr, MD
Robert B Murphy
Kermit Newcomer, MD
E J Nordby, MD
Mrs E J Nordby
Charles H Patton, MD
Robert E Phillips, MD
Joan Pyre
George F Roggensack, MD
Dr and Mrs Walter R Schwartz
Philip Shovers
MrsC LSteidinger
Mrs K Alan Stormo
Philip A Swanson
Mrs William G Weber
Margaret C Winston, MD
SUSTAINING MEMBERS
E M Dessloch, MD
George Kress
D L Martalock, MD
Mrs Frank X Schuler
Gamber F Tegtmeyer, Sr, MD
CES FOUNDATION
CONTRIBUTIONS
continued
BARBARA SCOTT
MARONEY FUND
H B Maroney, II
BEAUMONT 500
Dr and Mrs Richard W Edwards
Chesley Erwin, MD
Dr Roger von Heimburg
Mrs William D Hoard
Dr Ralph F Hudson
Leland C Pomainville, MD
Roy Selby, MD
Dr and Mrs K Alan Stormo
Dr and Mrs Leonard Torkelson
MUSEUM
ENDOWMENT
FUND
Roberta Baldwin
Mrs Rosena E Brunkow
Henry Chessin, MD
Coaches Restaurant
Crawford County
Dr and Mrs Ethan D Ptetterkorn
Etheldred L Schafer, MD Estate
Kathryn Slaught
William G Wendle
Wisconsin Otolaryngological
Society
IN MEMORIAM
Robert B Andrew, MD
Mrs Carolyn Appell
John L Armbruster, MD
Paul F Baker, MD
Barney B Becker, MD
DeWitt C Beebe, MD
Edwin L Bemis, MD
Paul H Biever, MD
Mr Edward Boemer
Mrs John Boersma
John J Boersma, MD
Mrs Robert Bahm
Mr August G Boldt
Donald Britton, MD
Mr James Broern
Bridget Brogan
Ben Brunkow
WarnerS Bump, MD
Leo F Burkheimer
Albert M Cohen, MD
Jesse Conner
Edgar J Craite, MD
Marshall Crull
Mr Elmer Denessen
Thomas Dernnestown
Joseph N Dhuey, MD
Mrs Allen Dickson
Alwin J Dupont, MD
Olive Ebert
Mr Arthur Erwin
Mrs William Ford
Robert Frentzel, MD
Donna Fritz
Anthony S Grahek, MD
Sigurd Gunderson, MD
L F Halron
Mr Fred Hansen
A H Hermann, MD
Mrs Earl Hess
Esther Holmgren
Luther Holmgren, MD
James L Jaeck, MD
Dr Richard E Jensen
John Jursich
Richard D Kennedy, MD
James J King, MD
Joyce C Kline-Puletti, MD
Mr Frank van Laanen, Jr
Derward Lepley, MD
George Light, MD
Alex Locke, MD
Carol D Lorton, MD
Isabel MacDonald
Dee Maertz
A P Magnus
Phillip McCanna, MD
Edward L Meyer
Mr Robert T Meyer
Christian F Middlefort, MD
Sherburne F Morgan, MD
Mrs Robert E Minahan, Sr
Charles Nemeth, MD
Mrs B B Norton
Roman C Pauley, MD
Mr Louis Petersen
Mrs Paul Priewe
Joseph Rastetter, MD
Alphonus M Rauch, MD
C G Reznichek, MD
Mr Donald Ripple
Alfred F Rodenbeck, MD
Sion Rogers, MD
Mr Donald Ruppa
Mr John J Saunders
Leonard J Schneeberger, MD
Leonard W Schrank, MD
Frank X Schuler, MD
Irwin Schultz, MD
Raymond PSchwalter, MD
Saul F Schwartz, MD
Mrs Christine Scott
David Shapiro, MD
Mr Donald Sharp
John Shields, MD
George M Shinners, MD
Donald W Springer, MD
Ernest V Stadel, MD
Charles S Stern, MD
Mr Steve Sturlaugson
John T Sullivan, MD
J C Swan, MD
Lillie Swanson
Mr Wayne Thompson
Mrs Agnes Tripp
Mr Andrew Tweet
Harold B Wagner, MD
Raymond F Wagner, MD
Joseph E Weber, MD
Kenneth J Winters, MD
Keith B Witte, MD
Robert A Wood, MD
WZZurek, MD
MEMORIAL
CONTRIBUTORS
Kristin L Bjurstrom
Dr and Mrs Irwin J Bruhn
Mrs Rosena E Brunkow
Robert W Burns Family
Dane County Medical Society
John E Dettmann, MD
Herman J Dick, Sr, MD
Dr and Mrs Donald Dieter
Dodge County Medical Society
Eau Claire-Dunn-Pepin Medical
Auxiliary
Richard W Edwards, MD
Dr and Mrs Farrell M Golden
David N Goldstein, MD
Grant County Medical Auxiliary
Marcella M Herfel
Dr and Mrs James Hoftiezer
Dr and Mrs William Janssen
Dr and Mrs Thomas A Leonard
H B Maroney, II
Mr and Mrs Reese Minor
Mr and Mrs Harry Moulton
Dr and Mrs E J Nordby
Mrs W R Raduchel
Dr and Mrs Robert T Schmidt
Rhea H Schulz
Kathryn Slaught
State Medical Society of Wisconsin
Dr and Mrs Lawrence J Stone
Patricia J Stuff, MD
Mr and Mrs Earl R Thayer
WPS Employees
PHYSICIANS
BENEVOLENT
ASSISTANCE
FUND
Roman E Acevedo, MD
Nestor C Alabarca, MD
James E Albrecht, MD
Herbert M Allen, MD
Valentino S Ancheta, MD
Anonymous
Richard P Barthel, MD
Harold A Bjork, MD
James J Brill, MD
Roy E Buck, MD
Kathryn S Budzak, MD
N L Bugarin, MD
WarnerS Bump, MD
Richard Byrne, MD
Robert G Carlson, MD
John O Chamberlain, MD
Richard W Clasen, MD
William L Coffey, Jr, MD
Richard A Collins, MD
Jeffrey P Davis, MD
Mariano F DeGuzman, MD
C A Desch, MD
James H DeWeerd, Jr, MD
William A Domann, MD
Robert F Douglas, MD
Loren J Driscoll, MD
Richard A Ducelle, MD
Roy J Dunlap, II, MD
Rey F Fame, MD
M M Ferrer, MD
Jacob M Fine, MD
Louis J Flock, MD
O M Francisco, MD
C William Freeby, MD
Albert L Freedman, MD
ECGIenn, MD
Paul N Gohdes, MD
Frank F Gollin, MD
Charles J Green, MD
Finn O Gunderson, MD
Hartford Memorial Hospital
Medical Staff
Hartford Memorial Hospital
Eric S Heaney, MD
Robert A Heiminiak, MD
Lavern H Herman, MD
Timothy R Hess, MD
Richard A Holden, MD
LH Huberty, MD
John L Hughes, MD
Donald G Ives, MD
John G Jamieson, MD
Samuel B Johnson, MD
Robert N JustI, MD
Ollie F Kaarakka, MD
Keith M Keane, MD
Kent E Keller, MD
Gerald C Kempthorne, MD
Ralph O Kennedy, MD
Edward R Kinsfogel, MD
R A Kjentvet, MD
Geoffrey C Kloster, MD
Dennis J Kontra, MD
Randolph W KreuI, MD
ArneT Lagus, MD
Richard B Lewan, Jr, MD
Jack M Lockhart, MD
Rolfs Lulloff, MD
Peter Madden, MD
Michael H Mader, MD
F Fuller McBride, MD
Neal A Melby, MD
Peter J Melcher, MD
G Daniel Miller, MD
Yousef Mobarek, MD
Joseph J Mueller, MD
Zebedee J Nevels, MD
Lyle Olson, MD
Alfred G Pennings, MD
Pierce-St Croix County
Medical Society
Louis J Ptacek, MD
John P Rahm, MD
Robert W Ramlaw, MD
Patrick T Regan, MD
Fred B Riegel, MD
Lee M Robak, MD
E P Rohde, MD
W E Rosenkranz, MD
Richard J Rowe, MD
Dennis K Ryan, MD
Nonito M Sablay, MD
F LeRoy Schaefer, MD
Albin J Schliper, MD
Mary H Schmidt, MD
R C Schmitz, MD
Irwin LSchroeder, MD
Skemp-Grandview
La Crosse Clinic
James T Small, Jr, MD
Robert Spellman, MD
E Y Strawn, MD
John J Suits, MD
SW VanderWoude, MD
Kenneth M Viste, Jr, MD
James D Warrick, MD
Daniel RWartinbee, MD
Alice D Watts, MD
James A Wenders, MD
Dean E Whiteway, MD
Tuenis D Zondag, MD
Kenneth LZucker, MD
POSTGRADUATE
WORKSHOP
IN THE
BASIC SCIENCES
Dr and Mrs Barry Rogers
STUDENT LOAN
FUNDS
Thomas R Connell, MD
Eau Claire-Dunn-Pepin County
Medical Auxiliary
Fond du Lac County Medical
Auxiliary
Marcella M Herfel
Lewis Jacobson
La Crosse County Medical
Society Auxiliary
Delores Miller
Nelson Muffler Corp Projects, Inc
Sue Waraczynski, MD
BROWN COUNTY
LOAN FUND
Robert W Burns Family
Dr and Mrs Robert T Schmidt
HARRINGTON-
WRIGHT
SCHOLARSHIP
FUND
Ashland-Bayfield-lron County
Medical Auxiliary
Barron-Washburn-Burnett County
Medical Society Auxiliary
Brown County Medical Auxiliary
Dodge County Medical Auxiliary
Grant County Medical Auxiliary
La Crosse County Medical
Society Auxiliary
Milwaukee County Medical
Auxiliary
Pierce-St. Croix County
Medical Auxiliary
Racine County Medical Society
Auxiliary
State Medical Society of
Wisconsin Auxiliary
Winnebago County Medical
Auxiliary
Wood County Medical Auxiliary
FAMILY
PHYSICIAN
FUND
L Wayne and Marion Brown
MARATHON
COUNTY MEDICAL
SOCIETY
STUDENT
LOAN FUND
Marathon County Medical
Society Auxiliary
RACINE COUNTY
LOAN FUND
Racine County Medical Society
Auxiliary
CGREZNICHEK,
MD
STUDENT LOAN
FUND
Mrs Cyrus G Reznichek
WORKWEEK
OF HEALTH
State Medical Society
of Wisconsin
State Medical Society
of Wisconsin Auxiliary
BUILDING AND
EQUIPMENT
Dr and Mrs James Barrock
Dr and Mrs C A Bauer
Dorothy Betlach, MD
Guy W Carlson, MD
Kenneth L Carter, MD
Albert L Fisher, MD
H J Hansen, MD
Dr and Mrs Thomas Leonard
Dr and Mrs E J Nordby
Dr and Mrs Michael Ries
Dr and Mrs E E Skroch
R L Waffle, MD
MISCELLANEOUS
DONATIONS
Lois Armstrong
Boli Company— McFarland-
John Boxrucker
Elaine Bradley
H O Brower
Mary Franks
William Guerten
Huck B Hausman-Stokes
Marcella Herfel
Jean Jacobs
LeRoy A Johnson
Barbara Kalupa
Judy Kerl
Noreen Krueger
J C LaBIssoniere
Arlene Meyer
Olive Powers
Jeannet Schimmele
Laurie Schmidt
Don Temby
Visiting Nurse Service
Mary Watkins
CES FOUNDATION
OFFICERS
President
R T Cooney, MD
Portage
Vice President
S B Webster, MD
La Crosse
Treasurer
L C Pomainville. MD
Wisconsin Rapids
Secretary
E R Thayer
Madison
Assistant Secretary
H B Maroney
Madison
Executive Director
K L Bjurstrom
Madison
CES Foundation
330 E Lakeside St
PO Box 1 109
Madison, Wl 53701
800/362-9080
608/2 57-6781
MEMORIAL GIFTS
Many of the donors to the Charitable, Educational
and Scientific Foundation give gifts in memory or in
honor of a friend, relative, or colleague. These gifts
provide the opportunity to recognize special
achievements and occasions. Additionally, gifts in
memory or honor signify the donor's good qualities
and attributes. Our friendships and fond memories
motivate us to show our admiration through such
lasting gifts. You can perpetuate the name of your
honoree as you support charitable, educational,
and scientific activities of the Foundation.
We invite you to support the Foundation the next
time you want to honor, recognize, or remember
someone. The Foundation sends the honoree and
the families of those memorialized acknowledg-
ments of your gift. All memory and honor gifts are
listed in the yearly report of the Charitable. Educa-
tional and Scientific Foundation. Memorial gifts may
be earmarked and are tax-deductible.
c
PUBLIC HEALTH
1
New Baby Doe rules proposed
The Reagan Administration has
proposed new rules which re-
quire treatment of handicapped
infants except in extreme cases.
The rules implement the Child
Abuse and Prevention and Treat-
ment Act, which require treat-
ment and nutrition for all handi-
capped infants except when the
infant is irreversibly comatose.
The treatment would merely pro-
long dying; or the treatment
would not prolong the infants'
life and would therefore be
"inhumane."
24
HOUR
Radio
dispatched
truck fleet
for
INDUSTRY, INSTITUTIONS,
SCHOOLS, ETC.
AUTHORIZED PARTS
AND SERVICE FOR
CLEAVER-BROOKS
Throughout Wisconsin
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Boiler room accessories
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Cleveland controls
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5401 N Park Dr
PO Box 365
Butler, WI 53007
Phone: 414/781-9620
The rules state that the decision
to treat a handicapped infant
must "be made by a reasonably
prudent physician, knowledge-
able about the case and the treat-
ment possibilities with respect to
the medical conditions involved
... It is not to be based on sub-
jective 'quality of life' or other
abstract concepts."
Under the rules, state child
abuse agencies must investigate
complaints of medical neglect;
and in order for states to receive
federal funds for their child abuse
programs, they must have pro-
grams in place by October 9,
1985 to respond to complaints,
coordinate with the hospital
ethics review boards, help par-
ents, and go to court if neces-
sary.
The AMA opposes the rules on
the grounds that families have the
right to make a decision about the
nature of their child's treatment.
The AMA says it will challenge
the implementation of the legis-
lation when it violates those
rights.
The new rules differ from the
regulations which were struck
down by courts earlier this year in
that they are not based on laws
prohibiting discrimination
against the handicapped, they do
not require that handicapped
infants be provided with the
same care as nonhandicapped
children. The rules do say that
handicapped children be pro-
vided the best care for their cir-
cumstances and admit that there
are circumstances where no care
is the best course. They do not
require federal intervention
when medical neglect is sus-
pected.*
SMS seeking repeal of rule allowing
chiropractors to draw blood
The State Medical Society ap-
pealed to the Legislature's Joint
Committee for Review of Ad-
ministrative Rules January 16 to
repeal a new Chiropractic Exam-
ining Board rule which gives
chiropractors the authority to
draw blood for diagnostic pur-
poses. The Society is asking
JCRAR to hold a hearing and seek
repeal of this rule on the grounds
that the Medical Practice Act in
Wisconsin clearly prohibits chiro-
practors, or anyone who is not a
licensed physician, from drawing
blood.
"The Chiropractic Board is not
empowered to expand chiro-
practic scope of practice into the
medical arena or elsewhere
simply because its appointed
members conclude the collective
profession has expertise in a new
procedure," SMS told JCRAR co-
chairman Senator John Plewa
(D-Milwaukee) and Representa-
tive Steven Brist (D-Chippewa
Falls).
"More thought is needed be-
fore chiropractors are authorized
to draw and analyze blood," SMS
said. "First of all, is the knowl-
edge to do so real or alleged, and
secondly, does such a procedure
really fit into a practice that heals
by remedying interferences in
nerve transmission? Our opinion
is that there is no public benefit
derived from this authorization,
but it could pose some risk to
public health."*
68
WISCONSIN MEDICAL JOURNAL, FEBRUARY 1985: VOL. 84
e Eastman Kodak Company, 1984
The KODAK EKTACHEM
DT60 Analyzer creates an
extra service for your pa-
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ment in labor. And because
it can pay for itself in three
months, it’s a timely invest-
ment in your future.
The chemistry tests
you need
With the DT60 Analyzer
you perform key chemistry
tests in your own office
instead of using an out-
side laboratory. Available
tests include glucose,
cholesterol, triglycerides,
BUN, uric acid, sodium,
and potassium, with total
hemoglobin and bilirubin
coming soon.
The time you need
Get test results in five
minutes or less; perform
up to 75 tests an hour.
Save time waiting for
results to assist in your
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The accuracy
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The DT60 Analyzer uses
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The simplicity
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The DT60 Analyzer, com-
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To see what the DT60
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write Eastman Kodak Com-
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or call 1 800 44KODAK,
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I
Leading the way in healthcare
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KODAKEKTACHEM
Clinical Chemistry Products
May not be available in all areas.
Political
responsibility
is responsible
medicine
Last November there were 123 state and federal
offices up for election in Wisconsin.
The Wisconsin Physicians Political Action
Committee— WISPAC— played an important role in
those elections and strengthened medicine’s posi-
tion in the legislative forum by providing financial
and technical support to those candidates who
understand and are responsive to our concerns.
Political action, however, must not end with the
elections; much more needs to be done, beginning
today, to ensure success in the future.
That success begins with concerned physicians
and their spouses throughout Wisconsin who make
up WISPAC.
Physicians control WISPAC— responsible physi-
cians like yourself; physicians who realize that their
political involvement at the local level and their
membership in WISPAC is essential to continuing
the effective voice of medicine in Wisconsin.
Your voice and support is needed. Join with those
who realize that medicine is a constituency.
Join WISPAC!
a small price to pay for political effectiveness
wispac
P.O. BOX 2595, MADISON, Wl 53701
(608) 257-6781
Wisconsin Physicians Poiiticai Action Committee
WISPAC and AMPAC political contributions are voluntary and not tax-deductible. If your practice is incorporated, WISPAC and AMPAC dues should be written on a PERSONAL check.
Copies of the WISPAC reports are filed with the Wisconsin State Elections Board. AMPAC reports are available for purchase from the Federal Election Commission. Washington, D C. 20463.
ISCONSIN GAZETTE
YALWIN^ Nx .. . BUILT-IN
PROTECTION AGAINST
MISUSE BY INJECTION
Major Analgesic
Reformulated
Now contains naloxone,
a potent narcotic antagonist
Extra security added
to proven efficacy and safety
No longer do doctors have to deny patients the
benefit of an effective oral analgesic for fear of its
misuse by injection.
Winthrop-Breon Laboratories has met a nagging
problem by reformulating TALWIN® 50 (pentazo-
cine HCl tablets) with the addition of naloxone,
equivalent to 0.5 mg base. The reformulated
product is called TALWIN® Nx.
The oririnal formulation had been subject to a
form of misuse among street abusers known as
“Ts and Blues.” TALWIN 50 and PBZf an anti-
histamine, would be ground up together, put into
solution, and injected intravenously. The combi-
nation produced a heroin-like high. Because
naloxone is a narcotic antagonist when injected
intravenously, it acts to nullify any high a “T’s and
Blues” addict might expect from the pentazocine
in a combination of TALWIN Nx and PBZ. When
taken as directed orally, the naloxone component
of TALWIN Nx is inactive. Thus, TALWIN Nx
continues to be a safe, effective, oral analgesic for
the relief of moderate to severe pain, now provid-
ing added security against misuse.
'Registered trademark of Ciba-Geigy Corp for tripelennamine.
T-540
.€
Ikilwiit^
NDC 0024-1951-04
100 tablets
, Each tablet contains pentazoane 0
nydrochlorlde.USP, equivalent to 50 mg
*nd naloxone hydrochloride, DSP. 0.5 nHI- 0
Caution; Federal law prohibits
dispensing without prescription
©Each tablet contains pentazocine HCI, USR
equivalent to 50 mg base and naloxone
HCI, USR equivalent to 0.5 mg base.
The reformulation of Talwin 50 to Talwin Nx
involved the addition of 0.5 mg naloxone to
help prevent misuse by injection.
n/nfhrop-Breon
© 1984 Winthrop-Breon Laboratories
Please see following page for Brief Summary.
iniiWf iii^A cy/
Each tablet contains pentazocine HCI, USR equivalent to
50 mg base and naloxone HCI. USR equivalent to 0,5 mg base
Analgesic for Oral Use Only
Contraindications: Hypersensitivity to either pentazocine or
naloxone
TALWIN® Nx IS intended for oral use only Severe, potentially
lethal, reactions may result from misuse of TALWIN® Nx by
iniection either alone or in combination with other substances
(See Drug Abuse and Dependence section )
Warnings: Drug Dependerice Can cause physical and psycho-
logical dependence (See Drug Abuse and Dependence ]Head
Injury and Increased Intracranial Pressure As with other potent
analgesics, respiratory depressant effects of the drug may elevate
cerebrospinal fluid pressure due to CDs retention; these effects may
be markedly exaggerated in the presence of head in|ury other
intracranial lesions, or a preexisting increase in intracranial pres-
sure Can obscure the clinical course of patients with head injuries,
in such patients, use with extreme caution and only if deemed
essential Usage with Alcohol Due to potential for increased CNS
depressant effects, alcohol should be used with caution Patients
Receiving Narcotics Rentazocine is a mild narcotic antagonist
Withdrawal symptoms have occurred in patients previously given
narcotics, including methadone Certain Respiratory Conditions
Should be administered with caution in respiratory depression from
any cause, severely limited respiratory reserve, severe bronchial
asthma and other obstructive respiratory conditions, or cyanosis
Precautions: CNS Pffect Use cautiously in patients prone to
seizures, seizures have occurred though no cause and effect
relationship has been established Therapeutic doses have in rare
instances, resulted In hallucinations (usually visual), disorientation,
and confusion, which cleared spontaneously within a period of
hours Such patients should be very closely observed and vital signs
checked, if the drug is reinstituted. it should be done with caution
since the acute CNS manifestations may recur Impaired Renal or
Hepatic Function Decreased metabolism of pentazocine in exten-
sive liver disease may predispose to accentuation of side effects, it
should be administered with caution in renal or hepatic impairment.
In long-term use. precautions should be taken to avoid increases in
dose by the patient Biliary Surgery Some evidence suggests that
unlike other narcotics pentazocine causes little or no elevation in
biliary tract pressures, the clinical significance of these findings is
notyet known Information lor Patients Since sedation, dizziness,
and occasional euphoria have been noted, ambulatory patients
should be warned not to operate machinery drive cars, or unneces-
sarily expose themselves to hazards May cause physical and
psychological dependence taken alone and may have additive CNS
depressant properties in combination with alcohol or other CNS
depressants Myocardial Infarction Use with caution in patients
with myocardial infarction who have nausea or vomiting Drug
Interactions Usage with Alcohol See Warnings. Carooogen-
esis. Mutagenesis. Impairment of Fertility No long-term studies
in animals to test for carcinogenesis have been performed Preg-
nancy Category C Should be given to pregnant women only if
clearly needed Labor and Delivery Use with caution in women
delivering premature infants Effect on mother and fetus, duration of
labor or delivery need for forceps delivery or other intervention or
resuscitation of newborn, or later growth, development, and
functional maturation of the child is unknown Nursing Mothers
Caution should be exercised when administered to a nursing
woman Pediatric Use Safety and effectiveness in children below
the age of 12 years have not been established
Adverse Reactions: Cardiovascular. Hypotension, tachycar-
dia, syncope Respiratory. Rarely, respiratory depression CNS
Acute CNS Manifestations. In rare instances, hallucinations
(usually visual), disorientation, and confusion which have cleared
spontaneously within a period of hours, may recur if drug is
reinstituted Other CNS Enacts: Dizziness, lightheadedness, seda-
tion, euphoria, disturbed dreams, hallucinations, irritability excite-
ment, tinnitus, tremor. Gastrointestinal Nausea, vomiting, con-
stipation, diarrhea, anorexia, rarely abdominal distress Allergic:
Edema of the face, dermatitis, including pruritus, flushed skin, includ-
ing plethora Ophthalmic: Visual blurring and fncus'nq difficulty
Hematologic: Depression of white blood cells (especially granulo-
c^es), which is usually reversible, moderate transient eosinophilia.
Other: Headache, chills, insomnia, weakness, urinary retention
Drug Abuse and Dependence: Controlled Substance
TALWIN Nx IS a Schedule IV controlled substance
Dependence and withdrawal symptoms have been reported with
orally administered pentazocine Patients with a history of drug
dependence should be under close supervision. Possible abstinence
syndromes in newborns after prolonged use of pentazocine during
pregnancy have been reported. In prescribing for chronic use, the
physician should take precautions to avoid increases in dose by the
patient. Tolerance to the analgesic effect is rarely reported, there is
no long-term experience with oral use of TALWIN Nx
The amount of naloxone present (0.5 mg per tablet) has no action
when taken orally and will not interfere with the pharmacologic
action of pentazocine, however, this amount of naloxone given oy
injection has profound antagonistic action to narcotic analgesics
TALWIN Nx has a lower potential for parenteral misuse than the
previous oral pentazocine formulation, but is still subject to patient
misuse and abuse by the oral route
Severe, even lethal, consequences may result from misuse of tablets
by injection either alone or in combination with other substances,
such as pulmonary emboli, vascular occlusion, ulceration and absces-
ses, and withdrawal symptoms in narcotic dependent individuals
Overdosage: Treatment Oxygen, intravenous fluids, vasopres-
sors. and other supportive measures should be employed as indi-
cated. Assisted or controlled ventilation should also be considered
For respiratory depression, parenteral naloxone is a specific and
effective antagonist.
Please consult full product information before prescribing
[W//7fArapSreo/7
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Accepted for advertising in the AMA Journal
CARE FOR YOUR
COUNTRY.
As an Army Reserve physician, you can serve
your country and community with just a small invest-
ment of your time. You will broaden your professional
experience by working on ,
interesting medical projects
in your community. Army
Reserve service is flexible, so it
won't interfere with your practice.
You'll work and consult with top
physicians during monthly Reserve
meetings. You'll also attend funded
continuing medical education pro-
grams. You will all share the bond of ^
being civic-minded physicians who are also commis-
sioned officers. One important benefit of being an officer
is the non-contributory retirement annuity you will get
when you retire from the Army Reserve. To find out
more, simply call the number below.
ARMY RESERVE.
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MAJOR DAVIDS BARRIE
COLLECT: (312)926-3161
WIN 4.41415FR
Winthrop-Breon Laboratories
Division of Sterling Drug Inc
New York, NY 10016
BALANCED
GALCrUMC
BT
Low incidence of side effects
CARDIZEM® (diltiazem HCl)
produces an incidence of adverse
reactions not greater than that
reported with placebo therapy,
thus contributing to the patient’s
sense of well-being.
’Cardizem is indicated in the treatment of angina pectoris due to
coronary arteiy spasm and in the management of chronic stable
angina (classic effort-associated angina) in patients who cannot
tolerate therapy with beta-blockers and/or nitrates or who remain
symptomatic despite adequate doses of these agents.
Esferences:
1. Strauss WE, McIntyre KM, Parisi AF, et ai: Safefy and efidcapy
of diltiazem hydrochloride for the treatment of stable angina
pectoris: Report of a cooperative cUnicaJ trial. Am J Cardiol
49:560-566, 1982.
2. Pool PE, Seagren SC, Bonanno JA, et al: The treatment of exercise-
inducible chronic stable angina with diltiazem: Effect on treadmill
exercise. Chest 78 (July suppl):234-238, 1980.
Reduces angina attack frequency*
42% to 46% decrease reported in
multicenter study
Increases exercise tolerance*
In Bruce exercise test,^ control
patients averaged 8.0 minutes to
onset of pain; Cardizem patients
averaged 9.8 minutes (P<.005).
CAR1XQ2EM
CdilUazem HCl)
THE BALANCED
CALCIUM CHANNEL BLOCKER
Please see full prescribing information on following page.
2/84
PROFESSIONAI, USE INFORMATION
cxardizem,
(dilfazem HCI)
50 m){ and 60 tablets
DESCRIPTION
CAROIZEM'^ (diltiazem hydrochloride) is a calcium ion inllux
mhihilor (slow channel blocker or calcium antagonist) Chemically,
diltiazem hydrochloride Is 1.5-Benzolhlazepin-4(5H)one,3-(acetyloxy)
-5-[2-(dimethylamino)ethyl]-2.3-dihydro-2-(4-methoxyphenyl)-,
monohydrochloride,(+) -cis- The chemical structure Is:
CHjCHjNiCHjIj
Diltiazem hydrochloride is a white to off-white crystalline powder
with a bitter taste It is soluble In water, methanol, and chloroform
If has a molecular weight of 450 98. Each tablef of CARDIZEM
contains either 30 mg or 60 mg diltiazem hydrochloride for oral
administration
CLINICAL PHARMACOLOGY
The therapeutic benefits achieved with CARDIZEM are believed
to be related to its ability to inhibit the influx of calcium ions
during membrane depolarization of cardiac and vascular smooth
muscle.
Mechanisms of Action. Although precise mechanisms of Its
antianginal actions are still being delineated, CARDIZEM is believed
to act In the following ways.
1 Angina Due to Coronary Artery Spasm CARDIZEM has been
shown to be a potent dilator of coronary arteries both epicardial
and subendocardial. Spontaneous and ergonovine-induced cor-
onary artery spasm are inhibited by CARDIZEM
2 Exertional Angina: CARDIZEM has been shown to produce
increases in exercise tolerance, probably due to its ability to
reduce myocardial oxygen demand This is accomplished via
reductions in heart rate and systemic blood pressure at submaximal
and maximal exercise work loads
In animal models, diltiazem interferes with the slow inward
(depolarizing) current in excitable tissue. It causes excitation-contraction
uncoupling in various myocardial tissues without changes in the
configuration of the action potential Diltiazem produces relaxation
of coronary vascular smooth muscle and dilation of both large and
small coronary arteries at drug levels which cause little or ho
negative inotropic effect The resultant Increases in coronary blood
flow (epicardial and subendocardial) occur in ischemic and nonischemic
models and are accompanied by dose-dependent decreases in sys-
temic blood pressure and decreases in peripheral resistance
Hemodynamic and Electrophyslologlc EHects. Like other
calcium antagonists, diltiazem decreases sinoatrial and atrioventricu-
lar conduction in isolated tissues and has a negative inotropic effect
in isolated preparations. In the intact animal, prolongation of the AH
interval can be seen at higher doses.
In man, diltiazem prevents spontaneous and ergonovine-provoked
coronary artery spasm. It causes a decrease in peripheral vascular
resistance and a modest fall in blood pressure and. In exercise
tolerance studies in patients with ischemic heart disease, reduces
the heart rate blood pressure product for any given work load
Studies to date, primarily in patients with good ventricular function,
have not revealed evidence of a negative inotropic effect, cardiac
output, election fraction, and left ventricular end diastolic pressure
have not been affected. There are as yet few data on the interaction
of diltiazem and beta-blockers Resting heart rate is usually unchanged
or slightly reduced by diltiazem
Intravenous diltiazem In doses of 20 mg prolongs AH conduction
time and AV node functional and effective refractory periods approxi-
mately 20% In a study Involving single oral doses of 300 mg of
CARDIZEM in six normal volunteers, the average maximum PR
prolongation was 14% with no instances of greater than first-degree
AV block Diltlazem-associated prolongation of the AH interval is not
more pronounced in patients with first-degree heart block. In patients
with sick sinus syndrome, diltiazem significantly prolongs sinus
cycle length (up to 50% In some cases).
Chronic oral administration of CARDIZEM in doses of up to 240
mg/day has resulted in small Increases In PR interval, but has not
usually produced abnormal prolongation. There were, however, three
instances of second-degree AV block and one instance of third-
degree AV block in a group of 959 chronically treated (tatients
Pharmacokinetics and Metabolism. Diltiazem is absorbed
from the tablet formulation to about 80% of a reference capsule and
IS subject to an extensive first-pass effect, giving an absolute
bioavailabillty (compared to intravenous dosing) of about 40%. CARDIZEM
undergoes extensive hepatic metabolism in which 2% to 4% of the
unchanged drug appears in the urine In vitro binding studies show
CARDIZEM IS 70% to 80% bound to plasma proteins. Competitive
ligand binding studies have also shown CARDIZEM binding is not
altered by therapeutic concentrations of digoxin, hydrochlorothiazide,
phenylbutazone, propranolol, salicylic acil or warfarin. Single oral
doses of 30 to 120 mg of CARDIZEM resulf in detectable plasma
levels within 30 to 60 minutes and peak plasma levels two to three
hours after drug administration. The plasma elimination half-life
following single or multiple drug administration is approximately 3.5
hours. Desacetyl diltiazem is also present In the plasma at levels of
10% to 20% of the parent drug and is 25% to 50% as potent a
coronary vasodilator as diltiazem. Therapeutic blood levels of
CARDIZEM appear to be in the range of 50 to 200 ng/ml. There is a
departure from dose-linearity when single doses above 60 mg are
given; a 120-mg dose gave blood levels three times that of the 60-mg
dose There is no information about the effect of renal or hepatic
impairment on excretion or metabolism of dilfiazem
INDICATIONS AND USAGE
1 Angina Pectoris Due to Coronary Artery Spasm. CARDIZEM
IS Indicated in the treatment of angina pectoris due to coronary
artery spasm CARDIZEM has been shown effective in the
treatment of spontaneous coronary artery spasm presenting as
Prinzmetal's variant angina (resting angina with ST-segment
elevation occurring during attacks)
2 Chronic Stable Angina (Classic Etfort-Assoclated Angina).
CARDIZEM Is Indicated in the management of chronic stable
angina CARDIZEM has been effective in controlled trials in
reducing angina frequency and increasing exercise tolerance.
There are no controlled studies of the etfectiveness of the concomi-
tant use of diltiazem and beta-blockers or of the safety of this
combination in patients with impaired ventricular function or conduc-
tion abnormalities
CONTRAINDICATIONS
CARDIZEM is contraindicated in (1) patients with sick sinus
syndrome except in the presence of a functioning ventricular pacemaker,
(2) patients with second- or third-degree AV block except in tbe
presence of a functioning ventricular pacemaker, and (3) patients
with hypotension (less than 90 mm Hg systolic).
WARNINGS
1 Cardiac Conduction. CARDIZEM prolongs AV node refrac-
tory periods without sigoiflcantly prolonging sinus node recov-
ery time, except in patients with sick sinus syndrome. This
effect may rarely result in abnormally slow heart rates (particularly
in patients with sick sinus syndrome) or second- or third-degree
AV block (six of 1243 patients for 0 48%). Concomitant use of
diltiazem with beta-blockers or digitalis may result in additive
effects on cardiac conduction A patient with Prinzmetal's
angina developed periods of asystole (2 to 5 seconds) after a
single dose of 60 mg of diltiazem,
2 Congestive Heart Failure. Although diltiazem has a negative
inotropic effect in isolated animal tissue preparations, hemodynamic
studies In humans with normal ventricular function have not
shown a reduction in cardiac index nor consistent negative
effects on contractility (dp/dt). Experience with the use of
CARDIZEM alone or in comblnafion with beta-blockers In patients
with impaired ventricular function is very limited. Caution should
be exercised when using the drug in such patients,
3 Hypotension. Decreases in blood pressure associated with
CARDIZEM therapy may occasionally result in symptomatic
hypotension
4 Acute Hepatic Injury. In rare instances, patients receiving
CARDIZEM have exhibited reversible acute hepatic injury as
evidenced by moderate to extreme elevations of liver enzymes
(See PRECAUTIONS and ADVERSE REACTIONS.)
PRECAUTIONS
General. CARDIZEM (diltiazem hydrochloride) is extensively metab-
olized by the liver and excreted by the kidneys and m bile. As with any
new drug given over prolonged periods, laboratory parameters should
be monitored at regular Intervals The drug should be used with
caution in patients with impaired rehal or hepatic function In sub-
acute and chronic dog and rat studies designed to produce toxicity,
high doses of diltiazem were associated with hepatic damage. In
special subacute hepatic studies, oral doses of 125 mg/kg and
higher in rats were associated with histological chaoges In the liver
which were reversible when the drug was discontinued In dogs,
doses of 20 mg/kg were also associated with hepatic changes:
however, these changes were reversible with cohtinued dosing.
Drug Interaction. Pharmacologic studies indicate that there
may be additive effects in prolonging AV conduction when using
beta-blockers or digitalis concomitantly with CARDIZEM, (See
Ifl/ARNINGS),
Controlled and uncontrolled domestic studies suggest that con-
comitant use of CARDIZEM and beta-blockers or digitalis is usually
well tolerated Available data are not sufficient, however, to predict
the effects of concomitant treatment, particularly in patients with left
ventricular dysfunction or cardiac conduction abnormalities. In healthy
volunteers, diltiazem has been shown to increase serum digoxin
levels up to 20%
Carcinogenesis, Mutagenesis, impairment ol Fertiiity. A
24-month study in rats and a 21-month study in mice showed no
evidence of carcinogenicity There was also no mutagenic response
In in vitro bacterial tests No intrinsic effect on fertility was observed
in rats
Pregnancy. Category C Reproduction studies have beeh con-
ducted in mice, rats, and rabbits. Administration of doses ranging
from five to ten times greater (on a mg/kg basis) than the daily
recommended therapeutic dose has resulted in embryo and fetal
lethality These doses, in some studies, have been reported to cause
skeletal abnormalities. In the perinatal/posthatal studies, there was
some reduction in early individual pup weights and survival rates.
There was an increased incidence ol stillbirths at doses of 20 times
the human dose or greater
There are no well-controlled studies in pregnant women, therefore,
use CARDIZEM in pregnant women only if the potential benefit
lustifies the potential risk to the fetus.
Nursing Mothers. It is not known whether this drug is excreted
in human milk. Because many drugs are excreted m human milk,
exercise caution when CARDIZEM is administered to a nursing
woman if the drug's benefits are thought to outweigh its potential
risks in this situation.
Pediatric Use. Safety and effectiveness in children have not
been established
ADVERSE REACTIONS
Serious adverse reactions have been rare in studies carried out to
date, but it should be recognized that patients with impaired ventricu-
lar function and cardiac conduction abnormalities have usually been
excluded.
In domestic placebo-controlled trials, the incidence of adverse
reactions reported during CARDIZEM therapy was not greater than
that reported during placebo therapy
The following represent occurrences observed in clinical studies
which can be at least reasonably associated with the pharmacology
of calcium influx inhibiflon In many cases, the relatiohship to
CARDIZEM has not been established. The most common occurrences,
as well as their frequency of presenfation, are edema (2.4%),
headache (2.1%), nausea (1.9%), dizziness (1.5%), rash (1.3%),
asthenia (1.2%), AV block (1.1%), In addilion, the following events
were reported infrequently (less than 1%) with the order of presenta-
tion corresponding to the relative frequency of occurrence
Cardiovascular
Nervous System
Gastrointestinal
Dermatologic
Other
Flushing, arrhythmia, hypotension, bradycar-
dia. palpitations, congestive heart failure,
syncope
Paresthesia, nervousness, somnolence,
tremor, insomnia, hallucinations, and amnesia.
Constipation, dyspepsia, diarrhea, vomiting,
mild elevations of alkaline phosphatase, SCOT,
SGPT, and LDH
Pruritus, petechiae, urticaria, photosensitivity.
Polyuria, nocturia.
The following additional experiences have been noted
A patient with Prinzmetal's angina experiencing episodes of
vasospastic angina developed periods of transient asymptomatic
asystole approximately five hours after receiving a single 60-mg
dose ol CARDIZEM,
The followihg postmarkefing events have been reported infre-
quently in patients receiving CARDIZEM erythema multiforme; leu-
kopenia: and extreme elevations of alkaline phosphatase, SCOT,
SGPT, LDH, and CPK However, a definitive cause and effect between
these events and CARDIZEM therapy is yet to be established
OVERDOSAGE OR EXAGGERATED RESPONSE
Overdosage experience with oral diltiazem has been limited
Single oral doses of 300 mg of CARDIZEM have been well tolerafed
by healthy voluhteers. In the event of overdosage or exaggerated
response, appropriate supportive measures should be employed in
addition to gastric lavage. The following measures may be considered:
Bradycardia
High-Degree AV
Block
Cardiac Failure
Hypotension
Administer atropine (0.60 to 1.0 mg). If there
is no response to vagal blockade, administer
isoproterenol cautiously
Treat as tor bradycardia above Fixed high-
degree AV block should be treated with car-
diac pacing.
Administer inotropic agents (isoproterenol,
dopamine, or dobutamine) and diuretics.
Vasopressors (eg, dopamine or levarterenol
bitartrate).
Actual treatment and dosage should depend on the severity of the
clinical situation and the judgment and experience of the treating
physician
The oral/LDso's in mice and tats range from 415 to 740 mg/kg
and from 560 to 810 mg/kg, respectively The intravenous LD^'s in
these species were 60 and 38 mg/kg, respectively The oral LD50 in
dogs is considered to be in excess of 50 mg/kg, while lethality was
seen in monkeys at 360 mg/kg. The toxic dose in man is not known,
but Wood levels in excess of 800 ng/ml have hot been associated
with toxicity
DOSAGE AND ADMINISTRATION
Exertional Angina Pectoris Due to Atherosclerotic Coro-
nary Artery Disease or Angina Pectoris at Rest Due to Coro-
nary Artery Spasm. Dosage must be adjusted to each patient's
needs Starting with 30 mg four times daily, before meals and at
bedtime, dosage should be increased gradually (given in divided
doses three or (our times daily) at one- to two-day intervals until
optimum response is obtained. Although individual patients may
respond to any dosage level, the average optimum dosage range
appears to be 180 to 240 mg/day There are no available data concern-
ing dosage requirements in patients with impaired renal or hepatic
function If (he drug must be used ih such patients, titration should be
carried out with particular caution.
Concomitant Use With Other Antianginal Agents:
1 . Sublingual NTG may be taken as required to abort acute
anginal attacks during CARDIZEM therapy
2 Prophylactic Nitrate Therapy -CARDIZEM may be safely
coadministered with short- and long-acting nitrates, but there
have been no controlled studies to evaluate the antianginal
effectiveness of this combination.
3. Beta-blockers. (See WARNINGS and PRECAUTIONS.)
HOW SUPPLIED
Cardizem 30-mg tablets are supplied in bottles of 100 (NDC
0088-1771-47) and in Unit Dose Identification Paks of 100 (NDC
0088-1771-49). Each green tablet is engraved with MARION on one
side and 1771 engraved on the other. CARDIZEM 60-mg scored
tablets are supplied in bottles of 100 (NDC 0088-1 772-47) and in Unit
Dose Identification Paks of 100 (NDC 0088-1772-49) Each yellow
lablet is engraved with MARION on one side and 1772 on the other.
Issued 4/1/84
Another patient benefit product from
PHARMACEUTICAL DIVISION
MARION
LABORATORIES INC
KANSAS CITY, MISSOURI 64137
COUNTY SOCIETIES
Brown County residents give
high marks to area medical care
BROWN: Residents of Brown
County feel they receive a high
level of quality care but that
something still has to be done to
decrease healthcare costs, ac-
cording to a recent public opinion
survey conducted by the Brown
County Medical Society and the
University of Wisconsin-Green
Bay.
The survey was a result of a
collaborative effort between the
Brown County Medical Society
and a University of Wisconsin-
Green Bay marketing class inter-
ested in conducting the survey as
a class project. Lee Richardson,
MD,* Green Bay, organized the
project on behalf of the county
medical society and worked with
the university to determine what
type of information should be
sought by the survey.
Questions were developed to
determine: overall patient satis-
faction with medical care in
Brown County, perceived prob-
lem areas, and patient awareness
of medical services available in
the community.
Findings of the survey included
these highlights:
• Brown County residents
visit a physician at about the
same rate as the national average.
• Less than 25% of respond-
ents have changed physicians in
the last three years, and that the
primary reasons for changing
physicians were patient reloca-
tion, and dissatisfaction with
care received (was not satisfied,
seldom saw own doctor, didn't
care for manner, or long wait). In
this case, the study confirmed
what was already suspected:
patients who are dissatisfied with
their physicians' services will
change to a different doctor.
• People feel the cost of Brown
County medical services is equal
to statewide costs, and that the
quality of medical care is high
when compared to the price. The
conclusion: people are basically
satisfied with the quality of
available healthcare.
Availability of medical services
is basically not a problem in
Brown County. Only 14.6% of
respondents went outside the
county for care with the most
frequent reasons being consulta-
tion (or referral) and the reputa-
tion of outside institutions, or
doctors.
Emergency room service is the
category of care needing the most
improvement; however, even
though it had the lowest satis-
faction rate, 87% ranked it aver-
age or higher.
More than 70% of Brown
County residents surveyed were
aware of medical services such
as the Free Clinic, County Im-
munization Program, Planned
Parenthood, Private Physician,
Emergency Room, Clinic, Hos-
pital Outpatient Services. Only
30.2% were aware of Company
Clinics; Emergency Room and
Private Physician Services
showed the highest level of
awareness, with 83% and 96%
respectively.
Eighteen percent of the re-
spondents felt "more doctors" is
the addition most needed in exist-
ing Brown County medical
care.
In response to the study find-
ings, the county medical society
also developed several recom-
mendations for action by local
physicians. They included:
• Although most Brown
County residents already feel the
quality of healthcare is high com-
pared to price, this belief needs
to be continually reinforced. Phy-
sicians must continue to provide
a high quality service.
• People feel the improvement
most needed is lower cost. While
recognizing that technological
advancements may necessitate
higher fees, medical professionals
must begin to balance the ad-
ditional benefits against the ad-
ditional cost. Physicians must
also begin to evaluate the cur-
rent healthcare system and find
ways to decrease both time and
cost inefficiencies. Failure to do
so can only lead to an increase in
competition, government inter-
vention, and alternative methods
of delivering these services.
Since a large number of people
indicated they do not know how
the cost of medical services in
Brown County compares with a
statewide cost, it is recom-
mended that measures be taken
to educate the public on this
matter. This would be a particu-
lar benefit if costs are indeed
lower in Brown County than
elsewhere.
A significant number of resi-
dents feel more doctors are
needed. If this judgment is ac-
curate, efforts should be made to
attract more doctors to Brown
County. If this judgment is inac-
curate, it indicates that physi-
cians currently practicing in the
area need to make therhselves
more available to patients.
• Based on respondents' eval-
uations, emergency room service
needs improvement. The county
medical society can only suggest
further study of these services
since this study did not deal with
emergency room care in detail.
• Further study is also recom-
mended to determine the exact
causes for dissatisfaction with
private physician care as indi-
continued
WISCONSIN MEDICAL JOURNAL, FEBRUARY 1985: VOL. 84
77
COUNTY SOCIETIES
BROWN COUNTY
continued
cated by those who had changed
doctors. Physicians need to be
more responsive to the needs of
these patients. Doctors who are
concerned about this might con-
sider using a brief survey of their
own patients to determine dis-
satisfactions pertaining to their
own practice.
BROWN: At the December meet-
ing of the Brown County Medical
Society, 55 members and guests
were present to hear the Most
Reverend Adam Maida, Bishop
of Green Bay, speak on "Tech-
nology and Medical Practice."
The following physicians were
accepted to membership: MDs
Jules H Blank;* Thomas P. Koeh-
ler;* and David L Samuel.*
EAU CLAIRE - DUNN - PEPIN:
At the November meeting of the
Eau Claire-Dunn-Pepin County
Medical Society, Paul Jacobson,
SMS Physicians Alliance field
consultant, discussed physician
licensure regarding CME credits
and also medical malpractice
suits and cases. Elected to office
for 1985 were MDs Patrick W
Connerly,* president; Michael F
Finkel,* vice president; Stanley
G Norman,* secretary-treasurer;
house of
BIDWELL, inc.
7954 West Harwood
and Watertown Plank Road
Milwaukee, Wisconsin 53213
1-414-744-6250
ORTHOTIC
AND
PROSTHETIC
SERVICES
Karl E Walter, * Thomas E Peder-
son,* James E Willard,* and Dan-
iel F Johnson,* delegates to SMS,
with Peter H Ullrich* and Verne
A Sperry* as alternate delegates.
JEFFERSON: Twenty-three mem-
bers and guests were present at
the December meeting of the
Jefferson County Medical So-
ciety. The following officers
were elected for 1985. They are
MDs Alan L Detwiler,* Fort
Atkinson, president; Brigido C
Calado,* Watertown, vice presi-
dent; and Edward J Hoy, * Water-
town, secretary-treasurer. The
Society sent $500 to the American
Red Cross for the African Food
Project through the University of
Wisconsin-Whitewater, and also
Ihe Toddler Car Safety Seat
Loaner Program at Fort Atkinson
Memorial and Watertown Mem-
orial hospitals; both received
checks for $200 to buy more
seats.
OUTAGAMIE: Twenty mem-
bers were present at the Novem-
ber meeting of the Outagamie
County Medical Society. Rick
Reas, executive assistant of the
SMS Physicians Alliance Di-
vision, spoke on the "Current
Status of the Malpractice Situa-
tion in Wisconsin." Charles E
Larson, MD, who transferred
from the Hennepin County Medi-
"WATS” LINE
FOR MEMBERS
The in-WATS (toll-free) line
can be used to contact any-
one at SMS headquarters
(330 East Lakeside Street,
Madison) from anywhere
within the State of Wiscon-
sin between the hours of
8:00 am and 4:30 pm week-
days. The number to dial is:
1-800-362-9080
cal Society in Minneapolis, Minn,
was accepted into membership
of the Society.
OUTAGAMIE: Andrew D Burish,
Madison, Account Executive of
Paine Webber Inc, spoke on
"Financial Planning and Tax
Shelters." Retired membership
status was approved for MDs
William A Dafoe* and James C
Curry;* and Jill P Harman, MD,*
Appleton, a transfer from Port-
age County, was accepted into
membership.
MARINETTE - FLORENCE:
Twenty-four members were
present at the January meeting of
the Marinette-Florence County
Medical Society to hear Edward
Percy, MD, Director of Sports
Medicine at the University of
Arizona in Tucson, speak on
"Sports Medicine— What Is It?"
MONROE: The January meeting
of the Monroe County Medical
Society met in Tomah on January
17. Thomas N Roberts, MD, La
Crosse, spoke on "Reyes Syn-
drome."
WINNEBAGO: Forty members
and one guest were present at
the January meeting of the Win-
nebago County Medical Society.
Brian Jensen, Director of the
SMS Physicians Alliance Di-
vision, spoke on "Politics in
Medicine in Wisconsin." A ques-
tion and answer session followed
the presentation. Harold J Dan-
forth, MD,* Oshkosh, was ap-
proved for retired status in the
membership of the Society. ■
1985
ANNUAL MEETING
APRIL 25-27
LA CROSSE
78
WISCONSIN MEDICAL JOURNAL, FEBRUARY 1985 . VOL. 84
MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
Internal Medicine. Join multispecialty
group of nine physicians in Sturgeon Bay,
Wisconsin. Primary care, consultations.
Modern 110-bed hospital. Attractive
financial package. Live in beautiful Door
County. Charles Nelson, Fox Hill Associ-
ates, 250 Regency Court, Waukesha,
Wisconsin 53186; ph 414/785-6500 col-
lect. p2-3/85
Second Family Practitioner needed to
staff a satellite of a 38-physician multi-
specialty group in Kiel, a beautiful small
community in East Central Wisconsin. At-
tractive income arrangements, association
membership possible after one year, pen-
sion and profit sharing, extensive fringe
benefits. Contact R B Windsor, MD, 1011
North 8 St, Sheboygan, WI 53081; ph 414/
457-4461. c2tfn/85
General Surgeon. Board certified or eli-
gible to replace retiring surgeon in 16-
physician multispecialty group practice (2
surgeons, 2 Ob/Gyn, 6 internists and 6
pediatricians). Two-year salary guarantee
with full partnership available at begin-
ning of third year. Send C V to T E Flood,
Administrator, Beaumont Clinic, Ltd,
1821 So Webster Ave, Green Bay, Wl
54301. p2-4/85
Family Practice Physicians. Oppor-
tunity available at the Grafton Clinic, an
affiliate of St Luke's Samaritan Health
Care, Inc, for Board certified or eligible
family practice physicians. Join our grow-
ing primary care clinic which emphasizes
the total family's health care needs. Posi-
tion offers excellent salary and benefit
package. The Grafton-Cedarburg area is
located 20 miles northwest of Milwaukee,
offering you country living near a large
metropolitan city. Inquiries or curriculum
vitae should be directed to Mr H Dere-
wicz, Vice President, Good Samaritan
Medical Center, 2224 West Kilbourn
Avenue, Milwaukee, WI 53233 or call
414/344-3840. 2/85
RATES: 50c per word, with a minimum
charge of $20.00 per ad. BOXED AD
RATES: $25.00 per column inch.
DEADLINE: Copy must be received by the
15th of the month preceding month of issue;
e.g., copy for the August issue is due July 15.
Send copy to: Wisconsin Medical Journal,
Box 1109, Madison, Wisconsin 53701; or
phone (area code 608) 257-6781; or toll-free
in Wisconsin: 800/362-9080.
Director-Medical Services. Bureau of
Correctional Health Services Wisconsin
Division of Health. Physician for full-time
administrative and clinical practice. Board
certified or eligible in family practice, in-
ternal or preventive medicine. Duties in-
clude supervising physicians who provide
care in correctional institutions, develop-
ing policies and procedures within avail-
able resources to assure quality of care
consistent with community standards,
devoting approximately 45 per cent of
time in direct clinical involvement at cor-
rectional facilities, and other related tasks.
Competitive salary and extensive fringe
benefits. Must possess or be eligible for a
Wisconsin license. Contact: Barbara Whit-
more, Director, Bureau of Correctional
Health Services, PO Box 309, Madison,
WI 53704; ph 608/267-7170. 2/85
Family Physician and Internist, Pedi-
atrician, OB/GYN, Board eligible /certi-
fied. Full or part-time, to join a busy,
established group of physicians in Mil-
waukee. Attractive income. Send cur-
riculum vitae to PO Box 17366, Milwau-
kee, Wl 53217. 2-7/85
Central Iowa community desires
family practice physician for office-based
practice. Reply to PO Box 1475, Marshall-
town, lA 50158. 2/85
Orthopedic Surgeon. An excellent op-
portunity is available for two orthopedic
surgeons to join a progressive Medical
Group in Central Minnesota. The com-
munity serves a population base of
225,000 individuals and is an excellent
base for an orthopedic surgeon. St Cloud,
Minnesota is the hub of the State and is
home to three major colleges. It is geo-
graphically located to provide quick ac-
cess to the Metropolitan-Twin Cities area.
The St Cloud community has a 500-bed
hospital with all the latest medical and
technological advancements to assist the
practicing orthopedic surgeon. If inter-
ested in this excellent opportunity, please
call collect either Dr LaRue Dahlquist,
President, and/or Daryl Mathews, Ad-
ministrator, at 612/251-8181 and/or send
curriculum vitae to St Cloud Medical
Group, 1301 West St Germain Street, St
Cloud, Minnesota 56301. 2-5/85
Family Practice Physician to share ex-
isting practice and fully-equipped medical
office in Central Wisconsin. Salary plus in-
centives and opportunity for eventual pur-
chase of practice. Excellent recreational
area, a great place to live and raise a
family. Send resume to Dept 552 in care
of the Journal. 2/85
Excellent opportunities for Ob / Gyn's
in beautiful lakefront cities in Wisconsin
and Michigan. Enjoy an outstanding qual-
ity of life within an easy commute to ma-
jor metropolitan areas. Reply in confi-
dence to: Director of Physician Recruit-
ment, Recruitment Consultants, 400
Renaissance Center, Suite 500, Detroit,
Michigan 48243; ph 313/259-2000. p2/85
Family Practice Physician needed.
Fremont Community Clinic, Minneapolis,
Minnesota. $20 to $22 per hour, plus bene-
fits. Part-time into full-time, some Nite-
call hours. 3300 Fremont Avenue North,
55412; or call 612/588-9416; Dr R Scott
Dyer, Jean, or Keta. p2-5/85
Board Eligible Orthopedic Surgeon to
join established orthopedic practice in
East Central Wisconsin. Contact Dept 553
in care of the Journal. 2tfn/85
Wanted— Qualified physician to prac-
tice emergency medicine in southeastern
Wisconsin. Our group is small and flexi-
ble. Salary is negotiable. If interested, send
CV to Associated Emergency Room Phy-
sicians, SC, 1131 Sherwood Lane, Cale-
donia, Wis 53108; ph 414/835-4489.
pl-3/85
General Internist or Family Practice
physician needed to join well established
solo internist /family practitioner in a
beautiful lake area community of 21,000.
Offering competitive salary with fringe
benefits. Send CV to R C Maniquiz, MD,
600 Bay St, Chippewa Falls, Wis 54729 or
call 715/723-0211. ltfn/85
Academic Internist to join expanding
dynamic young Ambulatory Care Group
at the Milwaukee Regional Medical
Center. Responsibilities to include: pri-
mary patient care, resident /physician
education, and employee health. Oppor-
tunities for program development, ad-
ministration, research, and advancement
in clinical faculty track. Send inquiries to
Kenneth E Smith, MD, Director, Primary
Care Clinic, Medical College of Wiscon-
sin, 8700 West Wisconsin Ave, Milwau-
kee, Wis 53226. Equal opportunity /affir-
mative action employer M/F/H. 1-3/85
Family Practitioner needed to join
established Family Practice group in East
Central Wisconsin city of 50,000 on
beautiful Lake Winnebago. Competitive
salary, fringes, excellent recreation area.
Send CV to MS Knier, MD, 555 S Wash-
burn, Oshkosh, Wis 54901; 414/426-0265.
lOtfn/84
WISCONSIN MEDICAL JOURNAL, FEBRUARY 1985: VOL. 84
79
MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
continued
Internal Medicine— Board certified or
eligible, to join 17-physician multi-
specialty clinic with 7-physician internal
medicine department. Located in beauti-
ful Wisconsin lakeshore community of
35,000. Competitive salary, complete
fringe benefits, generous vacation time.
Send CV to: Administrator, Manitowoc
Clinic, SC, PO Box 3008, Manitowoc, W1
54220. 1-5/85
Madison, Wisconsin. Experienced phy-
sician for ambulatory care center. Medic-
East, first and only independent ACC in
Madison. Now well established. Located
in heart of Eastside of Madison. Appli-
cants BC / BE demonstrated experience in
primary care, well-developed com-
munication skills. Competitive salary, ex-
cellent benefits, attractive practice setting.
Contact David A Goodman, MD, Medic-
East, 2810 E Washington, Madison, WI
53704; ph 608/244-1213. ltfn/85
Family Practitioner, General Surgeon,
Neurologist and Pediatrician /Central
Wisconsin. Excellent opportunity for
Board certified /eligible physician to join
26-physician multispecialty group.
180-bed modem hospitd. Plentiful recrea-
tional, cultural, and educational oppor-
tunities. Unique, attractive financial ar-
rangements. Contact: Administrator, Rice
Clinic, 2501 Main St, Stevens Point, WI
54481; ph 715/344-4120. ltfn/85
Family Practitioner. Rural Wisconsin
community, population 3500 with service
area of 8500, seeking additional family
practitioner. Fifteen minutes from State
Capitol with readily available tertiary
medical support. Family practice depart-
ment in multispecialty clinic. Excellent
fringe benefits and salary. Attractive
working conditions and environment.
Interested parties should contact Dept 550
in care of the Journal. 12/84;l-2/85
Medical Director. Opportunity for
physician with experience in medical
group practice administration to join
estabhshed HMO in Madison, Wiscon-
sin. Group Health serves 29,000 pa-
tients with its staff of 20 physicians and
total staff of 180. Excellent salary and
benefit program. This represents a re-
warding opportunity to develop or pro-
gress your career in medical admin-
istration. Contact: John Mueller,
Group Health Cooperative, 1 South
Park St, Madison, WI 53715; ph 608/
251-4156. 6tfn/84
Internists — BC / BE Internist needed to
join five general internists in multi-
specialty group practice in north-central
Wisconsin. Competitive salary and bene-
fits. General medicine training required.
Cosmopolitan community and excellent
recreational area. Send CV to D K Augen-
baugh, MD, 2727 Plaza Dr, Wausau, WI
54401; or phone 715/847-3328. ltfn/85
Family Practice physician MD or DO
Board eligible or certified. Contact Leon
Gilman, 4957 West Fond du Lac Ave, Mil-
waukee, Wi 53216 or call 414/ 871-7900.
1-3/85
Family Practice opportunities exist with
several expanding Marshfield Clinic,
hospital-affiliated satellites in north cen-
tral Wisconsin. The Board certified / Board
eligible candidate will share the philos-
ophy of oriented care with a preventive
focus, enjoy the support of over 200 phy-
sician and surgeon specialists, and live at
the doorstep of year-round recreational ac-
tivities. Marshfield Clinic offers an excel-
lent salary and benefit program including
a liberal vacation and education leave.
Please send curriculum vitae to: John P
Folz, Assistant Director, 1000 North Oak,
Marshfield, Wisconsin 54449.
12/84;2/85
Pediatrician needed by Marshfield
Clinic to join primary care satellite in
Ladysmith, Wisconsin. Current Lady-
smith staff includes five family practition-
ers, four internists, one general surgeon,
and a radiologist. An obstetrician will be
joining the group in 1985. Clinic adjoins
41-bed JCAH-accredited hospital. Rural
location in beautiful northern Wisconsin.
Must be Board eligible or certified. Send
curriculum vitae to Dr John Ziemer, 906
College Avenue West, Ladysmith, Wis-
consin 54848, or call 715/532-6651.
1-2/85
Family Practice physician needed to join
five family practitioners and a general
surgeon. Immediate opportunity in west
central Wisconsin near La Crosse. $45,000
first year guarantee plus incentive. Excel-
lent recreational area. Community Hos-
pital. Send CV to: Jerrold L Kamp, Ad-
ministrator, PO Box 250, Sparta, WI
54656; or phone 608/269-6731. 6tfn/84
Physicians: US Air Force Medical
Corps is currently accepting appli-
cants tor physicians in the following
specialties: Aerospace Medicine; Or-
thopedics; Ear, Nose, and Throat;
Obstetrics/ Gynecology; General
Surgeons; Family Practitioners; Inter-
nal Medicine, and Pediatrics. For more
information call: 414/258-2430.
2-4/85
Obstetrician-Gynecologist, Board cer-
tified or eligible, to join 17-physician
multispecialty clinic with two physician
OB/GYN department. Located in a
beautiful Wisconsin lakeshore commun-
ity of 35,000. Competitive salary, com-
plete fringe benefits, generous vacation
time. Send CV to: Administrator, Mani-
towoc Clinic, SC, PO Box 3008, Mani-
towoc, WI 54220. 6-12/84;l-5/85
Internal Medicine— Hospital-based pri-
vate practice in small community near
Eau Claire, Wisconsin. Involves critical
care management. Hospital less than 20
years old, 86-bed nursing home attached.
Call-sharing and guarantees provided. Af-
filiation with Marshfield Clinic. Two-hour
drive to Minneapohs. Charles Nelson, Fox
Hill Associates, 250 Regency Court, Wau-
kesha, WI 53186; ph 414/785-6500.
pl-2/85
Physicians needed full or part-time to
perform light physicals. Milwaukee area.
Professional liability provided. Phone
414/344-2100, Ms Jenkins. lOtfn/84
The Racine Medical Clinic, a progres-
sive cluster corporation of 31 physicians
is currently seeking an Obstetrician / Gyn-
ecologist physician. Full benefits, un-
limited earnings and a full and exciting
practice are offered. Please contact: Roger
D Lacock, Administrator, Racine Medical
Clinic, 5625 Washington Ave, Racine, WI
53406; ph 414/886-5000. 12tfn/84
Family Practice Oconto Falls, Wiscon-
sin. Thirty miles northwest of Green Bay.
Established practitioner needs associate to
share fully-equipped clinic adjacent to
50-bed hospital. Income guaranteed by
hospital. No ER call required. Abundant
hunting, fishing, recreational opportuni-
ties. Contact Brett Wilson, DO, 835 S Main
St, Oconto Falls, Wisconsin 54154 or call
1-800/242-4414, ext 278 or 414/ 846-2287.
lltfn/84
The Racine Medical Clinic, a progres-
sive cluster corporation of 31 physicians
is currently seeking an Internist-Infectious
Disease physician. Full benefits, un-
limited earnings and a full and exciting
practice are offered. Please contact: Roger
D Lacock, Administrator, Racine Medical
Chnic, 5625 Washington Ave, Racine, WI
53406; ph 414/886-5000. 12tfn/84
Diagnostic Radiology locum tenens
wanted. Responsible well-trained
radiology resident available to fit your
schedule including weekends and
holidays. Contact PO Box 5942,
Rochester, MN 55903; ph 507/284-
2311 or 507/281-4956. p2/85
80
WISCONSIN MEDICAL JOURNAL, FEBRUARY 1985: VOL. 84
MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
continued
14 MD multispecialty clinic wishes to
add third OB/GYN 7/1/85. Three pro-
gressive hospitals (regional referral center
for Maternal High Risk); ultrasound, of-
fice cytoscopy, colposcopy, laser, hys-
teroscopy, etc; no abortions. Competitive
salary and benefits leading to partnership
in two years. Excellent family commun-
ity with multiple recreational and cultural
activities available. Send CV to T E Flood,
Administrator, Beaumont Clinic, Ltd,
1821 S Webster Ave, Green Bay, WI
54301. pl2/84;l-3/85
Internist or Family Practitioner to join
two Internists and General Surgeon in
growing, established. Green Bay area
practice. Send CV to John Brusky, MD,
1203 South Military Ave, Green Bay, WI
53404. 7tfn/84
Wanted Board Certified Otolaryngol-
ogist. Head and neck surgeon. Join active
one-man practice. General otolaryngol-
ogy, head and neck surgery, facial plastic
surgery, nasal allergy. Computerized of-
fice with x-ray, audiologist, and hearing
aid dispensing. Northern Wisconsin near
Apostle Islands National Lakeshore. Con-
tact James A Hamp, MD, ENT Profes-
sional Associates, SC, 2101 Beaser Ave,
Suite 1, Ashland, WI 54806; ph 715/682-
9311. 10-12/84;l-3/85
Family Practitioners, Pediatricians,
Orthopedic Surgeons, and OB/GYNs.
Looking for qualified people in these areas
of medicine. Located in a prosperous com-
munity in SE Wisconsin close to Milwau-
kee, Madison, and Chicago. I can offer
pleasant surroundings, competitive salary,
benefits, and fully-staffed office all within
a newly decorated office. Write or call
Medical Consultants, SC, 137 W Chestnut,
Burlington, WI 53105; ph 414/763-3531.
12/84;l-2/85
Family Practice Physician to share fully
equipped medical office in central Wis-
consin city. Opportunity for partnership
and eventual purchase of practice. Excel-
lent recreational, educational, hospital,
and civic advantages. Send curriculum
vitae to Dept 503 in care of the Journal.
6tfn/82
Wanted— Board qualified— board cer-
tified obstetrician-gynecologist as an
associate. Modern well equipped facility.
Excellent starting salary and benefits in-
cluding profit sharing plan. Please contact
Elizabeth Allen Steffen, MD, 734 Lake
Ave, Racine, Wis 54303. 9tfn/83
Immediate opportunities for qualified
physicians who possess excellent clinical
and communication skills to join long-
standing group of Emergency Physicians.
Positions available in a popular Wiscon-
sin area bordering Illinois. If interested,
send resume to Barbara Wilczynski,
Medical Emergency, Service Associates
(MESA), SC, 15 S McHenry Road, Suite 2,
Buffalo Grove, IL 60090 or call collect
312/459-7304. 6tfn/83
Wanted: Young Family Practitioner to
join a ten-physician group in western Wis-
consin. Contact R M Hammer, MD, River
Falls, Wisconsin 54022; ph 612/436-8809
or 715/425-6701. 8tfn/84
Internist, with or without subspecialty,
and an OB/GYN needed (Board certified
or eligible) to practice in conjunction with
a 7-member Internal Medicine Depart-
ment and a 5-member OB/GYN Depart-
ment in a 24-member multispecialty
group. The Internal Medicine Department
currently has subspecialties in gastro-
enterology, pulmonary medicine, and car-
diology. The Group is located in South-
eastern Wisconsin in a city of 100,000, be-
tween two major metropolitan areas of
greater than one million. Estimated serv-
ice area is approximately 200,000. If Inter-
ested, please send CV to Stephen L
Wagner, Kurten Medical Group, 2405
Northwestern Ave, Racine, WI 53404. All
inquiries will be kept confidential and ad-
ditional information will be sent.
7tfn/84
St Francis Medical Center— La Crosse:
Full-time Family Practice faculty position
with opportunity for teaching and practice
in the St Francis/Mayo Family Practice
Residency with Mayo Clinic faculty ap-
pointment. Currently, four full-time
family physicians and 13 residents in
clinic and hospital. Send inquiries to: Ted
Thompson, MD, Program Director, St
Francis /Mayo Family Practice Residency,
700 West Avenue South, La Crosse, Wis-
consin 54601; ph 608/785-0940. 2-3/85
Family Practitioners needed to staff
satellite locations and Urgent Care
Centers located in Northeast Wisconsin.
Please send CV to Dept 554 in care of the
Journal. 2-5/85
MEDICAL FACILITIES
Family Practice for sale in Milwaukee.
Ideal starter or satellite office. Excellent
patient goodwill. Fully equipped and fur-
nished three examining rooms, waiting
room, and office. Approximately 900 sq
ft. Contact Greg Rodenbeck, DDS, 1200
E Oklahoma Ave, Milwaukee, Wis 53207;
414/481-8111. glOtfn/84
Take over lease: EKG equipment
(Phone-A-Gram) for computerized EKGs
and interpretation. EKG machine, print-
er, and all accessories. Instant interpreta-
tion via phone line as well as tracing. Take
over lease to 10-1-87 at $195 per month
with unlimited EKGs or monthly pay-
ment. Call 414/367-2128 or 414/367-2120
for information. Available immediately.
p2/85
Medical practice or equipment for sale
in Milwaukee. Completely equipped,
modern office with a modern x-ray ma-
chine. I am retiring. Please call 414/ 272-
0250 or 414/962-9382 for an appointment.
2/85
Madison, West Side. Hilldale Profes-
sional Building. Deluxe office suites, 1200-
1700 sq ft. Full service— undercover park-
ing. Call Ralph at office 608/273-5800 or
home 608 / 836-3586. 2tfn / 85
MISCELLANEOUS
Physicians Signature Loans to $50,000.
Up to 7 years to repay. Competitive fixed
rate, with no points, fees, or charges of any
kind. No prepayment penalties. Prompt,
courteous service. Physicians Service
Assn, Atlanta, GA. Toll-Free (800) 241-
6905. lOeom/83
FAMILY PRACTITIONERS
INTERNISTS, OB/GYN
The UW Office of Rural Health is seek-
ing primary care specialists for more
than 50 communities throughout Wis-
consin. Opportunities are available
throughout Wisconsin for Board certi-
fied physicians trained in US medical
schools and residencies.
CONTACT:
Laurie Glowac or Fred Moskol
New Physicians for Wisconsin
University of Wisconsin
Department of Family Medicine
777 S Mills St, Madison, WI 53715
Phone: 608/263-4095 7/84;6/85
WISCONSIN MEDICAL JOURNAL, FEBRUARY 1985: VOL. 84
8
MEDICAL YELLOW PAGES
MEDICAL MEETINGS-
CONTINUING MEDICAL
EDUCATION
WISCONSIN
MARCH 1-3, 1985: Wisconsin Psychia-
tric Association at Lake Lawn Lodge,
Delavan. gll-12/84;l-2/85
APRIL or MAY 1985: Wisconsin Asso-
ciation of Medical Directors Annual Meet-
ing (in conjunction with the County
Homes Association), tentatively at Stevens
Point. More definite details to come.
gl2/84
APRIL 12-13, 1985: 8th Annual Sports
Medicine Symposium. University of Wis-
consin, Clinical Science Center, Madison,
Sponsored by University School of Medi-
cine, Division of Orthopedic Surgery, Sec-
tion of Sports Medicine; and University of
Wisconsin-Extension Continuing Medical
Education. Credit: AM A Category 1, AOA
Category 2-D, AAFP prescribed, Univer-
sity of Wisconsin-Extension CEUs. Info:
Sarah Aslakson, Continuing Medical
Education, Room 465B WARE, 610
Walnut St, Madison, WI 53705; ph 608/
263-2856. 2/85
APRIL 17-19, 1985: Cocaine: A Sym-
posium. Features nationally known
speakers, including C Everett Koop, MD,
US Surgeon General, and William Pollin,
MD, Director, National Institute on Drug
THIS LISTING is compiled by the State
Medical Society of Wisconsin in coopera-
tion with others who wish to maintain a
centralized schedule of meetings and
courses of interest to Wisconsin physicians
and to avoid scheduling programs in conflict
with others. Hospitals, Clinics, Specialty
Societies, and Medical Schools are par-
ticularly invited to utilize this listing service.
There is a nominal charge for listing of Con-
tinuing Medical Education courses at the
following rates: 50« per word, with a mini-
mum charge of $20.00 per listing.
BOXED LISTINGS: $25.00 per column
inch. Listings of other scientific meetings
will be included at the discretion of the
editors.
COPY DEADLINE tor listings is 15th of the
month preceding the month of publication;
e.g., copy for the August issue is due by July
15. Address communications to: Wisconsin
Medical Journal, Box 1109, Madison, Wis-
consin 53701; or phone (area code 608)
257-6781; or toll-free in Wisconsin: 800/
362-9080.
FOR LISTING of other meetings see the
January 4, 1985 issue of the Journal of the
American Medical Association: Continuing
Education Opportunities for Physicians for
period January 1985 through December
1985.
Abuse. Marriott Hotel, Milwaukee, Wis-
consin. Major sponsors are Wisconsin In-
stitute on Drug Abuse and National Insti-
tute on Drug Abuse. AMA Category I and
University of Wisconsin-Extension CEUs.
Contact: Sarah Aslakson, University of
Wisconsin-Extension, Continuing Medical
Education, Room 465B, 610 Walnut St,
Madison, WI; ph 608/263-2856. 2/85
APRIL 19-20, 1985: Wisconsin Urolog-
ical Society, Pfister Hotel, Milwaukee.
glltfn/84
MAY 3, 1985: Wisconsin Orthopedic
Society, American Club, Kohler. g2-4/85
MAY 4, 1985: 17th Annual Southeastern
Wisconsin Cancer Conference, Pfister
Hotel, Milwaukee. "Considerations In
The Diagnosis and Treatment of Lung
Cancer." 8:00 am- 12:00 noon. Info: Ray-
mond C Zastrow, MD, 2400 W Villard
Ave, Milwaukee, WI 53209. g2-4/85
MAY 4-7, 1985: 115th Annual Session
Wisconsin Dental Association, MECCA,
Milwaukee. Info: Wisconsin Dental
State Medical Society
of Wisconsin
Dates and locations of
ANNUAL MEETINGS
1985-1992
All meetings will be held in Milwau-
kee at the Milwaukee Exposition and
Convention Center and Arena
(MECCA) and the new Hyatt Regency
as the headquarters hotel with the ex-
ception of 1985, when the meeting will
be held at the La Crosse Convention
Center.
1985- April 25-27
1986- April 17-19
1987- March 26-28
1988- April 28-30
1989- April 13-15
1990- April 26-28
1991- April 18-20
1992- April 23-25
Meeting days will be Thursday and
Friday; the first session of the House
of Delegates will convene on Thurs-
day, the second and third on Friday.
Scientific programming will be on Fri-
day and Saturday.
Further information: Commission on
Continuing Medical Education, State
Medical Society of Wisconsin, Box
1109, Madison, Wis 53701 . Local tele-
phone: 257-6781; toll-free in Wiscon-
sin: 1-800/362-9080.
Association, 633 West Wisconsin Ave,
Milwaukee, WI 53203. g2-4/85
MAY 9-11, 1985: Wisconsin Chapter,
American Academy of Pediatrics, Pioneer
Inn, Oshkosh. glltfn/84
JUNE 12-15, 1985: 37th Annual Scientific
Assembly of the Wisconsin Academy of
Family Physicians, Americana Resort
Hotel, Lake Geneva, Wisconsin. Info:
WAFP, 850 Elm Grove Road, Elm Grove,
WI 53122; ph 414/784-3656.
12/84;l-5/85
JULY 18-20, 1985: Wisconsin Society of
Obstetrics & Gynecology, Olympia Re-
sort, Oconomowoc. g2-6/85
SEPTEMBER 13-14, 1985: Wisconsin
Surgical Society, Paper Valley Hotel &
Conference Center, Appleton. g2-8/85
Wisconsin Specialty
Society Meetings
• Wisconsin Psychiatric Association,
March 1-3, 1985, Lake Lawn
Lodge, Delevan
• Wisconsin Urological Society,
April 19-20, 1985, Pfister Hotel,
Milwaukee
• Wisconsin Chapter: American
Academy of Pediatrics, May 9-11,
1985, Pioneer Inn, Oshkosh
• Wisconsin Academy of Family
Physicians, June 12-15, 1985,
Americana Resort, Lake Geneva
* * *
Specialty Society Meetings
to be held in conjunction
with SMS Annual Meeting,
April 25-27, 1985, La Crosse
• Wisconsin Society of Anesthesiolo-
gists
• Wisconsin Dermatological Society
• Wisconsin Chapter, American Col-
lege of Emergency Physicians
• Wisconsin Academy of Family
Physicians
• Wisconsin Society of Internal
Medicine
• Wisconsin Academy of Ophthal-
mology
• Wisconsin Otolaryngological
Society
• Wisconsin Society of Pathologists
• Wisconsin Society of Physical
Medicine & Rehabilitation
• Wisconsin Society of Plastic Sur-
geons
• Wisconsin Society for Preventive
Medicine
• Wisconsin Society of Radiation
Oncologists
• Wisconsin Surgical Society
82
WISCONSIN MEDICAL JOURNAL, FEBRUARY 1985: VOL. 84
MEDICAL YELLOW PAGES
MEDICAL MEETINGS-
CONTINUING MEDICAL
EDUCATION
continued
SEPTEMBER 13-15, 1985: Wisconsin
Society of Anesthesiologists, American
Club, Kohler. g2-8/85
OTHERS
MARCH 1-3, 1985 (Illinois): Midwest
Clinical Conference, sponsored by Chicago
Medical Society, at Westin Hotel, Chicago.
Info: Chicago Medical Society, 515 North
Dearborn St, Chicago, 111 60610; ph 312/
670-2550. gl-2/85
MARCH 20, 1985 (Illinois): Trends in
Specialization: Tomorrow's Medicine, at
Westin Hotel O'Hare, Chicago. Jointly
sponsored by the American Board of
Medical Specialties and the Royal College
of Physicians and Surgeons of Canada.
Info; American Board of Medical Special-
ties, One American Plaza, Suite 805,
Evanston, IL 60201; phone 312/491-9091.
gl2/84;l-2/85
APRIL 10-14, 1985 (Florida): 201/1 A«-
nual Clinical Conference at Longboat Key
Club, Longboat Key. Sponsored by the
Marquette-MCW Medical Alumni Asso-
ciation and the Medical College of Wis-
consin. Info: Marquette-MCW Medical
Alumni Association, 8701 Watertown
Plank Rd, Milwaukee, Wis 53226; ph
414/257-8367. 1-3/85
JUNE 5-8, 1985 (Alaska): Alaska State
Medical Association Annual Convention
in Haines. Info: Alaska State Medical
Association, 4107 Laurel St, Ste #1,
Anchorage, Alaska 99508; ph 907/
562-2662. g2-5/85
AUGUST 1-4, 1985 (Georgia): Inter-
national Doctors in Alcoholics Anonymous
Annual Meeting. Hyatt Regency Hotel,
Savannah. Reservations may be made at
a later date when specific details and in-
structions are published. For further infor-
mation contact: Information Secretary,
IDAA, 1950 Volney Road, Youngstown,
Ohio 44511;ph216 / 782-62 16. gl2tfn / 84
SEPTEMBER 17-18, 1985 (Illinois):
Medical Practice and Hospital Privileges, at
Chicago Marriott O'Hare, Chicago. Info:
American Board of Medical Specialties,
One American Plaza, Suite 805, Evanston,
IL 60201; phone 312/491-9091.
gl2/84;l-8/85
AMA
JUNE 16-20, 1985: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 8-11, 1985: Interim AMA
House of Delegates, Washington, DC.
JUNE 15-19, 1986: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 7-10, 1986: Interim AMA
House of Delegates, Las Vegas, NV.
JUNE21-25, 1987: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 6-9, 1987: Interim AMA
House of Delegates, Atlanta, GA.
JUNE 26-30, 1988: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 4-7, 1988: Interim House
of Delegates, Dallas, TX. ■
ADVERTISERS
Acme Laboratories 48
Advanced Technology Associates,
Inc 59
Medical Computer Systems
Ayerst Laboratories 35, 36, 37, 38
Inderal®
Benefit Tours International 49
Centralized Billing Systems 46
Knoll Pharmaceutical
Company 56, 57, 58
Isoptin®
House of Bidwell 78
Kodak Ektachem 69, 70, 71
Clinical Chemistry Products
Leasenu, Inc 23
Lilly & Co, Eli 24
Ceclor®
Marion Laboratories, Inc 75, 76
Cardizem®
Medical Protective Company 10
Navy Medical Programs 39
Offerman & Co, Inc 48
PBBS Equipment 68
Professionals Insurance
Company, The 4
Roche Laboratories 85, BC
Dalmane®
S&L Signal Company 74
United States Army Air Force 49
United States Army Reserve 74
Upjohn Company, The 55
Motrin®
Winthrop Company, The 73, 74
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WISPAC 72 ■
DIAGNOSIS & TREATMENT OF
COMMON HUMAN TUMORS
Presented by American Cancer
Society— Kentucky Division
April 10-13, 1985 /Lexington
Marriott Resort, Griffin Gate
Lexington, Kentucky
Info: John R van Nagell Jr, MD,
University of Kentucky
Medical Center
Lexington, KY 40536 g2-3/85
THE LA CROSSE EXERCISE
PROGRAM PRESENTS ITS
1985 WORKSHOP SCHEDULE
University of Wisconsin-La Crosse
La Crosse Lutheran Hospital/
Gundersen Clinic
Cardiac Rehabilitation: Apr 15-19;
June 10-14; July 15-19; Nov 18-22
Teaching Stress Management and
Relaxation Skills; June 2-7;
July 14-19; Nov 10-15
Development of Corporate &
Industrial Wellness Programs
by Health Care Providers:
June 10-13
Fitness and Weight Control:
Mar 25-29; June 3-7; July 22-26
Info: Philip K Wilson, La Crosse Exer-
cise Program, University of Wiscon-
sin-La Crosse, La Crosse, WI 54601; tel
608/785-8686 2/85
International Childbirth
Education Association
to host 1985 Conference
in cooperation with Methodist Hos-
pital who will coordinate the local
planning committee.
in Madison, June 20-23
at the Sheraton Inn and Conference
Center
The four-day conference is expected to
draw 400 to 500 persons from across
the nation, including childbirth educa-
tors, nurses, physicians, parent advo-
cates, and others interested in the cur-
rent changes in pregnancy, birthing,
and early parenting.
Persons interested in assisting with the
conference or learning more details
can call Methodist Hospital, Madison,
at 608/258-3290.
WISCONSIN MEDICAL JOURNAL, FEBRUARY 1985; VOL. 84
83
NEWS YOU CAN USE
MORE PHYSICIANS LEANING TOWARDS ADVERTISING. Radio, television advertising of physicians' fees
is an issue that generates strong reactions and differing opinions within the profession, according to the AMA
Dept of Survey and Opinion Research. The percentage of pro-advertising physicians more than doubled be-
tween 1978 and 1983, from 8% to 17%. The overwhelming proportion of physicians, however, continued to
disapprove of listing fees. Younger physicians were more than twice as likely as older physicians to approve
of fee advertising.*
WISCONSIN RANKS #17 IN MEDICARE SIGN-UP RATE. Nearly 35% of Wisconsin physicians elected to
become "participating” physicians under Medicare, according to data recently compiled by the Federal
Health Care Financing Administration. HCFA reports that 2,802 physicians (MDs and DOs) in Wisconsin
have signed agreements giving Wisconsin the rank of 17 in nationwide Medicare participation. Alabama is
ranked first in MD participation with 53.9% and South Dakota is ranked last or #51 with 5.6% of its physi-
cians participating. Other states in the North-Central region and their participation rank and percentage are:
Illinois: #30—23.5%; Iowa: 14th— 35.9%; Michigan: #9—43.4%; Minnesota: #43—18.0%; and North Dakota:
#49-10.4%*
PHYSICIANS TO RECEIVE 3% INCREASE IN MEDICAID REIMBURSEMENT. Physicians will receive an
overall 3% increase in the maximum allowable reimbursement paid by the Wisconsin Medical Assistance
Program (WMAP) for services rendered on or after January 1, 1985, the Bureau of Health Care Financing has
announced. For each covered service billed to the WMAP, the physician provider will be reimbursed the
lesser of the physician's usual and customary charge or the updated maximum allowable fee for the service.
Physicians may obtain copies of the updated maximum allowable fee schedule by writing: Records Custodian,
Bureau of Health Care Financing, Wisconsin Division of Health, PO Box 309, Madison, WI 53701.*
CHAMPUS APPOINTS NEW PROVIDER FIELD REP FOR WISCONSIN. CHAMPUS has named Pat Wis-
niewski as the new field representative to serve physician providers in the Wisconsin and Upper Michigan
Peninsula. She is available for handling problem situations, workshops, policy issues or on-site visits. She can
be reached by writing: Pat Wisniewski, PO Box 216, Greendale, WI 53219, or calling 1-414-423-0902.
Physician providers should not refer her name to CHAMPUS beneficiaries. They should be referred to a
Health Benefit Advisor. A list of Wisconsin Health Benefit Advisors is available through Ms Wisniewski's
office at the above address.
CHAMPUS/CHAMPVA claims should be submitted to CHAMPUS/CHAMPVA, RI Blue Cross and Blue
Shield, PO Box 1714, Providence, RI 02901-1714. Claims inquiries can be directed to the same address or by
calling toll-free at 1-800-622-3131 or 1-401-272-8500, extension 2546, 2547 or 2560.*
CANCER SOCIETY LAUNCHES EDUCATION CAMPAIGN ON COLORECTAL CANCER. The American
Cancer Society— Wisconsin Division has announced that it is beginning a public and professional education
and awareness campaign on colorectal cancer. Physicians should be aware of the campaign known as "Colo-
rectal Health Check" and be prepared for increased requests from patients for information on the tests for
colorectal cancer. The colorectal cancer awareness program is part of a major American Cancer Society three-
year accelerated nationwide campaign to reduce America's death toll from colorectal cancer. The campaign
will attempt to expand the use of the three standard diagnostic techniques for the early detection of colorectal
cancer in asymptomatic patients: the digital rectal examination, the stool blood test, and proctosigmoidos-
copy. As part of the campaign, the Cancer Society will be distributing 3"x5" cards telling persons, par-
ticularly those 50 years and over, to ask their physicians about colorectal cancer detection tests. For further
information contact the ACS-Wisconsin Division at 61 1 North Sherman Avenue, Madison, WI 53704.*
84
WISCONSIN MEDICAL JOURNAL, FEBRUARY 1985: VOL. 84
COMPLETE
LABORATORY ,,
DOCUMENTATION . . . EXTENSIVE
CLINICAL PROOF
FOR THE PREDIQABIUTY
CONFIRMED BY EXPERIENCE
QALMAHE®
flurozepom HCIMoche
THE COMPLETE HYPNOTIC
PROVIDES ALL THESE BENEFITS:
• Rapid sleep onset' "
• More total sleep time"’
• Undiminished efficacy for at least
28 consecutive nights^"*
• Patients usually awake rested and refreshed""
• Avoids causing early awakenings or rebound
insomnia after discontinuation of therapy' '"""
Caution patients about driving, operating hazardous machinery or drinking
alcohol during therapy. Limit dose to 15 mg in elderly or debilitated patients
Contraindicated during pregnancy
DALMAHE's
flurozepom HCI/Poche
References; 1. Kales J et al Clin Pharmacol Ther
72:691-697, Jul-Aug 1971. 2. Kales A ef a/: Clin Phar-
macol Ther 78:356-363, Sep 1975 3. Kales A etal
Clin Pharmacol Ther 79:576-583, May 1976 4. Kales A
et al: Clin Pharmacol TTier 32:781 -788, Dec 1982
5. Frost JD Jr, DeLucchl MR: J Am Geriatr Soc
27:541-546, Dec 1979. 6. Kales A. Kales JD: J Clin
Pharmacol 3:140-150, Apr 1983. 7, Greenblatl DJ,
Allen MD, Shader Rl: Clin Pharmacol Ther 27:355-361,
Mar 1977. 8. Zimmerman AM: Curr Ther Res
73:18-22, Jan 1971. 9. Amrein R et al: Drugs Exp Clin
Res 9(1):85-99, 1983 10. Monti JM: Methods Find Exp
Clin Pharmacol 3:303-326. May 1981 11. Greenblatl DJ
etal: Sleep 5(Suppl 1):S18-S27, 1982. 12. Kales A
et al: Pharmacology 26:121-137, 1983.
DALMANE« ®
flurazepam HCI/Roche
Before prescribing, please consult complete
product information, a summary of which follows:
Indications; Effective in all types of insomnia charac-
terized by difficulty in falling asleep, frequent nocturnal
awakenings and/or early morning awakening; in
patients with recurring insomnia or poor sleeping hab-
its; in acute or chronic medical situations requiring
restful sleep. Objective sleep laboratory data have
shown effectiveness for at least 28 consecutive nights
of administration. Since insomnia is often transient
and intermittent, prolonged administration is generally
not necessary or recommended. Repeated therapy
should only be undertaken with appropriate patient
evaluation
Contraindications: Known hypersensitivity to fluraze-
pam HCI; pregnancy. Benzodiazepines may cause
fetal damage when administered during pregnancy.
Several studies suggest an increased risk of congeni-
tal malformations associated with benzodiazepine use
during the first trimester. Warn patients of the potential
risks to the fetus should the possibility of becoming
pregnant exist while receiving flurazepam. Instruct
patient to discontinue drug prior to becoming preg-
nant. Consider the possibility of pregnancy prior to
instituting therapy.
Warnings: Caution patients about possible combined
effects with alcohol and other CNS depressants. An
additive effect may occur if alcohol is consumed the
day following use for nighttime sedation This potential
may exist for several days following discontinuation.
Caution against hazardous occupations requiring
complete mental alertness (e g., operating machinery,
driving). Potential impairment of performance of such
activities may occur the day following ingestion Not
recommend^ for use in persons under 15 years of
age Though physical and psychological dependence
have not been reported on recommended doses,
abrupt discontinuation should be avoided with gradual
tapering of dosage for those patients on medication
for a prolonged period of lime. Use caution in adminis-
tering to addiction-prone individuals or those who
might increase dosage.
Precautions: In elderly and debilitated patients, it is
recommended that the dosage be limited to 15 mg to
reduce risk of oversedation, dizziness, confusion and/
or ataxia. Consider potential additive effects with other
hypnotics or CNS depressants. Employ usual precau-
tions in severely depressed patients, or in those with
latent depression or suicidal tendencies, or in those
with impaired renal or hepatic function.
Adverse Reactions: Dizziness, drowsiness, light-
headedness, staggering, ataxia and falling have
occurred, particularly in elderly or debilitated patients.
Severe sedation, lethargy, disorientation and coma,
probably indicative of drug intolerance or overdosage,
have been reported. Also reported: headache, heart-
burn, upset stomach, nausea, vomiting, diarrhea,
constipation, Gl pain, nervousness, talkativeness,
apprehension, irritability, weakness, palpitations, chest
pains, body and joint pains and GU complaints. There
have also been rare occurrences of leukopenia, gran-
ulocytopenia, sweating, flushes, difficulty in focusing,
blurred vision, burning eyes, faintness, hypotension,
shortness of breath, pruritus, skin rash, dry mouth,
bitter taste, excessive salivation, anorexia, euphoria,
depression, slurred speech, confusion, restlessness,
hallucinations, and elevated SGOT, SGPT, total and
direct bilirubins, and alkaline phosphatase, and para-
doxical reactions, e.g., excitement, stimulation and
hyperactivity
Dosage: Individualize for mciximum beneficial effect.
Adults: 30 mg usual dosage; 15 mg may suffice In
some patients. Elderly or debilitated patients: 15 mg
recommended initially until response is determined
Supplied: Capsules containing 15 mg or 30 mg
flurazepam HCI.
Roche Products Inc.
Manati, Puerto Rico 00701
DOCUMENTED PROVEN IN
IN THE SLEEP THE PATIENT'S
lABORATORY’ . . HOME
15-MG/30-
FOR A COMPLETE
DAL
flurozepQ
STANDS
See preceding page for references and summary of product information
Copyright © 1984 by Roche Products Inc. All rights reserved.
• *
WISCONSIN
MEDICAL JOURNAL
WISCONSIN
MEDICAL JOURNAL
k
ISSN 0043-6542 /Established 1903
Owned and published by
State Medical Society of Wisconsin
Medical Editor
Victor S Falk MD, Edgerton
Editorial Board
Victor S Falk MD, Edgerton Chairman
Melvin F Fluth MD, Baraboo
M C F Lindert MD, Milwaukee
Wayne J Boulanger MD, Milwaukee
Richard D Sautter MD, Marshfield
Dean M Connors MD, Madison
George W Kindschi MD. Monroe
Charles H Raine MD, Racine
Darrell L Witt MD, Wausau
Garrett A Cooper MD, Madison Emeritus
Editorial Director
Wayne J Boulanger MD, Milwaukee
Editorial Associates
John P Mullooly MD, Milwaukee
Russell F Lewis MD. Marshfield
Raymond A McCormick MD, Green Bay
Victor S Falk MD. Edgerton
Medical Editor
Staff
Earl R Thayer, Madison
Secretary-General Manager
State Medical Society of Wisconsin
H B Maroney II. Madison
Assistant Secretary-Corporate Counsel
State Medical Society of Wisconsin
Mrs Mary Angell, Madison
Managing Editor
Mrs Marjorie Stafford, Madison
Publications Assistant
Mrs Diane Upton, Madison
Editorial Assistant
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TIVE: State Medical Journal Advertising
Bureau, Inc, 711 South Blvd, Oak Park, III
60302, Ph 312/383-8800,
LOCAL (WISCONSIN] ADVERTISING: Con-
tact: Mrs Mary Angell, Wisconsin Medical
Journal, Box 1109, Madison, Wis 53701. Ph
608/257-6781.
SUBSCRIPTION RATES: Members, $12.50
per year (included in dues); nonmembers,
$25.00. Single copy: current year, $2.00; pre-
vious years, $3.00. SPECIAL RATES: Foreign
and Canada, $30.00. Blue Book issue, $8.00.
Membership Directory issue, $15.00.
SECOND CLASS POSTAGE PAID at
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PUBLISHED MONTHLY. "Acceptance for
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Authorized August 7, 1918." Address all com-
munications to THE WISCONSIN MEDICAL
JOURNAL. Street address: 330 East Lakeside
Street. Mailing address: Box 1109, Madison,
Wis 53701.
POSTMASTER: Send address changes to
Wisconsin Medical Journal, PO Box 1109,
Madison, Wis 53701.
COPYRIGHT 1985
State Medical Society of Wisconsin
[contents
SPECIAL FEATURES
President's Page
5 Welcome to Wisconsin regula-
tion
Timothy T Flaherty, MD
Neenah
Editorials
6 Dying with your "rights on" or
. . . killing with your "rights on"
Richard D Sautter, MD
Marshfield
7 Appropriate disposition
7 Product liability laws
8 Doctors' draft
8 Futility
9 Fresh frozen plasma
9 $2,500 per day
Victor S Falk, MD
Edgerton
Letters
10 Medical staffs and peer review
S E Sivertson, MD
Madison
10 Work-related injuries
Steve Hargarten, MD
Milwaukee
1 1 William H Studley, MD:
1903-1985
George E Moore, MD
Ashland, Illinois
March 1985
Special
13 Child abuse— After the report is
made
16 Magnetic resonance imaging
(MRI): View of the Wisconsin
Radiological Society
Roland A Locher, MD
La Crosse
17 Suggested patient form for ob-
taining DES-exposure informa-
tion
18 Pediatricians establish policy
statement for alcohol abuse edu-
cation in school
Socioeconomics
49 Governor delivers 1985-87
budget; many healthcare items
included
1983 Flealth spending
News you can use
64 Recent changes in Medicare
regarding durable medical equip-
ment
Practice management study
courses offered
Physician fee increases slow
WISCONSIN MEDICAL JOURNAL (ISSN 0043-6542) is the official publication of the State Medical
Society of Wisconsin, devoted to the interests of the medical profession and health care in Wisconsin.
Its affairs are handled by the Editorial Board, subject to policy direction of the Society's Board of
Directors. The Managing Editor is responsible for the production, business operation, and coor-
dination of contents as well as the final responsibility of the entire publication. The Editorial Director
IS responsible for Editorials. Unsigned Editorials express views consistent with the policies of the
State Medical Society of Wisconsin. Signed Editorials express personal views of the author for which
the Society takes no responsibility. Neither the Editors nor the State Medical Society will accept
responsibility for statements made or opinions expressed in the pages of the Journal. Indexed in
"Index Medicus," "Hospital Literature Index," and "Cambridge Scientific Abstracts."
V,
A.
Vol. 84, No. 3
CONTENTS
SCIENTIFIC MEDICINE
23 Endemic Kawasaki disease in
rural Wisconsin
Thomas M Sutton, MD
Bradley Sullivan, MD
Marshfield
25 Tech net ium®®"'-pyrophosphate
scintigraphy in amyloid cardio-
myopathy
Michael J Ptacin, MD
Virinderjit Barnrah, MD
Edmund Duthie, MD
Wood
28 Legal aspects of medical genetics
in Wisconsin
Ellen Wright Clayton, JD
Madison
Cover design by KC Graphics,
Inc, Madison, depicting the plight
of individuals in need of institu-
tional care and who, because of
mental illness, drug addiction, or
alcoholism are unable to accept
such care voluntarily. The courts
give them the right to remain
"free" until ' 'dangerousness'' is
proved, usually when a crime has
been committed or an unfortunate
death occurs. Legislators, at the
urging of involved families, profes-
sionals, and social agencies, will
soon be introducing legislation
that will make it easier for indi-
viduals needing psychiatric care to
be involuntarily committed.
33 Physician morbidity: a limited
study
Jeffrey Larson, MD
Betty Joan Maly, MD
Joanna Spiro, EdD
Milwaukee
ORGANIZATIONAL
39 SMS Board reaffirms its position:
Don't drop CME requirement
40 Mark your calendar for SMS
Annual Meeting April 25-27 in
La Crosse
Medical Society asks broadcast-
ers to help fight alcohol abuse
41 SMS Task Force on Medical Care
to meet March 22
42 State Medical Society of Wiscon-
sin Program Schedule— Annual
Meeting Apr 25-26-27, 1985,
La Crosse
44 House of Delegates: 1985 State
Medical Society of Wisconsin (list
of delegates and alternates by
district and sections)
46 SMS dues due by May 15
DEPARTMENTS
46 County societies: Dane . . . She-
boygan . . . Brown
59 Medical Yellow Pages: Physi-
cians exchange . . . Medical facil-
ities . . . Miscellaneous . . . An-
nouncements . . . Advertisers . . .
Medical meetings— continuing
medical education ■
the state medical society of WISCONSIN, created by the Territorial Legislature in 1841,
represents over 5600 member physicians in Wisconsin, comprising 55 county medical societies
and 25 medical specialty sections. The purpose of the Society is to "bring together the physicians
of the State of Wisconsin to advance the science and art of medicine and the better health of the
people of Wisconsin, and to secure the enactment and enforcement of just medical laws." The major
activities of the Society include continuing medical education, peer review, legislation, community
health education, scientific affairs, socioeconomics, health planning, services for physicians, opera-
tion of a Charitable, Educational and Scientific Foundation, and publication of the Wisconsin Medical
Journal.
7 \
Officers
President: Timothy T Flaherty, MD
Neenah
President-Elect: John K Scott, MD
Madison
Secretary-General Manager:
Earl R Thayer. Madison
Treasurer: John J Foley, MD
Menomonee Falls
Board of Directors
Chairman: Darold A Treffert, MD
Fond du Lac
Vice Chairman: Roger L
von Heimburg, MD, Green Bay
First District
John P Mullooly. MD, Milwaukee
Jerome W Eons Jr, MD. Cudahy
Carl S Eisenberg, MD, Milwaukee
Thomas A Hofbauer, MD,
Menomonee Falls
Wayne H Konetzki, MD, Waukesha
Fredrick Wood Jr, MD, Kenosha
William L Treacy, MD, Milwaukee
Charles W Landis, MD, Milwaukee
Richard D Fritz, MD, Milwaukee
William J Listwan, MD, West Bend
Second District
J D Kabler, MD, Madison
Cyril M Helsko, AID, Madison
James J Tydrich, AID, Richland Center
Allen O Tuftee, MD, Beloit
Alwin E Schultz, MD, Madison
Third District
Pauline M Jackson, AID, La Crosse
Fourth District
John J Kief, AID, Rhinelander
Jung K Park, MD, Wisconsin Rapids
W George Locher, MD, Wausau
Fifth District
Darold A Treffert, AID, Fond du Lac
Kenneth M Viste Jr, MD, Oshkosh
C William Freeby, MD, Appleton
Sixth District
Roger L von Heimburg. MD, Green Bay
Vacancy
Seventh District
Alarwood E Wegner, MD, St Croix Falls
Eighth District
Joseph AI Jauquet, MD, Ashland
President: Doctor Flaherty
President-Elect: Doctor Scott
Past President: Chesley P Erwin, MD,
Milwaukee
Speaker: Duane W Taebel, MD.
La Crosse
Vice Speaker: Vernon M Griffin, MD,
Mauston
A,
J
Keflex^
cephalexin
Additional information
availabie to the profession
on request.
420113
Dista Products Company
Division of Eli Lilly and Company
Indianapolis, Indiana 46285
Mfd. by Eli Lilly Industries, Inc.
Carolina, Puerto Rico 00630
PRESIDENT'S PAGE
^
Timothy T Flaherty, MD
Welcome to Wisconsin Regulation
That MAY NOT be the wording of the sign at our state borders;
however, that is the message that has been, and is continuing to be,
received by the citizens of Wisconsin involved in health care; please
see the Report of the Wisconsin Radiological Society's Committee on
Magnetic Resonance Imaging (MRI) appearing in this
issue on page 16.
When the chairman of Wisconsin's largest corporation (Kimberly Clark) initially announced his concern
about continued corporate residency in Wisconsin, he enumerated three areas which he perceived as negative
factors: (1) Wisconsin's high level of taxation. (2) Wisconsin's state bureaucracy (the Regulators). (3) The high
cost of medical care in the Fox Valley.
On May 30, 1984 1 attended the dedication of the General Electric Medical Systems, Magnetic Resonance
Center, (MRI) a new 216,000 sq ft MRI plant representing an expenditure of $25,000,000 by GE in Wiscon-
sin. Governor Anthony S Earl delivered the dedication address and took personal pride and "credit" for the
expansion of GE Medical Systems in Wisconsin. During that same time interval, a special law was passed
and signed by Governor Earl allowing the Medical College of Wisconsin-Milwaukee, and the University of
Wisconsin-Madison, to be exempted from the Certificate-of-Need (CON) process and from the $1,000,000
capital expenditure moratorium established by the Department of Health and Social Services (DHSS). As you
will read in the report of the Wisconsin Radiological Society, the State (DHSS) has now taken the position
of not accepting letters of intent for MRI scanners until February 1986. Unbelievably, the State Regulators
(DHSS) have refused to accept CON applications (now called Capital Expenditure Review— CER) from the
two University facilities that have operational scanners. This stance denies the University Medical Centers
the opportunity to receive the approval necessary to capitalize the expense of these MRI scanners.
Are the State Regulators (DHSS) against advances in medical technology?
Evaluating the recent performance of the State Regulators regarding the distribution of CT scanners
throughout Wisconsin the answer to that question by many would be "YES." The State Regulators through
the CON process denied a number of hospitals the authority to obtain CT scanners. Physicians in many of
these hospitals believed this denial restricted their ability to deliver high quality medical care and thus many
of these denials were appealed through the legal process. To my knowledge, the applicants won all of the
appeals and the State Regulators lost without exception. The legal expense of waging such a battle against
the resources of the State Regulators consistently cost the hospitals between $ 100,000 and $200,000. For one
Fox Valley Hospital, the legal costs of fighting the denial through the "system" exceeded the cost of purchas-
ing the CT scanner. The Kimberly Clark Chairman certainly would be correct in characterizing this expense
as an excessive health care cost. Additionally, we do not have an accounting, nor is the State very account-
able, for its share of the legal and administrative costs of the battle to halt the acquisition of this state-of-the-
art imaging modality.
SMS has consistently recommended elimination of the CON (CER) process. However, the determination
to retain CER review authority in DHSS or logically shift this to the new Mandatory Hospital Rate Review
Commission is the skirmish now being fought in the Madison bureaucracy.
Brandeis Dean Stewart Altman, PhD, who is chairman of Medicare's Prospective Payment Assessment
Commission, lists three qualifications of a regulator: (1) The regulator should be under 40 years of age and
in good health, (2) should know nothing about the industry that he will regulate, and (3) must be inconsistent
and able to change rules rapidly.
I have been attending farewell events with Fox Valley friends of employees of Kimberly Clark Corpora-
tion who are moving to the new Corporate Headquarters in Dallas. Texas has no personal income tax, a
business-friendly State Government, and has a "sunset provision" on its Health Facilities Review (CON) that
will expire this year.
Justice John Marshall said many years ago, "The power to tax is the power to destroy." Wisconsin Regula-
tion has demonstrated its power to control, to prop-up, to disturb, and potentially to destroy. ■
WISCONSIN MEmCAI JOl KNAl , MAKC ll 1985:\OI,. 84
c
EDITORIALS
1
Wayne J Boulanger, MD, Edilorial Director
Unsigned editorials express views consistent with the policies of the State Medical Society of Wisconsin.
Signed editorials express personal views of the author for which the Society takes no responsibility.
Dying with your "rights on" or . . .
killing with your "rights on"
In 1972 THE FEDERAL district court
declared Wisconsin's civil com-
mitment procedure statutes un-
constitutional (Lessard vs
Schmidt, ED, Wisconsin 1972,
349F Supp. 1098.)
In the name of fundamental
liberties, involuntary commit-
ment was virtually eliminated.
What has followed has been an
unspeakable suffering of families
with persons in need of institu-
tional care and who, because of
mental illness, drug addiction, or
alcoholism are unable to accept
Editor’s note: State Senators
Brian Rude, Coon Valley, and
Susan Engeleiter, Menomonee
Falls, atid Representative John
Medinger, Im Crosse, (at the State
Medical Society's request! will
soon be introducing legislation
that will make it easier for in-
dividuals needing psychiatric care
to be involuntarily committed.
Their bills propose a new stand-
ard for civil commitment to be
placed on the statutes. This stand-
ard would require a determina-
tion that "unless the individual re-
ceives immediate treatment, he or
she will suffer substantial mental
deterioration or develop irreversi-
ble chronic mental illness or that
the individual is unable to make
an infonned decision because of a
mental condition." "Dangerous-
ness" would not have to be
proved.
The legislators hope, as does the
Society's Mental Health Commit-
tee, that the proposal would help
reduce the needless suffering by
getting these people off the street
and into psychiatric treatment.
The legislators are to be com-
mended for introducing this
enlightened legislation.
— Victor S Falk, MD, Edgerton
such care voluntarily. There are
families who could do nothing to
help family members known to be
dangerous to others. (The tragedy
in Onalaska may be a recent ex-
ample.)
This is a pernicious law admin-
istered in a perverse manner.
I have had personal experience
with this procedure and with the
courts. I have found the court to
be primarily concerned with the
letter of the law, procedure, pro-
tocol, and so forth, with not a par-
ticle of empathy, or more impor-
tantly, a halfpenny's worth of
common sense. The court was
greatly concerned, to a pious fault,
that my son's rights be protected
at all costs, his life included. As I
stood at the hearing, it occurred to
me that tio one could possibly be
as interested in my son's welfare
as I, which I suspect is a common
and familiar feeling for family
members at such hearings. It was
the "case" that was being con-
sidered: not a sixteen-year-old's
welfare but the "case" to be set-
tled by prescribed procedure,
51.15, 51.70, 51.45. Had my son
declined voluntary commitment
he would in all likelihood not now
be in college but severely physic-
ally ill and perhaps worse. We
were very fortunate.
I grieve for the parents who
fought to have their child or
family member receive treatment,
knowing them to be suicidal or
homicidal, and having the fact
ultimately proved.
I know the feeling of total help-
lessness described by many par-
ents realizing their family mem-
ber required help, apparent even
to those with questionable mental
competency. I, as others, went to
the courts seeking help. What I
received was a crude lesson in the
vagaries and inhumanity of the
law and an exposure to a cold con-
tempt for an individual's welfare
to say nothing of the welfare of
others. I was hard pressed to im-
agine any citizen being treated so
poorly. No crime was committed;
no one suffered tangible loss.
Where was the compassion, the
so-called mercy of the court? It is
very hard to have respect for such
a system. The fault may not be en-
tirely with the system but also
with the players; but more likely
both.
I wonder if the courts feel a
twinge of conscience following a
suicide or murder; after all the let-
ter of the law was fulfilled. They
are unable or don't wish to recog-
nize that in protecting an individ-
ual's civil liberties they may be
denying them the right to appro-
priate treatment, and at times
sentencing them, or others, to
death. If a problem is recognized
by the courts, why then have they
not initiated change? It is their
system.
Somewhere it is written "the
law should serve the people."
This concept was obviously
thrown aside regarding Wiscon-
sin's commitment procedure,
both as it applies to individuals
and the public. What group or in-
dividual does this law serve? Only
the practitioners of the law?
Change should not be delayed.
Medicine serves the individual,
and though our profession may
not be lily-white in all areas in this
regard, the legal system on this
issue would be hard pressed to
become even charcoal in color. It
behooves us as physicians to help
initiate change in the statutes to
protect the individual, his family,
and other persons from a capri-
cious, pernicious law and its
servants.
—Richard D Sautter, MD, Marshfield
WISCONSIN MEDICAI |Ol RNAl., MARCH 198.’j:\01,. 84
EDITORIALS
Edilorial Boiircl comment: This is a
beautifully written editorial a)id so very
true. Another Board member's son was
not so lucky as was the author's, and now
spends his time in a state of paranoid ter-
ror. But the law says his freedom is his
paramount interest, but freedom to do
what?— to wander up and down State
Street (Madisonf sleep in empty build-
ings and in churches, and hit the soup
lines? For him it is a terribly painful and
unending affliction. Yet, our laws insist
no one can do anything for him until he
hurts himself or someone else, because it
is his inalienable legal "right" to be free
if he chooses. But unfortunately the law
doesn't realize it is not the son who is
making this decision— it is mental illness.
What a tragedy and what a waste, and
unfortunately there are many, many
more just like him. We were brought up
and taught that we are a country where
the people rule, not the courts or the
lawyers— where does it divide the rights
of one vs the rights of another— currently
it (the law] does not.
Appropriate
disposition
HHS Secretary Heckler has pro-
posed that the federal excise tax
on cigarettes be extended to shore
up Medicare. The 16<t a pack is
scheduled to drop to 8<t on Octo-
ber 1. If renewed at the current
level, the tax would generate $ 1 .7
billion a year. Secretary Heckler
has proposed that this be ear-
marked for the Medicare trust
fund. The AMA supports increas-
ing the excise tax, and agrees that
revenues should be earmarked for
Medicare.
It certainly is appropriate that
the funds generated from the tax
on cigarettes should go to Medi-
care. Certainly tremendous
amounts of Medicare funds are
expended on those unfortunate
but misguided individuals who
have been cigarette smokers and
subsequently developed emphy-
sema,- lung cancer, and/or other
tobacco-related illnesses. It would
be difficult to estimate the extent
to which the care of these respira-
tory cripples drains the Medicare
fund, but Secretary Heckler cer-
tainly has the right idea.
— Victor S Falk. MD. Edgerton
Product
liability laws
Senator Robert W Kasten, Jr of
Wisconsin, along with 28 cospon-
sors, has introduced legislation to
clarify the product liability laws.
Sidney Shindell, MD, LLB, Pro-
fessor and Chairman of the De-
partment of Preventive Medicine
at the Medical College of Wiscon-
sin, Milwaukee, wrote in the No-
vember/December 1984 issue of
the American Council on Science
and Health News and Views on the
subject.
Doctor Shindell pointed out that
the question of product liability
depends on where the injury oc-
curs. This is true because of the
idiosyncrasies of state laws and
the fact that there is little agree-
ment among states on these
issues.
The sponsors of the bill (S-44,
98th Congress) have attempted to
bring order out of this confusing
state of affairs by proposing uni-
form national standards for prod-
uct liability. Naturally there are
two schools of thought about the
proposed legislation. The pro-
ponents of the bill are organized
into two major coalitions, the
Products Liability Alliance (189
corporations and trade associa-
tions) and the Coalition for Uni-
form Product Liability Law (252
corporations and trade associa-
tions). These include the Chamber
of Commerce, National Associa-
tion of Manufacturers, National
Federation of Independent Busi-
nesses, American Insurance As-
sociation, Alliance of American
Insurers, and the American Legis-
lative Exchange Council. As might
be expected, those opposed to the
bill include the American Trial
Lawyers Association and Public
Citizen's Congress Watch, as well
as other labor and consumer
groups.
The new law would provide
one uniform definition of liability
for the multitude of definitions
that now exist. Liability would
result if:
... a product is unreasonably
dangerous in construction or
design, or
. . . there is a failure to provide
adequate warnings or in-
struction, or
. . . the product does not conform
to an express warranty, and
. . . the unreasonably dangerous
aspect of the product causes
harm.
Studies indicate that under the
current situation more money
goes into the pockets of lawyers
and expert witnesses than even-
tually gets to the claimants.
Doctor Shindell concludes that
the approach of the Kasten bill is
the compromise that many have
been searching for: to bring order
out of the present chaos, to give
manufacturers and suppliers rea-
sonable guidelines, and to give
consumers reasonable protection.
This appears to be a reasonable
approach to a complicated prob-
lem, and deserves the support of
the medical profession.
— Victor S Falk, MD. Edgerton
Editorial Board comment: Several
years ago when physicians were un-
able to purchase medical malprac-
tice insurance, limits on liability for
medical malpractice were opposed
by some Wisconsin business men
because limited liability for physi-
cians established a “special class"
favoring physicians while manufac-
turers had no such protection.
Manufacturers now feel the heat of
heavy and sometimes unwarranted
awards and they scurry for the um-
brella of legal protection. We agree
that the medical profession should
support legislation in the area of
product liability, but Senator Kasten
and others should be reminded that
order needs to be brought out of the
chaos of the medical malpractice
situation as well.
\VISCO\SI\ Mi:i)K Al, |Ol KX.AI , ;\1AR( M . 84
EDITORIALS
Doctors' draft
You MAY RECALL that a couple
years ago I wrote an editorial
inspired by a release from the
Department of Defense and pub-
lished in the American Medical
News. It reported at that time that
there were only enough medical
personnel in the armed services
to care for one out of ten military
casualties in the event of a nation-
al emergency. This inspired
hundreds of older doctors to offer
their services to the military in
the event of a national emergency
and to be available on 24-hour
notice. However, the military
was not interested in these old
fuds or retreads. Conversely,
younger physicians were not
interested in the military.
On January 12 of this year an
editorial appeared in the Chicago
Tribune. It was entitled "Un-
tended American Wounded." It
pointed out the shortage of quali-
fied medical personnel in the
military and used exactly the
same figures stating that the
shortage was so severe that only
one in ten wounded in any major
conventional war would receive
life-saving treatment. The Tribune
editorial writer concluded that
Congress should grant what the
report urgently requested, a re-
writing of the law to permit the
immediate drafting of needed
medical personnel and that this
was national security at its most
essential. The armed forces need
at least 60,000 additional doctors
and nurses and other medical
specialists if the government is to
comply with the Selective Service
Act.
This sounds rather drastic, but
it has happened before. Many
physicians who had served for
years during World War II were
quite shocked when a special
doctors' draft was enacted in the
early 1950s. It was especially dis-
tressing for physicians who had
served slightly less than 24
months in World War II and
were recalled to active duty for
another two years.
An Associated Press release
which came out at the same time
as the Tribune editorial reported
on an NBC news program. The
NBC news reported that numer-
ous cases of questionable medical
practices, including some that in-
volved death of the patients, have
been found in all of the military
services. NBC said a confidential
report by the Navy "details how
previous efforts to improve medi-
cal care have failed at all six Navy
hospitals investigated."
It appears that doctors' draft,
although undoubtedly unpalat-
able to young physicians, may be-
come necessary to not only im-
prove the quantity but also the
quality of medical care for the
armed services.
The image of medicine as a pro-
fession is already somewhat
scruffy in some eyes. Editorials
and press releases like these are
not polishing that image. There
seem to be three alternative
solutions: younger physicians
must plan to spend some time in
service; or the services must learn
to accept older physicians who
are available because of retire-
ment of their own volition or by
virtue of mandatory retirement
requirements within their
groups; or another doctors' draft!
—Victor S Falk, MD, Edgerton
Futility
Although it is contrary to the
policy of the Wisconsin Medical
Journal to reprint material that
has been published elsewhere,
the following comments deserve
to be more widely disseminated.
Dr C Rollins Hanlon, who is
director of the American College
of Surgeons, wrote in the January
issue of the Bulletin of the Ameri-
can College of Surgeons. He first
described advances in surgery
and technology and the wave of
editorial effusion that resulted
after the baboon-heart transplant
and the two mechanical hearts.
He then went on to say, "Scien-
tific developments that foster
such surgical attempts are akin
to the technology that allows a
plaintiff's lawyer to fly halfway
around the world to establish his
representation for victims of an
industrial disaster and to enter
the nation's living rooms on tele-
vision soon thereafter. Here one
may see a bland defense of the
contingent fee even in the face of
hostile inquisition by television
personalities skilled in the art of
electronic karate. Answers to
whether the Bhopal catastrophe
will result in fair compensation
for the Indian victims of this
stunning tragedy may be looked
for in the record of personal in-
jury litigation in the United
States. It has clearly benefited
US lawyers enormously, and
small numbers of patients or their
relatives have also profited finan-
cially. But there is little evidence
that mammoth awards do much
more than increase the costs and
hazards of medical practice."
Doctor Hanlon also expressed
concern similar to that noted in
an earlier editorial by Dr Wayne
Boulanger. "On a similar note of
futility, when state Professional
Review Organizations absurdly
dictate a specified percentage
goal for reduction in complica-
tions after cholecystectomy, it
seems unlikely that such regula-
tion and threats will bring about
a higher standard of practice than
the medical profession has been
able to achieve by pride of per-
formance and the ingrained de-
sire of physicians to provide for
their individual patients the best
possible care."
Doctor Hanlon expresses very
well his thoughts and the con-
cerns of many of us.
— Victor S Falk, MD, Edgerton
WISCONSIN MEDICAI IOL'RN,\l„ MARCH 1985:\'OL. 84
EDITORIALS
Fresh frozen
plasma
The National Institutes of
Health hold periodic conferences
on a variety of subjects and pub-
lish a consensus statement at
the end of each. A recent confer-
ence was devoted to the use of
fresh frozen plasma.
The conference statement con-
cluded that the administration of
fresh frozen plasma has increased
dramatically in recent years de-
spite the paucity of definitive indi-
cations for its use. This increase
has occurred in the presence of
mounting evidence of its poten-
tial risks, which include viral
hepatitis and possibly AIDS.
Many patients who receive fresh
frozen plasma can be managed
more effectively and safely with
alternative modalities.
Fresh frozen plasma is indi-
cated for some documented coag-
ulation protein deficiencies as
well as for selected patients who
require massive transfusions. It
is indicated for patients with
multiple coagulation defects as in
liver disease, in conjunction with
therapeutic plasma exchange for
thrombotic thrombocytopenic
purpura, for infants with protein-
losing enteropathy, and for
selected patients with other im-
mune deficiencies.
Its use in most other cases
should be discouraged. There is
no justification for the use of
fresh frozen plasma as a volume
expander or as a nutritional
source.
Figures from Wisconsin blood
banks indicate that utilization of
fresh frozen plasma has increased
far beyond all reasonable indi-
cations. Apparently this utiliza-
tion is going through a phase
comparable to the former use of a
single unit of whole blood or a
series of vitamin B-12 injections
simply as a "tonic."
— Victor S Falk, MD, Edgerton
$2,500 per day
A FORMER Wisconsin physician
has retired to Florida. Recently he
stuck the tip of his finger with a
catfish spine. Although in his own
opinion it was not necessary, he
was hospitalized for two days. His
bill was $5,000!
Small wonder that there are
complaints about the high cost of
medical care.
— Victor S Falk, MD, Edgerton
Editorial Board comment: Usual
and customary charges!!? Was he in-
sured? DRGs anyone? m
PSYCHIATRIST
‘frlinerto Chl • d • tflst
psychi-a-try o -
-lATRl.J . . 3|.|y
f_p§y Cnl*»^ - * uai T Psychiatrist. Look it up in a dictionary and you will likely find definitions
that speak of a doctor whose practice pertains to working with patients
afflicted with mental, emotional, and behavioral disorders. And that’s
true ... as far as it goes.
ST
(hARV5
ITAL
2350 NORTH LAKE DRIVE
MILWAUKEE. WISCONSIN 53211
414/271-5555
Sponsored by the
School Sisters of St Francis
Since 1912
Active Medical Staff — Psychiatry
John T. Andersen. M.D.
Bruce H, Axelrod, M.D.
John T, Bond. M.D.
George E. Currier, M.D.
Dinshah D. Gagrat, M.D.
Jack E. Geist, M.D.
Donald P. Hay, M.D.
Robert E. Holt. M.D
Charles W, Landis, M.D
Anthony T. Machi, M.D.
Gilbert J. Nock. M.D
Muni H. Patel. M.D.
Ezzeldin M. Salama. M.D
K. Kwang Soo, M.D.
Frederic A. Steiger, M.D.
Brian T. Sleinhaus, M.D.
Wess R. Vogt, M-D-
David H. Zarwell. M.D
At Milwaukee’s St. Mary’s Hill Hospital, we believe some elaboration
is necessary . . .
“PSYCHIATRIST; 1) a fully trained and experienced physician engaged
in the practice of psychiatry; 2) one who understands that when you
make a referral for psychiatric treatment, you should be kept informed
of and involved in your patient’s care; 3) the medical professional who has
the primary responsibility for treating patients at St. Mary’s Hill Hospital.”
Whether your patient is an adult, young adult, adolescent or child,
when professional psychiatric care is required — it makes good sense
to talk with an expert.
WISCONSIN MKRICAI. JOURNAL, MARCH 1985: VOL. 84
LETTERS
Medical staffs and peer review
Editor's Note: In mid-November
S E Sivertson, MD, Madison, made
a presentation on peer review before
the Divine Savior Hospital Medical
Staff, Portage. Later this corres-
pondence developed. It may be use fid
to all medical staffs concerned with
peer review.
To Joseph Pavelsek, MD, Por-
tage: After my presentation on
peer review one of those in atten-
dance pointed out— and rightly
so— that I did not offer positive
things physicians could do. Upon
returning home, I thought about
this and summarized some com-
ments which were sprinkled
throughout the discussion.
The recommendations I would
make at this time are:
1. Each physician should thor-
oughly learn the claim form and
how it is used.
2. Each physician should thor-
oughly learn the language used on
the claim form; ie, the Interna-
tional Classification of Diseases
(ICD-9) and how it has been
adapted into DRGs.
3. Discharge diagnoses should
be complete, with the proper
language of DRGs.
4. Each physician should learn
the system now employed and
follow its evolution, including the
definitions; ie, for primary diag-
nosis, elective procedure, etc.
5. The hospital could develop
its own ongoing peer review sys-
tem modeled after the PSRO tech-
nique (which is currently used by
nongovernmental third party
payers).
6. Once knowledgeable about
the system physicians should be
better prepared to identify inher-
ent weaknesses in it and act ac-
cordingly.
7. Physicians should work
closely with components of the
State Medical Society to assist in
lobbying.
8. A peer review cost analysis
system with the county medical
society and/or hospital should be
looked at; ie, average cost and ac-
ceptable range for procedure or
other type of service. (County
boards are among those also in-
terested.)
9. At regular intervals the hos-
pital should provide an anony-
mous copy of a patient's bill to
each of its medical staff.
From the standpoint of these
data lending themselves to objec-
tives for continuing medical edu-
cation, let me suggest the follow-
ing:
Work-related injuries
To THE EDITOR: In a recent editor-
ial entitled, "The cost of work ac-
cidents," in the December 1984
issue of the Wisconsin Medical
Journal, physicians were en-
lightened about the high cost of
work-related injuries. In addition,
an interesting paragraph of the
editorial showed how a $500
work injury offsets the profits of
a company making bread or pack-
ing meats.
My problem with the editorial
was how it ended— on a note of
finger-waving, parental caution-
ing. Be careful of the malingerer!!
"Fudging is both unethical and
unconscionably costly"— so ends
the editorial and so begins the for-
mation of attitudes towards pa-
tients who are injured while at
work.
The problem of work-related
fatal and disabling injuries in the
United States is immense, as the
editorial points out. The challenge
to prevent or ameliorate the injur-
1. When inviting guest speak-
ers, send them your outcome data
in advance so that they can relate
the presentation to it.
2. Another variation of this is to
schedule the guest lecturer's pre-
sentation after the guest sits in on
an outcome data review session
by the committee.
Until something better comes
along, this must suffice. I can
assure you, however, that many
of the things listed above have
been and are being implemented
at the University Hospital.
—5 E Sivertson. MD
Assistant Dean for Student
and Clinical Affairs
University of Wisconsin-Madison
Medical School
1300 University Avenue
Madison, Wisconsin 53706
ies is tremendous— a point omit-
ted in the editorial. The problems
of rehabilitation and getting the
employee back to work are real
and demand forthright attention.
But what about the 1 1,200 fatali-
ties in 1982? And what about the
fact that the highest death rate
among agricultural workers is in
the 5-14 year age group!! The
problem of work-related injuries,
including rehabilitation, needs the
unbiased involvement of physi-
cians, not further views on the be-
havior of some workers.
To be blunt: I call upon the phy-
sicians in this state to reduce the
toll of work-related injuries by
working with the employer and
the employee in identifying stra-
tegies for injury control. Failure to
tell your patients to wear seat belts
is simply unconscionable.
—Steve Hargarten, MD, MPH
Emergency Department
St Joseph's Hospital
5000 West Chambers St
Milwaukee, Wisconsin 53210
10
WISC ONSIN MKDIC.M jot RN.U . .MARCH I98,S : \ CM . S4
I.HTTFKS
William H Studley, MD: 1903-1985
To THE Editor; Dr William H
Studley was perhaps Wisconsin's
most influential and well-known
psychiatrist of the post World War
II period. Because of his consider-
able psychiatric accomplishments
and leadership, his demise is of
particular interest to the profes-
sion of our state.
I was asked to eulogize Doctor
Studley during his memorial serv-
ice at the St Paul's Episcopal
Church in Milwaukee and did so
on February 8. A copy of the ora-
tion is enclosed for consideration
in publishing in the Wisconsin
Medical Journal.
Editor's note: Although we generally refrain
from publishing eulogies (mostly because of
other space commitments!, there are occa-
sions when we take exception such as this
one. Therefore, we are pleased to publish
Doctor Moore's eulogy.
quiet passing of Dr William
H Studley on the third day of Feb-
ruary (1985) marked the close of
one of Milwaukee's most distin-
guished and colorful medical ca-
reers. For me, it was also the
terrestrial conclusion of a sterling
friendship of nearly 40 years. It
is a large company of friends,
family, professional associates,
former patients, and community
now realizing a loss for which
there is no replacement.
Doctor Studley' s charismatic
presence in Milwaukee medicine
began in 1930 when he returned
from academic work at the Uni-
versity of Wisconsin and the
School of Medicine at Columbia
University. He interned at St
Mary's Hospital in Milwaukee
and joined the staff of the Shore-
wood Psychiatric Hospital of Mil-
waukee following in the footsteps
of his famous father who was the
first practicing alienist in this
region, and the founder and
builder of the Shorewood Hos-
pital in the year of 1904. Assum-
ing the medical directorship of
the hospital about three years
later, the capable younger Stud-
ley was soon caught up in the
new era of psychiatry during and
following World War II. He was
to lead in a broad range of ac-
tivities that greatly influenced
other practitioners and specialties
to accept psychiatry as an equal
and full status medical specialty
in the community. He gave freely
of time and energy to the neuro-
logic clinics of Milwaukee
County Hospital, to the psychiat-
ric teaching of Marquette medical
students, and to the continuing
education of his nurses and
assistants. He was an Associate in
Neurology on the Marquette
faculty from 1937 to 1959 and
Associate Clinical Professor from
1959 until retirement. His lec-
tures were stimulating and
sparkled with wit.
Early in his career. Doctor
Studley undertook court re-
sponsibilities in the examination
of psychiatric cases. He ulti-
mately qualified himself as an
expert in forensic psychiatry
and during the last 25 or 30 years
of his busy career was in con-
tinual demand by the Milwaukee
courts. His testimony was crucial
in many of the city's spectacu-
lar trials. For many years sub-
sequent to 1949, Doctor Studley
served as board member, and
later as chairman, of the Wiscon-
sin State Department of Welfare
and Social Services; in this
capacity he accomplished much
in advancing more modern prac-
tices for rehabilitating the crimi-
nally insane.
Doctor Studley played the
role of pioneer in the introduction
and practice of the shock thera-
pies in Wisconsin. Collaborating
with Dr Roland Jefferson, insulin
shock therapy for schizophrenia
was first used at Shorewood Hos-
pital. His work with electric
shock therapy was classic and
singularly free of complications.
His experience in this field be-
came very extensive gaining him
wide recognition. When electric
shock was restricted in Cali-
fornia several years ago, his was
an important voice in defense
of this treatment.
With the development of other
hospital psychiatric facilities in
Milwaukee, Shorewood Hospital
continued to be a prestigious
center for inpatient care, widely
sought by rich and poor alike.
Doctor Studley, with the superb
assistance of Mrs Studley, the
hospital business manager, con-
ducted a most idealistic institu-
tion with doors open to all,
irrespective of financial circum-
stances, creed, or station of life.
With hospital costs soaring astro-
nomically elsewhere. Shore-
wood's costs were kept at a
modest $35 daily rate and the
hospital was still successful and
profitable at the conclusion of
its physical plant usefulness in
197^ At that time Doctor Studley
retired to write, organize hospital
records and history, and to enjoy
some of his many personal
interests.
Of the numerous exemplary
accomplishments of this versatile
physician, perhaps most im-
portant of all was his ability to
inspire and motivate his students.
Many of his junior staff assistants
and externes went on in psychiat-
ric careers. All of his staff, in-
cluding attending physicians,
responded to his professional
dedication and charming person-
ality with the greatest faith and
loyalty. His optimism, enthu-
siasm, and cheerfulness com-
prised the dynamic center of
the hospital's morale and were a
big constructive influence in
patient well-being and recovery.
I first met Doctor Studley in
1947, the year I entered practice
in Milwaukee. His welcome was
1 1
VVISCOXSIX MHDICAI JOI KX’AI , \1AH( H 1985:VOI.. 84
LETTERS
WILLIAM H STUDLEY
warm and unreserved. He gave
me vital assistance and encour-
agement for which I am forever
grateful. Collaborating with
him in the care of patients was
always pleasant and rewarding.
On a more personal level, Bill
Studley was uniformly popular
and well-liked by his colleagues.
His sunny charisma was always
evident and vested him with
great power of persuasion. He
was an inveterate meeting at-
tender, relished intellectual
challenge, and was a great dinner
companion. Many of his ener-
gies were devoted to the Mil-
waukee Neuropsychiatric So-
ciety. He served in all of its
offices and, without question,
was the Society's brightest guid-
ing star throughout his entire
professional life.
Other interesting facets of the
Bill Studley career can be
glimpsed through the man's
lighter pursuits and hobbies.
An accomplished arborist, his
passion for planting and cultivat-
ing trees resulted in the Shore-
wood block becoming a sophisti-
cated arboretum comprising
many rare and beautiful speci-
mens.
There was much enjoyable
time with Bill, discussing trees,
and planting and pruning them
here, on our farm in the central
Illinois countryside, and at his
beloved retreat at his Aunt Kitty's
in central Wisconsin. Aunt Kitty
and her husband. Doctor Cooper,
a country practitioner, were great
favorites of Bill during his early
adulthood, and visiting them in
their 19th century cottage in
Almond became a principal
pastime for him. He loved and re-
vered every square inch of these
environs, was fascinated by the
old fashioned household articles,
planted fine trees and shrubs to
further beautify the yard, and the
town, and entertained his
friends and colleagues there as
often as possible.
Anyone to have known Bill
Studley is fortunate. His generos-
ity to everyone was one of his
stellar characteristics. His phil-
osophical, humorous sayings
were always refreshing, and will
continue to ring in our ears for a
long time to come. The good
things he has done for others are
beyond count. He has been an
inspiration to everyone within
his reach, and, as stated at first,
there can be no replacement!
—George E Moore, MD
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U I.SC'ONSIN MKIJICAI. |Ol RNAI., MARCH 1985 :\ OL. 84
SPECIAL
Child abuse— After the report is made
A CHILD IS brought to a physi-
cians's office. Abuse is suspected,
and the mandatory report is
made. But, what happens next?
What wheels are set in motion to
ensure that timely intervention
takes place and that that child will
not get "lost" in the system?
The common underlying goal is
to provide a protective response
system for children, generally
through the county social services
or protective services department.
But, physicians fear that parents
will withdraw their children from
treatment if a report is made. To
compound this, there is often an
inability on the part of child pro-
tective workers to keep up with
the ever-increasing amount of re-
ports being made.
When physicians make a re-
port, they frequently feel that they
are sending the child off into a
void, the unknown. They seldom
have time to follow the reported
cases. Often, on those rare occa-
sions when they have tried to ob-
tain information, it is not readily
available.
Conflict arises in developing
programs for the protection of
children because of the under-
lying debate on whether children
have rights of their own. Article
.17 of the International Covenant
on Civil and Political Rights
(United Nations, December 16,
1966) states, "No one shall be sub-
jected to arbitrary or unlawful
interference with their privacy,
family, home . . . Everyone has
the right to the protection of the
'International Covenant on Civil and
Political Rights Article .17 United Nations
General Assembly, December 16, 1966.
^Declaration of the Rights of the Child by
the United Nations General Assembly,
November 20, 1959.
law against such interference.
The privacy of the home, how-
ever, may make it difficult to ful-
fill the United Nations' Declara-
tion of the Rights of the Child:
"The child shall be protected from
all forms of neglect, cruelty, and
exploitation. "2
Professionals expert in child
protection should work together
to provide needed medical, social,
and psychiatric services to fam-
ilies in which children have been
abused and neglected. Develop-
ment of a multidisciplinary team
approach is a fairly new concept
that has evolved in the last dec-
ade. Its growth, in part, has come
from a need to relieve the over-
burdened social services depart-
ments which are unable to pro-
vide the many services needed by
these families whose children are
reported as victims. The emphasis
is then placed on treatment and
not just separation of the children
from the home.
All too frequently physicians ig-
nore or resist dealing with these
cases because of limited experi-
ence, or an experience of a close
colleague has been too emotion-
ally draining. The agencies
created to aid the families are
Table 1— Services provided by result of investigation*
Indicated
Indicated
Indicated
Abuse &
Services
Abuse
Neglect
Neglect
Unfounded
Total
%
Caseworker
935
527
20
3,435
4,917
55.7
Homemaker
21
58
3
122
204
2.3
Day care
17
11
0
60
88
1.0
Foster care
107
111
13
135
366
4.1
Moved to
71
67
1
142
281
3.2
relative's home
Shelter/
36
7
1
55
99
1.1
institutional care
Health /mental
210
85
12
418
725
8.2
health
Financial
45
34
6
175
260
2.9
assistance
Referred to
149
32
7
253
441
5.0
51 Board
Referred to
147
21
5
490
663
7.5
other agency
Referred to
247
115
14
229
605
6.9
juvenile court
Referred to
346
51
5
113
515
5.8
criminal court
No services
47
22
0
3,005
3,074
34.8
action taken
Other services
109
39
0
355
503
5.7
provided
Totals in table do not equal total number of
cases as more than one service is often
provided in a case. Percentages are based
on 8,821 cases or respondents.
■"Source: Annual Report to the Governor and the Legislature on the Wisconsin
Child Abuse and Neglect Act; Chapter 355, Laws of 1977, section 48.981; Divi-
sion of Community Services, Dept of Health & Social Services, August 1, 1983.
WISCONSIN- .MEDICAL JOURNAL, MARCH 1985: VOL. 84
13
SPECIAL
CHILD ABUSE
overworked, and sometimes the
cure for child abuse can be worse
than the disease. The agencies
that were established to deal with
not only the short-term, crisis
intervention but also the long-
term support, fall far short of
these expectations. The contin-
uing rise in reported cases of
abuse and neglect tax the system
to the point where only early in-
tervention can be accomplished,
and the victim and perpetrator do
not receive the long-term services
necessary for rehabilitation.
Because child protection and
therapeutic intervention are the
primary objectives of the civil
laws mandating reporting of sus-
pected or blatant cases of abuse or
neglect, physicians must keep this
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premise foremost in their minds.
The reporting laws were uo(
created to punish the perpetrator,
but aid the child.
No two cases are alike, so it is
difficult to describe what happens
to a "typical” case after a case is
reported. Similarities do exist as
far as prescribed time frames and
a predictable flow through the
system, and these are outlined
below.
According to Wisconsin law,
the county agency must initiate a
diligent investigation within 24
hours of a report to determine if
the child is in need of protection
or services. There may be those
rare occasions when a physician
may deem it improper or unadvis-
able to allow the child to be taken
by the parents or legal guardian
because of a fear that the child
will be further injured. In those
extreme cases, the physician
should call the police and the
county social services agency and
explain the circumstances. The
police will act immediately to take
the child into protective custody.
The initial investigation of a re-
ported case of abuse or neglect re-
quires that a person from the
county agency visit the child's
home or living quarters. They are
also free to contact, observe, or
house of
BIDWELL, inc.
7954 West Harwood
and Watertown Plank Road
Milwaukee, Wisconsin 53213
ORTHOTIC
AND
PROSTHETIC
SERVICES
1-414 744-6250
interview the child at any location
without permission from the
child's parents or legal guardian.
The person making the investi-
gation must determine if any child
in the home requires immediate
protection, and, if so, the person
must take the child into custody
and deliver the child to a court in-
take worker.
If the county agency determines
that a child, any member of the
child's family, or the child's guar-
dian or legal custodian is in need
of services, the county agency
must offer to provide appropriate
services. If the child's parent,
guardian, or legal custodian re-
fuses to accept the services, the
county agency may request that a
petition be filed alleging that the
child, who is the subject of the
report, or any other child in the
home, is in need of protection or
services.
A determination of whether
abuse or neglect has occurred or
that the child has been threatened
with an injury and that abuse of
the child is likely to occur must be
made by the county agent within
60 days after receipt of a report.
Under Act 172, the agency's
determination of abuse or neglect
must be based on a preponderance
of the evidence produced by the in-
vestigation. A record must be
maintained of actions taken in
connection with each report the
agency receives. Included in the
record is a description of the serv-
ices provided to any child and to
the parents or legal guardian of
the child, and the record must be
updated every six months by the
agency.
Within 60 days after the agency
receives a report from a mandated
reporter, the agency must inform
the reporter what action, if any,
was taken to protect the health
and welfare of the child who is the
subject of the report.
In a format prescribed by the
Department of Health and Social
Services, each county agency
14
WISCONSIN' MFUICAI lOl RN'AI,, , MARCH 198.S:VOI . 84
CHILD ABUSE
SBl-CIAL
must provide the Department
with information about each re-
port it receives and about each in-
vestigation it conducts. The infor-
mation is to be used by the De-
partment to monitor services pro-
vided. Nonidentifying informa-
tion is used to maintain statewide
statistics on child abuse and neg-
lect and for planning and policy
developments.
During the next several months,
members of the Ad Hoc Commit-
tee on Child Abuse will be review-
ing various established protocols
from other states developed to aid
the multidisciplinary team when
examining and interviewing cases
of child abuse and neglect. A pro-
tocol will be devised for Wiscon-
sin physicians to follow and will
be made available at the sched-
uled May 18, 1985, Child Abuse
and Neglect Conference/ Work-
shop to be held in Madison. De-
tails of the upcoming meeting will
appear in the April WMJ.
— Prepared by Deb Powers, Policy
Analyst, SMS Physicians Alliance
Division ■
Table 2— Case disposition by result*
Indicated
Indicated
Indicated
Abuse &
Abuse
Neglect
Neglect
Unfounded
Total
Child at home
96
371
6
6535
7819
Disposition pending
23
11
1
24
59
Voluntary placement
63
46
2
119
230
Court-ordered placement
86
99
12
129
326
Consent to adoption
0
2
0
1
3
Child died
2
2
0
5
9
Other
73
48
0
232
353
Unreported
811
0
0
22
23
TOTAL
1154
579
21
7068
8822
%
13.1
6.6
0.2
80.1
'Source; Annual Report to the Governor and the Legislature on the Wisconsin Child Abuse &
Neglect Act; Chapter 355, Laws of 1977, section 48.981; Division of Community Services, Dept
of Health & Social Services, August 1, 1983.
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WISCONSIN MEDIC, \1, JOURNAL, MARCH 198.5: VOL. 84
SPECIAL
Magnetic resonance imaging (MRI): View
of the Wisconsin Radiological Society
Roland A Locher, MD, La Crosse
The Wisconsin Radiological So-
ciety, as the professional organiza-
tion representing the group of
radiologists practicing medicine in
the State of Wisconsin, takes a
vital interest in the variety of im-
aging techniques available to the
specialty and the ability to offer
these techniques to the general
public. The increasing and some-
times awe-inspiring sophistication
of modern medical equipment
and the ability to use such equip-
ment is counterbalanced by the
frequently extraordinarily high
cost of the equipment itself. It is
not surprising, therefore, that
vigorous efforts are being made by
concerned citizens, third-party
payers and local and state gov-
ernments to limit medical expen-
ditures. This occasionally results
in the medical community being
at odds with another group, as it
had been up until recently with
the Department of Health and
Social Services (DHSS) of the State
Members of the Committee
on Magnetic Resonance
Imaging of the Wisconsin
Radiological Society
Roland A Locher, MD, La Crosse
Chairman
Marshall Colburn, MD, Oregon
Robert Douglas, MD, Neenah
Robert C Feulner, MD, Waukesha
Thomas D Hinke, MD, Marshfield
J Bruce Kneeland, MD, Fox Point
Mr Larry Narum, Madison
Daniel J Price, MD, Milwaukee
Joseph F Sackett, MD, Madison
James J Sherry, MD, Milwaukee
Eugene J Valentini, MD, La Crosse
Eric B Wilson, MD, Oshkosh
James E Youker, MD, Milwaukee
of Wisconsin regarding CT scan-
ners.
The medical community fore-
saw the necessity of having a wide
distribution of CT scanners
throughout the state. The state, on
the other hand, chose to wage,
through its Certificate-of-Need
process, a rather strong battle
against the acquisition of CT scan-
ners by a number of hospitals to
the extent that suits were brought
against the state by several hos-
pitals claiming restraint of trade.
Physicians in these various hos-
pitals felt that their inability to ob-
tain this remarkable new modal-
ity severely restricted their ability
to offer high-quality medical care.
Looking back, this seems unques-
tionably true, and to our knowl-
edge the state lost all of the suits
brought against it and has largely
acceded that computerized tom-
ography (CT) is a necessary device
in the modern medical era.
A similar situation arises now
with the advent of another modal-
ity known as nuclear magnetic
resonance, or more commonly
now, "magnetic resonance" or
"magnetic resonance imaging"
(MRI). This shows every sign of
becoming as remarkable a diag-
nostic tool as CT has proved to be.
It has already been shown to be
the best modality available for the
diagnosis of a variety of condi-
tions, particularly within the ner-
vous system. The Department of
Health and Social Services of the
State of Wisconsin has chosen to
describe MRI as "innovative,"
and in so-doing, has restricted the
acquisition of MRI to the medical
schools at Madison and Milwau-
kee. In our view the term "in-
novative" as applied to MRI is un-
fortunate. It implies, it seems to
us, not only a new modality but
also, perhaps more appropriately,
an unproven or experimental
modality. The committee agrees
that MRI is new; but, particularly
as it applies to certain neurologic
diseases, MRI is at this time no
longer experimental.
The refusal of the Department
of Health and Social Services to
consider the application to acquire
MRI of other institutions under
the Capital Expenditure Review
process (CER), provides the medi-
cal schools at Madison and Mil-
waukee with a de facto monopoly
on this modality and may pre-
clude patients across the state
from having easy access to MRI.
There are a number of large, ac-
tive hospitals, consortia of hospi-
tals and clinics across the state
which need to be able to offer
their patients magnetic resonance
services. The road should be open
for these institutions to obtain the
modality, dependent upon the
usual approval under the Capital
Expenditure Review process and
the patient volume necessary to
provide the service at a reasonable
cost. We see the latter as being
largely governed in the very near
future by the DRG system of
reimbursement which will vir-
tually force hospitals to obtain
diagnoses in the most expeditious
and least expensive manner. We
expect that in many cases this will
include magnetic resonance
imaging.
The medical community has
already realized that because of
the expense of MRI, cooperation
among groups in various areas
allowing maximum utilization of
each unit will be necessary to in-
sure economic viability. Several
groups or consortia have already
16
WISCONSIN MEDICAL JOURNAL, MARCH 1985: VOL. 84
MAGNETIC RESONANCE IMAGING-Locher
SPECIAL
submitted letters of intent to the
DHSS. These have been turned
down without formal review
under the Capital Expenditure Re-
view process. This is lamentable.
We feel that each project should
be fully reviewed and a decision
for or against made on the merits
of each.
In summary, this task force con-
cludes and recommends that:
1. Insofar as imaging (not spec-
troscopy) is concerned, MRI is not
to be considered innovative [ie, is
not experimental).
2. The ultimate tremendous
medical utility of CT was foreseen
early on by the medical commun-
ity and put to good use despite the
restrictive attitude of the DHSS.
Indeed, we have great reservation
that these restrictions did any
good at all and, ultimately, may
have done more harm than good
in restricting the availability of
this most useful diagnostic tool to
patients across the state. We,
therefore, feel that the road to the
acquisition of MRI should be
open. The medical necessities and
cost should be examined through
the CER process and the DHSS
should not refuse, out of hand, to
receive applications. Each applica-
tion should stand on its own
merits, and decisions for or
against approval should be made
on that basis.
3. We firmly believe that the
medical community in the State of
Wisconsin is ethical and responsi-
ble and believe that the above will
allow for and encourage orderly
and financially and medically
sound development of MRI in this
state. ■
Suggested patient form for obtaining
DES-exposure information
In an earlier edition of the Wisconsin Medical Journal (February 1985),
physicians were encouraged to question all individuals born between
1940 and 1971 as to their mother's possible exposure to diethylstilbestrol
(DES). Printed below is a suggested form which could facilitate this
important questioning.
Patient history for DES exposure of individuals
born between 1940 and 1971
Name;
Address:
Date of Birth: ! !
Did your mother have any difficulties (spotting, miscarriages)
with any of her pregnancies?
Yes No Don't know
Did your mother have any difficulties while she was carrying
you?
Yes No Don't know
Did your mother take any medication (hormones) while she was
pregnant with you?
No
Yes What kind?
If you don't know, can you find out from your mother, her doctor,
or the hospital where you were born (if your mother took any
medication during her pregnancy with you)?
Yes No Don't know
Women: Have you had problems with your periods, vaginal dis-
charges, or other symptoms? Please describe:
Men: Have you had, or been told you had, any problems with
undescended testicle(s), abnormal sperm, or other symp-
toms? Please describe:
3|c 4: 4= 4=
Women who became pregnant after 1940:
Did you have any difficulties (spotting, miscarriages) in any of
your pregnancies?
Yes No
Did you take any medication (hormones) during any of your
pregnancies?
No
Yes What kind?
If you don't know whether you took any medication during your
pregnancies, can you find out from your doctor/ hospital where
you delivered and let us know?
Yes No
WISCONSIN MEDICAL JOL RNAL, MARCH 1985: VOL. 84
17
SPECIAL
SMS Committee on School
Health member Conraci An-
dringa, MD, Madison, served as
consultant to the AAP Committee
on School Health in developing
the adjacent policy statement on
Alcohol Abuse Education in
School.
Currently the Society's School
Health Committee is working on
several fronts to promote alcohol
abuse education. The Committee
is represented on the Wisconsin
Coalition for School Health Edu-
cation which recently completed
a resource guide for Wisconsin
health educators on materials
available on health education, in-
cluding alcohol abuse prevention.
The coalition has also prepared a
report on "Critical Health Prob-
lems of Wisconsin School Aged
Youth" of which one section is
devoted to discussing alcohol and
other drug problems of Wiscon-
sin's school children.
The Committee also has en-
gaged in a joint television and
radio public service campaign
with the Wisconsin Broadcasters
Association on preventing alcohol
abuse. The first set of public serv-
ice announcements was aimed at
adolescents and featured well-
known Wisconsin athletes urging
moderation in alcohol consump-
tion. Future PSAs are planned on
the topics of fetal alcohol syn-
drome and parental responsibility
in alcohol education.
For further information on this
issue contact:
Conrad Andringa, MD
1313 Fish Hatchery Road
Madison, WI 53715
608/252-8181 ■
Pediatricians establish policy statement
for alcohol abuse education in school
The American Academy of
Pediatrics in cooperation with its
local chapters has established a
policy statement relative to alco-
hol abuse education in school.
The statement was published in
the AAP's November 1984 Bulle-
tin and is reprinted below.
* * *
Alcohol abuse education
in school
Alcohol abuse is a serious con-
cern in our society. Its effect on
the adult population has been well
publicized. Addiction, spouse
abuse, lost jobs, and driving while
intoxicated, with its attendant risk
of injury and death, are among the
issues we hear about daily. For
our children, the harm is equally
great. The most dramatic exam-
ples are fetal alcohol syndrome,
broken homes, and physical and
mental abuse.
But the alcohol problem is even
more directly a problem for many
of our nation's young people.
There are an estimated three mil-
lion problem drinkers in the 13-to-
1 7-year age group and more than
300,000 teenage alcoholics. Prob-
lem drinking often begins as early
as the sixth or seventh grade, and
it worsens in the high school
years. Alcohol is a "socially ac-
ceptable" drug and is often openly
abused. Adults, by word and ex-
ample, contribute to the confusion
regarding the distinction between
use and abuse.
The financial cost of this abuse
is high. Each year, more than $65
billion in public and private
money is known to be spent and
lost in dealing with the problems
caused by alcohol abuse. The alco-
hol industry, meanwhile, spends
more than $1 billion annually to
encourage continued alcohol use;
much of the advertising is directed
at the youth market.
Because the problem is a multi-
faceted one and because we be-
lieve that education can be part of
the solution, the Committee on
School Health urges a coordinated
campaign to provide our nation's
children with appropriate infor-
mation to combat the incessant
peer and media pressure to drink.
The Committee, therefore, recom-
mends that:
1. A year-by-year educational
program be incorporated in all
school curricula (kindergarten
through 12th grade) designed to
make students aware of the prob-
lems associated with alcohol use
and abuse;
2. Local AAP chapters work
with parent-teacher organizations
and other associations to promote
awareness of the harm that results
from encouraging the use of alco-
hol by our young people;
3. Local AAP chapters make
themselves available to schools
and school organizations to assist
in this education process; and
4. Local AAP chapters use the
media to promote alcohol abuse
awareness programs to educate
children both at home and in the
school.
RECOMMENDED READING:
Alcohol, Tobacco and Firearms: Summary
Statistics. Department of the Treasury:
Bureau of Alcohol, Tobacco and Firearms,
1979.
Alcoholic Beverage Abuse Control: Wis-
consin Dept of Health and Social Services,
Division of Community Services, 1979.
Mayer JE, Filstead W, eds: Adolescence
and Alcohol. Cambridge, MA: Ballinger
Publ, 1980. ■
IH
VVISCON.SIN MEmCAI. JOCRNAL. MARCH l9H.S:\ OI.. 84
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VELOSEF® CAPSULES
Cephradine Capsules USP
VELOSEF® FOR ORAL SUSPENSION
Cephradine for Oral Suspension USP
DESCRIPTION: Velosef '250' Capsules and Velosef '500' Capsules
(Cephradine Capsules USP) provide 250 mg and 500 mg cephradine,
respectively, per capsule. Velosef '125' for Oral Suspension and Velosef '250'
for Oral Suspension (Cephradine for Oral Suspension USP) after constitution
provide 125 and 250 mg cephradine, respectively, per 5 ml teaspoonful.
INDICATIONS AND USAGE: These preparations are indicated for the
treatment of infections caused by susceptible strains of designated
microorganisms as follows: Respiratory Tract Infections (e.g., tonsillitis,
pharyngitis, and lobar pneumonia) due to S. pneumoniae (formerly D. pneu-
moniae) and group A beta-hemolytic streptococci [penicillin is the usual drug
of choice in the treatment and prevention of streptococcal infections, includ-
ing the prophylaxis of rheumatic fever: Velosef (Cephradine, Squibb) is
generally effective in the eradication of streptococci from the nasopharynx;
substantial data establishing the efficacy of Velosef in the subsequent preven-
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moniae: Skin and Skin Structures Infections due to staphylococci and beta-
hemolytic streptococci; Urinary Tract Infections, including prostatitis, due to
E. coli, P. mirabilis, Klebsiella species, and enterococci (S. faecalis).
Note: Culture and susceptibility tests should be initiated prior to and dur-
ing therapy.
CONTRAINDICATIDNS: In patients with known hypersensitivity to the
cephalosporin group of antibiotics.
WARNINGS: Use cephalosporin derivatives with great caution in penicillin-
sensitive patients since there is clinical and laboratory evidence of partial
cross-allergenicity of the two groups of antibiotics: there are instances of
reactions to both drug classes (including anaphylaxis after parenteral use).
In persons who have demonstrated some form of allergy, particularly to
drugs, use antibiotics, including cephradine, cautiously and only when abso-
lutely necessary.
Pseudomembranous colitis has been reported with the use of
cephalosporins (and other broad spectrum antibiotics); therefore,
it is important to consider its diagnosis in patients who develop
diarrhea in association with antibiotic use. Treatment with broad spec-
trum antibiotics alters normal flora of the colon and may permit overgrowth of
Clostridia. Studies indicate a toxin produced by Clostridium difficile is one
primary cause of antibiotic-associated colitis. Cholestyramine and colestipol
resins have been shown to bind the toxin in vitro. Mild cases of colitis may
respond to drug discontinuance alone. Manage moderate to severe cases
with fluid, electrolyte and protein supplementation as indicated. Oral vanco-
mycin is the treatment of choice for antibiotic-associated pseudomembra-
nous colitis produced by C. difficile when the colitis is severe or is not
relieved by drug discontinuance; consider other causes of colitis.
PRECAUTIDNS: General: Follow patients carefully to detect any side
effects or unusual manifestations of drug idiosyncrasy. If a hypersensitivity
reaction occurs, discontinue the drug and treat the patient with the usual
agents, e.g., pressor amines, antihistamines, or corticosteroids. Administer
cephradine with caution in the presence of markedly impaired renal function.
In patients with known or suspected renal impairment, make careful clinical
observafion and appropriate laboratory studies prior to and during therapy as
cephradine accumulates in the serum and tissues. See package insert for
information on treatment of patients with impaired renal function. Prescribe
cephradine with caution in individuals with a history of gastrointestinal dis-
ease, particularly colitis. Prolonged use of antibiotics may promote the over-
growth of nonsusceptible organisms. Take appropriate measures should
superinfection occur during therapy. Indicated surgical procedures should be
performed in conjunction with antibiotic therapy.
Information for Patients: Caution diabetic patients that false results
may occur with urine glucose tests (see PRECAUTIONS, Drug/Laboratory
Test Interactions). Advise the patient to comply with the full course of therapy
even if he begins to feel better and to take a missed dose as soon as possible.
Tell the patient he may take this medication with food or milk since G.l. upset
may be a factor in compliance with the dosage regimen. The patient should
report current use of any medicines and should be cautioned not to take other
medications unless the physician knows and approves of their use (see
PRECAUTIONS, Drug Interactions).
Laboratory Tests: In patients with known or suspected renal impair-
ment, it is advisable to monitor renal function.
Drug Interactions: When administered concurrently, the following drugs
may interact with cephalosporins;
Other antibacterial agents — Bacteriostats may interfere with the bacterici-
dal action of cephalosporins in acute infection; other agents, e g., amino-
glycosides, colistin, polymyxins, vancomycin, may increase the possibility of
nephrotoxicity.
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© 1985 E.R. Squibb S. Sons, Inc , Princeton, NJ 08540 785-501 A Issued; Jan, 1985 Printed in U S A
VELOSEF Capsules
(Cephradine Capsules USP]
BID
Diuretics (potent “loop diuretics,” e.g., furosemide and ethacrynic acid)
— Enhanced possibility tor renal toxicity.
Probenecid — Increased and prolonged blood levels of cephalosporins,
resulting in increased risk of nephrotoxicity.
Drug/Laboratory Test Interactions; After treatment with cephradine, a
false-positive reaction for glucose in the urine may occur with Benedict’s
solution, Fehling's solution, or with Clinitest® tablets, but not with enzyme-
based tests such as Clinistix® and Tes-Tape®. False-positive Coombs test
results may occur in newborns whose mothers received a cephalosporin prior
to delivery. Cephalosporins have been reported to cause false-positive reac-
tions in tests for urinary proteins which use sulfosalicylic acid, false
elevations of urinary 17-ketosteroid values, and prolonged prothrombin
times.
Carcinogenesis, Mutagenesis: Long-term studies in animals have not
been performed to evaluate carcinogenic potential or mutagenesis.
Pregnancy Category B: Reproduction studies have been performed in
mice and rats at doses up to 4 times the maximum indicated human dose and
have revealed no evidence of impaired fertility or harm to the fetus due to
cephradine. There are, however, no adequate and well-controlled studies in
pregnant women. Because animal reproduction studies are not always predic-
tive of human response, use this drug during pregnancy only if clearly
needed.
Nursing Mothers; Since cephradine is excreted in breast milk during
lactation, exercise caution when administering cephradine to a nursing
woman.
Pediatric Use: Adequate information is unavailable on the efficacy of
b.i.d. regimens in children under nine months of age.
ADVERSE REACTIONS: Untoward reactions are limited essentially to G.l.
disturbances and, on occasion, to hypersensitivity phenomena. The latter are
more likely to occur in persons who have previously demonstrated hypersen-
© 1985 E.R. Squibb & Sons, Inc.
sitivity and those with a history of allergy, asthma, hay lever, or urticaria.
The following adverse reactions have been reported following use of
cephradine: G.l. — Symptoms of pseudomembranous colitis can appear dur-
ing antibiotic therapy; nausea and vomiting have been reported rarely. Skin
and Flypersensitivity Reactions — mild urticaria or skin rash, pruritus, joint
pains. Hematologic — mild transient eosinophilia, leukopenia and neutrope-
nia. Liver — transient mild rise of SGOT, SGPT, and total bilirubin with no
evidence of hepatocellular damage. Renal — transitory rises in BUN have
been observed in some patients treated with cephalosporins; their frequency
increases in patients over 50 years old. In adults for whom serum creatinine
determinations were performed, the rise in BUN was not accompanied by a
rise in serum creatinine. Others — dizziness, tightness in the chest, and
candidal vaginitis.
DOSAGE; Adults — For respiratory tract infections (other than lobar
pneumonia) and skin and skin structure infections: 250 mg q. 6 h or 500 mg
q. 12 h. For lobar pneumonia: 500 mg q. 6 h or 1 g q. 12 h. For uncompli-
cated urinary tract infections: 500 mg q. 12 h; for more serious UTI, including
prostatitis, 500 mg q. 6 h or 1 g q, 12 h. Severe or chronic infections may
require larger doses (up to 1 g q. 6 h). For dosage recommendations in
patients with impaired renal function, consult package insert.
Children over 9 months of age — 25 to 50 mg/kg/day in equally divided
doses q. 6 or 12 h. For otitis media due to H. influenzae: 75 to 100 mg/kg/day
in equally divided doses q. 6 or 12 h but not to exceed 4 g/day. Dosage for
children should not exceed dosage recommended for adults. There are no
adequate data available on efficacy of b i d. regimens in children under 9
months of age.
For full prescribing information, consult package insert.
HOW SUPPLIED: 250 mg and 500 mg capsules in bottles of 24 and 100
and Unimatic® unit-dose packs of 100. 125 mg and 250 mg for oral suspen-
sion in bottles of 100 ml and 200 ml.
785-501 Issued: Jan. 1985
NO POSTAGE
NECESSARY
IE MAILED
IN THE
UNITED STATES
BUSINESS REPLY MAIL
First Class Permit No. 99, Syosset, New York 11791
Postage will be paid by
“Computers in Health Care Drawing”
RO. Box 303B
Syosset, New York 11775
Victor S Falk, MD, Medical Editor
SCIENTIFIC MEDICINE
Endemic Kawasaki disease
in rural Wisconsin
Thomas M Sutton, MD, MS and Bradley Sullivan, MD, PhD
Marshfield, Wisconsin
Abstract. Between July 1977 and
June 1984, twenty-two cases of
Kawasaki disease (mucocutaneous
lymph node syndrome) were seen at
the Marshfield Clinic. All cases ful-
filled the Centers for Disease Control
(CDCj criteria for Kawasaki disease.
Twenty-one cases occurred in white
children with one native American
child. All cases except one occurred
in the rural population of North-
central Wisconsin. Cases occurred
with an even distribution over the
study years with no epidemic out-
breaks. Most cases occurred in the
first half of the year. Four patients
(18%) developed significant cardio-
vascular abnormalities. There were
no deaths. Nineteen cases occurred
in children less than five years of age.
Among children less than five years
of age, in our study area, the average
annual incidence was 3.8 cases/
100,000 children /year, which is
much greater than expected, based
on CDC information.
Key words: Kawasaki disease, Mucocu-
taneous lymph node syndrome. Endemic
infections
SINCE THE FIRST case of Kawa-
saki disease was described in
the United States,' over 500 cases
of Kawasaki disease have been re-
corded by the Centers for Disease
Control (CDC).2'3 Among these
From the Pediatrics Department, Marsh-
field Clinic, Marshfield. Reprint requests
to: Thomas M Sutton, MD, MS, Marsh-
field Clinic, 1000 North Oak Ave, Marsh-
field, Wis 54449 (ph 715/387-5251).
Copyright 1985 by the State Medical
Society of Wisconsin.
cases Kawasaki disease occurred
significantly more frequently
among Asians than in blacks or
whites. Cardiovascular complica-
tions were noted in 22% of pa-
tients with death occurring in
1.2% of patients. 3 Several epi-
demic outbreaks have been noted
since 1978.'*® A large outbreak
was recently reported in Milwau-
kee, Wisconsin in 1982 in a bul-
letin from the State of Wisconsin,
Department of Health and Social
Services.'® On review of the liter-
ature, there are no other descrip-
tions of Kawasaki disease in the
Midwest or in a rural, primarily
white population in the United
States.
Methods. The combined records
of the Marshfield Clinic and St
Joseph's Hospital, Marshfield,
Wisconsin, were reviewed for pa-
tients with the diagnosis of Kawa-
saki disease or mucocutaneous
lymph node syndrome. Between
January 1, 1977 and June 1984 (90
months), 22 patients were found
to fulfill the Centers for Disease
Control (CDC) criteria for this dis-
ease. Analysis of these charts was
performed to define the incidence
and characteristics of Kawasaki
disease in our service area.
Results. Twenty-one of 22 pa-
tients were Caucasian with one
native American child. There
were 1 1 male and 1 1 female pa-
tients. Median age at onset was
two years and ten months with a
mean of three years and three
months and a range of five
months to 13 years and one
month.
Clinical presentation in our pa-
tients was typical for Kawasaki
disease. Mean maximal tempera-
ture was 39.8 C among 20 patients
in whom this was recorded. There
was a range of 38.3 C to 40.5 C.
Mean duration of fever was 7.8
days with a range of five to 14
days. Eighteen of 22 patients
(82%) had cervical adenopathy.
All 22 patients had bilateral con-
junctivitis, variable erythematous
rash, and typical oral findings of
strawberry tongue and cracking
and fissuring of lips.
Erythrocyte sedimentation rate
(ESR), Westergren method, was
determined in 21 patients. Mean
maximal ESR was 88 mm /hr with
a range of 15 to 150 mm /hr. The
white blood cell count per cu mm
(WBC/mm®) was determined in
20 patients. Mean maximal WBC
was 16,600/mm® with a range of
8, 100 /mm® to 26, 600 /mm®. Mean
maximal platelet count deter-
mined in 15 patients was 784,000/
mm® with a range of 380,000/
mm® to 1,600,000/mm®.
Electrocardiographic studies
were performed during the acute
stage of illness in 21 of 22 patients.
Eight patients had sinus tachycar-
dia. No patients had signs of acute
ischemia or significant rhythm
disturbance.
Thirteen patients had two-
dimensional echocardiograms
performed. Four patients were
found to have significant cardiac
involvement. All four were males
ranging from 1 1 months to three
years and six months. Two of
these patients had small pericar-
dial effusions which later re-
solved. One patient had multiple
coronary artery aneurysms which
later resolved. One patient had a
dilated left main coronary artery
which later returned to normal
size. No heart catheterizations
WISCONSIN VIKDICAI. JOIRNAI,. MARCH l985:\OI.. 84
23
SCIENTIFIC MEHICINE
ENDEMIC KAWASAKI DISEASE
were performed in any of our pa-
tients.
Nineteen of 21 patients were
treated with aspirin alone. The
other two received no treatment.
There were no deaths during the
acute or followup period in any
patients. All patients identified
with cardiac involvement are
alive and well without apparent
sequelae. Echocardiographic
studies have returned to normal.
In addition to the previously
mentioned cardiac abnormalities,
several patients experienced other
complications. These included
one patient with hepatitis, one
with ileus, one with pneumonia,
one with hydropic gallbladder,
one with arthritis and abdominal
pain, and one with aseptic men-
ingitis. All complications were
transient in nature and resolved
without sequelae.
All patients with the exception
of one traveler from Southeastern
Wisconsin were residents of the
rural North-central Wisconsin
area at the time of the onset of
their illnesses. In the counties
which represent our service area,
there are no cities larger than
53,000 in population. Cases were
fairly evenly distributed over the
study period (Fig 1). Onset of ill-
ness showed mild clustering in the
months of January and February,
and also July and August, but no
other trends were observed (Fig
2).
Considering the 21 patients who
were permanent residents of our
service area, the average annual
incidence among children 13
years of age or less was 2.8 cases/
year, or 1.54 cases/ 100,000 chil-
dren/year. Considering only those
18 patients who were permanent
residents of our service area and
also less than five years of age, the
annual incidence was 2.4 cases/
year, or 3.82 cases/ 100,000/year.
These rates are based on a 1980
census data by county for Wiscon-
sin.
Discussion. Since the initial de-
scription of Kawasaki disease in
the United States there have been
numerous reports of outbreaks in
large urban areas and in areas of
high percentage of Asian popula-
tion.* To our knowledge there
have been no previously reported
occurrences of endemic Kawasaki
disease in a rural Caucasian popu-
lation, and we believe this is the
first such report.
The average annual incidence
during our study period was 3.82/
cases/ 100,000/year for children
less than five years of age. This
can be compared to a national an-
nual incidence of 0.59 cases/
100,000 children younger than
five years of age reported by the
Centers for Disease Control be-
tween July 1976 and December
1980.^ Our estimate for annual in-
cidence also may be lower than
the actual incidence since not all
cases of Kawasaki disease in our
area may have been diagnosed
and not all cases may have been
seen or treated at our institution.
The reason for an increased an-
nual incidence in our area is not
clear.
Four of 22 patients (18%) were
found to have significant cardiac
involvement. While this is com-
parable to other large series,
this estimate may be low since
echocardiographic studies were
performed only on the 13 most
recent patients. We believe it is
significant that there were no
deaths and no residual cardio-
vascular abnormalities on follow-
up echocardiographic studies in
these patients. We would support
the use of echocardiography alone
for following patients with cardiac
involvement in the absence of
ischemic symptoms.
Our findings demonstrate the
endemic occurrence of Kawasaki
disease in our predominantly
rural Caucasian population with a
high annual incidence. Other
practitioners should be alerted to
this occurrence and should con-
sider Kawasaki disease in the dif-
ferential diagnoses of patients pre-
Figure I— Distribution of cases of Kawasaki
disease by year of onset.
Figure 2— Distribution of cases of Kawasaki
disease by month of onset.
24
WISCONSIN' Ml;mCAI, JOCRNAl,, MARCH 198,5:\'OI.. 84
ENDEMIC KAWASAKI DISEASE
S C 1 1 : N T I M C \ 1 1 ; 1 ) I C I N E
senting with typical history, phy-
sical examination, and laboratory
findings.
REFERENCES
1. Melish ME. Hicks RM, Larson EJ: Mucocu-
taneous lymph node syndrome in the
United States. Am J Dis Child 1976:1 30:599-
607.
2. Morens DM, Anderson LJ, Hurwitz ES: Na-
tional surveillance of Kawasaki disease.
Pediatrics 1980:65:21-25.
3. Bell DM, Morens, DM, Holman RC, el al:
Kawasaki syndrome in the United States.
Am J Dis Child 1983:137:211-214.
4. Melish ME, Hicks, RM, et al: Endemic and
epidemic Kawasaki syndrome. Pediatric Res
1981:15:617, Abstract 1045.
5. Jacobs JC: Successful treatment of Kawasaki
disease with high-dose aspirin. Pediatric Res
1978:12:494, Abstract 783.
6. Bell DM, Brink EW, Nitzkin JL, et al: Kawa-
saki syndrome: description of two out-
breaks in the United States. N Engl J Med
1981:304:1568-1575.
7. Meade III RH, Brandt L: Manifestations of
Kawasaki disease in New England outbreak
of 1980. /Fed 1982:100:558-562.
8. Mason W, Wu E, Cote S, et al: Kawasaki
syndrome: Epidemiologic evaluation of a
cluster of 36 cases. Clin Res I981:29:126A.
9. Patriarca PA, Rogers ME, Morens DM, et al:
Kawasaki syndrome: Association with the
application of rug shampoo. Lancet 1982;2:
578-580.
10. Bulletin: State of Wisconsin, Department of
Health and Social Services, January 25,
1983. ■
T echnetium®^“-pyrophosphate scintigraphy
in amyloid cardiomyopathy
Michael J Ptacin, MD; Virinderjit Bamrah, MD; and Edmund Duthie, MD, Wood, Wisconsin
Abstract. The diagnosis of amyloid
cardiomyopathy can be difficult due
to the lack of specific studies short of
myocardial biopsy. Recent reports
suggest that technetium^^"^ -pyro-
phosphate (Tc^^"^-PYPI scintigraphy
may be of diagnostic value. De-
scribed below is a case showing the
salient features of the scan in this
disease.
Key words: Amyloidosis, Technetium*®"’-
pyrophosphate scintigraphy
The presentations of systemic
amyloidosis are separated
into three broad categories, pri-
mary, secondary, and senile. Al-
though their pattern of distribu-
tion is individually different, all
forms of the disease can infiltrate
the heart. In the setting of
myeloma, chronic inflammatory
diseases, or advanced age, the
onset of unexplained left ven-
tricular dysfunction suggests the
possibility of myocardial amyloi-
dosis when bedside examination
rules out more common causes of
heart failure.^ ®
Reprint requests to: Michael J Ptacin, MD,
Section of Cardiology HIM, Wood Vet-
erans Administration Medical Center,
5000 West National Ave, Wood, Wis
53193 (ph 414/384-2000]. Copyright 1985
by the State Medical Society of Wisconsin.
Recently, technetium®^™-pyro-
phosphate (Tc®®™-PYP) scintigra-
phy has been shown to be a pro-
mising diagnostic technique as
long as strict diagnostic criteria
are used.®® The following case
shows that Tc®®"’-PYP was a
helpful adjunct in the diagnosis of
amyloid cardiomyopathy.
Case 1. A 90-year-old white male
was admitted to the hospital with
the new onset of exertional
dyspnea, orthopnea, and demen-
tia. No history of hypertension,
angina pectoris, myocardial in-
farction, or valvular disease could
be elicited.
Physical examination revealed
a disoriented white male in mod-
erate respiratory distress. His
pulse was 100 beats per minute
and irregularly irregular. Blood
pressure was 100/70 mmHg.
Jugular venous distention to the
angle of the jaw at 90 ° was pres-
ent. Specific wave forms could
not be discerned. The first heart
sound's intensity was variable.
Paradoxical splitting of the
second heart sound was noted. A
loud third sound was audible at
the apex. A grade II /VI apical
systolic murmur was heard at the
apex, radiating towards the axilla.
The liver was 16 cm in span and
was without systolic pulsation.
Diffuse bibasilar rales and pleural
effusions were evident. Mild peri-
pheral edema was noted. Electro-
cardiographic studies revealed an
atrial flutter and a complete left
bundle branch block. Cardio-
megaly, pulmonary vascular con-
gestion, and pleural effusions
were noted bilaterally on chest
x-ray film.
Two-dimensional echocardio-
graphic (2DE) studies revealed
marked left and right ventricular
hypertrophy. The mitral valve
and interatrial septum were
thickened. The ventricular myo-
cardium displayed a fine granular
appearance suggesting an infiltra-
tive myocardial process. A small
pericardial effusion was present.
In view of the patient's ad-
vanced age, and a suggestion of
myocardial infiltration by 2DE,
amyloid cardiomyopathy was
suspected. A Tc®®"’-PYP scan
showed 4 ■+ diffuse uptake in the
right and left ventricular myocar-
dium (Pig 1). Both ventricles ap-
peared to be hypertrophied. The
diffuse uptake of Tc^^^’-PYP and
infiltrative appearance of the
myocardium by 2DE was
strongly suggestive of amyloid
cardiomyopathy. Rectal biopsy
confirmed the suspicion of
W ISCONSIN MEDICAL JOL RNAI., .MARCH 1985 :\ OI.. 84
25
SCIENTIFIC MEDICINE
TECHNETIUM’’"'
systemic amyloidosis. Walden-
strom's macroglobulinema was
diagnosed when an IgM gam-
mopathy was found in the serum
and diffuse lymphocytoid
lymphocyte infiltration was
found in the bone marrow and
was felt responsible for his
systemic amyloidosis.
Discussion. Systemic amyloidosis
is classified in major categories
which are defined by the specific
type of amyloid protein and pre-
sumed pattern of infiltration.
These patterns are arbitrary but
the potential for cardiac involve-
ment in all should be recog-
nized.The diagnosis of
amyloid cardiomyopathy can be
difficult. It represents approxi-
mately 5 percent of noncoronary
cardiomyopathies.^ Outside of a
high clinical suspicion, physical
examination, electrocardio-
graphic studies, and chest x-ray
films do not provide specific in-
formation to support the diagno-
sis. In general these techniques
point to a restrictive myocardial
process of the noncoronary type.
When a patient susceptible to
amyloidosis (one with multiple
myeloma, chronic inflammatory
state, or advanced age) presents
with advanced biventricular fail-
ure, amyloid cardiomyopathy
should be suspected.
In symptomatic patients the
Tc99ni-PYP scan strongly favors
amyloidosis when: (1) biventri-
cular uptake is present, (2) the in-
tensity of the tracer is greater
than sternal activity, (3) concen-
tric thickening of the left ventri-
cle is noted, (4) concomitant up-
take of the tracer is noted over the
liver, (5) other etiologies for tracer
uptake such as myocardial infarc-
tion, cardiac tumor or trauma,
metastatic calcification, myocar-
ditis or post-cardioversion
changes are eliminated. The exact
mechanism for the strong uptake
of tracer is unclear. Amyloid
material from the liver is known
to have a high content of calcium.
Whether affinity of the tracer for
calcium explains this has not
been elucidated.®
When compared with two-
dimensional echocardiographic
studies, the magnitude of tracer
uptake tends to correlate with left
ventricular thickness. As can be
appreciated, the present criteria
are relatively strict. The ability to
detect early amyloid infiltration
has not been adequately evalu-
ated. Larger studies in patients
with biopsy-proven amyloid car-
diomyopathy are necessary to
define the sensitivity and speci-
ficity of this study.
Where the Tc^®'"-PYP scan
stands in the diagnostic algor-
hithm for amyloid cardiomyo-
pathy remains unclear. Recent
reports suggest that two-dimen-
sional echocardiography is sensi-
tive even in early infiltrative
states. The key to premortem
diagnosis appears to be a high
index of clinical suspicion, and
through physical examination,
electrocardiography and chest
x-ray film eliciting a restrictive
myocardial process. Anatomic
confirmation using two-dimen-
sional echocardiography or Tc^®'"-
PYP may alleviate the need for a
tissue diagnosis.
Summary. The Tc^^'^-PYP scan
can be used to detect or confirm
amyloid cardiomyopathy in
symptomatic patients when strict
diagnostic criteria are used.
REFERENCES
1. Osserman EF: Amyloidosis. In Textbook of
Medicine. Beeson P and McDermott W. Ch
781, 1975;(14):1546-1548.
2. Przybojewski JZ, Daniels AR, Van Der Walt
JS: Primary cardiac amyloidosis: review of
the literature. S Afr Med J 1980 (May
17)57:831-837.
3. Brigden W: Cardiac amyloidosis. Progress in
Cardiovascular Disease 1964(Sept):7(2):142-
150.
Figure \—Technetium^^"''-pyrophosphate scan of a patient with biopsy-proven amyloid cardiomyopathy
showing biventricular tracer activity greater than the sternum.
ANTERIOR
L.L.
45° LAO 70°LAO
WOODVAMC 4/20/83
26
WISCONSIN .MEOICAl. lOl'RN.AI., MARCH 1985 :\ Ol,. 84
TECHNETIUM’^'"
SCIENTIFIC MEDICINE
4. Franklin EG: Immunopathology of the
amyloid disease. Hasp Pract 1980(Sept):
15(9|:70-77.
5. Case Records of the Massachusetts General
Hospital (Case 27, 1981). N Engl J Med 1981
(Jul 2):305(l):33-40.
6. Schiffs BT, Moffat R, et al: Diagnostic con-
siderations in cardiomyopathy: Unique
scintigraphic pattern of diffuse biventricular
technetium”'"-pyrophosphate uptake in
amyloid heart disease (Part 1). Am Heart J
1982(Apr|; 103(41:562-563.
7. SobelSM, Brown JM, Bunker SR, et al: Non-
invasive diagnosis of cardiac amyloidosis by
technetium”'"-pyrophosphate myocardial
scintigraphy (Part 1). Am Heart J 1982(Apr);
103(41:563-565.
8. Ali A, Turner DA, Rosenbush SW, et al: Clin
Nucl Cardiol 1981 (Mar);6: 105-108.
9. Willerson JT, Parkey RW, Bonte FJ, et al:
Pathophysiologic considerations and clini-
copathologic correlates of technetium”'"-
pyrophosphate myocardial scintigraphy.
Sem Nucl Med 1980(Jan);10(l|:54-69.
10. Kula, RW, Engel LW, Line BR: Scanning for
soft tissue amyloid. Lancet 1977;1:92.
1 1. Youd RA, Skinner M, Cohen AS, et al: Soft
tissue uptake of bone seeking radionuclide
in amyloidosis. J Rheumatol 1981;8:760-766.
12. Falk RH, Lee VW, Rubinow A, et al: Sensi-
tivity of technetium’^-pyrophosphate scin-
tigraphy in diagnosing cardiac amyloidosis.
Am J Cardiol 1983 (Mar l);51:826-830.
13. Child JS, Levisman JA, Abbasi AS, et al:
Echocardiographic manifestations of infil-
trative cardiomyopathy; report of seven
cases due to amyloid. Chest 1976(Dec|;70(6);
726-731.
14. Child JS, Kirvokapich J, Abbasi AA: In-
creased right ventricular wall thickness on
echocardiography in amyloid infiltrative
cardiomyopathy. Am J Cardiol 1979(Dec|;
44:1391-1395.
15. Borer JS, Henry WL, Epstein SE: Echocardi-
ographic observations in patients with
systemic infiltrative disease involving the
heart. Am J Cardiol 1977 (Feb|;39:184-188.
16. Siqueira-Filho AG, Cunha CLP, Tajik AJ: M-
mode and two-dimensional echocardio-
graphic features in cardiac amyloidosis. Cir-
culation 1981 (Jan);l:188-196.
1 7. St John Sutton MG, Reichik N, Kastor JA, et
al: Computerized M-mode echocardio-
graphic analysis of left ventricular dysfunc-
tion in cardiac amyloid. Circulation 1982
(Oct|;66(4|:790-799.
18. Cueto-Garcia L, Tajik AJ, Kyle RA, et al:
Serial echocardiographic observations in pa-
tients with primary systemic amyloidosis:
an introduction of the concept of early
amyloid infiltration of the heart. Mayo Clinic
Proc 1984 (Sept);59:589-597. ■
All contact lenses have protein deposits
All soft contact lenses have protein adherent to their surface as
a result of normal wear, according to a new study in the February
Archives of Ophthalmology. The surface deposits are capable of
decreasing the life of a lens, causing discomfort and contributing to
blurred image. Olafur G Gudmundsson, MD, of Harvard Medical
School, and colleagues examined worn soft contact lenses from five
asymptomatic subjects by immunofluorescence microscopy for type
of protein on the lens surface. They found lysozyme, IgA, lactoferrin,
and IgG. "New, never-worn soft contact lenses did not stain for any
of the proteins examined in this study," the researchers report. ■
Immune system deficiency related to depression
Decreased lymphocyte function appears to be associated
specifically with clinical depression and not to effects of hospitaliza-
tion or to other psychiatric disorders, according to a study from New
York's Mount Sinai School of Medicine. Writing in the February
Archives of General Psychiatry, Steven J Schleifer, MD, and colleagues
say they compared lymphocyte responses of ambulatory patients
with major depressive disorder with those of matched controls. They
also compared responses of hospitalized schizophrenic patients with
those hospitalized for elective surgery. Study results suggest that
"altered immunity in depression may be related to severity of
depressive symptoms," they say. ■
Report new technique for studying kidney function
Correction of a dangerous buildup of acid in kidney tissue can be
gained by administration of adenosine triphosphate (ATP)-
magnesium chloride, according to a new study in the February
Archives of Surgery. Bauer E Sumpio, MD, PhD, and colleagues from
Yale University School of Medicine say they were able to track
molecular events in intact living cells and perfused kidneys by using
high-resolution phosphate 31-nuclear magnetic resonance spec-
troscopy. Using animal models, they were able to correct intra-
cellular acidosis within 75 minutes, following blood-flow stoppage
and reperfusion. ATP levels increased to 69 percent within ten
minutes, they say. ■
Spinal-cord patients can be independent
Most patients can anticipate a satisfying independent life follow-
ing spinal cord injury, according to a study from the St Louis
Veterans Administration Medical Center appearing in the February
Archives of Neurology. Robert M Woolsey, MD, followed the re-
habilitation outcome of 100 consecutive patients. Among his find-
ings: "About half of our patients with incomplete injuries regained
the ability to walk. Almost all complete paraplegic and quadriplegic
patients with lower-level injuries were able to live independently.
Many resumed work or school. Unfortunately, the outlook for
patients with higher-level injuries and for elderly or poorly
motivated patients remains bleak." Of the 100 patients, 43 sustained
injuries in auto accidents. ■
WISCONSIN .MEDICAL JOURNAL, MARCH I985:VOL. 84
27
SCIENTIFIC MEDICINE
Legal aspects of medical
genetics in Wisconsin
Ellen Wright Clayton, JD, Madison, Wisconsin
Abstract. This article addresses several of the legal issues arising from re-
cent advances in medical genetics that affect physicians in Wisconsin. Either
in caring for their own patients or in responding to telephone consultations,
practitioners who do not use reasonable care in detecting genetic risks or who
fail to disclose those risks that a reasonable prospective parent would want to
know may be liable at least for the additional expenses involved in caring for
an affected child. Physicians who conscientiously object need not provide
genetic counseling or prenatal diagnosis, but they are required nonetheless to
use reasonable care in detecting which of their patients are at risk, to disclose
those risks, and to offer to refer them elsewhere. Although patients usually
have a right to confidentiality, the risk of genetic disorders for family mem-
bers in some instances is so great that physicians may be justified in convey-
ing this information to relatives at risk even over their patients' objections.
As evidence of a public policy in favor of making genetic information avail-
able, the Wisconsin Legislature recently established procedures to enable
adopted children to obtain such information - about their biologic parents.
Currently, there is no way to obtain a court order authorizing the steriliza-
tion of a mentally retarded person, no matter whether the procedure is re-
quested for genetic or for other reasons.
Key words: Medical genetics, Genetic counseling. Legal issues, Laws of Wisconsin
IN THE LAST decade, several fac-
tors have converged to increase
the interest in the legal implica-
tions of medical genetics among
physicians, lawyers, and society
at large.
First, the explosion of molecular
genetics has added powerful new
techniques to the tools of pedigree
analysis and clinical examination
traditionally used in medical gene-
tics. Many more genetic disorders
Ms Clayton is a Visiting Assistant Pro-
fessor in the University of Wisconsin-
Madison Law School and Program in
Medical Ethics. She is a graduate from the
Yale Law School and completed her re-
quirements for the MD degree from Har-
vard Medical School in October 1984.
Reprint requests to: Ellen Wright Clayton,
JD, University of Wisconsin-Madison Law
School, Madison, Wisconsin 53706
(phone: 608/262-2240). Copyright 1985 by
the State Medical Society of Wisconsin.
have been recognized, and the
availability of screening for car-
riers of numerous deleterious
genes and of prenatal diagnosis for
an increasing array of disorders
can offer many prospective par-
ents greater certainty rather than
statements of probability.
Second, the legalization of abor-
tion in 1973 made the use prenatal
diagnosis and selective termina-
tion a more realistic option. The
availability of effective modes of
contraception and sterilization
similarly enabled couples at risk
more easily to avoid childbearing
altogether either if they were op-
posed to selective abortion or if
prenatal diagnosis were not an
alternative.
Finally, the increasing desire of
patients to have more control over
their own health and over their
reproductive decisions has been
reflected in a greater willingness
on the part of patients to seek leg-
islative and judicial protection of
their interests.
The analysis that follows dis-
cusses several legal problems in-
volving medical • genetics that
commonly confront individual
health care providers in Wiscon-
sin. Medical geneticists and gene-
tics associates are not the only
practitioners affected. Obstetri-
cians and pediatricians frequently
must address these issues, too,
and, from time to time, most other
medical specialists are touched by
medical genetics. This analysis
focuses on Wisconsin law and
points out both where the rules
are clear and where they are still
undecided. The separate, but sub-
stantial, legal issues surrounding
genetic screening are not ad-
dressed.
I. The prototypical genetic coun-
seling case
The most commonly litigated
problem in medical genetics is the
doctor's failure to tell prospective
parents that they are at risk for
having a defective child. The phy-
sician may simply have missed a
potentially heritable disorder in
the family history or may have
failed to diagnose such a trait in
the prospective parents' prior off-
spring. Problems also arise when
physicians or laboratory person-
nel mishandle samples.
These cases are usually decided
according to the dictates of medi-
cal malpractice law, an area of tort
law. In order to win, the parties
who bring these suits— the parents
and often the affected child— must
prove four facts.
1 . They must prove that the party
being sued— usually the doctor
—owed the plaintiffs some duty. In
28
WISCONSIN MEDICAI. JOCRNAI,, MARCH I98.S:\OL. 84
MEDICAL GENETICS
SCIENTIFIC MEDICINE
the usual situation, the mother is
the physician's actual patient, but
the courts hold that the doctor's
legal obligation extends to the
father and the unborn child as
well. The courts justify this ex-
tended duty on the basis that phy-
sicians surely must foresee that
the father and the unborn child
will be significantly affected by
the care given to the mother. ^ This
analysis was implicitly applied by
the Wisconsin Supreme Court. ^
In another commonly encoun-
tered situation, the doctor is a
pediatrician or family practitioner
caring for a child with, for exam-
ple, cystic fibrosis or congenital
deafness who fails either to diag-
nose the disorder or to recognize
a risk for recurrence. The courts
hold that the physicians who treat
these children owe a duty not only
to the affected child but also to the
parents and to any future sib-
lings.^
2. They must prove that the phy-
sician failed to fulfill his duty.
This failure is termed negligence. It
is important to recognize that neg-
ligence in the law does not mean
"mistake" or imply any morally
culpable act. Instead, it means
simply the failure to comply with
the governing standard of care. In
genetic counseling, there are two
components to the standard of
care. The first governs the extent
of the doctor's duty to know about
the genetic risk. A physician must
use that degree of care exercised
by other reasonable similarly situ-
ated practitioners, both in the ex-
tent of their medical knowledge
and in their performance of diag-
nostic procedures.^
More highly trained specialists
must exercise greater skill than
general practitioners. All physi-
cians, however, have an obliga-
tion to "keep up," and all must
use reasonable care in determin-
ing when referral to a medical
geneticist is appropriate. Signifi-
cantly, this rule also means that
mistakes made when one is using
reasonable care do not lead to lia-
bility.
The second component governs
the extent of the physician's duty
to disclose genetic risks to prospec-
tive parents. This issue raises
questions of informed consent, for
which there are two general rules.
Some states hold that doctors are
responsible for telling patients
only what other reasonable practi-
tioners would tell.^ Other states,
including Wisconsin, hold that
physicians must tell patients what
other reasonable patients would
want to know.^
3. They must prove that the phy-
sician's breach of duty was the
proximate cause of the plaintiff's
injuries. Analytically, one can see
that any given action can have vir-
tually endless ramifications, like
ripples in a pond, but the law im-
poses liability only for those
events that follow "proximately"
or relatively directly from the ini-
tial negligent act. In the usual
case, the parents must show that
had they been given adequate
genetic risk information, they
would not have had the child.
Wisconsin law may also require
parents to show that similarly sit-
uated reasonable parents would
also have elected not to have the
child.®
4. They must prove that the plain-
tiffs suffered legally compen-
sable injuries. In general, plaintiffs
usually seek three types of dam-
ages; (a) the parents' cost of caring
for the affected child; (b) the par-
ents' emotional pain and suffer-
ing; and (c) the child's claim for
his/her own injuries— the so-
called "wrongful life" claim.
The states differ significantly in
their decisions about whether, as
a matter of public policy, any or
all of these damages should be
recoverable. Wisconsin has ruled
that parents may recover the ad-
ditional expenses involved in car-
ing for an affected child, ^ but not
the "ordinary" childrearing ex-
penses.'^ The courts here have not
ruled on the parents' claim for
emotional pain and suffering, and
it is not clear how they would res-
pond were the issue to be raised.
Finally, Wisconsin has denied
the affected child's claim for dam-
ages.^ Interestingly, in reaching
this decision denying the "wrong-
ful life" claim, the Wisconsin
Supreme Court relied heavily on
a New Jersey decision® that was
recently overruled by the New
Jersey Supreme Court. ^ This does
not mean, however, that the Wis-
consin Court would reverse its
ruling were it to address another
"wrongful life" claim in the
future.
II. Telephone inquiries
The answer to the question of
what duty is owed by a health
care provider to a person who
simply calls on the telephone and
is never seen in the office turns on
the issue of when the doctor-
patient relationship arises, a mat-
ter determined largely by the law
More highly trained specialists must exercise greater
skill than general practitioners. All physicians, however,
have an obligation to 'keep up, ' and all must use reason-
able care in determining when referral to a medical
geneticist is appropriate. Significantly, this rule also
means that mistakes made when one is using reasonable
care do not lead to liability.^'
VVISCO!\JSI.\ iVlEmC AI, JOl KN/U„ M.ARCH 1985 :V01,. 84
29
SCIENTIFIC MEDICINE
MEDICAL GENETICS
of contracts. Generally, a contract
exists between two people only
when one party makes an offer
that the other accepts, both under-
stand the content of the agree-
ment, and both agree to exchange
something of value with the other.
In addition, a physician is free to
refuse to enter into a contractual
relationship with a patient.
Despite these formal rules,
which would seem to make the
presence of a physician-patient
relationship hard to demonstrate,
the law of contracts is altered
somewhat in dealings between
physicians and patients because a
relatively uninformed person, the
patient, is likely to rely on the
statements and actions of another
more knowledgeable person, the
physician. In response to this
marked inequality of position, the
law is quick to find that a contrac-
tual relationship exists. Although
a contract usually contains an im-
plicit duty on the part of the pa-
tient to pay, the physician's gen-
eral duties under the contract may
nonetheless be enforceable even
when it is understood that the pa-
tient will not pay.®
In light of this low threshold for
the physician-patient relationship,
it seems likely that the relation-
ship arises in a simple telephone
inquiry once the provider begins
to give medical information to the
caller. At this point, the usual
duties— the reasonable practi-
tioner standard of knowledge and
the reasonable patient standard of
disclosure— apply. This does not
mean that one should refuse to
answer questions on the tele-
phone. It does mean that one
should use reasonable care in
deciding which questions may ap-
propriately be answered without
seeing the patient and in provid-
ing those answers. Although
documentation is not legally re-
quired, it is sound practice here,
as in all areas of medical care, rou-
tinely to note the substance of
such conversations.
III. The conscientiously objecting
physician
In some cases of inadequate
disclosure, physicians have
argued in defense that they delib-
erately refused to disclose genetic
risk information because they ob-
jected to abortion. Conscien-
tiously objecting health care pro-
fessionals cannot be forced to par-
ticipate in performing abortions.
This is particularly clear in insti-
tutions receiving federal funds
because Congress has enacted a
law specifically protecting this
right. From this, it might be
argued that health care providers
have a right to avoid any connec-
tion whatsoever with abortion, no
matter how distant. Yet the physi-
cian's refusal to provide such in-
formation may have a much more
profound impact on a woman's
reproductive decision-making
than does the refusal to perform
abortions.
For practical purposes, most
women learn of genetic risks only
from their physicians so that a
refusal to disclose such risks
means that some women would
not know of factors that might
lead them to seek abortion. By
contrast, if a woman knows that
she wishes to obtain an abortion
but her physician refuses, she has
the option of seeking out a doctor
who will provide this service.
In light of the effect of withhold-
ing genetic risk information, the
courts of Washington^ and Michi-
gani2 have held that conscien-
tiously objecting physicians are
required to use reasonable care in
detecting which of their patients
are at risk to disclose the risk, and
to offer to refer them elsewhere.
They need not, of course, "coun-
sel” abortion, particularly since
most genetic counselors do not ac-
tually recommend abortion but
rather discuss the options avail-
able to couples at risk. This places
a minimal burden on physicians
while preserving their patients'
opportunity to make informed
reproductive decisions.
IV. Confidentiality— disclosure to
relatives who are at risk
When patients are told that they
carry a genetic defect such as a
chromosome translocation or X-
linked recessive trait that repre-
sents increased risk to their rela-
tives, they usually agree to coop-
erate in informing their relatives.
In some situations, however, the
patients may refuse to share this
information with family mem-
bers. As a general rule, patients
have the privilege to require that
their communications with physi-
cians not be disclosed to third
parties. Although there have
been no reported cases involving
unwanted disclosure to relatives,
a physician's breach of confiden-
tiality can give rise to liability for
damages for mental pain and suf-
fering, humiliation, and loss of
reputation.
There are several recognized ex-
ceptions to the patient's privilege
in which his or her confidentiality
not only may but must be breach-
ed in order to prevent harm to
third parties. For instance, many
states, including Wisconsin, re-
quire that persons with certain in-
fectious diseases be reported to
public health authorities.^® By
analogy, there is growing consen-
sus that there may be circum-
stances in which the risk of gene-
tic disorders in the offspring of the
patient's siblings is so great that
the doctor may be justified in
breaching the patient's confi-
dence. The President's Commis-
sion for the Study of Ethical Prob-
lems in Medicine and Biomedical
and Behavioral Research recently
suggested that such disclosures
can be made:
... if and only if the following four
conditions are met: (a) reasonable
efforts to elicit voluntary consent to
disclosure have failed; (b) there is a
high probability both that harm will
:jo
WISCONSIN MEDICAl.JOl KNAL, MARCH 1985: VOL. 84
MEDICAL GENETICS
SCIENTIFIC MEDICINE
occur if the information is withheld
and that the disclosed information
will actually be used to avert harm;
(c) the harm that identifiable indi-
viduals would suffer if the informa-
tion is not disclosed would be ser-
ious; and (d) appropriate precau-
tions are taken to ensure that only
the genetic information needed for
diagnosis and/or treatment of the
disease in question is disclosed.'®
Although the report of the Presi-
dent's Commission is quite per-
suasive, compliance with its sug-
gestions will not necessarily pro-
tect practitioners from liability.
The law in Wisconsin about when
physicians may reasonably dis-
close genetic risk information to
relatives over a patient's objection
will not be entirely clear until the
courts or the Legislature address
the issue. By far the safest course
of action, then, is prophylactically
to dispel the counselee's expecta-
tion of privacy or confidentiality
by establishing criteria in advance
for deciding when relatives
should be sought out and by tell-
ing all patients about these guide-
lines at the beginning of the
counseling process. So long as any
subsequent disclosures and in-
quiries are no broader than rea-
sonably necessary and made with
due care, therre can be no lia-
bility.'^
V. Confidentiality— opening adop-
tion records
States have traditionally re-
quired that adoption records be
sealed, citing interests in pro-
moting adoption, the integrity of
the adoptive family, and the pri-
vacy of the biologic parents. Re-
cently, these statutes have come
under considerable attack. While
these statutes have uniformly
been upheld as constitutional,
several courts have suggested that
adoption records can be opened
for good cause, including the
adopted child's need for medical
or genetic information.'® The
President's Commission has
strongly recommended that adop-
tion statutes be altered to ensure
access to such information.'®
In 1981, before the Commission
issued its report, Wisconsin re-
vised its adoption law to make
genetic and medical information
much more easily available.'®
Under the new law, the parents of
a child placed for adoption or re-
moved from the home after Feb-
ruary 1, 1982 are required to pro-
vide extensive medical and gene-
tic information; parents of chil-
dren placed before that date are
encouraged to provide such infor-
mation. This information, after
removal of identifying data, is to
be made available to, among
others, the child after the age of 18
or to the child's adoptive parents
or guardians before that age.
If the medical and genetic rec-
ords are incomplete, the statute
provides mechanisms to obtain
additional information from the
biologic parents, but the request
for such a search must be accom-
panied by a physician's statement
"either that the [adopted person]
has or may have acquired a gene-
tically transferable disease or that
the [adopted person's] medical
condition requires access to the in-
formation." Finally, the statute
provides that any report of a gene-
tic disorder in either the adopted
child or his siblings and/or bio-
logic parents is to be given to the
biologic parents or to the adopted
child, respectively.
The President's Commission
has also recommended that chil-
dren who are conceived by arti-
ficial insemination by donor (AID)
should have access to genetic in-
formation about the donor.'® This
is particularly compelling in those
relatively common situations
where AID is used specifically to
avoid passing on an undesirable
genetic trait carried by the hus-
band. Wisconsin, however, has
not revised its AID statute to en-
sure that such information be
made available.
VI. Sterilization of the mentally
retarded
The courts recently have been
presented with numerous peti-
tions to authorize the sterilization
of mentally retarded individuals.
The reasons offered in support of
sterilization vary from case to
case, but include: (1) prevention of
inheritable causes of mental re-
tardation in the offspring, an argu-
ment from genetics or eugenics;
(2) the inability of the retarded
person both to control her sexual
activity and to cope with the
trauma of pregnancy and child-
birth, an argument often phrased
in terms of the retarded person's
"best interests"; and (3) the in-
ability of the retarded person to
provide adequate parental nur-
ture, an argument based both on
the child's interests and on the
avoidance of burdens on the state.
In responding to these petitions,
the courts in various states have
discussed not only the propriety of
using any of these arguments to
justify sterilization but also the
question of whether the courts
have the authority in these cases
to grant judicial approval.
In In re Eberhardy,^^ a deeply
divided and highly controversial
decision, the Wisconsin Supreme
Court decided that the courts had
jurisdiction to rule on petitions for
the sterilization of incompetent
mentally retarded persons. The
Court, however, ruled that the
policy issues involving steriliza-
tion were so complex that the
courts would not exercise their
power until the Legislature de-
cided when sterilization was ac-
tually in the "best interests" of a
retarded person.
In its conclusion, the Court
added that it could, at some future
time, reverse its decision and
choose to rule on petitions for
sterilization of the mentally re-
tarded if it became clear that the
Legislature was not going to act in
this area and if the appropriate
case were presented. Since the
\V[SCO.\'SIN MKDICAI, JOl'RNAI., MARCH 19S5:\OI. 84
31
SCIENTIFIC .MEDICINE
MEDICAL GENETICS
Wisconsin Supreme Court held
that it would not rule on these
petitions at all, it did not decide
which, if any, reasons would be
sufficient to justify sterilization. It
did note in passing that the Legis-
lature's recent repeal of a eugenic
sterilization law could be inter-
preted as disapproval of steriliza-
tion for genetic reasons.
The Eberhardy court's refusal to
rule on sterilization petitions has
come under heavy attack, particu-
larly in light of its statement that
it might choose to decide this issue
in the future. The Legislature has
not responded to the Eberhardy
decision. Thus, there is no way for
parents and physicians to obtain
prior approval from the courts for
the sterilization of a mentally re-
tarded person. This leaves them
open to potential liability if they
proceed with sterilization under
both tort and constitutional law
for deprivation of the retarded
person's right to have children.
The courts' refusal to grant prior
protection does not necessarily
mean that they will decline to im-
pose liability if sterilizations were
performed for inappropriate rea-
sons. Physicians and parents who
believe that sterilization of the
mentally retarded may in some in-
stances be justifiable must pursue
vigorously their legislative reme-
dies and perhaps should seek fur-
ther judicial review.
Conclusion. The increasing
power of medical genetics has
created a whole array of pressing
legal issues. In Wisconsin the
judicial resolution of some of
these problems provides substan-
tial guidance to health care pro-
viders, particularly with regard to
the physician's duty to know
about and to disclose genetic risk
information. Similarly, the Wis-
consin Legislature made a great
stride forward in its revision of
the adoption statute to ensure
adoptees' access to medical and
genetic information about their
biologic families.
Many issues, however, have
not yet been presented to the
courts, leaving areas of uncer-
tainty which will be resolved
only by future litigation or pos-
sibly by legislative action. Some
areas, in particular, such as re-
vision of the AID statute and
development of guidelines for the
sterilization of the mentally re-
tarded, clearly require legislative
attention that they have not re-
ceived.
The existence of these areas of
uncertainty about legal issues has
two significant implications for
health care providers. First, it
means that ethical norms, which
must guide all medical practice
and which often require more of
practitioners than does the law,
are particularly important in
areas where the legal rules are
unclear. Secondly, it suggests that
providers have an obligation to
participate in the legislative proc-
ess in order to resolve some of the
as yet unanswered questions for
the benefit of themselves and of
their patients.
Acknowledgment: The author wishes to
thank Renata Laxova, MD and Richard
Pauli, MD for their insightful comments
on an earlier draft of this article.
REFERENCES
1 . Procanik v. Cillo, 97 N.J. 339, 478 A.2d 755
(1984) (rubella syndrome).
2. Dumer v. St. Michael's Hosp., 69 Wis.2d
766, 233 N.W.2d 372 (1975) (rubella
syndrome).
3. Turpin v. Sortini, 31 Cal. 3d 220, 463 P.2d
954, 182 Cal. Rptr. 337 (1982) (congenital
deafness).
4. Shier v. Freedman, 58 Wis.2d 269, 206
N.W.2d 166, aff'don rehearing per curiam, 58
Wis.2d 269, 208 N.W.2d 328 (1973).
5. N.Y. Pub. Health Law S 2805-d(l) (McKin-
ney 1983).
6. Scaria v. St. Paul Fire & Marine Ins. Co., 68
Wis,2d 1, 227 N.W.2d 647 (1975).
7. Rieck v. Medical Protective Co., 64 Wis.2d
514, 219 N.W.2d 242 (1974).
8. Gleitman v. Cosgrove, 49 N.J. 22, 227 A. 2d
689 (1967) (rubella syndrome).
9. Pegalis SE & Wachsman HF, American Law
of Medical Malpractice § 2:3 (Lawyers Coop-
erative Publ. Co. 1980).
10. Church Amendment, 42 U.S.C. S 300a-7
(1983).
1 1 . Harbeson v. Parke-Davis, Inc., 98 Wash. 2d
460, 656 P.2d 483 (1983) (fetal hydantoin
syndrome).
12. Eisbrenner V. Stanley, 106 Mich. App. 351,
308 N.W.2d 209 (1981) (rubella syndrome).
13. Wis. Stat. Ann. SS 146.82, 905.04 (West
1983).
14. Comment, Confidentiality of Genetic Informa-
tion, 30 U.C.L.A. L. Rev. 1283 (1983).
15. Wis. Stat. Ann. SS 143.04, 143.06, 143.07
(West 1983) (communicable disease, tuber-
culosis, sexually transmitted disease, re-
spectively).
16. President's Commission for the Study of
Ethical Problems in Medicine and Bio-
medical and Behavioral Research, Screening
and Counseling for Genetic Considerations:
The Ethical, Social, and Legal Implications of
Genetic Screening, Counseling and Education
Programs (February 1983) (recent extensive
discussion with heavy emphasis on ethical
issues).
17. Wright EE & Shaw MW, Legal Liability in
Genetic Screening, Genetic Counseling and
Prenatal Diagnosis, Clin. Obstet. Gynecol.
24: 1 133 (1981) (legal primer for physicians).
18. Comment, Adoption Records Reform: Impact
on Adoptees, 67 Marquette L. Rev. 110
(1983) (very thorough discussion).
19. Wis. Stat. Ann. SS 48.422(9), 48.425(l)(am),
48.427(6), 48.432 (West 1983).
20. Wis. Stat. Ann. S 891.40 (West 1983).
21 . Comment, In re Guardianship of Eberhardy:
The Sterilization of the Mentally Retarded,
1982 Wis. L. Rev. 1199.
22. In re Eberhardy, 102 Wis. 2d 539, 307
N.W.2d 881 (1981) ■
^^The increasing power of medical genetics has created
a whole airay of pressing legal issues. In Wisconsin the
judicial resolution of some of these problems provides
substantial giddance to health care providers, par-
ticularly with regard to the physician's duty to know
about and to disclose genetic lisk infonnation. Similarly,
the Wisconsin Legislature made a great stride forward in
its revision of the adoption statute to ensure adoptees'
access to medical and genetic information about their
biologic families.^'
32
WISCONSIN MKDIC \I JOl RNAI,. MARCH 1985 ;\ OI.. 84
SCIENTIFIC MEDICINE
Physician
morbidity:
a limited
study
Jeffrey Larson, MD
Betty Joan Maly, MD
Joanna Spiro, EdD
Milwaukee, Wisconsin
Abstract. Physicians as patients
have been identified as a group at
risk for inadequate evaluation and
treatment of illness in their resis-
tance to seek regular medical care.
One hundred and fifty Milwaukee
area physicians, 50 each from in-
ternal medicine, surgery, and psy-
chiatry, were surveyed for the pur-
pose of obtaining data in the num-
ber, age, gender, chief complaints,
and diagnoses of doctor-patients
from 1977-1982. Of the 361 phy-
sician-patients identified, 94% were
male and more than 50% had con-
sulted surgeons. The male/female
ratio was considerably lower among
those who saw psychiatrists. Ap-
proximately a third of responders
indicated physician-patients had
problems with alcohol, depression,
and anxiety. Morbidity pattern and
health needs could not be defined
by the data, but further study may
benefit physicians as patients and
those who treat them.
Key words: Physician morbidity, Im-
paired physician, Physician-patient,
Epidemiology
Professor Spiro is Director of Psychologi-
cal Services, Office of Student Affairs, and
Assistant Professor, Psychiatry and Men-
tal Health Services, Medical College of
Wisconsin, Milwaukee. Reprint requests
to: Joanna H Spiro, EdD, MCW Office of
Student Affairs, 8701 Watertown Plank
Road, Milwaukee, Wis 53226 (ph 414/
257-8207). Copyright 1985 by the State
Medical Society of Wisconsin.
ILLNESS, a disruption of most
people's lives, may be doubly
difficult when it occurs in the life
of a physician. Illness seems to
undermine the physician-patient's
sense of both personal and profes-
sional identity.^
All aspects of care pose prob-
lems for the physician, beginning
with neglect of his own health and
an unwillingness to admit or
recognize symptoms to grudging
and half-hearted attempts to ar-
range for treatment, and culmi-
nating in devious and noncooper-
ative efforts with the treating
physician or a treatment regimen.
Healthcare professionals, in-
trigued by this situation, have con-
cluded that doctors fear death and
disease and that they work hard to
combat them for their patients,
but not for themselves. Indeed,
they may become so imbued with
the magic and protection of the
doctor's role, they "may use their
own knowledge and skills to de-
fend themselves against their own
anxiety . . ."^
Ten years ago an article classi-
fied doctor-patients into four
groups. The smallest group con-
sisted of doctors who had yearly
physicals and followed the advice
of their doctor. The largest group
was composed of those doctors
who willfully neglected their own
health and put out of mind any
disturbing signs or symptoms of
disease. 3
Because of issues like these, we
were interested in learning to
whom physicians turned when
they needed a doctor. Our study
had three aims: to determine a
sample number of physicians
seeking medical attention; to in-
vestigate the presenting health
problems of physician patients as
well as the diagnoses made by the
doctors treating their colleagues,
and to examine some of the char-
acteristics of the physician-pa-
tients, including gender and age
and area of medical practice.
METHOD.
Study population. One hundred
and fifty Milwaukee area physi-
cians were asked to participate in
this study, 50 each from the prac-
tice areas of internal medicine,
general surgery, and psychiatry.
These physicians were randomly
selected from the internists, sur-
geons, and psychiatrists listed in
the 1980 Milwaukee Telephone
Yellow Pages. The telephone list-
ing is a select population, noteably
deficient in medical school-based
physicians.
Instrument. A letter of introduc-
tion, a questionnaire, and a
stamped, self-addressed envelope
were sent to the offices of the
physicians in the study popula-
tion. The survey design reflected
a need for simplicity and brevity
while protecting physician and
patient anonymity. Responding
physicians were not requested to
identify themselves, their special-
ties, or physician-patients. Ques-
tionnaires sent to surgeons, in-
ternists, and psychiatrists differed
in the list of diagnoses presented
for classification of their physician
patients and were thereby dis-
tinguished and grouped upon
return.
RESULTS
Response. A response was re-
ceived from 40% of all doctors
(n = 150) who were sent question-
naires. Twenty-two surgeons, 20
internists, and 18 psychiatrists re-
turned the questionnaire.
Number of doctors treating phy-
sician-patients. Among the 60
physicians who responded to the
questionnaire, 49 (81%) reported
at least one physician-patient in
their medical practice in previous
five years. Eighteen of 22 respond-
VVISCO>J.SI\ MKDICAI. |Ol RNAl„ MAKCII 1985: VOL. 84
33
SCIENTIFIC MEDICINE
PHYSICIAN MORBIDITY
ing surgeons reported physician-
patients (82%). Nineteen of 20
responding internists reported
physician-patients (90%). Thirteen
of 18 responding psychiatrists re-
ported physician-patients (72%).
Number of physician-patients.
The 60 physicians returning ques-
tionnaires reported a total of 361
physician-patients within their
medical practices over the five
years. The mean is six physician-
patients per respondent.
Of the 361 physician-patients
identified by the total respon-
dents:
192 (53%) were seen by
surgeons,
108 (30%) by internists, and
61 (17%) by psychiatrists.
Gender of physician-patients.
Gender identification was pro-
vided for 345 of the 361 physician-
patients described in the total
respondent population. Male
physician-patients predominated
representing about 94% of the
total number.
Table l~Ratio of number of men
physician-patients to number of women
physician-patients
Total Respondent Population
Surgeons
17:1
Internists
26:1
Psychiatrists
7:1
An examination of the ratios of
men to women physician-patients
(Table 1) illustrates a fairly pro-
nounced difference between sur-
geons, internists, and psychia-
trists. Note that surgeons and in-
ternists report a men-to-women
ratio of about 20:1. In contrast,
psychiatrists report a much
smaller ratio of around 6:1.
Physician-patients' chief com-
plaints. The questionnaire asked
physicians to list, but not to quan-
tify, the most common chief com-
plaints presented by their physi-
cian-patients.
Surgeons reported only physical
chief complaints (distinguished
from psychological) among their
physician-patients. Gastrointes-
tinal chief complaints were recog-
nized by three of the surgeons,
while cardiovascular problems,
genitourinary problems and
hernia were each reported by two
surgeons. Both respiratory-ear,
nose, and throat and neurologic
chief complaints were each identi-
fied by one surgeon.
Internists, in contrast with the
surgeons, described a greater
variety of physician-patients' chief
complaints, including both physi-
cal and psychological problems.
Seven internists listed cardiovas-
cular problems as physician-pa-
tient chief complaints. With the
exceptions of hernia and genito-
urinary problems, internists de-
scribed chief complaints in most
broad categories of physical ill-
ness, including gastrointestinal
problems, respiratory problems,
malignancy, metabolic disorder,
neurologic disorder, infection,
and obesity. In addition to the
somatic chief complaints, three in-
ternists reported depression and
problems with drugs or alcohol in
their physician patients.
The psychiatrists found no
purely physical complaints among
their physician-patient's chief
complaints. A majority of psychia-
trists listed depression. Marital
problems were identified as physi-
cian-patient chief complaints by
six psychiatrists. Chief complaints
of anxiety and alcohol /drug prob-
lems were each reported by four
of the psychiatrists.
DISCUSSION
Response. The 40% response to
the questionnaire may not be a
representative sample of the study
population. Information concern-
ing the expected rate of response
among a physician study popula-
tion is not presently available in
the literature.
Although the distributed num-
ber of responses from surgeons,
internists, and psychiatrists did
not differ significantly, some in-
teresting differences were noted
in the characteristics of response.
Considered as a group, surgeons
tended to return their question-
naires rapidly, providing less than
complete information. In contrast,
psychiatrists tended to return
completed questionnaires, taking
a considerable length of time to
respond. Internists seemed to
respond in a pattern between that
of surgeons and psychiatrists;
moderately complete question-
naires returned fairly rapidly.
Number of doctors treating physi-
cian-patients. Unfortunately the
study does not offer a basis for
quantifying use of physician serv-
ices by physician-patients com-
pared to nonphysician-patients.
Although the majority of respond-
ing doctors (81%) reported having
fellow physicians as patients dur-
ing the last five years, the sample
did not select randomly among all
practicing physicians in a com-
munity surrounding a major med-
ical center and thus may not be
representative. The self-selected
responders did provide a finite
number of physician-patients to
consider.
Number of physician-patients.
Just over one-half of all physician-
patients recognized by this study
were patients of surgeons. The
tendency of surgeons to have a
considerably greater portion of
the physician-patient population
than either internists or psychia-
trists may suggest that physicians
rely upon self-treatment until
problems arise which largely pro-
hibit self-treatment (le, surgical
care).
Ages of physician-patients. Al-
though information on age was
not supplied for many of the phy-
sician-patients described by this
34
WISCONSIN MKmCAI. |Ol RNAl, MARCH 1985;\OL. 84
PHYSICIAN MORBIDITY
SCIENTIFIC MEDICINE
study, a simple comparison of age
distribution for patients of inter-
nists versus psychiatrists merits
discussion. As might be antici-
pated for the internist, generally
providing well-rounded primary
care for adults of all ages, ages of
physician-patients were fairly
evenly distributed from age 30 up-
ward. In rather marked contrast
to the internists' pattern, physi-
cian-patients of psychiatrists
tended to be concentrated in the
40- through 60-year age range.
Perhaps the socalled "mid-life
crisis," an age of disappointment,
disenchantment and disillusion-
ment, prompts the middle-age
physician to more readily seek
psychiatric help. Insufficient data
from the surgeons on ages of their
physician-patients precludes dis-
cussion.
Gender of physician-patients. This
study demonstrated a thought-
provoking difference among phy-
sician-patients of psychiatrists,
surgeons, and internists, with
regard to gender distribution.
While both surgeons and inter-
nists reported a male-to-female
physician-patient ratio close to
20: 1, psychiatrists reported a ratio
of about 6:1. Several hypotheses
may be further investigated:
... a greater proportion of female
physicians require psychiatric
care than medical or surgical care
compared to their male counter-
parts,
. . . female physicians are less re-
luctant to seek psychiatric care
than their male counterparts,
. . . female physicians are more
reluctant to seek out surgical or
medical care than their male
counterparts,
... a smaller proportion of female
physicians requires surgical or
medical care compared to their
male counterparts.
These investigations are beyond
the scope of this study.
Physician-patients' chief com-
plaints. This study demonstrates
fairly obvious differences in the
nature of physician-patients' chief
complaints as perceived by sur-
geons, internists, and psychia-
trists. As might be anticipated,
physician-patient chief complaints
reported by surgeons were well-
defined within six disorder cate-
gories: cardiovascular, genitourin-
ary, gastrointestinal, ear-nose-
throat, neurologic, and hernia.
While chief complaints of cardio-
vascular problems and physical
examination were most common
among the sampled internists, dis-
orders of nearly all organ systems
as well as functional problems
such as depression and drug /alco-
hol abuse were reported. Perhaps
most noteworthy is the observa-
tion that the majority of psychia-
trists described depression as a
physician-patient chief complaint.
Diagnosing physician-patients.
Diagnoses made by surgeons
closely paralleled their physician-
patients' chief complaints. The
largest concentrations clustered
around respiratory, neurologic,
genitourinary, and cardiovascular
categories, more than half of 147.
Reflecting the varied nature of
chief complaints offered by phy-
sician-patients to their internists,
diagnoses reported by internists
included disorders of many organ
systems. However, the largest
concentrations of physician-pa-
tients fell into two diagnostic
categories: cardiovascular prob-
lems (25 of 67 diagnoses) and gas-
trointestinal problems (10 of 67
diagnoses).
Of 74 physician-patients diag-
nosed by psychiatrists, 27 (just
over one-third) were found to be
experiencing depression. Sub-
stance abuse was next most com-
monly diagnosed (17 out of 74
diagnoses) followed by anxiety (12
of 74) and personality disorder (8
of 74). Interestingly, three cases of
manic-depressive illness, two
cases of psychosexual disorder,
"Owr project, which
focused on physician
morbidity, is intended to
provide background in-
formation which may be
helpful to those working
towards a preventive ap-
proach to physician im-
pairment.'^
and one case of schizophrenia
were reported among psychia-
trists' diagnoses.
SUMMARY. Beyond our data are
many more questions on this sub-
ject than answers. These ques-
tions revolve around such issues
as: How does a physician-patient
share in the responsibility for his/
her own treatment? How does the
treating physician overcome his
own feeling of incompetence or
competition or frustration in car-
ing for a colleague? How does a
physician assume the sick role
when that's what he's been
trained to fight? Does the physi-
cian never really become a pa-
tient? Do physicians mostly seek
the competent physician for their
illness, or do they turn to friends,
or to colleagues they don't respect
in an effort to maintain security in
the unknown?'^ Our project,
which focused on physician mor-
bidity, is intended to provide
background information which
may be useful to those working
towards a preventive approach to
physician impairment.
REFERENCES
1. Meissner W, Wohlauer P: Treatment prob-
lems of the hospitalized physician. Inter-
national J Psychoanalytic Psychotherapy 1978-
1979;7:437-467.
2. Rabinowitz C: Recognizing why physicians
neglect their health— and helping them. Front
Psych, Roche Report 1979(Mar);9(4|:l.
3. Scheiler S: Recognizing why physicians
neglect their health— and helping them. Front
Psych, Roche Report 1979|Mar);9|4):l.
4. Crosbie S: The physician as a patient. Rocky
Mount MedJ 1972(Jun);69:49-52. ■
VVISCONSI.N MEDICAL JOI RNAI., MARCH I98.S: VOL. 84
35
WITH SO MANY CHOICES,
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All it takes is a good diet, including the
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If you would like more information on calcium in the diet, including brochures for your patients, please call or write us.
ISCONSIN GAZETTE
TALWIN* Nx . . . BUILT-IN
PROTECTION AGAINST
MISUSE BY INJECTION
Major Analgesic
Reformulated
Now contains naloxone,
a potent narcotic antagonist
Extra security added
to proven efficacy and safety
No longer do doctors have to deny patients the
benefit of an effective oral analgesic for fear of its
misuse by injection.
Winthrop-Breon Laboratories has met a nagging
problem by reformulating TALWIN® 50 (pentazo-
cine HCl tablets) with the addition of naloxone,
equivalent to 0.5 mg base. The reformulated
product is called TALWIN® Nx.
The oririnal formulation had been subject to a
form or misuse among street abusers known as
“T’s and Blues.” TALWIN 50 and PBZf an anti-
histamine, would be ground up together, put into
solution, and injected intravenously. The combi-
nation produced a heroin-like high. Because
naloxone is a narcotic antagonist when injected
intravenously, it acts to nullify any high a “T’s and
Blues” addict might expect from the pentazocine
in a combination of TALWIN Nx and PBZ. When
taken as directed orally, the naloxone component
of TALWIN Nx is inactive. Thus, TALWIN Nx
continues to be a safe, effective, oral analgesic for
the relief of moderate to severe pain, now provid-
ing added security against misuse.
•Registered trademark of Ciba-Geigy Corp for tripelennamine.
Each tablet contains pentazocine ub
’’ydrochloride.USP, equivalent to 50 mg bast
and naloxone hydrochloride, DSP, 0.5 mg- *}, .
Caution: Federal law prohibits l«
dispensing without prescription.
Ikilwiif^
©Each tablet contains pentazocine HCI, usf^
equivalent to 50 mg base and naloxone
HCI, USR equivalent to 0.5 mg base.
The reformulation of Talwin 50 to Talwin Nx
involved the addition of 0.5 mg naloxone to
help prevent misuse by injection.
Vv/nfhrap-Breo/j
® 1984 Winthrop-Breon Laboratories
Please see following page for Brief Summary.
Tnlwiif^®
Each tablet contains pentazocine HCI, LISP equivalent to
50 mg base and naloxone HCI. USR equivalent to 0 5 mg base
Analgesic for Oral Use Only
Contraindications; Hypersensitivity to either pentazocine or
naloxone
TALWIN® Nx IS intended for oral use only Severe, potentially
lethal, reactions may result from misuse of TALWIN' Nx by
iniection either alone or in combination with other substances
(See Drug Abuse and Dependence section |
Warnings: Drug Dependence Can cause physical and psycho-
logical dependence (See Drug Abuse and Dependence ) Head
Injury and Increased Intracranial Pressure As with other potent
analgesics, respiratory depressant effects of the drug may elevate
cerebrospinal fluid pressure due to COj retention, these effects may
be markedly exaggerated in the presence of head in|ury, other
intracranial lesions, or a preexisting increase in intracranial pres-
sure Can obscure the clinical course of patients with head in|unes,
in such patients, use with extreme caution and only if deemed
essential Usape with Alcohol Due to potential for increased CNS
depressant effects, alcohol should be used with caution Patients
Receiving Narcotics Pentazocine is a mild narcotic antagonist
Withdrawal symptoms have occurred in patients previously given
narcotics, including methadone Certain Respiratory Conditions
Should be administered with caution in respiratory depression from
any cause, severely limited respiratory reserve, severe bronchial
asthma and other obstructive respiratory conditions, or cyanosis
Precautions: CNS Effect Use cautiously in patients prone to
seizures, seizures have occurred though no cause and effect
relationship has been established Therapeutic doses have in rare
instances, resulted in hallucinations (usually visual), disorientation,
and confusion, which cleared spontaneously within a period of
hours Such patients should be very closely observed and vital signs
checked, if the drug is reinstituted. it should be done with caution
since the acute CNS manifestations may recur Impaired Renal or
Hepatic Function Decreased metabolism of pentazocine in exten-
sive liver disease may predispose to accentuation of side effects, it
should be administered with caution in renal or hepatic impairment
In long-term use. precautions should be taken to avoid increases in
dose by the patient Biliary Surgery Some evidence suggests that
unlike other narcotics pentazocine causes little or no elevation in
biliary tract pressures, the clinical significance of these findings is
notyet known Information for Patients Sincesedation, dizziness,
and occasional euphoria have been noted, ambulatory patients
should be warned not to operate machinery drive cars, or unneces-
sarily expose themselves to hazards May cause physical and
psychological dependence taken alone and may have additive CNS
depressant properties in combination with alcohol or other CNS
depressants Myocardial Infarction Use with caution in patients
with myocardial infarction who have nausea or vomiting Drug
Interactions Usage with Alcohol See Warnings. Carcrrtogen-
esis. Mutagenesis. Impairment of Fertility No long-term studies
in animals to test for carcinogenesis have been performed Preg-
nancy Catepory C Should be given to pregnant women only if
clearly needed Labor and Delivery Use with caution in women
delivering premature infants Effect on mother and fetus, duration of
labor or delivery need for forceps delivery or other intervention or
resuscitation of newborn, or later growth, development, and
functional maturation of the child is unknown Nursing Mothers
Caution should be exercised when administered to a nursing
woman Pediatric Use Safety and effectiveness in children below
the age of 12 years have not been established
Adverse Reactions: Cardiovascular Hypotension, tachycar-
dia. syncope Respiratory Rarely, respiratory depression CNS
Acute CNS Manifestations In rare instances, hallucinations
(usually visual), disorientation, and confusion which have cleared
spontaneously within a period of hours, may recur if drug is
reinstituted Other CNS Effects (Dizziness, lightheadedness, seda-
tion. euphoria, disturbed dreams, hallucinations, irritability, excite-
ment. tinnitus, tremor Gastrointestinal Nausea, vomiting, con-
stipation, diarrhea, anorexia, rarely abdominal distress Allergic
Edema of the face, dermatitis, including pruritus, flushed skin, includ-
ing plethora Ophthalmic. Visual blurring and fncus'ng difficulty
Hematologic Depression of white blood cells (especially granulo-
cytes). which IS usually reversible, moderate transient eosinophilia.
Other Headache, chills, insomnia, weakness, urinary retention
Drug Abuse and Dependence: Controlled Substance.
TALWIN Nx IS a Schedule IV controlled substance
Dependence and withdrawal symptoms have been reported with
orally administered pentazocine Patients with a history of drug
dependence should be under close supervision Possible abstinence
syndromes in newborns after prolonged use of pentazocine during
pregnancy have been reported In prescribing for chronic use, the
physician should take precautions to avoid increases in dose by the
patient Tolerance to the analgesic effect is rarely reported, there is
no long-term experience with oral use of TALWIN Nx
The amount of naloxone present (0 5 mg per tablet) has no action
when taken orally and will not interfere with the pharmacologic
action of pentazocine, however, this amount of naloxone given by
injection has profound antagonistic action to narcotic analgesics
TALWIN Nx has a lower potential for parenteral misuse than the
previous oral pentazocine formulation, but is still subject to patient
misuse and abuse by the oral route
Severe, even lethal, consequences may result from misuse of tablets
by injection either alone or in combination with other substances,
such as pulmonary emboli, vascular occlusion, ulceration and absces-
ses. and withdrawal symptoms in narcotic dependent individuals
Overdosage; Treatment Oxygen, intravenous fluids, vasopres-
sors, and other supportive measures should be employed as indi-
cated. Assisted or controlled ventilation should also be considered
For respiratory depression, parenteral naloxone is a specific and
effective antagonist
Please consult full product information before prescribing
Winthrop-Breon Laboratories
Division of Sterling Drug Inc
New York, NY 10016
l^//r^rapBreo/7
MEDICAL
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June 28, 1985 • 8 am - 5 pm
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WHAX: A one-day computer seminar and ex-
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AMONG FEATURED SPEAKERS: Peter W.
Tolos, PhD, Stanford Medical School and
Howard L. Bleich, MD, Harvard Medical
School.
REQISTRATION: $50 fee before May 15 In-
cludes admission, lunch and reception.
CONTACT: Micros In Medicine, MOW
Libraries, 8701 Watertown Plank Rd,
Milwaukee, WI 53226 (414) 257-8323.
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ORGANIZATIONAL
SMS Board reaffirms its position:
Don't drop CME requirement
The SMS Board of Directors re-
affirmed its opposition to drop-
ping mandatory continuing edu-
cation for physicians at its Febr-
uary 2 meeting in Madison. De-
partment of Regulation and Licen-
sing Secretary Barbara Nichols
and Ronald M Sommer appeared
before the Board to discuss the
agency's recent recommendation
to abolish continuing education
for physicians and other profes-
sionals.
Ms Nichols told the Board that
"invoking the police power of the
state to condone professionalism
is an inappropriate way for the
state to use its limited resources.
This (CE process) squarely be-
longs within the professions," she
said.
Mr Sommer, who authored the
Department's report on contin-
uing education, said that manda-
tory continuing education was
"perpetrating a fraud upon the
public." The report concluded
that continuing education mis-
leads the consumer by giving the
false impression that those who
meet the requirements are compe-
tent to practice.
While Mr Sommer said he was
"convinced that there is no way to
truly assure the public of the com-
petency of professionals," he be-
lieves "there are alternatives to
CME to move us closer to compe-
tency." These alternatives in-
clude: (1) periodic retesting at the
"minimum competency level," (2)
a voluntary recertification pro-
gram at the state level, and (3) an
"extraordinarily tight" system of
CME which requires physicians
to take needs assessment tests and
then take courses to correct identi-
fied deficiencies.
Several SMS Board members
pointed out the problems associ-
ated with defining competency
and said that the defrauding-the-
public argument about continuing
education could be made about
licensing itself. Any certification
process implies competence, the
Board maintained.
In other action February 2, the
SMS Board of Directors voted to:
• Support the Medical Examin-
ing Board in its effort to fight a
rule recently adopted by the
Chiropractic Examining Board al-
lowing chiropractors to draw
blood.
• Seek a $1 million "cap" on
awards for medical malpractice in
Wisconsin, as opposed to a cap on
the Patients Compensation Fund
liability.
• Approve the appointment of
the following physicians to an
SMS Committee on Membership:
Timothy T Flaherty, MD,
Neenah; Allen O Tuftee, MD,
Beloit, and Richard D Fritz, MD,
Milwaukee.
• Approve a 1985 State Medical
Society budget of $2, 142,700; sub-
ject to House of Delegates review.
• Recommend to the House of
Delegates, which sets dues in
April, that there be no dues in-
crease in 1986.
• Accept a report from SMS
Services, Inc that it netted a
$49,000 profit in 1984.
• Endorse a "Drug Abuse Co-
caine Symposium" to be held on
April 18 and 19 in Milwaukee.
The symposium is being spon-
sored by the Wisconsin Institute
on Drug Abuse of the Tellurian
Community and the American
Medical Association.
• Cosponsor a second "Citizen's
Conference on Alcohol and Drug
Abuse" scheduled for October 3
and 4, 1985.
• Allow a student from each
medical school to attend Board
meetings as nonvoting members.
• Appoint Doctors John K Scott,
MD, Madison, SMS president-
elect; Jack Westman, MD, Madi-
son, and a representative from the
Society's Subcommittee on the
Public Health Consequences of
Nuclear Armaments, to represent
the Society in a special discussion
on the health consequence of nu-
clear war on February 11 with
Soviet physicians touring the US.
(See separate story elsewhere in
this issue.)
• Support a VISTA project ap-
plication of the Coalition of Wis-
consin Aging Groups aimed at ad-
dressing the cost of healthcare and
lack of housing alternatives for
low-income elderly persons.
• Approve a public relations
proposal for the Society, entitled
"REACH-Resource for Education
and Awareness of Community
Health: A Program to Improve the
Public Image of Physicians." This
proposal will be the subject of an
"SMS Update" report and mailed
to all SMS physicians.
• Sponsor a physician confer-
ence on child abuse scheduled
tentatively for May 18 in Madi-
son.
• Appoint David G DeCock,
MD, Madison, to the Regional Ad-
visory Committee of the UW Hos-
pital and Clinics' Med Flight serv-
ice (a helicopter emergency trans-
port service).
• Appointed Susan Turney,
MD, Marshfield, as the Internal
Medicine Section representative
on the Commission on Govern-
mental Affairs. ■
WISCONSIN MEmCAl.JOl'RNAI., MARCH l98.S:VOI.. 84
39
ORGANIZATIONAL
Mark your calendar for SMS Annual
Meeting April 25-27 in La Crosse
The State Medical Society of
Wisconsin will hold its 1985 An-
nual Meeting on April 25-27 in La
Crosse. The La Crosse Center is
the site for House of Delegates
and Scientific Sessions and the
Radisson La Crosse is the conven-
tion hotel.
"Cost Effective Care of the
Geriatric Population" is the theme
for several panels featured during
the meeting. Panels will be held
on: "Drugs and the Geriatric Pop-
ulation, A Masquerade"— Thurs-
day afternoon, April 25; "Eco-
nomic Considerations in Ration-
ing of Geriatric Care"— Friday
morning, April 26; "The Ethics of
Rationing Geriatric Care"— Friday
afternoon, April 26; and "Osteo-
porosis: Its Prevention and Treat-
ment"—Saturday morning, April
27.
The first session of the House of
Delegates will begin at 9:00 am
Thursday, April 25, with second
and third sessions scheduled for
1:45 pm Friday, April 27.
A summary of the resolutions to
be taken up by the House of Dele-
gates will appear in the April issue
of WMJ. [Physicians are urged to
contact their county society of-
ficers and delegates to express
their views. A list of county so-
ciety presidents and secretaries
appeared in the February issue. A
list of delegates and alternates ap-
pears elsewhere in this issue.]
Thursday evening, April 25,
SMS President Timothy Flaherty,
MD and Auxiliary President
Roberta Baldwin invite physicians
and spouses to attend the Presi-
dents' Reception and Dinner.
Musical entertainment will be
provided.
The Reverend Gary Turner,
Episcopal Diocese of Eau Claire,
will speak at the Medicine and
Religion Breakfast on Friday,
April 26, at 7:00 am. Reverend
Turner will discuss a "Native
American View of Medicine and
Religion."
WISPAC will once again spon-
sor the Socioeconomic Luncheon
featuring a prominent speaker
from political circles on Friday,
April 26, at 11:45 am.
Scientific programs from the
The link between alcohol abuse
and advertising and current ef-
forts to ban beer and wine adver-
tising on radio and television was
debated among representatives of
medicine, broadcasting, and the
beer industry February 12 in
Madison.
Conrad Andringa, MD, a mem-
ber of the State Medical Society's
Committee on School Health, told
members of the Wisconsin Broad-
casters Association that he saw
alcohol on a different level than
they did.
"As a physician I see the end
result of alcohol. Alcohol is the
number three killer in the US to-
day and 20 percent of all admis-
sions to Madison General Hospital
are alcohol related," he said.
Doctor Andringa illustrated the
pervasiveness of the problem by
pointing out that in 1981 Wiscon-
sin consumed 1 1 million gallons
of liquor and 164 million gallons
of beer.
He said that alcohol is the num-
ber one abused drug in the US to-
day. "I'm not so naive as to think
that we can ban it," he said.
"Rather, we should concentrate
on what we can do to prevent
alcohol from being misused."
He urged the broadcasters to do
more than produce and air public
service announcements on pre-
major specialties will be presented
throughout the day on Saturday,
April 27.
All Society physicians are
strongly encouraged to attend the
SMS Annual Meeting and take
part in both the business and
scientific matters of the Society.
The Annual Meeting Program
was mailed to members in early
March. ■
venting alcohol abuse. "We
should look at improving the
alcohol ads," he said. According to
Doctor Andringa, this means
changing the way alcohol is pro-
moted and by whom.
"Perhaps we could add a tag to
the end of commercials urging
people not to misuse this drug,"
he said. "We (medicine, broad-
casting, and the beer industry)
have a chance to do something
positive for a lot of people who go
through tragedy because of
alcohol."
Also speaking on the panel with
Doctor Andringa was John Sum-
mers, executive vice president of
government relations of the Na-
tional Association of Broadcasters,
and Thomas Reed, government
affairs manager for Miller Brew-
ing Company.
Mr Reed agreed with Doctor
Andringa that there was a tre-
mendous alcohol abuse problem
in this country, but said answers
that many legislators have pro-
posed such as banning advertising
of beer and wine and raising the
drinking age will do little to solve
the problem.
Mr Reed conceded that much of
the pressure the beer manufactur-
Medical Society asks broadcasters
to help fight alcohol abuse
40
WISCONSIN MEDICAI. |Ol RNAI-, MARCH 1985: VOL. 84
MEDICAL SOCIETY
ORGAN IZATIONAI,
ers are facing today from the
public to do something about their
advertising is because of their
reluctance to push alcohol moder-
ation in the past.
He said that the major brewers
have developed educational pro-
grams for the schools and civic
groups stressing that "moderate
consumption is an individual
responsibility and if you have a
problem, please seek help."
John Summers of the National
Broadcasters Association stated
that the evidence has turned up
no firm link between alcohol
abuse and advertising. He said
that his association is confident
that they have turned around
"Project Wart" movement to ban
beer and wine advertising over
the airwaves.
He still fears that someone on
Capitol Hill will tack an ad ban
proposal onto a Congressional
spending bill.
"One part of our act that we
really have to clean up," accord-
ing to Summers, "is our marketing
approaches for beer such as 100
free minutes of drinking in
taverns, sponsoring beer buses,
etc."
"We've started this, but we're
not finished and this is where we
are most vulnerable.” ■
SMS Task Force
on Medical Care
to meet Mar 22
The 1984 SMS Task Force on
Medical Care was to meet at So-
ciety offices in Madison March 22
to review preliminary reports of
the five work groups. These work
groups focus on the subjects of
Reimbursement and Delivery,
Quality Care, Competition, Phy-
sician-Hospital Relations, and
Physician Contracting. The Task
Force and its component work
groups have been meeting over
the past several months to re-
search, analyze, and offer policy
recommendations and strategies
for the future. The Task Force will
be reporting to the SMS House of
Delegates in April. The Task
Force is assigned to the SMS Phy-
sicians Alliance Division/Brian
Jensen, director. ■
HEALTH PROFESSIONALS!
The Army Medical Department
represents the largest comprehensive
system of health care in the United
States and offers unique advantages
to the student, resident, and practi-
tioner in the following professions;
• Neurosurgery
• General Surgery
• Orthopedic Surgery
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As an Army Officer, you will receive
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SPECIALTY AREA OF INTEREST
Medical School Scholarships are Available
WISCONSIN MF.mCALJOCRNAI,, MARCH 1985 :V01. 84
4
ORGANIZATIONAL
State Medical Society of Wisconsin
Program Schedule— Annual Meeting, Apr 25-26-27, 1985, La Crosse
THURSDAY, APRIL 25
Section Delegates Caucus
Taebel Room (LC), 8:00 am
District 1 Caucus
Erwin Room (LC), 8:00 am
Registration H/D
Flaherty /Treffert Room (LC), 8:00 am
House of Delegates First Session
Flaherty /Treffert Room (LC), 9:00 am
Drugs & The Geriatric Population
Luncheon / Program
Taebel Room (LC), 12:00-1:30 pm
Reference Committee Meetings
Mezzanine Level, Radisson, 1:00 pm
Presidents' Reception and Dinner
Ballroom, Radisson, 7:00 pm
FRIDAY, APRIL 26
Medicine & Religion Breakfast
Ballroom, Radisson, 7:00 am
Economic Considerations in
Rationing of Geriatric Care, Panel 1
Scott Room (LC), 9:00 am-1 1:30 am
The Ethics of Rationing of Geriatric
Care, Panel II
Scott Room (LC), 2:00 pm-4:00 pm
Wisconsin Academy of
Ophthalmology BOD Meeting
Erwin Room (LC), 11:00 am
District 1 Caucus
Scott Room (LC), 11:30 am
Socioeconomic/ WISP AC Luncheon
Radisson, 11:45 am
Physical Medicine & Rehabilitation
Luncheon & Program
Taebel Room (LC), 12:15 pm
Plastic Surgery Program
Directors Room (LC), 1:00 pm
Registration H/D
Flaherty /Treffert Room (LC), 1:00 pm
Ophthalmology Program
Erwin Room (LC), 1:30 pm
House of Delegates Second & Third
Sessions
Flaherty /Treffert Room (LC), 1:45 pm
Key: La Crosse Center (LC)
Family Physicians Program
Scott Room (LC), 2:00 pm
Wisconsin Society of Pathologists
BOD Dinner /Meeting
Minnesota Room, Radisson, 6:00 pm
Wisconsin Surgical Society
Council Dinner
Iowa Room, Radisson, 5:30 pm
Wisconsin Society of Internal
Medicine Dinner
Ballroom, Radisson, 6:30 pm
Past Presidents' Reception and
Dinner
Illinois Room, Radisson, 6:00 pm
SATURDAY, APRIL 27
Surgery Program & Luncheon
St Francis Medical Center
7:45 am-l:00 pm
Surgery Program
Scott Room (LC), 1:30 pm
Surgery Evening Program
and Dinner
Country Club, 600 Losey Blvd
South, 6:30 pm (by invitation only)
SMS Board of Directors Breakfast
Meeting
Illinois Room, Radisson, 8:00 am
Osteoporosis: Its Prevention and
Treatment, Panel HI
Scott Room (LC), 8:00 am- 12:00 noon
Internal Medicine Program
Scott Room (LC), 8:00 am
Wisconsin Society of Internal
Medicine Council
Minnesota B Room, Radisson,
12:30 pm
Preventive Medicine Program
Scott Room (LC), 8:00 am
Otolaryngology Program
Treffert Room (LC), 8:30 am
Pathology Program
Flaherty Room (LC), 9:00 am
Wisconsin Society of Pathologists
Reception and Dinner
La Crosse Club, 5:00-9:00 pm
Dermatology Program
Taebel Room (LC), 9:00 am-l:00 pm
Gundersen Clinic, 1:00 pm-5:00 pm
Anesthesiology Luncheon and
Program
Erwin Room (LC), 12:15 pm
Radiation Oncology Luncheon and
Program
Iowa Room, Radisson, 12:15 pm
Psychiatry Luncheon and Program
Zielke Room (LC), 12:15 pm
Emergency Medicine Program
Directors Room (LC), 1:00 pm
SCIENTIFIC PROGRAM
COMMITTEE
Kenneth 1 Gold, MD, Beloit
Chairman
Charles L Junkerman, MD, Milwaukee
Edwin L Overholt, MD, La Crosse
John L Raschbacher, MD, Waukesha
Philip H Utz, MD, La Crosse
SCIENTIFIC PROGRAM PLANNERS
Commission on Continuing
Medical Education
C William Freeby, MD, Appleton
Chairman
Martin Z Fruchtman, MD, Waukesha
Vice-chairman
Bradley G Garber, MD, Osseo
Kenneth I Gold, MD, Beloit
Edwin L Overholt, MD, La Crosse
Thomas P Simerson, MD, Merrill
Frank E Berridge, MD, Milwaukee
J David Lewis, MD, West Bend
Joseph J Mazza, MD, Marshfield
Kathy P Belgea, MD, Wausau
James T Houlihan, MD, Woodruff
Charles L Junkerman, MD, Milwaukee
Charles E Holmburg, MD, Waukesha
Benson L Richardson, MD, Green Bay
Ed Overholt, UW, Madison
(medical student)
Ex officio
Dean Arnold L Brown, MD, Madison
University of Wisconsin Medical
School
Dean Edward J Lennon, MD,
Milwaukee
Medical College of Wisconsin
42
WISCONSIN MEOICAI JOI RNAI,, MARCH 1985: VOl.. 84
^^Windo(xr± to ^^Wo%[d
sponsored by The Medical College of Wisconsin
• Travel with Fellow Medical College of • Tax-Deductible Contribution Portion to
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• Accredited Medical Education offered
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June 1985 Rio de Janeiro - Buenos Aires
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HOUSE OF DELEGATES: 1985
State Medical Society of Wisconsin
Speaker: Duane W Taebel/Vice Speaker: Vernon M Griffin
County Medical Society
Delegate
Alternate
County Medical Society
Delegate
Alternate
FIRST DISTRICT
SECOND DISTRICT
KENOSHA
. Douglas G Devan
Lee H Huberty
COLUMBIA-
Charles E Pechous Jr
William J Jeranek
MARQUETTE-
Clifton E Peterson
Edward L Koch
ADAMS
. Robert T Cooney
Martin L Janssen
MILWAUKEE
. Richard P Barthel
Avadh B Agarwal
DANE
. A D Anderson
S Craighead Alexander
John E Cordes
William H Annesley, Jr
Raymond W M Chun
Dolores A Buchler
Thomas J Cox
Daniel P Collins
Peter L Eichman
Robert P J Christraann
Donald P Davis
Carl S L Eisenberg
Robert B Gage
Paul F Dvorak
William E Finlayson
Pamela Parke-Miller
William L Kopp
Norman M Jensen
Harry R Foerster Jr
Richard D Lindgren
Robert A McDonald
Jerome W Fons Jr
Howard S Lubar
Paul A McLeod
Beth Foster
Bernard F Micke
Kathryn P Nichol
Glenn H Franke
David L Nelson
Joseph F Sackett
Lucille B Glicklich
Sandra L Osborn
William R Scheibel
Paul E Hankwitz
John K Scott
Phillip J Schoenbeck
Jacqueline C Howell
Robert B Shapiro
Benton C Taylor
H Myron Kauffman
Sigurd E Sivertson
Richard 0 Welnick
Stanley A Korducki
Paul M Stiegler
Ronald D Wenger
Charles W Landis
John D Wegenke
Paul A Wertsch
Robert F Madden
DODGE
. Norman J Schroeder 11
M Ahmad Ali
James A Means HI
Dean D Miller ,
GRANT
. Glenn C Hillery
Leo E Becher
John P Mullooly
Archebald R Pequet
Robert F Purtell, Jr
GREEN
. Melvin S Blumenthal
Jan E Erlandson
Carlos A Jaramillo
Velayudhan K Nair
Thomas A Reminga
IOWA
. Harald P L Breier
Timothy A Correll
Roger L Ruehl
William L Treacy
JEFFERSON
. Roland R Liebenow
George L Gay, Jr
Frank H Urban
LAFAYETTE
. Richard G Roberts
Lyle L Olson
Wess R Vogt
Patrick R Walsh
RICHLAND
. James J Tydrich
Gerald R Wisnewski
Jeffrey M Weber
ROCK
. Jordon Frank
Jovan L Djokovic
DeLore Williams
Arthur C Plautz, Jr
William H Pollard Jr
D MacLean Willson
Marshall F Purdy
William P West
Donald A Wollheim
Carol E Young
Raymond C Zastrow
SAUK
. John A DeGiovanni
Donald W Vangor
OZAUKEE
. Ted D Elbe
Robert A Pfeffer
RACINE
. Gary C Larmore
Robert G Anderson
THIRD DISTRICT
Carl F Myers
Dai Kap Kim
Marvin G Parker
Kevin W McCabe
CRAWFORD
. Eli M Dessloch
Vacancy
WALWORTH
Raymond E Skupniewicz
. Irwin J Bruhn
Jerome J Veranth
Rocco S Galgano
JUNEAU
. Leon J Radant
. David L Nelson
Vacancy
Arthur G Barbier
LA CROSSE
WASHINGTON
. Charles S Geiger Jr
William J Listwan
Kermit L Newcomer
Thomas P Lathrop
Michael C Reineck
Eric F Weber
Stephen B Webster
Jack M Lockhart
WAUKESHA
. John A Harris
Michael P Dailey
David E Westgard
Steven T Tichy
Charles E Holmburg
Peter T Geiss
MONROE
. Edward 0 Lukasek
Lou R Schmidt
G Daniel Miller
Patrick K Keane
TREMPEALEAU-
Michael G O'Mara
Uriel R Limjoco
John D Riesch
James A Stabler, II
Timothy G McAvoy
Thomas C Nolasco, Jr
JACKSUN-
BUFFALO
. Jeffrey K Polzin
Elmer P Rohde
Lee M Tyne
John W Wakely
VERNON
. Timothy J Devitt
Robert A Starr
County Medical Society
Delegate
Alternate
FOURTH DISTRICT
CLARK
. Bahri 0 Gungor
Reganti V R Reddy
FOREST
. Burton S Rathert
Enzo F Castaldo
LANGLADE
. James 0 Moermond Jr
Michael J Reinardy
LINCOLN
. James S Janowiak
Modesto M Ferrer
MARATHON
. Curt G Grauer
William R Owen
J Garry Sack
Gerald H Schroeder
Kathy P Belger
Joel R De Koning
Thomas 0 Miller
Thomas H Peterson
ONEIDA-VILAS
. James T Houlihan
William F Raduege
Fred W Fletcher
Vacancy
PORTAGE
. Daniel L Brick
Robert J Jaeger
PRICE-TAYLOR
. T Bayard Frederick
Michael A Haase
WOOD
. Raymond L Hansen
William J Maurer
Michael P Mehr
Charles C Sorensen
John E Thompson
Richard H Ulmer
Michael J Kryda
John P Milbauer
Jung Kyun Park
Robert E Phillips
Mario V Ponce
John W Schaller
FIFTH DISTRICT
CALUMET
. . Badri N Ganju
Julio C De Arteaga
FOND DU LAC
. . Kenneth A Stormo
Brian C Christenson
David R Weber
Russell S Felton
GREEN LAKE-
WAUSHARA
. . Alan L Taber
Jeffrey J Carroll
OUTAGAMIE
Jack K Burr
C William Freeby
Henry Chessin
Vacancy
Henry A Folb
Vacancy
John R Lindstrom
Vacancy
WAUPACA
. . Lloyd P Maasch
Joseph W Weber
WINNEBAGO
. . George W Arndt
Roy E Buck
James L Basiliere
Owen L Felton
Fredric L Hildebrand
Gerald A Gehl
Kenneth M Viste, Jr
Johan A Mathison
Eric B Wilson, Jr
Vacancy
SIXTH DISTRICT
BROWN
. . Rolf S Lulloff
Myron M Marlett
Sally M Schlise
Robert T Schmidt Jr
Jack A Swelstad
Thomas P Koehler
Carl R Poley
Benson L Richardson
Ronald G Thune
Fred H Walbrun
DOOR-KEWAUNEE . , . .
. . John J Beck
Mark 0 Weisse
MANITOWOC
. . Edward J Barylak
David D Pfaffenbach
Steven D Driggers
Vacancy
MARINETTE-
FLORENCE
. . Burnell D Stripling
John E Kraus
OCONTO
. . Glen J HeinzI
Vacancy
SHAWANO
. . Ronald L Logemann
John J Albright
SHEBOYGAN
. . D King Aymond
Robert A Keller
Vytas K Kerpe
George L Hess
James R Pawlak
Stephan C Westcott
County Medical Society
Delegate
Alternate
SFVFNTH DISTRICT
BARRON-WASHBURN
BURNETT
Donald E Riemer
James F Maser
CHIPPEWA
Merne W Asplund
Peter W Holm
EAU CLAIRE-
DUNN-PEPIN
Daniel F Johnson
Thomas E Pederson
Karl E Walter
James E Willard
Verne A Sperry
Peter H Ullrich
Vacancy
Vacancy
PIERCE-ST CROIX
Joseph E Powell
James R Beix
POLK
John 0 Simenstad
William W Young
RUSK
Howard T Chatterton
Douglas M DeLong
EIGHTH DISTRICT
ASHLAND-BAYFIELD-
IRON Vacancy John C Oujiri
DOUGLAS KG Ramesh Clarence M Scott
SAWYER Lloyd M Baertsch Paul Strapon 111
SFCTIONS
Delegate
Alternate
Allergy & Clinical
Immunology
. . Martin Z Fruchtman
John J Ouellette
Anesthesiology
. . Warren J Holtey
John F Kreull
Dermatology
. . Joel E Taxman
Nyles R Eskritt
Emergency Medicine . . .
. . Emma K Ledbetter
Vacancy
Family Physicians
. . Robert S Viel
Vacancy
Hospital Medical Staff . .
. . Leo R Grinney
Stephen R Peters
Internal Medicine
. . Philip J Dougherty
Anthony P Ziebart
Medical Faculties
. . Mark J Ciccantelli
Manucher J Javid
Medical Students
. . John R Meurer
John A Zernia
Neurology
. . R Clarke Danforth
Gamber F Tegtmeyer, Jr
Neurosurgery
. . Glen A Meyer
S Marshall Cushman
Obstetrics-Gynecology . .
. . Charles Hammond
Mark J Popp
Ophthalmology
. . M Thomas Chemotti
Vacancy
Orthopedics
. . Paul A Jacobs
David D Mellencamp
Otolaryngology
. . Glenn M Seager
Thomas W Grossman
Pathology
. . Edward A Burg Jr
Jay F Schamberg
Pediatrics
. . Ferrin C Holmes
Vacancy
Physical Medicine &
Rehabilitation
. . Sridhar V Vasudevan
William J Lajoie
Plastic Surgery
. . John E Hamacher
Vacancy
Preventive Medicine . . . .
. . Vacancy
Paul R Ebling
Psychiatry
. . Rudolf W Link
Vacancy
Radiology
. . Marcia J S Richards
Vacancy
Resident Physicians
. . Vacancy
Vacancy
Surgery
. . P Richard Sholl
Louis C Bernhardt
Urology
. . Stuart W Fine
Charles W Troup
COUNTY SOCIETIES
Health education radio series is renewed
Doctor and Mrs Waldkirch
DANE: Dane County Medical So-
ciety members have been asked
to assist in preparing one-minute
features on health topics for pre-
sentation on a Madison radio
station. The Dane County Medi-
cal Society Board of Trustees
heartily endorsed revival of this
program of several years ago.
Under its new call letters WTDY
Radio— 1480 (formerly WISM—
AM) has changed its program-
ming format to include more in-
formation directed to an adult
audience. Part of this change in-
cludes broadcasting one- to two-
minute features on various health
topics five days per week. Under
the renewed program a differ-
ent DCMS member will prepare
five features, one to two minutes
in length, suitable to his/her
specialty. Program credits will
identify the individual physician
and the Dane County Medical
Society. Further information
may be obtained by contacting
the Dane County Medical So-
ciety, PO Box 1109, Madison,
W1 53701; or calling (608) 257-
6781.— Don A Bukstein, MD,*
Secretary
SHEBOYGAN: Robert A Hel-
miniak, MD,* recently was
elected president of the Sheboy-
gan County Medical Society. He
will serve through December
1986. Also elected to serve for
two years are Christopher L Lar-
son, MD,* president-elect; and
Robert] Scott, MD,* secretary.
—Robert J Scott, MD, * Secretary
BROWN: Raymond M Wald-
kirch, MD,* Green Bay, was
honored for his 50 years of prac-
tice by the Brown County Medi-
cal Society at its January meeting
and by the State Medical Society.
Both societies presented him
with a plaque recognizing him for
distinguished service for fifty
years as a member of the Brown
County Medical Society and the
State Medical Society, 1934-1984.
County society President James R
Mattson, MD* conducted the
meeting and Lyle H Edelblute,
MD, * chairman of the Awards
Committee, gave a brief bio-
graphical sketch of Doctor Wald-
kirch who responded with a few
comments regarding the changes
in the practice of medicine during
his 50 years of service.
The remainder of the evening
revolved around the annual
auction sponsored by the Brown
CMS's Auxiliary to raise funds
for the local scholarship program.
One hundred and fifty members
and their spouses attended the
meeting.— Stephen D Hathway,
MD,* Secretary ■
SMS dues due by May 15
In April members will receive their final dues statement for membership in the State Medical Society.
Regular member dues of $455 must be paid in full no later than May 15, 1985 to continue as a member,
as well as other member classifications with varying dues amounts. The Society's official member-
ship roster, listing all paid members of record at SMS headquarters as of May 31, 1985, will be used
in the preparation of the Wisconsin Medical Journal's Membership Directory to be published in the
July issue. To ensure a complete and accurate roster of current members and those planning to join
for the first time are urged to make their final payments well in advance of the May 15 deadline to
allow for administrative functions to be completed by the May 31 cutoff date. ■
46
WISCONSIN MEDICAL JOURNAL, MARCH 1985: VOL. 84
Mohin*
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A public service of this publication.
SOCIOECONOMICS
^
Governor delivers 1985-87 budget;
many healthcare items included
On January 29 Governor Earl
formally presented to the Legisla-
ture his 1985-87 budget which
contained a number of healthcare
items. They include:
• A 3.5% increase in Medicaid
rates is proposed for each year of
the biennium. Additionally, cov-
erage of several Medicaid services
(drugs, certain dental procedures,
ambulatory services for children)
is restored.
• The State proposes to subsi-
dize the enrollment of low-income
Medicare beneficiaries in HMOs.
Under the proposal, persons with
income less than 140% of the
poverty level would be eligible, in
up to four pilot areas, to have the
State pay all or a portion of the
cost of HMO enrollment. Approx-
imately $500,000 is allocated to
pay for these HMO premiums (in
addition to Medicare reimburse-
ments) between January 1, 1986
and June 30, 1987.
SMS has expressed its concern
that this proposal, as it now
stands, subsidizes HMOs instead
of subsidizing low-income elderly.
Funding designed to relieve the
burden of healthcare costs on low-
income elderly consumers should
not force those consumers to give
up their choice of healthcare pro-
vider. SMS believes subsidies
made directly to the client, to be
used to offset healthcare costs,
would be preferable to subsidies
only to HMOs.
• Under the Governor's budget
bill, the mandated insurance cov-
erage for mental health, alcohol-
ism, and drug abuse would be
substantially modified. Required
inpatient coverage would be
reduced from 30 days to the lesser
of $6,300 or 25 days, with a 10%
copayment by the recipient. Out-
patient coverage requirements
would be increased from $500 to
$1,000, with a 10% copayment;
also, a requirement is added for
$1,000 worth of coverage for day
treatment /partial hospitalization,
with a 10% copayment. Total an-
nual coverage (inpatient, out-
patient, and day treatment) would
not have to exceed $7,000.
The State Medical Society has
objected to these proposed
changes. The Society is on record
in opposition to mandated insur-
ance benefits and further believes
that the proposed changes would
make a bad mandate worse.
• An expansion of the 51.42/
Medicaid "gatekeeper" program
is proposed. Presently under this
program, all mental health, alco-
holism, or drug abuse care for
Medicaid recipients between ages
22-64 years must be approved by
the county 51.42 board. The board
1983 Health spending
The nation's 1983 health expenditures were $355 billion— an
average of $1,459 per person— Health Care Financing Review has
reported. This is 10.8% of the GNP. Of the total $313 billion was
for personal healthcare.
In its detailed annual review of data compiled by the Health Care
Financing Administration, the publication said that healthcare cost
outlays rose 10.3% between 1982 and 1983.
Here are the funding sources for the 1983 healthcare dollar (which
totaled $313 billion of the $355 billion spent for health in the US in
1983):
Private health insurance
31 cents
Direct patient payments
24 cents
Medicare
17 cents
State, local governments
8 cents
Other federal government programs
7 cents
Federal Medicaid
5 cents
State Medicaid
5 cents
Philanthropy
3 cents
Here's where the money goes:
Hospital care
41 cents
Physicians' services
19 cents
Nursing home care
8 cents
Other services, goods
20 cents
Research, construction, etc.
12 cents
The 29-page article, "National Health Expenditures, 1983," by
Robert M Gibson, et al, appeared in the Winter, 1984 volume of
Health Care Financing Review, which has just been published.
Physicians who wish reprints may direct their request to M Carol
Pearson, Division of National Cost Estimates, Room 2-C-7, Meadows
East Building, 6325 Security Boulevard, Baltimore, Maryland
21207. ■
WISCONSIN MEniCAI.JOl RNAI., MARCH 1985:VOL. 84
49
SOCIOECONOMICS
GOVERNOR DELIVERS
also pays a share of the Medicaid
cost, usually 10% or 20%. With
the proposed expansion, mental
health or AODA services for all
Medicaid recipients would re-
quire 51.42 board approval, with
the board paying the entire state
share (42%) for inpatient care to
persons aged 22-64 and paying
20% for all other services and
persons.
The gatekeeper program, in its
current form, has been proble-
matic with sometimes arbitrary or
inappropriate denials of service by
the local 51.42 board. The pro-
gram puts the county in the diffi-
cult position of having a strong
financial incentive to disapprove
requests for care or having to pay
out of limited funds for care pre-
viously funded through Medicaid.
The State Medical Society has ob-
jected to any expansion of this al-
ready problematic program.
In addition to these issues SMS
expects strong efforts to be made
seeking inclusion of mandatory
chiropractic insurance coverage,
mandatory open-panel participa-
tion in HMOs and PPOs for den-
tists, optometrists, podiatrists, and
others, and repeal of the Capital
Expenditure Review Program.
The budget bill has now gone to
the Joint Finance Committee
which will be working on it for
the next several months.
SMS lobbyists Don Lord and
Terry Hottenroth of the Society's
Physicians Alliance Division will
be following all of the healthcare-
related issues as well as other
issues of particular concern to
physicians as citizens. ■
1985 ANNUAL MEETING: APRIL 25-27, LA CROSSE
Make yours
a smokeless
pregnancy
Bright, colorful and conveniently sized, this brochure,
pointing out the hazards smoking poses for both baby and
mother, is ideal for insertion in patient mailings. Order a
supply for your medical practice— at no charge! To order,
write;
SMS Communications Dept
PO Box 1109
Madison, Wisconsin 53701
50
WISCONSIN’ MFDICAI. jOl'RNAL, MARCH 1985: VOL. 84
For professional liability insurance, the stakes are too
high to depend on anyone else.
That's why the State Medical Society has endorsed a
professional liability plan which has been developed
especially for Wisconsin physicians.
Available only to members of the SMS— and offered
through SMS Services, Inc.— this medical malpractice policy
has superior features including:
• Consent of the physician is required before settlement of
any claim.
• Availability of legal counsel, experienced in defendant
medical liability.
• All members of claims and underwriting committees are
Wisconsin physicians.
• Occurrence coverage provided for claims arising during
the policy period, even if claim is reported at a later
time.
For the best in professional liability coverage, contact
SMS Services, Inc. at (608) 257-6781 or toll-free 1-800-362-9080
We know how vital it is to safeguard the present...
and to protect the future.
Endorsed by the
State Medical Society
of Wisconsin
A respected leader in coverage for preferred markets.
.P^^^bbottl^sJorthwes^eh^ western, SisteijKennylnstiliite^
A(x6rrJriodwns%C^ Ghildrgn’s Medical Certe'&^^ ..
%'kytSi dJ#^ ^ . and Men^s caii' stay a short, v
budget' , The Ar^oinmo^atjoris al^ ;
.' ^onomieM'fc^^ pahoi^ befere^d after /
•S..V
Turn of the century
trephine forcranial surgery
and tonsillotome for
removing tonsils.
We’ ve been defending
doctors since
these were the
state of the art.
These instruments were the best available at
the turn of the century. So was our professional
liability coverage for doctors. In fact, we
pioneered the concept of professional
protection in 1899 and have been providing
this important service exclusively to doctors
ever since.
You can be sure we’ll always offer the most
complete professional liability coverage you
can carry. Plus the personal attention and
claims prevention assistance you deserve.
For more information about Medical
Protective coverage, contact your Medical
Protective Company general agent.
tutrix
William E. Herte, Jerry E. Kronsnohle, 850 North Elm Grove Road, Elm Grove, Wisconsin 53122, 414/784-3780
New KODAK EKTACHEM DT60 Analyzer
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With the DT60 Analyzer
you perform key chemistry
tests in your own office
instead of using an out-
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tests include glucose,
cholesterol, triglycerides,
BUN, uric acid, sodium,
and potassium, with total
hemoglobin and bilirubin
coming soon.
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Get test results in five
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up to 75 tests an hour.
Save time waiting for
results to assist in your
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The DT60 Analyzer uses
proven technology and
methodology from the
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provide millions of accurate,
precise results to clinical
laboratories nationwide.
The simplicity
you need
The DT60 Analyzer, com-
pact as a personal com-
puter, features dry slide
technology to eliminate
wet reagents. It is auto-
mated to free up your
staff, and training takes
only minutes. From the
finger-stick sample to
results printout, the DT60
Analyzer is simplicity itself.
To see what the DT60
Analyzer can do for you,
write Eastman Kodak Com-
pany, Dept. 740-B, 343 State
Street, Rochester, NY 14650,
or call 1 800 44KODAK,
Ext 423(1 800 445-6325,
Ext 423) today.
Leading the way in healthcare
technology for over 100 years.
KODAKEKTACHEM
Clinical Chemistry Products
May not be available in all areas.
who IS number 1
in medical
office computer
systems in
Wisconsin?
HDX Clinical Hanagenent Systen
1) Financial Accounting
2) Insurance Clain Tracking
6) Appointnent Scheduling
7) Hedical History
Not IBM nor Apple nor any other nationally-known
computer name. The answer is Advanced Technology
Associates. Number 1 means the most complete systems; the
most logical match of hardware, software and services. ATA is
the source for total packages — computers, terminals, printers,
special medical programs, careful installation, training for
your people and after-sale support.
Considering the scope of our Wisconsin experience, it
should not surprise you that ATA is endorsed by the State
Medical Society.
May we send you information listing your benefits from
a strictly medical office computer system? Call or write.
Advanced Technology Associates
4710 W. North Avenue, Milwaukee, Wl 53208
(414) 445-4280
In Wisconsin call toll free 1-800-242-4280.
Endorsed by SMS Services, Inc For members of the State Medical Society ot Wisconsin.
PHYSICIANS EXCHANGE
Primary Care Physician position is
available at the University of Minnesota
Boynton Health Service, a comprehensive
outpatient facility serving a population of
66,000 students, faculty and staff on the
Twin Cities campus. Thirty-five full-time
equivalent physicians, 5 nurse practi-
tioners, and 15 registered nurses are on
staff. The physician is case manager for a
set of established patients. Specialty con-
sultations available on-site. Continuing
medical education, quality assurance
review, and clinic accreditation provided.
The position requires an MD degree.
Board certification or eligibility in a pri-
mary care specialty, and license to prac-
tice in Minnesota. Must have a broad
range of medical abilities and relate well
to an educated, health-conscious clientele.
Experience or interest desirable in public
health aspects of infectious disease control
and group practice. Salary competitive
and commensurate with training and ex-
perience. Regular hours and excellent
fringe benefits including paid professional
liability insurance. Position available July
1, 1985. Please send resume by May 10,
1985 to Donald Severson, MD, Chair,
Physician Search Committee, University
of Minnesota, Boynton Health Service,
410 Church Street SE, Minneapolis, Minn
55455. For further information, call Dr
Severson at (612) 376-5293. The Univer-
sity of Minnesota is an equal opportunity
educator and employer and specifically in-
vites and encourages applications from
women and minorities. 3/85
Internal Medicine. Join multispecialty
group of nine physicians in Sturgeon Bay,
Wisconsin. Primary care, consultations.
Modern 110-bed hospital. Attractive
financial package. Live in beautiful Door
County. Charles Nelson, Fox Hill Associ-
ates, 250 Regency Court, Waukesha,
Wisconsin 53186; ph 414/785-6500 col-
lect. p2-3/85
RATES: 50« per word, with a minimum
charge of $20.00 per ad. BOXED AD
RATES; $25.00 per column inch.
DEADLINE: Copy must be received by the
1 5th of the month preceding month of issue;
e.g., copy for the August issue is due July 15.
Send copy to: Wisconsin Medical Journal,
Box 1109, Madison, Wisconsin 53701; or
phone (area code 608| 257-6781; or toll-free
in Wisconsin; 800/362-9080.
MEDICAL YELLOW PAGES
Second Family Practitioner needed to
staff a satellite of a 38-physician multi-
specialty group in Kiel, a beautiful small
community in East Central Wisconsin, At-
tractive income arrangements, association
membership possible after one year, pen-
sion and profit sharing, extensive fringe
benefits. Contact R B Windsor, MD, 101 1
North 8 St, Sheboygan, WI 53081; ph 414/
457-4461. c2tfn/85
General Surgeon. Board certified or eli-
gible to replace retiring surgeon in 16-
physician multispecialty group practice (2
surgeons, 2 Ob/Gyn, 6 internists and 6
pediatricians). Two-year salary guarantee
with full partnership available at begin-
ning of third year. Send CV to T E Flood,
Administrator, Beaumont Clinic, Ltd,
1821 So Webster Ave, Green Bay, WI
54301. p2-4/85
Orthopedic Surgeon. An excellent op-
portunity is available for two orthopedic
surgeons to join a progressive Medical
Group in Central Minnesota. The com-
munity serves a population base of
225,000 individuals and is an excellent
base for an orthopedic surgeon. St Cloud,
Minnesota is the hub of the State and is
home to three major colleges. It is geo-
graphically located to provide quick ac-
cess to the Metropolitan-Twin Cities area.
The St Cloud community has a 500-bed
hospital with all the latest medical and
technological advancements to assist the
practicing orthopedic surgeon. If inter-
ested in this excellent opportunity, please
call collect either Dr LaRue Dahlquist,
President, and/or Daryl Mathews, Ad-
ministrator, at 612/251-8181 and/or send
curriculum vitae to St Cloud Medical
Group, 1301 West St Germain Street, St
Cloud, Minnesota 56301. 2-5/85
Family Physician and Internist, Pedi-
atrician, OB/GYN, Board eligible /certi-
fied. Full or part-time, to join a busy,
established group of physicians in Mil-
waukee. Attractive income. Send cur-
riculum vitae to PO Box 17366, Milwau-
kee, WI 53217. 2-7/85
Academic Internist to join expanding
dynamic young Ambulatory Care Group
at the Milwaukee Regional Medical
Center. Responsibilities to include: pri-
mary patient care, resident /physician
education, and employee health. Oppor-
tunities for program development, ad-
ministration, research, and advancement
in clinical faculty track. Send inquiries to
Kenneth E Smith, MD, Director, Primary
Care Clinic, Medical College of Wiscon-
sin, 8700 West Wisconsin Ave, Milwau-
kee, Wis 53226. Equal opportunity /affir-
mative action employer M/F/H. 1-3/85
Family Practitioner needed to join
established Family Practice group in East
Central Wisconsin city of 50,000 on
beautiful Lake Winnebago. Competitive
salary, fringes, excellent recreation area.
Send CV to MS Knier, MD, 555 S Wash-
burn, Oshkosh, Wis 54901; 414/426-0265.
lOtfn/84
Board Eligible Orthopedic Surgeon to
join established orthopedic practice in
East Central Wisconsin. Contact Dept 553
in care of the Journal. 2tfn/85
Wanted— Qualified physician to prac-
tice emergency medicine in southeastern
Wisconsin. Our group is small and flexi-
ble. Salary is negotiable. If interested, send
CV to Associated Emergency Room Phy-
sicians, SC, 1131 Sherwood Lane, Cale-
donia, Wis 53108; ph 414/835-4489.
pl-3/85
Internal Medicine— Board certified or
eligible, to join 17-physician multi-
specialty clinic with 7-physician internal
medicine department. Located in beauti-
ful Wisconsin lakeshore community of
35,000. Competitive salary, complete
fringe benefits, generous vacation time.
Send CV to: Administrator, Manitowoc
Clinic, SC, PO Box 3008, Manitowoc, WI
54220. 1-5/85
Madison, Wisconsin. Experienced phy-
sician for ambulatory care center. Medic-
East, first and only independent ACC in
Madison. Now well established. Located
in heart of Eastside of Madison. Appli-
cants BC/BE demonstrated experience in
primary care, well-developed com-
munication skills. Competitive salary, ex-
cellent benefits, attractive practice setting.
Contact David A Goodman, MD, Medic-
East, 2810 E Washington, Madison, WI
53704; ph 608/244-1213. ltfn/85
Internists— BC / BE Internist needed to
join five general internists in multi-
specialty group practice in north-central
Wisconsin. Competitive salary and bene-
fits. General medicine training required.
Cosmopolitan community and excellent
recreational area. Send CV to D K Augen-
baugh, MD, 2727 Plaza Dr, Wausau, WI
54401; or phone 715/847-3328. ltfn/85
Family Practice physician MD or DO
Board eligible or certified. Contact Leon
Gilman, 4957 West Fond du Lac Ave, Mil-
waukee, Wi 53216 or call 414/871-7900.
1-3/85
WISCONSIN MEDICAL JOURNAL, MARCH 1985: VOL. 84
59
MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
continued
Family Practice position available at
Stanley, Wisconsin. This physician would
join an existing family practitioner in a
hospital-affiliated satellite center of
Marshfield Clinic, a major multispecialty
referral center. The ideal candidate would
enjoy practicing a full medical spectrum
including obstetrics and pediatrics, would
enjoy working in a modern clinic facility
that is physically attached to a 41 -bed
community hospital, and would enjoy liv-
ing in a small rural community only 30
minutes from Wisconsin's fastest growing
metropolitan area that contains a major
University of Wisconsin campus. This op-
portunity offers a $63 thousand starting
salary plus an extensive fringe benefit pro-
gram. Please send curriculum vitae with
first letter to: John P Folz, Assistant Direc-
tor, 1000 North Oak, Marshfield, Wiscon-
sin 54449. l/85;3/85
Family Practitioner, General Surgeon,
Neurologist and Pediatrician /Central
Wisi'onsin. Excellent opportunity for
Board certified /eligible physician to join
26-physician multispecialty group.
180-bed modern hospital. Plentiful recrea-
tional, cultural, and educational oppor-
tunities. Unique, attractive financial ar-
rangements. Contact: Administrator, Rice
Clinic, 2501 Main St, Stevens Point, WI
54481; ph 715/344-4120. ltfn/85
Obstetrician-Gynecologist, Board cer-
tified or eligible, to join 17-physician
multispecialty clinic with two physician
OB/GYN department. Located in a
beautiful Wisconsin lakeshore commun-
ity of 35,000. Competitive salary, com-
plete fringe benefits, generous vacation
time. Send CV to: Administrator, Mani-
towoc Clinic, SC, PO Box 3008, Mani-
towoc, WI 54220. 6-12/84:1-5/85
Orthopedic Surgery. Nicolet Clinic,
SC, Neenah, Wisconsin, is seeking a
third orthopedic surgeon to join a
busy, expanding department. Recent
clinic expansion has provided excel-
lent orthopedic facilities, and is located
close to Theda Clark Regional Medi-
cal Center, a modern full-service hos-
pital, fully-equipped for all orthopedic
inpatient services. Neenah is centrally
located in the beautiful Fox River
Valley of Eastern Wisconsin. Excellent
cultural, educational, and recreational
opportunities available. Contact Roger
A Rathert, MD, Nicolet Clinic, SC, 41 1
Lincoln Street, Neenah, WI 54956.
3/85
14 MD multispecialty clinic wishes to
add third OB/GYN 7/1/85. Three pro-
gressive hospitals (regional referral center
for Maternal High Risk); ultrasound, of-
fice cytoscopy, colposcopy, laser, hys-
teroscopy, etc; no abortions. Competitive
salary and benefits leading to partnership
in two years. Excellent family commun-
ity with multiple recreational and cultural
activities available. Send CV to T E Flood,
Administrator, Beaumont Clinic, Ltd,
1821 S Webster Ave, Green Bay, WI
54301. pl2/84;l-3/85
Internist or Family Practitioner to join
two Internists and General Surgeon in
growing, established. Green Bay area
practice. Send CV to John Brusky, MD,
1203 South Military Ave, Green Bay, WI
53404. 7tfn/84
Wanted Board Certified Otolaryngol-
ogist. Head and neck surgeon. Join active
one-man practice. General otolaryngol-
ogy, head and neck surgery, facial plastic
surgery, nasal allergy. Computerized of-
fice with x-ray, audiologist, and hearing
aid dispensing. Northern Wisconsin near
Apostle Islands National Lakeshore. Con-
tact James A Hamp, MD, ENT Profes-
sional Associates, SC, 2101 Beaser Ave,
Suite 1, Ashland, WI 54806; ph 715/682-
9311. 10-12/84:1-3/85
Family Practitioners needed to staff
satellite locations and Urgent Care
Centers located in Northeast Wisconsin.
Please send CV to Dept 554 in care of the
Journal. 2-5/85
Family Practice Physician to share fully
equipped medical office in central Wis-
consin city. Opportunity for partnership
and eventual purchase of practice. Excel-
lent recreational, educational, hospital,
and civic advantages. Send curriculum
vitae to Dept 503 in care of the Journal.
6tfn/82
FAMILY PRACTITIONERS
INTERNISTS, OB/GYN
The U W Office of Rural Health is seek-
ing primary care specialists for more
than 50 communities throughout Wis-
consin. Opportunities are available
throughout Wisconsin for Board certi-
fied physicians trained in US medical
schools and residencies.
CONTACT:
Laurie Glowac or Fred Moskol
New Physicians for Wisconsin
University of Wisconsin
Department of Family Medicine
777 S Mills St, Madison, WI 53715
Phone: 608/263-4095 7/84;6/85
St Francis Medical Center— La Crosse:
Full-time Family Practice faculty position
with opportunity for teaching and practice
in the St Francis/Mayo Family Practice
Residency with Mayo Clinic faculty ap-
pointment. Currently, four full-time
family physicians and 13 residents in
clinic and hospital. Send inquiries to: Ted
Thompson, MD, Program Director, St
Francis /Mayo Family Practice Residency,
700 West Avenue South, La Crosse, Wis-
consin 54601; ph 608/785-0940. 2-3/85
Physicians needed full or part-time to
perform light physicals. Milwaukee area.
Professional liability provided. Phone
414/344-2100, Ms Jenkins. lOtfn/84
The Racine Medical Clinic, a progres-
sive cluster corporation of 31 physicians
is currently seeking an Obstetrician /Gyn-
ecologist physician. Full benefits, un-
limited earnings and a full and exciting
practice are offered. Please contact: Roger
D Lacock, Administrator, Racine Medical
Clinic, 5625 Washington Ave, Racine, WI
53406: ph 414/886-5000. 12tfn/84
The Racine Medical Clinic, a progres-
sive cluster corporation of 31 physicians
is currently seeking an Internist-Infectious
Disease physician. Full benefits, un-
limited earnings and a full and exciting
practice are offered. Please contact: Roger
D Lacock, Administrator, Racine Medical
Clinic, 5625 Washington Ave, Racine, WI
53406; ph 414/886-5000. 12tfn/84
Family Practice physician needed to join
five family practitioners and a general
surgeon. Immediate opportunity in west
central Wisconsin near La Crosse. $45,000
first year guarantee plus incentive. Excel-
lent recreational area. Community Hos-
pital. Send CV to: Jerrold L Kamp, Ad-
ministrator, PO Box 250, Sparta, WI
54656; or phone 608/269-6731. 6tfn/84
Immediate opportunities for qualified
physicians who possess excellent clinical
and communication skills to join long-
standing group of Emergency Physicians.
Positions available in a popular Wiscon-
sin area bordering Illinois. If interested,
send resume to Barbara Wilczynski,
Medical Emergency, Service Associates
(MESA), SC, 15 S McHenry Road, Suite 2,
Buffalo Grove, IL 60090 or call collect
312/459-7304. 6tfn/83
Wisconsin-BC/BE Pediatrician to
assume an established position of a
pediatrician leaving. Join a three-man
pediatric department. Call or write:
David L Lawrence, MD, 92 E Division
St, Fond du Lac, WI 54935; ph 414/
921-0560. p3-8/85
60
WISCONSIN .MEDICAL JOL'RNAL, MARCH 1985 :\ OL. 84
MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
continued
Wanted: Young Family Practitioner to
join a ten-physician group in western Wis-
consin. Contact R M Hammer, MD, River
Falls, Wisconsin 54022; ph 612/436-8809
or 715/425-6701. 8tfn/84
Internist, with or without subspecialty,
and an OB/GYN needed (Board certified
or eligible) to practice in conjunction with
a 7-member Internal Medicine Depart-
ment and a 5-member OB/GYN Depart-
ment in a 24-member multispecialty
group. The Internal Medicine Department
currently has subspecialties in gastro-
enterology, pulmonary medicine, and car-
diology. The Group is located in South-
eastern Wisconsin in a city of 100,000, be-
tween two major metropolitan areas of
greater than one million. Estimated serv-
ice area is approximately 200,000. If inter-
ested, please send CV to Stephen L
Wagner, Kurten Medical Group, 2405
Northwestern Ave, Racine, WI 53404. All
inquiries will be kept confidential and ad-
ditional information will be sent.
7tfn/84
Wanted— Board qualified— board cer-
tified obstetrician-gynecologist as an
associate. Modern well equipped facility.
Excellent starting salary and benefits in-
cluding profit sharing plan. Please contact
Elizabeth Allen Steffen, MD, 734 Lake
Ave, Racine, Wis 54303. 9tfn/83
MEDICAL FACILITIES
Family Practice for sale in Milwaukee.
Ideal starter or satellite office. Excellent
patient goodwill. Fully equipped and fur-
nished three examining rooms, waiting
room, and office. Approximately 900 sq
ft. Contact Greg Rodenbeck, DDS, 1200
E Oklahoma Ave, Milwaukee, Wis 53207;
414/481-8111. glOtfn/84
Medical-Dental Facility. Share desir-
able clinic and reception area, front office
personnel. Ample parking. Westside. Call
608/238-6529. 3/85
Medical practice or equipment for sale
in Milwaukee. Completely equipped,
modern office with a modern x-ray ma-
chine. I am retiring. Please call 414/272-
0250 or 414/962-9382 for an appointment.
3/85
Madison, West Side. Hilldale Profes-
sional Building. Deluxe office suites, 1200-
1700 sq ft. Full service— undercover park-
ing. Call Ralph at office 608/273-5800 or
home 608 / 836-3586. 2tfn / 85
MISCELLANEOUS
Will instruct physicians in the art of
Hypnosis using their own medical facili-
ties and patients. Thirty-five years experi-
ence. For information call 414/ 628-2839,
John H De Werth, MD. p3/85
ANNOUNCEMENTS
Reye syndrome. Although the evidence
linking aspirin and other salicylates with
Reye syndrome is not conclusive, it
would be prudent for parents to avoid
giving aspirin or other medications con-
taining salicylates to children with
chickenpox or influenza-like illnesses, a
report by the American Council on
Science and Health states. Entitled "Reye
Syndrome: Questions and Answers,"
the report may be obtained by sending
a self-addressed, stamped (39 cents
postage), business-size (#10) envelope
to Reye Syndrome Report, ACSH, 47
Maple St, Summit, NJ 07901.
ADVERTISERS
Abbott Northwestern Hospital . .52, 53
Acme Laboratories 38
Advanced Technology Associates,
Inc 58
Medical Computer Systems
Centralized Billing Systems 12
Dairy Council of Wisconsin 36
Dista Products Co (Div of Eli
Lilly & Co) 4
Keflex®
House of Bidwell 14
Kodak Ektachem 55, 56, 57
Clinical Chemistry Products
Medical Protective Company 54
Microcomputers in Medicine 38
PBBS Equipment 14
Professionals Insurance
Company, The 51
Roche Laboratories 65, BC
Dalmane®
S & L Signal Company 15
Squibb & Sons,
Inc, E R 19, 20, 21, 22
Velosef'
St Mary's Hill Hospital 9
United States Army Active 41
United States Army Air Force 43
United States Army Reserve 15
Upjohn Company, The 47
Motrin®
Winthrop Breon Laboratories ... 37, 38
Talwin® NxU
Physicians: US Air Force Medical
Corps is currently accepting appli-
cants tor physicians in the following
specialties: Aerospace Medicine; Or-
thopedics; Ear, Nose, and Throat;
Obstetrics/Gynecology; General
Surgeons; Family Practitioners; Inter-
nal Medicine, and Pediatrics. For more
information call: 414/258-2430.
2-4/85
WISCONSIN MEDICAL JOURNAL, MARCH 1985. VOL. 84
61
MEDICAL YELLOW PAGES
MEDICAL MEETINGS-
CONTINUING MEDICAL
EDUCATION
WISCONSIN
APRIL or MAY 1985: Wisconsin Asso-
ciation of Medical Directors A«nwa/Meef-
ing (in conjunction with the County
Homes Association), tentatively at Stevens
Point. More definite details to come.
gl2/84
APRIL 19-20, 1985: Wisconsin Urolog-
ical Society, Pfister Hotel, Milwaukee.
glltfn/84
MAY 2-3, 1985: Introduction to Com-
puters in the Medical Office. Wisconsin
Center, Madison. Course is designed for
physicians who have interest in computer
applications in the medical office, but little
knowledge or experience upon which to
base decisions. Focus is on the basics.
AMA Category 1 and UW-Extension
CEUs. Contact Dick Hansen, UW-Exten-
sion, Continuing Medical Education,
Room 460 WARE Bldg, 610 Walnut St,
Madison, W1 53705: ph 608/263-2853.
3/85
MAY 3, 1985: Wisconsin Orthopedic
Society, American Club, Kohler. g2-4/85
THIS LISTING is compiled by the State
Medical Society of Wisconsin in coopera-
tion with others who wish to maintain a
centralized schedule of meetings and
courses of interest to Wisconsin physicians
and to avoid scheduhng programs in conflict
with others. Hospitals, Clinics, Specialty
Societies, and Medical Schools are par-
ticularly invited to utilize this listing service.
There is a nominal charge for listing of Con-
tinuing Medical Education courses at the
following rates: 50e per word, with a mini-
mum charge of $20.00 per listing.
BOXED LISTINGS: $25.00 per column
inch. Listings of other scientific meetings
will be included at the discretion of the
editors.
COPY DEADLINE tor listings is 1 5th of the
month preceding the month of publication:
e.g., copy for the August issue is due by July
15. Address communications to: Wisconsin
Medical Journal, Box 1109, Madison, Wis-
consin 53701; or phone (area code 608)
257-6781: or toll-free in Wisconsin: 800/
362-9080.
FOR LISTING of other meetings see the
January 4, 1985 issue of the Journal of the
American Medical Association: Continuing
Education Opportunities for Physicians for
period January 1985 through December
1985.
APRIL 17, 1985: New aspects of patho-
genesis and treatment in osteoarthritis, at the
Pioneer Inn, Oshkosh. Sponsored by
Berlin Memorial Hospital and Pfizer Com-
pany. Speaker: Gary Gordon, MD, Uni-
versity of Pennsylvania. Accredited for 2
hours of CME Category I credit by AMA.
Preregistration required: $20 includes pro-
gram and dinner. Info: Linda Tieman,
Berlin Memorial Hospital, phone 414/
361-1313, ext 583. 3/85
MAY 9-11, 1985: Wisconsin Chapter,
American Academy of Pediatrics, Pioneer
Inn, Oshkosh. glltfn/84
MAY 9-10, 1985: Methodist Hospital
presents its 4th annual Problem Solving in
Emergency Care, symposium, Madison.
Physician, nurse, paramedic and EMT
tracks. Tuition: $25-$ 150. Accreditation:
14 hours AMA Category I, App ACEP
Category I. Contact: Mark Olsky, MD
(Director), Methodist Hospital, 309 West
Washington Ave, Madison, WI 53703; ph
608/251-2371, ext 3015. 3-4/85
State Medical Society
of Wisconsin
Dates and locations of
ANNUAL MEETINGS
1985-1992
All meetings will be held in Milwau-
kee at the Milwaukee Exposition and
Convention Center and Arena
(MECCA) and the new Hyatt Regency
as the headquarters hotel with the ex-
ception of 1985, when the meeting will
be held at the La Crosse Convention
Center.
1985- April 25-27
1986- April 17-19
1987- March 26-28
1988- April 28-30
1989- April 13-15
1990- April 26-28
1991- April 18-20
1992- April 23-25
Meeting days will be Thursday and
Friday; the first session of the House
of Delegates will convene on Thurs-
day, the second and third on Friday.
Scientific programming will be on Fri-
day and Saturday.
Further information: Commission on
Continuing Medical Education, State
Medical Society of Wisconsin, Box
1109, Madison, Wis 53701. Local tele-
phone: 257-6781; toll-free in Wiscon-
sin; 1-800/362-9080.
MAY 16-18, 1985: Diagnosis and Treat-
ment of Thromboembolic Disease— 1985.
Pfister Hotel, Milwaukee. Sponsored by
University of Wisconsin-Milwaukee
Clinical Campus, Mount Sinai Medical
Center; and University of Wisconsin-
Extension, Department of Continuing
Medical Education. AMA Category 1,
UW-Extension CEUs, 10 hours. Contact:
Sarah Aslakson, UW-Extension CME,
Room 465B, 610 Walnut St, Madison, WI
53705; ph 608/263-2856. 3/85
JUNE 3-8, 1985: 18th Annual Postgrad-
uate Course in Gynecological Pathology, En-
docrinology, and Maternal-Fetal Medicine.
presented by the Department of Gyn-
ecology and Obstetrics of the Medical Col-
lege of Wisconsin. The course will be held
at Olympia Resort, Oconomowoc. The six-
day course includes an up-to-date review
of endocrinology, maternal-fetal medi-
cine, and cytogenetics in addition to a
thorough resume of gynecologic path-
ology. Registration is limited. Course ap-
Wisconsin Specialty
Society Meetings
• Wisconsin Urological Society,
April 19-20, 1985, Pfister Hotel,
Milwaukee
• Wisconsin Chapter: American
Academy of Pediatrics, May 9-11,
1985, Pioneer Inn, Oshkosh
• Wisconsin Academy of Family
Physicians, June 12-15, 1985,
Americana Resort, Lake Geneva
* **
Specialty Society Meetings
to be held in conjunction
with SMS Annual Meeting,
April 25-27, 1985, La Crosse
• Wisconsin Society of Anesthesiolo-
gists
• Wisconsin Dermatological Society
• Wisconsin Chapter, American Col-
lege of Emergency Physicians
• Wisconsin Academy of Family
Physicians
• Wisconsin Society of Internal
Medicine
• Wisconsin Academy of Ophthal-
mology
• Wisconsin Otolaryngological
Society
• Wisconsin Society of Pathologists
• Wisconsin Society of Physical
Medicine & Rehabilitation
• Wisconsin Society of Plastic Sur-
geons
• Wisconsin Society for Preventive
Medicine
• Wisconsin Society of Radiation
Oncologists
• Wisconsin Surgical Society
62
WISCONSIN MEDICAL JOCRNAL, MARCH 1985: VOL. 84
MEDICAL YELLOW PAGES
MEDICAL MEETINGS-
CONTINUING MEDICAL
EDUCATION
continued
proved for 46 cognates, Formal Learning,
by the American College of Obstetricians
and Gynecologists and 46 credit hours.
Category I, PRA/AMA. Eighty selected
35-mm slides will be available for pur-
chase to all participants. Contact Richard
F Mattingly, MD, The Medical College of
Wisconsin, 8700 West Wisconsin Ave,
Milwaukee, WI 53226: tel 414/257-5560.
p3-5/85
JUNE 12-15, 1985: 37th Annual Scientific
Assembly of the Wisconsin Academy of
Family Physicians, Americana Resort
Hotel, Lake Geneva, Wisconsin. Info:
WAFP, 850 Elm Grove Road, Elm Grove,
WI 53122: ph 414/784-3656.
12/84:1-5/85
JUNE 28-29, 1985: Anxiety Disorders—
Update 1985, Wisconsin Center, Madison.
Sponsored by School of Medicine, De-
partment of Psychiatry, University of
Wisconsin: Continuing Medical Educa-
tion, University of Wisconsin-Extension.
AMA Category 1 credit. University of Wis-
consin-Extension CEUs. For more infor-
mation contact: Ann Bailey, UW Exten-
sion, Continuing Medical Education, 454
WARE Bldg, 610 Walnut St, Madison, WI
53705: ph 608/263-2854. 3/85
JUNE 28, 1985: Microcomputers in Medi-
cine, Milwaukee. A one-day computer
seminar and exposition for health care
professionals. Topics include choosing a
system: office practice management,
computer-aided diagnosis. Fee: $50 before
May 15 includes admission, lunch, and
reception. Info: Micros in Medicine,
MCW Libraries, 8701 Watertown Plank
Rd, Milwaukee, WI 53226: ph 414/257-
8323. g3-4/85
JULY 18-20, 1985: Wisconsin Society of
Obstetrics & Gynecology, Olympia Re-
sort, Oconomowoc. g2-6/85
SEPTEMBER 13-14, 1985: Wisconsin
Surgical Society, Paper Valley Hotel &
Conference Center, Appleton. g2-8/85
SEPTEMBER 13-15, 1985: Wisconsin
Society of Anesthesiologists, American
Club, Kohler. g2-8/85
OTHERS
MARCH 29, 1985 (Minnesota): Sixth
Annual Update in Occupational Medicine,
Radisson Plaza Hotel, St Paul. Info: St
Paul-Ramsey Medical Center, Continuing
Medical Education, 640 Jackson St, St
Paul, MN 55101: ph 612/221-3977. g3-85
APRIL 10-14, 1985 (Florida): 20t/? A«-
nual Clinical Conference at Longboat Key
Club, Longboat Key'. Sponsored by the
Marquette-MCW Medical Alumni Asso-
ciation and the Medical College of Wis-
consin. Info: Marquette-MCW Medical
Alumni Association, 8701 Watertown
Plank Rd, Milwaukee, Wis 53226: ph
414/257-8367. 1-3/85
APRIL 1 1-12, 1985 (Minnesota): Third
Annual OB/GYN Update, Radisson Plaza
Hotel, St Paul. Info: St Paul-Ramsey
Medical Center, Continuing Medical
Education, 640 Jackson St, St Paul, MN
55101: ph 612/221-3977. g3-85
MAY 16-17, 1985 (Minnesota): Pri-
mary Care for CNS Trauma and Disease,
Radisson Plaza Hotel, St Paul. Info: St
Paul-Ramsey Medical Center, Continuing
Medical Education, 640 Jackson St, St
Paul, MN 55101: ph 612/221-3977. g3-85
JUNE 5-8, 1985 (Alaska): Alaska State
Medical Association Annual Convention
in Haines. Info: Alaska State Medical
Association, 4107 Laurel St, Ste #1,
Anchorage, Alaska 99508: ph 907/
562-2662. g2-5/85
International Childbirth
Education Association
to host 1985 Conference
in cooperation with Methodist Hos-
pital who will coordinate the local
planning committee.
in Madison, June 20-23
at the Sheraton Inn and Conference
Center
The four-day conference is expected to
draw 400 to 500 persons from across
the nation, including childbirth educa-
tors, nurses, physicians, parent advo-
cates, and others interested in the cur-
rent changes in pregnancy, birthing,
and early parenting.
Persons interested in assisting with the
conference or learning more details
can call Methodist Hospital, Madison,
at 608/258-3290.
JUNE 22-23, 1985 (Minnesota):
agement of Common Psychiatric Problems in
Primary Care, Breezy Point Resort, Brain-
erd. Info: St Paul-Ramsey Medical Center,
Continuing Medical Education, 640 Jack-
son St, St Paul, MN 55101: ph 612/221-
3977. g3-85
AUGUST 1-4, 1985: Second Annual St
Paul-Ramsey Trauma Conference (Fishing
& Family Recreation), Fox Hills Resort,
Mishicot. Info: St Paul-Ramsey Medical
Center, Continuing Medical Education,
640 Jackson St, St Paul, MN 55101: ph
612/221-3977. g3/85
SEPTEMBER 5-7, 1985 (Texas): Amer
lean Cancer Society, Second National Con-
ference on Diet, Nutrition and Cancer,
Shamrock Hilton, Houston. Info:
American Cancer Society, Second Na-
tional Conference on Diet, Nutrition and
Cancer, 90 Park Ave, New York, NY
10016. g3-8/85
1985 CME Cruise/Conferences on
Selected Medical Topics— Caribbean,
Mexican, Hawaiian, Alaskan, Medi-
terranean. 7-14 days year-round. Ap-
proved for 20-24 CME Category I credits
(AMA/PRA) & AAFP prescribed credit.
Distinguished professors. Fly roundtrip
free on Caribbean, Mexican, & Alaskan
Cruises. Excellent group fares on finest
ships. Registration limited. Prescheduled
in compliance with present IRS require-
ments. Info: International Conferences,
189 Lodge Ave, Huntington Station, NY
11746: ph 516/549-0869.
p9-ll/84:l, 3,4/85
AMA
JUNE 16-20, 1985: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 8-11, 1985: Interim AMA
House of Delegates, Washington, DC.
JUNE 15-19, 1986: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 7-10, 1986: Interim AMA
House of Delegates, Las Vegas, NV.
JUNE 2 1-25, 1987: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 6-9, 1987: Interim AMA
House of Delegates, Atlanta, GA.
JUNE 26-30, 1988: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 4-7, 1988: Interim House
of Delegates, Dallas, TX. ■
WISCONSIN iVlEDICAI. JOURNAL, MARCH I98.S: VOL. «4
63
NEWS YOU CAN USE
RECENT CHANGES IN MEDICARE REGARDING DURABLE MEDICAL EQUIPMENT. Effective February 1,
1985 the Health Care Financing Administration revised payment guidelines for all durable medical equip-
ment (DME) payable under the Medicare program. The changes will cause physicians to alter the way they
write prescriptions in order to allow their Medicare eligible patients to be reimbursed for their DME expenses.
Transmittal #1067 to the Medicare carriers Manual changes the method of decision-making as it relates
to whether the item is rented or purchased. After February 1, the decision to rent or purchase is still the
beneficiary's. However, it is not binding on Medicare as far as payment is concerned. Payment will be made
based on the Medicare carriers determination regarding the least costly method of payment (except for items
costing less than $ 120 which will always be purchased). Prior to February 1, 1985, the Medicare beneficiary
made the decision to rent or purchase the item and Medicare paid accordingly.
If it is known at the time the prescription is written that the patient will need the equipment for at least
nine months, Medicare Part B would pay $720 (80% of $100 Medicare allowable) on a billed charge of $1,000.
The patient would have an immediate $180 co-insurance payment to make. If the patient still wants to rent
the equipment regardless of Medicare's determination, Medicare would pay seven months rent (applied toward
the purchase price), and the patient would owe the final three months rent.
In order that timely payments continue from Medicare on behalf of Medicare beneficiaries, this change
will require physicians to furnish more information than in the past. As in the past, a prescription is required
for each item.
Most suppliers will work with the prescribing physicians to make sure that the information will be present
on the initial and subsequent claims which show a continuing medical need. However, if medical necessity
is not shown to the satisfaction of the.carrier, (i.e. diagnosis, prognosis, physician estimate in months of need
duration), a follow up letter will be sent to the physician indicating that payment will cease if sufficient
documentation of Medicare need is not received in 30 days.
Maintenance of purchased durable medical equipment is not covered and is an obligation of the patient.
If a patient cannot perform routine equipment maintenance required to keep the unit properly functioning,
it must be so stated with the reasons explained. It is believed that Medicare will continue to allow rental which
includes repair and maintenance. If a certain type of product is medically required, it must also be stated in
such instances in the prescription the reasons, i.e., liquid oxygen as opposed to high pressure tanks to sup-
port therapeutic ambulation or special add-on equipment for a wheelchair. Supply companies can help
determine when this may be required.
In order for this new program to work to benefit the patients, a close cooperation between discharge plan-
ners, therapists, physicians, and suppliers is imperative. Suppliers realize the increased burden on physicians
and will develop methods to assist you to facilitate payment on behalf of the Medicare beneficiary.
If physicians have specific questions, they are urged to contact the WPS-Medicare Inquiry Services Dept
in Madison: (608) 221-4711. ■
PRACTICE MANAGEMENT STUDY COURSES OFFERED. The American Medical Association's Dept of
Practice Management has prepared a special series of videocassette and audiocassette courses to help physi-
cians develop their management and marketing skills. Programs are available on "Developing a Marketing
Plan for Your Medical Practice;" "Borrowing Money: What A Doctor Needs to Know;" "Medical Collection
Study Course," and "Handling Patient Telephone Calls Effectively." For more information on any of these
courses call the AMA toll-free at 1-800-621-8335. ■
PHYSICIAN FEE INCREASES SLOW. An economist from the Bureau of Labor Statistics was recently quoted
as stating that there has been a substantial drop in the rate of increase of doctors' fees. Daniel H Ginsburg
of the Bureau attributes this, in part, to the fact that many doctors froze their fees last March at the sugges-
tion of the American Medical Association. ■
(i4
WISCONSIN MFmCAl.JOl'RNAI,, MARCH 198.i:\OL. 84
COMPLETE
LABORATORY
DOCUMENTATION . . . EXTENSIVE
CLINICAL PROOF
FOP, THE PREDIQABIUTY
CONFIRMED BY EXPEITIENCE
Q4LMANE®
flurozepom HCI/Roche
THE COMPLETE HYPNOTIC
PROVIDES ALL THESE BENEFITS:
• Rapid sleep onset‘s
• More total sleep time' "
• Undiminished efficacy for at least
28 consecutive nights' "
• Patients usually awake rested and refreshed'^
• Avoids causing early awakenings or rebound
insomnia after discontinuation of therapy"""'
Caution patients about dnving, operating hazardous machinery or drinking
alcohol during therapy. Limit dose to 15 mg in elderly or debilitated patients.
Contraindicated during pregnancy
DALMAHE^
flurozepom HCI/Poche
References: 1. Kales J ef at: din Pharmacol Ther
72:691-697, Jul-Aug 1971. 2. Kales A ef a/: din Phar-
macol Ther 78:356-363, Sep 1975 3. Kales A ef a/:
din Pharmacol Ther 79:576-583, May 1976. 4. Kales A
ef al: din Pharmacol Tfier 32:781 -788, Dec 1982
5. Frost JD Jr, DeLucchl MR: J Am Gehatr Soc
27:541-546, Dec 1979. 6, Kales A, Kales JD: J din
Pharmacol 3:140-150, Apr 1983. 7. Greenblatt DJ,
Allen MD, Shader Rl: din Pharmacol 7/ier 27:355-361,
Mar 1977. 8. Zimmerman AM: Curr Ther Res
73:18-22, Jan 1971. 9, Amrein R ef al: Drugs Exp din
Res 9(1):85-99, 1983. 10. Monti JM: Methods Find Exp
din Pharmacol 3:303-326, May 1981 11. Greenblatt DJ
ef a/. Sleep 5(Suppl 1):S18-S27, 1982. 12. Kales A
ef al: Pharmacology 26:121-137, 1983.
DALMANE" <S
flurazepam HCI/Roche
Before prescribing, please consult complete
product information, a summary of which follows;
Indications: Effective in all types of insomnia charac-
terized by difficulty in falling asleep, frequent nocturnal
awakenings and/or early morning awakening; in
patients with recurring insomnia or poor sleeping hab-
its; in acute or chronic medical situations requiring
restful sleep. Objective sleep laboratory data have
shown effectiveness for at least 28 consecutive nights
of administration. Since insomnia is often transient
and intermittent, prolonged administration is generally
not necessary or recommended. Repeated therapy
should only be undertaken with appropriate patient
evaluation.
Contraindications; Known hypersensitivity to fluraze-
pam HCI; pregnancy. Benzodiazepines may cause
fetal damage when administered during prMnancy.
Several studies suggest an increased risk of congeni-
tal malformations associated with benzodiazepine use
during the first trimester. Warn patients of the potential
risks to the fetus should the possibility of becoming
pregnant exist while receiving flurazepam. Instruct
patient to discontinue drug prior to becoming preg-
nant. Consider the possibility of pregnancy prior to
instituting therapy.
Warnings: Caution patients about possible combined
effects with alcohol and other CNS depressants. An
additive effect may occur if alcohol is consumed the
day following use for nighttime sedation. This potential
may exist for several days following discontinuation.
Caution against hazardous occupations requiring
complete mental alertness (e g., operating machinery,
driving). Potential impairment of performance of such
activities may occur the day following ingestion. Not
recommend^ for use in persons under 15 years of
age. Though physical and psychological dependence
have not been reported on recommended doses,
abrupt discontinuation should be avoided with gradual
tapering of dosage for those patients on medication
for a prolonged period of time. Use caution in adminis-
tering to addiction-prone individuals or those who
might increase dosage
Precautions: In elderly and debilitated patients, it is
recommended that the dosage be limited to 15 mg to
reduce risk of oversedation, dizziness, confusion and/
or ataxia. Consider potential additive effects with other
hypnotics or CNS depressants. Employ usual precau-
tions in severely depressed patients, or in those with
latent depression or suicidal tendencies, or in those
with impaired renal or hepatic function.
Adverse Reactions: Dizziness, drowsiness, light-
headedness, staggering, ataxia and falling have
occurred, particularly in elderly or debilitated patients.
Severe sedation, lethargy, disorientation and coma,
probably indicative of drug intolerance or overdosage,
have been reported. Also reported: headache, heart-
burn, upset stomach, nausea, vomiting, diarrhea,
constipation, Gl pain, nervousness, talkativeness,
apprehension, irritability, weakness, palpitations, chest
pains, body and joint pains and GU complaints There
have also been rare occurrences of leukopenia, gran-
ulocytopenia, sweating, flushes, difficulty in focusing,
blurred vision, burning eyes, faintness, hypotension,
shortness of breath, pruritus, skin rash, dry mouth,
bitter taste, excessive salivation, anorexia, euphoria,
depression, slurred speech, contusion, restlessness,
hallucinations, and elevated SGOT, SGPT, total and
direct bilirubins, and alkaline phosphatase; and para-
doxical reactions, e.g., excitement, stimulation and
hyperactivity.
Dosage: Individualize for maximum beneficial effect.
Adults: 30 mg usual dosage: 15 mg may suffice in
some patients. Bderty or debilitated patients: 15 mg
recommended initially until response is determined.
Supplied: Capsules containing 15 mg or 30 mg
flurazepam HCI.
Roche Products Inc.
Manati, Puerto Rico 00701
DOCUMENTED
IN THE SLEEP
LABORATORY’
PROVEN IN
THE PATIENT’S
HOME
FOR A COMPLETE
-7
flurazepQ
STANDS
15-MG/30-M
See preceding page for references and summary of product information.
Copyright © 1984 by Roche Products Inc. All rights reserved.
WISCONSIN
MEDICAL JOURNAL
WISCONSIN
MEDICAL JOURXAL
I
CONTENTS
1
April 1985
ISSN 0043-6542 / Established 1903
Owned and published by
State Medical Society of Wisconsin
Medical Editor
Victor S Falk MD. Edgerton
Editorial Board
Victor S Falk AID, Edgerton Chairman
Melvin F Fhith AID, Baraboo
M C F Lindert MD. Milwaukee
Wayne J Boulanger MD, Milwaukee
Richard D Sautter AID, Marshfield
Dean M Connors MD. Madison
George W Kindschi MD. Monroe
Charles H Raine MD. Racine
Darrell L Witt AID. Wausau
Garrett A Cooper AID, Madison Emeritus
Editorial Director
Wayne ] Boulanger MD, Milwaukee
Editorial Associates
John P Mullooly MD, Milwaukee
Russell F Lewis MD. Marshfield
Raymond A AlcCormick AID, Green Bay
Victor S Falk MD, Edgerton
Medical Editor
Staff
Earl R Thayer, Madison
Secretary-General Manager
State Medical Society of Wisconsin
H B Alaroney II, Madison
Assistant Secretary-Corporate Counsel
State Medical Society of Wisconsin
Airs Alary Angell, Madison
Managing Editor
Airs Alarjorie Stafford, Madison
Publications Assistant
Airs Diane Upton. Madison
Editorial Assistant
NATIONAL ADVERTISING REPRESENTA-
TIVE: State Medical Journal Advertising
Bureau, Inc, 711 South Blvd, Oak Park, 111
60302. Ph 312/383-8800.
LOCAL IWISCONSIN) ADVERTISING: Con-
tact: Mrs Mary Angell, Wisconsin Medical
Journal, Box 1109, Madison, Wis 53701. Ph
608/257-6781.
SUBSCRIPTION RATES: Members, $12.50
per year (included in dues); nonmembers,
$25.00. Single copy: current year. $2.00; pre-
vious years, $3.00. SPECIAL RATES: Foreign
and Canada, $30.00. Blue Book issue, $8.00.
Membership Directory issue, $15.00.
SECOND CLASS POSTAGE PAID at
Madison, Wisconsin, and at additional mail-
ing offices.
PUBLISHED MONTHLY. "Acceptance for
mailing at special rate of postage provided for
in Section 1103, Act of October 3, 1917.
Authorized August 7, 1918." Address all com-
munications to THE WISCONSIN MEDICAL
JOURNAL. Street address: 330 East Lakeside
Street. Mailing address: Box 1 109, Madison,
Wis 53701.
POSTMASTER: Send address changes to
Wisconsin Medical Journal, PO Box 1109,
Madison, Wis 53701.
COPYRIGHT 1985
State Medical Society of Wisconsin
SPECIAL FEATURES
President's Page
5 What are you going to do for me
in the future?
Timothy T Flaherty, MD
Neenah
Editorials
6 Save a child— save the world
6 MRI
Victor S Falk, MD
Edgerton
7 The computer says
Victor S Falk, MD
Edgerton
Letters
9 Nicaragua— diversified views
Gonzalo Madiedo, MD, PhD
Milwaukee
Sean Keane, MD
Gonzalo Madiedo, MD
Pablo Pedraza, MD
Thomas Schlenker, MD
Lucille Glicklich, MD
Milwaukee
David G Dibbell, MD. FACS
Madison
Henry A Peters, MD
Madison
11 Is your hospital in compliance?
Larry A Lindesmith, MD
La Crosse
29 AMA Physician's Recognition
Award recipients
33 AMA Physician's Recognition
Award recipients
Public Health
46 Wisconsin and Soviet physicians
meet in Chicago
Socioeconomics
48 SMS speaks out on mandated
benefits, involuntary commitment
laws
SMS testifies on peer review
legislation
49 Malpractice premiums to rise
106%
SMS asks business leaders' help
on malpractice problem
Joint Finance Committee con-
siders healthcare regs
Malpractice seminar scheduled for
May 11
50 WISPAC: A brief profile of the
1985 Wisconsin State Legislature
News you can use
79 Doctor union executive speaks to
Dane County Medical Society
AMA Guide for hospital medical
staff bylaws available
Have you been receiving com-
plaints from patients about DRGs?
All physicians! Plan to participate
in the 1985 PPA census
80 Governor's budget bill
Also in the Legislature
AMA helping states track physi-
cian licensing actions
Child abuse conference May 18
in Madison
Biomedical ethics conference
coming up June 6 and 7
Malpractice conference
May 10-1 1— Milwaukee
SCIENTIFIC MEDICINE
13 Pneumatic injury from a nailgun
Mark J Mirick, MD
Jeff Kurtz, MD
George Tanner, MD
Wausau
WISCONSIN MEDICAL JOURNAL (ISSN 0043-6542) is the official publication of the State Medical
Society of Wisconsin, devoted to the interests of the medical profession and health care in Wisconsin.
Its affairs are handled by the Editorial Board, subject to policy direction of the Society's Board of
Directors. The Managing Editor is responsible for the production, business operation, and coor-
dination of contents as well as the final responsibility of the entire publication. The Editorial Director
is responsible for Editorials. Unsigned Editorials express views consistent with the policies of the
State Medical Society of Wisconsin. Signed Editorials express personal views of the author for which
the Society takes no responsibility. Neither the Editors nor the State Medical Society will accept
responsibility for statements made or opinions expressed in the pages of the Journal. Indexed in
'"Index Medicus," "Hospital Literature Index," and "Cambridge Scientific Abstracts."
A,
STATE MEDICAL
SOCIETY
OF WISCONSIN
Vol. 84, No. 4
CONTENTS
15 Abstract: Patient selection and
results of simultaneous coronary
and carotid artery procedures, by
Herbert A Berkhoff, MD and
William D Turnipseed, MD,
Madison
Abstract: Perihepatitis
(Fitz-Hugh— Curtis syndrome),
by Hania W Ris, MD, Madison
16 Clonorchis sinensis infection
associated with adenocarcinoma
of the gallbladder and cystic duct
Paul Drinka, MD
Greg Sheehy, MD
Madison
19 Clinical and laboratory findings in
ten Milwaukee patients with the
acquired immunode-ficiency syn-
drome or prodromal syndromes
Paul A Turner, MD
Kari S Larratt, MS
Timothy R Franson, MD
Michael W Rytel, MD
Milwaukee
ORGANIZATIONAL
23 SMS Annual Meeting focuses on
critical medical issues
Dr Pomainville resigns
CESF treasurer post
Biomedical ethics conference
coming up June 6 and 7
24 Annual Meeting: Professional
liability, emergency medical
services, and government regula-
tions are key issues for '85 House
of Delegates (resolution
summaries)
30 SMS launches campaign to
improve communications
31 Court halts attempt to get SMS
records
Child abuse conference May 18 in
Madison
32 Membership Directory— Update
34 Membership facts
42 CES Foundation: Contributions
during months of January and
February 1985
DEPARTMENTS
51 Physician Briefs
54 News Highlights
56 Publication Information
66 Obituaries
William N Young, MD
Milwaukee
Richard E Jensen, MD
Green Bay
Albert P Hable, MD
Marshfield
Donald F Jarvis, MD
Tomahawk
Nicholas D Demeter, MD
Wauwatosa
Russell C Darby, MD
Oshkosh (Wautoma)
William H Studley, MD
Shorewood
Paul B Mason, MD
Sheboygan
Philip W Limberg, MD
Glenwood City
Harry Gonlag, MD
Eau Claire
Walter E Clasen, MD
Wauwatosa
Jerry W McRoberts, MD
Sheboygan
74 Medical Yellow Pages:
Physicians exchange . . , Medical
facilities . . . Miscellaneous . . .
Advertisers . . . Medical meetings
—continuing medical education ■
THE STATE MEDICAL SOCIETY OF WISCONSIN, created by the Territorial Legislature in 1841,
represents over 5600 member physicians in Wisconsin, comprising 55 county medical societies
and 25 medical specialty sections. The purpose of the Society is to "bring together the physicians
of the State of Wisconsin to advance the science and art of medicine and the better health of the
people of Wisconsin, and to secure the enactment and enforcement of just medical laws." The major
activities of the Society include continuing medical education, peer review, legislation, community
health education, scientific affairs, socioeconomics, health planning, services for physicians, opera-
tion of a Charitable, Educational and Scientific Foundation, and publication of the Wisconsin Medical
Journal.
Officers
President: Timothy T Flaherty, MD
Neenah
President-Elect: John K Scott, MD
Madison
Secretary-General Manager:
Earl R Thayer, Madison
Treasurer: John J Foley, MD
Menomonee Falls
Board of Directors
Chairman: Darold A Treffert, MD
Fond du Lac
Vice Chairman: Roger L
von Heimburg, MD, Green Bay
First District
John P Mullooly, MD, Milwaukee
Jerome W Fons Jr, MD, Cudahy
Carl S Eisenberg, MD, Milwaukee
Thomas A Hofbauer, MD,
Menomonee Falls
Wayne H Konetzki, MD, Waukesha
Fredrick Wood Jr, MD. Kenosha
William L Treacy, MD, Milwaukee
Charles W Landis. MD, Milwaukee
Richard D Fritz, MD, Milwaukee
William J Listwan, MD, West Bend
Second District
J D Kabler, MD, Madison
Cyril M Hetsko, MD, Madison
James J Tydrich, MD, Richland Center
Allen O Tuftee, MD, Beloit
Alwin E Schultz, MD, Madison
Third District
Pauline M Jackson, MD, La Crosse
Fourth District
John J Kief, MD, Rhinelander
Jung K Park, MD, Wisconsin Rapids
W George Locher, MD, Wausau
Fifth District
Darold A Treffert. MD, Fond du Lac
Kenneth M Viste Jr, MD, Oshkosh
C William Freeby, MD, Appleton
Sixth District
Roger L von Heimburg, MD, Green Bay
Vacancy
Seventh District
Marwood E Wegner, MD, St Croix Falls
Eighth District
Joseph M Jauquet, MD. Ashland
President: Doctor Flaherty
President-Elect: Doctor Scott
Past President: Chesley P Erwin, MD,
Milwaukee
Speaker: Duane W Taebel, MD.
La Crosse
Vice Speaker: Vernon M Griffin, MD,
Mauston
For professional liability insurance, the stakes are too
high to depend on anyone else.
That's why the State I^edical Society has endorsed a
professional liability plan which has been developed
especially for Wisconsin physicians.
Available only to members of the SP1S— and offered
through SP1S Services, Inc.— this medical malpractice policy
has superior features including:
• Consent of the physician is required before settlement of
any claim.
• Availability of legal counsel, experienced in defendant
medical liability.
• All members of claims and underwriting committees are
Wisconsin physicians.
• Occurrence coverage provided for claims arising during
the policy period, even if claim is reported at a later
time.
For the best in professional liability coverage, contact
Sm Services, Inc. at (608) 257-6781 or toll-free 1-800-362-9080
We know how vital it is to safeguard the present...
and to protect the future.
Endorsed by the
State Medical Society
of Wisconsin
A respected leader in coverage for preferred markets.
[president S PAGE
What are you going to do
for me in the future?
TT HE ACHIEVEMENTS of our State Medical Society, both in the past and present, are well-documented. The
current paramount issues of medical liability legislative reform and more acutely of obtaining relief from the
proposed exorbitant increases in malpractice insurance premiums are consuming a major portion of SMS staff
time and resources to educate the public and our legislators to preserve the integrity of healthcare in Wis-
consin.
Historically, from the time of the "Flexner Report" in 1910 until the passage of Medicare and Medi-
caid in 1965, physicians and the organization of physicians controlled and were responsible for the healthcare
system. We controlled the medical educational requirements, the medical curricula, the licensing of phy-
sicians, and also the disciplining of physicians. The revolutionary advances in medical technology and treat-
ments have produced progressive improvements in the quality and length of life, but due to the proliferation
of government programs, it is at an annual cost of 400 billion inflated dollars. Now, all physicians are aware
that almost everyone— federal -state- local government, insurance companies, for-profit chains, nonprofit
hospitals, large employers, healthcare coalitions, etc— are all trying to control, to limit, or to at least get a piece
of that $400 billion.
This almost singular focus on healthcare cost by government, health insurance companies, and payors
—while simultaneously tightening the noose of regulation around healthcare institutions and physician-
providers— threatens the traditional access and quality of care. The organization of physicians, SMS and
AMA, has been the major voice for patient advocacy in this environment of intensified regulation and com-
petition. Our State Medical Society has been active representing and communicating the concerns and
opinions of Wisconsin's physicians to the media, to the public, and to the legislators.
I sincerely believe that the State Medical Society represents all of the physicians of Wisconsin and as-
suredly all physicians benefit from the accomplishments of SMS! Disappointingly, there is a small but sig-
nificant segment of Wisconsin physicians who for a variety of stated reasons have decided not to financially
support organized medicine. Examples are; "I couldn't afford it this year." "I don't like the stand they took on
this or that issue." "They don't represent me." By far the most frequently stated reason is one of economics;
ie, they don't believe that membership benefits are worth the "deductible dues" expense.
After reminding those nonmember colleagues about SMS activities in the education of the public on the
critical issues [ie, malpractice) and the pursuit of legislative reform [ie, medical liability), ask those nonmember
colleagues if they want organized medicine to discontinue these activities? We, involuntarily, are assuming the
responsibility for these nonpaying passengers and their free ride on the vehicle of organized medicine.
Forecasting future events is at best an imperfect science. I am encouraged by the proactive stand and
the relevancy of the State Medical Society to present issues and future strategies.
My immediate request (not for the future) is the delivery by SMS members of sufficient peer pressure,
therapeutically applied, to our nonmember colleagues. It will ensure that all Wisconsin physicians will share
membership pride in the representation and accomplishments of our State Medical Society. ■
VVISCONSIN MEIMCAL JOURNAL, APRIL 1985: VOL. 84
EDITORIALS
Wayne J Boulanger, MD, Editorial Director
Unsigned editorials express views consistent with the policies of the State Medical Society of Wisconsin.
Signed editorials express personal views of the author for which the Society takes no responsibility.
Save a child— save the world
In several special reports on
child abuse and neglect in this
Journal, the magnitude of the
problem and the various aspects
relating to the law were eluci-
dated, and actions to be taken
immediately following a report of
abuse and neglect were defined.
Great strides, not only in a
heightened awareness of the
problem but also in the enact-
ment of legislation for the pro-
tection of the child, have taken
place since C Henry Kempe, MD,
wrote about the "Battered-Child
Syndrome" in 1962.
With the focus centered on
legal actions, the physician often
feels "left out" or "isolated." Is
his role only that of whistle-
blower? Is the physician hesitant
to become involved because of a
fear that the "case" may take too
much of his time, or worse, that
he will lose the family as pa-
tients? Some physicians fear that
their legal involvement may re-
sult in the loss of the family as
patients, and thus remove their
ability to help the child and fam-
ily. But '[h]e who helps to save a
child is as if he saved the whole
world, and he who neglects a
child destroys the world.'
(Talmud)
The physician's role in the big
picture of abuse and neglect has
in the past been extremely nar-
row. That narrow "role" is not
obsolete. All physicians must be-
gin to work with other legitimate
healthcare providers to allow for
better treatment and followup.
The current system is not ade-
quate for dealing with the ever-
increasing numbers of reports.
The facilities currently available
for treatment are too few and
too complex.
But there are concrete things
physicians can do:
1) Develop an understanding
that takes into consideration the
need for legal as well as medical
intervention in some cases—
not only to protect the individual
child from possible re-assault but
also to protect other children in
the community.
2) Develop a working relation-
ship not only with law enforce-
ment officials but also with the
division of community services in
their area. Learn how these par-
ticular groups handle suspected
or blatant cases of child abuse
and neglect and ask about be-
coming involved in the treatment
aspects after the report is made.
Health, legal, and social pro-
fessionals working together can
do much to alleviate the potential
problems of children involved in
legal proceedings. Anticipatory
guidance and emotional support
to child victims and families can
go a long way in this extremely
stressful situation.
3) Develop an understanding
that child abuse and neglect is not
a single entity. Understand the
dynamics of abuse and neglect.
More and better treatment pro-
grams or program components
must be established.
4) Work for the development of
prevention programs relating to
child abuse and neglect. This can-
not be the burden of one profes-
sion alone; it needs the exper-
tise of a multidisciplinary team.
No single prevention strategy can
deal with the complexity of the
problem. Primary prevention re-
quires active outreach and ed-
ucation.
The task is formidable and not
readily conducive to immediate
change. The wheels must be put
in motion, not only for the wel-
fare of the child but also for the
good of the family and entire
community. A well-executed
child abuse program will inevit-
ably reveal the physician in his
or her strongest role— healer and
advocate.
MRI
An article in the Wisconsin State
Journal of Madison March 17 re-
ported that in addition to the MRI
machine at University Hospital
that three Madison hospitals had
requested state authorization to
build a joint MRI facility. The con-
sortium of Madison hospitals had
sued Secretary of Health and
Social Services Linda Reivitz be-
cause she had refused to even
send the hospitals an application
form. Secretary Reivitz was
ordered to send them the applica-
tion, although she is not required
to approve it.
The article pointed out that MRI
(Magnetic Resonance Imaging)
machines cost about $2 million
and cost another $900,000 or so to
operate. Also the machine re-
quires special housing because it
uses a magnet and can't be around
a great deal of other metal. It is
estimated that the cost to a patient
for an MRI scan would be approx-
imately $600.
The Madison hospital radiolo-
gists (and undoubtedly those in
Milwaukee and other medical
centers) want their own MRI be-
cause they feel that the unit will
be essential to quality medical
care in the future. They also fear
that if only the University has an
MRI machine, the other hospitals
and radiologists would be limited
in their ability to compete for pa-
tients and would be in a second-
rate status.
The state's attitude is that the
MRI diagnostic device is still ex-
6
WISCONSIN MEDICALJOL'RNAL, APRIL 1985:VOL. 84
MRI
EDITORIALS
perimental and there are two al-
ready operating in Wisconsin.
Also since the state would be
billed for diagnostic tests per-
formed on Medicaid patients at
$600 each, the MRI scan would be
expensive.
But is the state going to play
God, "knowing best” what is
good for the people's health and
what isn't? A few years ago the
state was openly advocating that
institutions share costly equip-
ment and facilities. Madison's
private hospitals and physicians
are making sense with their idea
for sharing an MRI. They should
be encouraged, not stonewalled
by the state.
— Victor S Falk, MD, Edgerton
The computer says
A 73 -YEAR-OLD patient was ad-
mitted to the hospital with a
badly comminuted fracture of
her wrist. This was promptly re-
duced and a cast applied. Be-
cause of her age and the fact
that she lived alone in another
town, it was deemed prudent to
observe her overnight for fre-
quent checks of the circulation
to her hand.
She was discharged 19^2
hours after admission. This re-
sulted in a denial from WiPRO.
The WiPRO computer says that
the patient was in the hospital
two days and kept a hospital
bed "tied up for two days.” The
hospital's business office billed
the patient only for the day of
admission and not for the day of
discharge, which is the custom-
ary procedure.
How in the name of Hippo-
crates can a computer spit out a
figure of two days after a 19V'2
hour hospital stay? The frustrat-
ing aspect of the situation is that
arguing with a computer is like
tilting with a windmill.
— Victor S Falk, MD, Edgerton
Editorial Board comment: The
WiPRO computer . . . another mon-
ster born of "cost control" feeding on
the mother's milk of those it is sup-
posed to serve. However, we do have
to keep in mind that the computer
only reflects the confusion of the
people who tell it what to do— if
these individuals don't realize that
19 hours is less than, not more than
24 hours, should we blame the com-
puter? M
CLASSICAL ITALIAN
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MADISON (608) 233-2200
ELEGANT DINING • FINE WINES • INTIMATE
COCKTAIL LOUNGE • OPEN DAILY AT 5:00 PM
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WISCONSIN MEDICAL JOURNAL, APRIL 1985: VOL. 84
7
Broaden your medical experience
in the Army National Guard...
...and make your community, state
and country feel a lot better.
When you give two days a month and two weeks active
duty a year to the Army National Guard, you get a lot back;
• A chance to continue your medical education at our
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• A chance to serve where people really need you-right
in your own community and state. In the Army National Guard,
you may join a unit near your home. You'll be ^
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Guard members and assisting victims of floods,
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• A chance to do something different. In the Guard,
you'll meet new friends, new colleagues and new
challenges. Every time you serve.
And that's what the Guard is all about.
New opportunities to serve others. New oppor
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im:
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f \
LETTERS
^ . J
The Editors would like to encourage physicians to contribute to the LETTERS section where they can ventilate their frustrations as well as opinions. This feature
is intended to he lively and spirited as well as informative and educational. /I5 with other material which is submitted for publication, all letters will he subject
to the usual editing. Address correspondence to: The Editor, Wisconsin Aledical Journal Bo.\ 1 109. Madison. VV/s 53701.
Nicaragua— diversified views
To THE Editor: I have read with
interest Doctor Falk's letter about
Nicaragua.! He believes that the
cooperation between Wisconsin
and Nicaragua was easier before
the revolution. He gives the read-
er a totally negative picture of to-
day's situation in the country and
expresses how comfortable he felt
working there at the time when
the dictator Somoza was in power.
His views are certainly in sharp
contrast with those of Doctor
Schlenker.2 j h^ye been at several
presentations given by Doctor
Schlenker after his extensive trips
to Nicaragua. He, as many
others,^ shows evidence that the
health conditions for the entire
population have improved dra-
matically after the revolution in
spite of the kidnappings and as-
sassinations of health personnel
and destruction of health facilities
perpetrated by the United States'
trained and financed "contras."
Doctor Falk gives some facts like
the burning of Moskito villages in
the eastern part of Nicaragua and
the lack of medical supplies suf-
fered by the local physicians. Re-
gretfully he fails to explain that
these and many other calamities
(like the mining of the ports) are
the consequences of the campaign
of the "contras" against the San-
dinistas. Recently, for example, a
vaccination team directed by Dr
Gustavo Siquiera, vice dean of the
Managua campus of the School of
Medicine in Nicaragua, was at-
tacked by Mr Reagan's "freedom
fighters." After killing three of the
health workers and destroying the
vaccine. Doctor Siquiera and
three other persons were kid-
napped. Their fate is still un-
known."!
Doctor Falk's apprehension
about the presence of foreigners in
Nicaragua is also interesting. I
hope that Doctor Falk agrees that
these foreign doctors, nurses, and
other individuals who try to serve
the people will have a greater
ideological impact upon the
Nicaraguans than the guerrillas
who assassinate women and chil-
dren.
Our concern as physicians
should be the well-being of the
people above politics and na-
tionalities. We should realize that
the United States is not improving
the health of the people in Central
America by financing guerrillas, ie
"freedom fighters" to overthrow
the government of Nicaragua
which continues to make progress
in improving the health of the
people.
We should be encouraged, how-
ever, that Wisconsin has been so
helpful to Nicaragua in this critical
time. Large shipments of medical
supplies have been sent.® Five
physicians from Wisconsin, to-
gether with 196 from other states,
have generously donated their
time and effort travelling to
Nicaragua in September 1984 to
participate in the second annual
Nicaragua-United States Col-
loquium on health. In this way the
United States will be able to exer-
cise influence upon other nations
by means other than brutal force.
‘Falk VS: Wisconsin Med j 1984:83:12.
^Schlenker T: Wisconsin Med J 1984:83:9.
^Halperin DC, Garfield R: N Engl J Med 1982;
307:308.
•'New York Times, Feb 10, 1985.
^Milwaukee Journal, Nov 28, 1984.
—Gonzalo Madiedo, MD. PhD
8700 Wisconsin Ave
Milwaukee, Wisconsin 53226
Editorial Board comment: American
Medical News, March 1, 1985, states: "The
medical people may have been in untform and
carrying weapons, which might have con-
fused the contras, said Armstrong Wiggins,
the Indian leader in Washington. Now that
it is clear that they are medical people, they
should be released, Wiggins said. "
To THE Editor
(Press release dated
February 6, 1985, Milwaukee):
Dr Gustavo Siquiera, vice-
dean for medical sciences at the
UNAN medical school in Man-
agua, Nicaragua, along with three
other healthcare workers were
kidnapped on the morning of Jan-
uary 26 by as yet unidentified
"contra" forces from the island of
Rama Quay situated about 10
kilometers from Bluefields on
Nicaragua's East Coast. Doctor
Siquiera and the others were
there at that time as volunteers
participating in a campaign to
vaccinate the island's children.
During the attack, three people
were killed by the "contras" and
all of the vaccination supplies
were stolen.
We, as physicians practicing
in Milwaukee and as faculty
members of the Medical College
of Wisconsin, appeal to the
governments of Costa Rica and
Honduras and to the government
of the United States to apply pres-
sure on the contras to save the
lives of these four Nicaraguans
and to facilitate their release.
We also ask every doctor and
every nurse and all other health-
care workers in this community
to speak out loudly now in pro-
test over this cruel attack on our
colleagues in Central America.
And we petition the US govern-
ment to reject both publicly and
WISCONSIN MEDICAI. JOURNAL, APRIL 1985:\'OL. 84
9
LETTERS
NICARAGUA
privately all activities that serve
to promote this kind of vicious
and immoral act.
— Sean Keane, MD
Orthopedic Surgery
St Francis Hospital
—Gonzalo Madiedo, MD
Assistant Professor of Pathology
Medical College of Wisconsin
—Pablo Pedraza, MD
Cardiovascular Surgery
St Mary's Hospital
—Thomas Schlenker, MD
Clinical Instructor of Pediatrics
Medical College of Wisconsin
—Lucille Glicklich, MD
Associate Professor of Psychiatry
Medical College of Wisconsin
Milwaukee, Wisconsin
To THE Editor; It is my under-
standing that there have been two
letters to the Journal asking Wis-
consin physicians to decry the ac-
tivities of the Contra guerrillas in
Nicaragua against the Sandinista
government. These complaints
specifically involve the kidnap-
ping of a military health team
which reportedly was involved in
vaccination of indigents on the
East coast of Nicaragua. I would
like to make a couple of points
about such letters supporting a
particular political point of view:
1. Anytime difficulties accrue in
an area such as Central Amer-
ica there is usually polarization of
the political and moral viewpoints
of sympathetic observers. The
above mentioned letters reflect
such polarization. For example,
the kidnapped health team was
actually in military garb and
carrying weapons at the time, (this
is against the rules of the Geneva
Convention). This certainly would
create problems in identifying
these military persons as non-
combatants. Such details were not
mentioned in the letters though
they are extremely important in
the interpretation of the incident.
2. These same letters should have
raised equal outcries against
the Sandinistas who with their
new, absolutely state-of-the-art
M-1 Russian-supplied attack heli-
copters created havoc on the East
coast. These helicopters are more
than a match for the best attack
helicopters owned by the United
States military and are vastly
superior to any aircraft owned by
other countries in Central
America.
As a demonstration of the
power of the new Russian chop-
pers, the Sandinistas essentially
eliminated Greytown from the
face of the earth. Greytown was
one of the oldest towns on the East
coast of Central America. The
Sandinistas felt that it was sym-
pathetic to the rebel cause and
two of these attack helicopters,
each carrying the destructive
capability close to a squadron of
B-17s, erased Greytown from its
geographic location. I had the op-
portunity to talk to some of the
refugees from the area as little as
three weeks ago and their descrip-
tion of the holocaust made the
Mai Lai incident look like a simple
parlor monopoly game.
It has also been recently
brought to our attention that the
island of Rama Cay was also
leveled by the Sandinistas, prob-
ably by the same mechanism.
Rama Cay was the home of the
Rama Indians, a very small and
ethnically discrete group on the
Nicaraguan coast. At one time
they were politically nonaligned
and preferred to be left alone. The
previous regime actually did this.
Evidently, the Sandinistas have
elected not to.
3. Let us also be very careful how
we describe the Contras as
rapists, murderers, and militarists.
Some of them indeed are old
guard Somosistas. This does not
immediately label them as rapists
and murderers. Most, in fact, are
disenfranchised Mosquito Indians
who had supported the Sandinista
revolution before it turned upon
them. Another large group is old
disaffected revolutionaries
headed by one of the top generals
in the Sandinista revolution army.
This general became totally dis-
enchanted with the Communist/
Russian /Cuban backed takeover
of the revolutionary government.
Many more are current defectors
from the Sandinista army who do
not approve of the militaristic
changes in their country.
4. Extreme and naive stands
taken on both sides only serve
to muddy the waters. The State of
Wisconsin has always had a
strong and sympathetic relation-
ship with Nicaragua and the
Nicaraguan people. We should be
sympathetic to their political as
well as ethnic diversity. It is not
helpful to us in understanding
their problems and the problems
with Central America to read stri-
dent letters from ostensibly well-
meaning physicians who in fact
are probably only quoting the
partyline which has been fed
them by an admittedly shakey
Managuan government.
-David G. Dibbell, MD. FACS
Professor and Chairman
Division of Plastic and Reconstructive
Surgery
University of Wisconsin School of
Medicine
600 Highland Avenue
Madison, Wisconsin 53792
To THE editor: I read with inter-
est the letters describing both
the political situation and the
state of health in Nicaragua now
as opposed to prerevolutionary
days. Based upon my experi-
ence in that country on eight or
more occasions before the revo-
lution and more recently last
June, I would have to state that
indeed there are massive
changes that have taken place.
Prior to the revolution, between
1968 and 1978, an average of 10
10
WISCONSIN MEDICAL JOURNAL, APRIL 1985: VOL. 84
NICARAGUA
I.ETTERS
medical students yearly from
the University of Wisconsin
Medical School spent three
months in projects relative to
health in various Mosquito In-
dian villages on the east coast of
Nicaragua. An additional 10
students from three other uni-
versities likewise participated
yearly, and this resulted in con-
siderable improvement in the
health of these Indian com-
munities. In addition to this,
more than a dozen physicians
from Wisconsin donated their
time serving in various capaci-
ties largely on the east coast of
Nicaragua. Health care facilities
were built by Wisconsin at
several sites on the Rio San Juan
River and there was a large in-
fluence on the Rio Coco River at
Waspam and at Bilwaskarma
where paramedical and medical
personnel participated. Before
the earthquake, and especially
after the earthquake, the Wis-
consin Hospital Association and
other people working with the
Wisconsin/Nicaragua Partners
sent trainloads of hospital
equipment to Nicaraguan hos-
pitals throughout the country,
in addition to which a 1,000 stu-
dent school was built in Mana-
gua which is still in operation.
Thirteen Wisconsin communi-
ties were linked with counter-
part cities in Nicaragua with
interchange of people, projects
that linked churches, schools
and service clubs in the two
countries; the Wisconsin Medi-
cal Society worked with their
counterpart in Nicaragua. Vac-
cination campaigns were con-
ducted throughout Central
America including Nicaragua on
at least two occasions that in-
cluded Wisconsin physicians
and personnel. Shortly after the
revolution, the new government
destroyed over 61 Indian vil-
lages, including the large city
of Waspam and this included re-
settlement in camps for these
Indian families far from their
ancestral homes. This made
continuance of medical activi-
ties in eastern Nicaragua im-
possible. Doctor Madiedo men-
tions the recent kidnapping of a
vaccination team that was
working on Rama Key off the
coast of Bluefields. He does not
add that these personnel were
subsequently released by the
contras. Although the general
To MY colleagues: Are your asth-
matic patients worsening after ad-
mission to the hospital because
someone in the next bed is smok-
ing? Do you have to brown bag
your lunch in your office rather
than go to the hospital cafeteria
because of the dense cigarette
smoke? Are your ward secretaries
at risk from the ill health effects of
secondhand smoke because visi-
tors smoke in front of the desk?
The State Medical Society urges
physicians to take an active role in
effecting the compliance of hos-
pitals with Wisconsin's new Clean
Indoor Air Act, which states that
smoking is not permitted in hos-
pitals and other public buildings
except where smoking areas are
specifically designated by posted
signs.
In a brief meeting a subcommit-
tee of the hospital medical staff
along with an administrative
designee can rapidly devise an ap-
propriate plan and arrange for the
placement of signs. In accordance
with the law, signs designating
smoking areas need not be costly,
but should have letters at least
3 / 4 " in size and include the inter-
national smoking-allowed sign.
(Posting no-smoking signs in non-
smoking areas is optional, but
probably a good idea since the
general public does not yet realize
health of the Nicaraguan Indians
may be improving in recent
years, this cannot have included
their peace of mind; and it is
this mistreatment of east coast
Indians that we should all pro-
test.
—Henry A Peters, MD
Center for Health Sciences
University of Wisconsin-Madison
University Hospital and Clinics
600 Highland Avenue
Madison, Wisconsin 53792
that hospital areas which are not
posted as smoking areas are auto-
matically nonsmoking areas.)
While some hospitals have
designated the entire hospital as a
no-smoking area, others have pro-
vided smoking areas within
lounges or have provided separate
lounges for smokers. They have
also set up no-smoking policies for
patient rooms with exceptions for
certain private rooms or semi-pri-
vate rooms in which both patients
wish to smoke.
The hospital cafeterias can gen-
erally be divided into separate
smoking and nonsmoking areas,
and a few waiting rooms can be
designated as smoking areas.
The doctors of the state of Wis-
consin were steadfast in the cam-
paign to obtain this Clean Indoor
Air Law. Now we need to act to be
sure that the law is enforced in
hospitals to protect our patients,
our employees, and ourselves
from the effects of secondhand
smoke and to discourage smoking
—the number one preventable
cause of emphysema, lung cancer,
and arteriosclerotic heart disease.
—Larry A Lindesmith, MD, La Crosse
Vice Chairman
Committee on Environmental
and Occupational Health
State Medical Society of Wisconsin ■
Is your hospital in compliance?
1 1
WfSCONSIN MEDICAL JOURNAL, APRIL 1985: VOL. 84
Consider the
causative organisms...
cefaclor
250-mg Pulvules^ t.i.d.
offers effectiveness against
the major causes of bacterial bronchitis
H. influenzae, H. influenzae, S. pneumoniae, S. pyogenes
(ampicillin-susceptible) (ampicillin-resistant)
Brief Summary Consult the package literature lor prescribing
information
Indications and Usage Ceclor' (cefaclor, Lilly) is indicated in the
treatment of the tollowing infections when caused by susceptible
strains of the designated microorganisms
Lower respiratory infections including pneumonia caused by
Strepiococcus pneumoniae iDiplococcus pneumoniae) Hsetnoph
iius mtiuemae. and S pyogenes (group A beta-hemolytic
streptococci)
Appropriate culture and susceptibility studies should be
performed to determine susceptibility ot the causative organism
to Ceclor
Contraindication: Ceclor is contraindicated in patients with known
allergy to the cephalosporin group ot antibiotics
Warnings IN PENICILLIN-SENSITIVE PATIENTS, CEPHALO-
SPORIN ANTIBIOTICS SHOULD BE ADMINISTERED CAUTIOUSLY
THERE IS CLINICAL AND LABORATORY EVIDENCE OF PARTIAL
CROSS-ALLERGENICITY OF THE PENICILLINS AND THE
CEPHALOSPORINS. AND THERE ARE INSTANCES IN WHICH
PATIENTS HAVE HAD REACTIONS. INCLUDING ANAPHYLAXIS,
TO BOTH DRUG CLASSES
Antibiotics, including Ceclor. should be administered cautiously
to any patient who has demonstrated some form of allergy,
particularly to drugs
Pseudomembranous colitis has been reported with virtually all
broad-spectrum antibiotics (including macrolides. semisynthetic
penicillins, and cephalosporins), therefore, it is important to
consider its diagnosis in patients who develop diarrhea in
association with the use of antibiotics Such colitis may range in
severity from mild to life-threatening
Treatment with broad-spectrum antibiotics alters the normal
flora of the colon and may permit overgrowth ot clostiidia Studies
indicate that a toxin produced by ClostnPium difficile is one
primary cause of antibiotic-associated colitis
Mild cases of pseudomembranous colitis usually respond to
drug discontinuance atone in moderate to severe cases, manage-
ment should include sigmoidoscopy, appropriate bacteriologic
studies, and fluid, electrolyte, and protein supplementation
When the colitis does not improve after the drug has been
discontinued, or when it is severe, oral vancomycin is the drug
of choice for antibiotic-associated pseudomembranous colitis
produced by C difficile Other causes of colitis should be
ruled out
Precautions Geneial Precautions ~ if an allergic reaction to
Ceclor* (cefaclor, Lilly) occurs, the drug should be discontinued,
and. If necessary, the patient should be treated with appropriate
agents, e g . pressor amines, antihistamines, or corticosteroids
Prolonged use of Ceclor may result in the overgrowth ot
nonsusceptible organisms Careful observation of the patient is
essential If superinfection occurs during therapy appropriate
measures should be taken
Positive direct Coombs' tests have been reported during treat
ment with the cephalosporin antibiotics In hematologic studies
or in transfusion cross-matching procedures when antiglobulin
tests are performed on the minor side or in Coombs' testing of
newborns whose mothers have received cephalosporin antibiotics
before parturition, it should be recognized that a positive
Coombs' lest may be due to the drug
Ceclor should be administered with caution in the presence of
markedly impaired renal function Under such conditions, careful
clinical observation and laboratory studies should be made
because sate dosage may be lower than that usually recommended
As a result of administration of Ceclor. a false-positive reaction
for glucose in the urine may occur This has been observed with
Benedict's and Fehling's solutions and also with Clinitest''
tablets but not with Tes-Tape* (Glucose Enzymatic Test Strip.
USP. Lilly)
Broad-spectrum antibiotics should be prescribed with caution in
individuals with a history of gastrointestinal disease, particularly
colitis
Usage in Pregnancy - Pregnancy Category B - Reproduction
studies have been performed in mice and rats at doses up to 12
times the human dose and in ferrets given three times the maximum
human dose and have revealed no evidence ot impaired fertility
or harm to the fetus due to Ceclor* (cefaclor. Lilly) There are
however, no adequate and well-controlled studies in pregnant
women Because animal reproduction studies are not always
predictive ot human response, this drug should be used during
pregnancy only if clearly needed
Nursing Mothers - Small amounts ot Ceclor have been detected
in mother s milk tollowing administration of single SOO-mg doses
Average levels were 0 18. 0 20. 0 21 . and 0 Id mcg/ml at two.
three, four, and five hours respectively Trace amounts were
detected at one hour The effect on nursing infants is not known
Caution should be exercised when Ceclor is'administered to a
nursing woman
Usage in Children - Safely and effectiveness of this product tor
use in infants less than one month ot age have not been established
Adverse Reactions: Adverse effects considered related to therapy
with Ceclor are uncommon and are listed below
Gaslroinlestinal symptoms occur in about 2 5 percent of
patients and include diarrhea (1 in 70)
Symptoms of pseudomembranous colitis may appear either
during or after antibiotic treatment Nausea and vomiting have
been reported rarely
Hypersensitivity reactions have been reported in about 1 5
percent of patients and include morbilitorm eruptions (1 in 100)
Pruritus, urticaria, and positive Coombs' tests each occur in less
than 1 in 200 patients Cases ot serum-sickness-like reactions
(erythema multiforme or the above skin manifestations accompanied
by arthritis/arthralgia and. frequently, fever) have been reported
These reactions are apparently due to hypersensitivity and have
usually occurred during or following a second course of therapy
with Ceclor Such reactions have been reported more frequently
in children than in adults Signs and symptoms usually occur a few
days after initiation of therapy and subside within a tew days
after cessation of therapy No serious sequelae have been reported
Antihistamines and corticosteroids appear to enhance resolution
of the syndrome
Cases of anaphylaxis have been reported, half of which have
occurred in patients with a history of penicillin allergy
Other effects considered related to therapy included
eosinophilia (1 in 50 patients) and genital pruritus or vaginitis
(less than 1 in 10() patients)
Causal Relationship Uncertain ~ Transitory abnormalities in
clinical laboratory test results have been reported Although they
were ot uncertain etiology, they are listed below to serve as
alerting information tor the physician
Hepatic - SUghi elevations in SCOT. SGPT. or alkaline
phosphatase values |l in 40)
Hematopoietic -fiansmt fluctuations in leukocyte count,
predominantly lymphocytosis occurring in infants and young
children |1 in 40)
Renal - Slight elevations in BUN or serum creatinine (less than
1 in 500) or abnormal urinalysis (less than 1 in 200)
[061782RI
Note Ceclor* (cefaclor. Lilly) is contraindicated in patients
with known allergy to the cephalosporins and should be given
cautiously to penicillin-allergic oatients
Penicillin is the usual drug of choice in the treatment and
prevention of streptococcal infections, including the prophylaxis
of rheumatic fever See prescribing information
© 1984 ELI LILLY AND COMPANY
Addiiional mtonnsiion availahle to
the profession on reguesi from
ill Lilly and Company.
Indianapolis Indiana 46285
Eli Lilly ifldDsihes, Inc
Carolina. Puerto Rico 00630
V'ictor S Falk, MO, Medical Editor
SCIENTIFIC MEDICINE
Pneumatic injury from a nailgun
Mark J Mirick, MD; Jeff Kurtz, MD; and George Tanner, MD
Wausau, Wisconsin
ABSTRACT. The authors present a
case history involving a high-pres-
sure air injection injury. The eval-
uation of the prognostic indicators:
substance, location, amount, neu-
rologic vascular damage, led to
conservative therapy with close
supervision and a favorable out-
come with no functional impair-
ment.
Key words: Pneumatic injury, High-
pressure injection
shot a nail into the back of his left
wrist. Unfortunately, the high-
pressure air hose that runs the
gun was also nailed to the man's
wrist. This caused air at approxi-
mately 200 lb per square inch to
be injected along the entry
wound path of the nail. A com-
panion immediately pulled the
air hose and nail from the man's
wrist, and he subsequently was
brought to the Emergency De-
partment.
Condition upon arrival: The
initial findings consisted of a
puncture wound/entry wound at
the dorsal area of the left wrist
approximately over the capitate.
There was no exit wound or ob-
vious foreign body remaining.
There was minimal tenderness at
the site. Circulation, motor, and
sensory exam was intact and the
patient had full range of motion
at the wrist. The dorsum of the
hand was markedly swollen and
there was a slight increase in the
circumference of the forearm. No
signs of compartment syndrome
existed. There was palpable sub-
cutaneous emphysema of the
hand (excluding the palm), fore-
H IGH-PRESSURE injection in-
juries are primarily occupational
accidents of certain industries.
Previous reports have demon-
strated that the severity of the
injury was related to the composi-
tion of the substance injected.
Devastating injuries have been
described for paint and grease
gun injuries, and the reported
substances injected include paint,
grease, diesel oil, hydraulic fluid,
plastics, wax solvents, cement,
river water, and nitrogen gas.'
The following case describes a
nailgun injury that caused a mas-
sive injection of air without other
agents.
CASE REPORT
Prehospital events: A 21 -year-old
construction worker was using a
nailgun when he accidentally
From the Department of Emergency Med-
icine (MJM) and the Department of Sur-
gery (JK,GT), Wausau Hospital Center,
Wausau. Reprint requests to: Mark j
Mirick, MD, Dept of Emergency Medi-
cine, Wausau Hospital Center, Wausau,
Wis 54401 (phone 715/847-2160|. Copy-
right 1985 by the State Medical Society of
Wisconsin.
WISCONSIN MEDICAL JOCRNAE, APRIL 1985 : VOL. 84
3
SCIENTIFIC MEDICINE
PNEUMATIC INJURY-Mirick, Kurtz, and Tanner
arm, and arm. Air could be seen
bubbling from the entrance
wound. X-ray films revealed
massive subcutaneous air of the
left upper extremity as well as air
up into the neck on chest x-ray
study (Fig 1 & 2). There was no
bony injury. The patient's im-
munization status was checked.
Subsequent events and treat-
ment: The wound edges were
sharply excised and thorough
irrigation and debridement were
performed. The wound was left
open and the patient started on
parenteral penicillin and cefa-
zolin. Steroids were not admin-
istered.
The patient was admitted to the
hospital for close observation.
This decision of conservative
management was based on two
favorable prognostic factors:
the substance injected was air
and the location was not into a
small confined space.
The patient's hospital course
was unremarkable. No neuro-
Figure 2— Shows subcutaneous air from
vascular or infectious problems
developed. After five days of
elevation, the subcutaneous air
had been absorbed and was vir-
tually gone.
He was discharged with
normal function of the left upper
extremity and was able to resume
work ten days after the injury. A
followup examination at two
weeks was normal.
DISCUSSION
Numerous articles concerning
high-pressure injection injuries
have appeared since the original
report by Rees.^° The patho-
physiology involves chemical
irritation, inflammation, circu-
latory embarrassment, and vessel
thrombosis with resulting gan-
grene, slow healing, or fibrosis
and sinus formation.
The mechanism of obliterative
thrombosis and necrosis has been
postulated to involve sudden
massive thrombosis caused by
the injected substance volatiliz-
injection injury.
ing, acute temporary arterial
spasm, venous obstruction, and
arterial obstruction secondary
to increased pressure (compart-
ment syndrome). Whether all
these factors are operational has
been the subject of previous
reports.^^
Well documented, however, is
the ability to predict prognosis
based on certain factors sur-
rounding the accident.
A. Substance injected— the tox-
icity relates to the volatility of
the agent; ie, solvents > paints >
oil > grease.
B. Location injected— the
smaller the potential space,
the worse the prognosis; ie,
fingers > palm > arm.
C. Time to intervention— in
general the longer the delay
in definitive therapy, the worse
the prognosis. Unfortunately, in
some cases despite early inter-
vention, the functional outcome
has been poor.
D. Amount injected— the more
material into a confined
space, the worse the outcome.
The emergency medicine phy-
sician is likely to see the injury
first, and it is his or her responsi-
bility to recognize that the seem-
ingly trivial appearing lesions
are truly surgical emergencies.
Radiographic evaluation is es-
sential.*'' The subsequent treat-
ment is usually surgical although
there are published reports advo-
cating conservative therapy for a
very select subgroup based upon
evaluation of the prognostic in-
dicators. The basic principles of
immediate debridement, decom-
pression (including neurolysis,
arteriolysis, tenolysis, and fascio-
tomy), and evacuation should
strictly be adhered to when deal-
ing with the more devastating in-
juries. Amputation becomes
likely for a paint injury into a
finger, otherwise amputation
as a primary procedure is con-
traindicated.‘"°
14
WISCONSIN MEDICALJOURNAL, APRIL 1985:VOL. 84
PNEUMATIC INJURY— Mirick, Kurtz, and Tanner
SCIENTIFIC MEDICINE
Kendrick described the first
case of a conservatively man-
aged high-pressure injection in-
jury based upon sound evaluation
of the prognostic indicators.!^ His
criteria for conservative therapy
included:
1. Injected agent is less
damaging.
2. Favorable anatomical site.
3. No signs of central nervous
system damage.
4. Adequate close supervision
with the expertise to apply
surgical therapy if needed.
Other reported cases where the
conservative approach was used
include air injected into the left
thenar eminence/ and nitrogen
gas injected into the femur and
thigh during a closed intramedul-
lary nailing with a power reamer.
In these cases decompression,
or amputation, was not needed
and the patients recovered with-
out functional impairment.
Acknowledgment: The authors wish to thank
the Wisconsin Chapter, American College of
Emergency Physicians, for its support in prep-
aration of this manuscript.
REFERENCES
1. Apfelberg DB, et al: High-pressure sili-
cone injection injury of the hand. J Traum
1975:15:922-925.
2. Booth CM: High-pressure pain gun
injuries. Brit Med J 1977;2:1333-1335.
3. Dickson RA: High-pressure injection
injuries of the hand: a clinical, chemical
and histological study. Hand 1976;8:
189-193.
4. Gelberman RH, Posch JL, Jurist JM: High-
pressure injection of the hand. J Bone Jt
Surg 1975:57:935-937.
5. Greenberg MI: High-pressure injection
injury with river water. J Am Coll Emerg
Phy 1978;7:241-242.
6. Griffiths JC: Plastic injection injury
of the hand. Injury 1976;8: 143-144.
7. Hayes CW, Pan HC: High-pressure in-
jection injuries to the hand. S Med J
1982:75:1491-1498.
8. Herrick RT, Godsil RD, Widener JH:
High-pressure injection injuries to the
hand. 5 Med J 1980:73:896-898.
9. Hutchinson CH: Hand injuries caused
by injection of cement under pressure.
J Bone Jt Surg 1968;50:131-133.
10. Kaufman HD: The clinicopathological
correlation of high-pressure injection
injuries. Brit J Surg 1968;55:214-218.
11. Kaufman HD: High-pressure injection
injuries: the problems, pathogenesis
and management. Hand 1970;2:63-73.
12. Kendrick RW, Colville J: Conservative
management of a high-pressure injection
injury to the hand. Hand 1982:14: 159-161.
13. LeBlanc JV: High-pressure petroleum in-
jection injuries. / Occup Med 1977:19:276-
277.
14. O'Reilly RJ, Blatt G: Accidental high-
pressure injection gun injuries of the hand.
JTraum 1975:15:24-31.
15. Philps DB, Hastings II H, Boswick JA:
Systemic corticosteroid therapy for
high-pressure injection injuries of the
hand. /Traum 1977;17:206-210.
16. Ramos H, Posch JL, Lie KK: High-pressure
injection injuries of the hand. Plastic Recon
Surg 1970;45:221-226.
17. Schoo MJ, Scott FA, Boswick JA: High-
pressure injection injuries of the hand. /
Traum 1980;20:229-238.
18. Whitehill R, et al: Nitrogen— gas in-
jection from a power reamer: a compli-
cation of closed intramedullary nailing
of the femur. / Bone Jt Surg 1983:65:
860-861.
19. Zook EG, Kinkead LR: Pressure gun
injection injuries of the hand. / Am Coll
Emerg Phy 1979;8:264-266.
20. Rees CE: Penetration of tissue by fuel oil
under high pressure from a diesel engine.
JAMA 1937;109:866.H
ABSTRACTS
Patient selection and results of simultaneous
coronary and carotid artery procedures
HERBERT A BERKOFF, MD; WILLIAM D TURNIPSEED, MD, Department of
Surgery, University of Wisconsin Clinical Science Center, Madison, Wis: Ann
Thorac Surg 1984 (Aug);38:172-175.
The high incidence of severe coronary artery disease in patients
with symptomatic carotid artery disease makes careful evaluation
of both carotid and coronary systems important to the successful
short-term and long-term management of these patients.
They have established guidelines for patient evaluation and pro-
cedure selection based on symptomatic assessment of each system,
supplemented by angiographic and hemodynamic data. With this
information, three operative groups are established: (1) carotid
artery operation first or alone, (2) coronary artery bypass grafting
first followed by carotid artery operation, and (3) simultaneous
carotid artery and coronary artery bypass procedures. The bene-
fit of this selection process has been shown by the low operative
mortality in each group. This report presents their selection pro-
cess and evaluates the results for 21 patients in the group having
simultaneous carotid and coronary artery procedures. ■
Perihepatitis (Fitz-Hugh— Curtis syndrome)
HANIA W RIS, MD, Dept of Pediatrics, University of Wisconsin Medical School,
Madison, Wis; / Adolescent Health Care 1984;5:272-276
Perihepatitis, or Fitz-Hugh— Curtis syndrome (FHC), is a com-
plication of pelvic inflammatory disease (PID). Although in the
past Neisseria gonorrhoeae was thought to be the only etiological
agent, recent data indicate that chlamydia trachomatis can produce
the syndrome. Because cervical cultures frequently fail to demon-
strate the presence of C. trachomatis, the serologic microimmuno-
fluorescence antibody test is essential to diagnosis; the antibody
titer in FHC syndrome is markedly higher than in PID without
FHC syndrome. The classic presenting symptom of perihepatitis
is severe right upper quadrant abdominal pain. If unnecessary
diagnostic and surgical procedures are to be avoided, the FHC
syndrome in the sexually active young woman must be includ-
ed in the differential diagnosis of abdominal pain irrespective of
its location. Tetracycline is recommended for treatment. If tetra-
cycline is contraindicated, erythromycin may be used. ■
WISCONSIN MEDICAL JOURNAL, APRIL 1985: VOL. 84
SCIENTIFIC MEDICINE
Clonorchis sinensis infection associated
with adenocarcinoma of the gall-
bladder and cystic duct
Paid Drinka, MD and Greg Sheehy, MD
Madison, Wisconsin
ABSTRACT. Infection with Clon-
orchis sinensis, the "Chinese liver
fluke," is common in residents of
Southeast Asia. We present a case
of a 33-year-old Laotian who de-
veloped acute right upper quadrant
pain, low-grade fever, and ele-
vations in bilirubin and trans-
aminase levels. All of these par-
ameters improved spontaneously.
This episode may represent low-
grade "Oriental cholangitis." Five
weeks later the patient presented
with painless jaundice and was
found to have adenocarcinoma of
the gallbladder and cystic duct.
Biliary secretions revealed ova of
C. sinensis. Clonorchis infection
has been implicated previously in
the pathogenesis of both Oriental
cholangitis and adenocarcinoma
of the mirahepatic biliary radicles.
Key words: Liver fluke, Clonorchis sinen-
sis. Biliary carcinoma. Oriental cholangitis
From the Department of Internal Medi-
cine, Geriatrics (PD), William S Middle-
ton Memorial Veterans Hospital, and
Department of Internal Medicine (GS),
Madison General Hospital, Madison,
Wisconsin. This work was supported in
part by the Veterans Adminsitration.
Reprint requests to: Paul Drinka, MD,
Dept of Internal Medicine, Geriatrics, VA
Hospital, 2500 Overlook Terrace, Madi-
son, Wis 53705 (phone; 608/256-1901,
ext 446). Copyright 1985 by the State
Medical Society of Wisconsin.
TT HE American physician is in-
creasingly called upon to care for
immigrants from Southeast Asia.^
Optimal care requires familiarity
with pathological states endemic
in this population. We report a
case of infection by Clonorchis
sinensis (Chinese liver fluke) as-
sociated with adenocarcinoma of
the gallbladder and possibly low-
grade cholangitis.
CASE REPORT. A 33-year-old
Laotian male presented to the
Madison General Hospital Emer-
gency Room in November 1981
with a four-day history of pro-
gressive right upper quadrant and
periumbilical pain. He denied
constitutional symptoms, change
in bowel or bladder habits, or
use of alcohol.
On examination he appeared in
mild distress. Vital signs showed
a blood pressure of 120/70
mmHg, a pulse rate of 72/min,
and a temperature of 37C (98.6 F)
orally. Direct tenderness in the
right upper quadrant without re-
bound was present. The
remainder of the examination
was unremarkable.
Laboratory data are presented
in Table 1. The white blood cell
count was 7,800/pl, with 37%
polymorphonuclear leukocytes,
8% bands, 2% basophils, 1%
eosinophils, 26% lymphocytes,
and 26% monocytes. Hemoglobin
was 13.4 g/dL. Hepatitis B sur-
face antigen was absent, and
two blood cultures were nega-
tive. One stool culture revealed
normal bowel flora and one stool
was negative for ova and para-
sites. The serum titer of antibody
to Entamoeba histolytica was less
than 1:64 (normal). Other labora-
tory tests were within normal
limits, including cholesterol and
erythrocyte sedimentation rate.
Barium contrast x-ray studies
of the upper gastrointestinal tract
were normal. There was no
visualization on oral cholecysto-
gram. Ultrasound revealed a di-
lated gallbladder and a layering
of echogenic material consistent
with milk of calcium bile. Some
dilatation of the intrahepatic
bile ducts was noted. Chest x-ray
film and liver scan were normal.
The patient's hospital course
was one of prompt resolution of
symptoms and signs, with some
improvement of laboratory para-
meters within 48 hours of ad-
mission (Table 1). At the time, it
was believed that the patient had
passed a common duct stone.
Since he was asymptomatic and
wished to return to work, he was
discharged to return in one week.
He was seen again a month
later when he presented with
painless jaundice. There had
been no recurrence of abdominal
pain. He was in no distress. Ex-
amination was unchanged from
the previous month except for
icterus and the absence of ab-
dominal tenderness (Table 1).
Complete blood count revealed a
white blood cell count of 6,900/
pi with 35% eosinophils. Pro-
thrombin time and partial throm-
boplastin time were normal. Mul-
tiple stool samples were ex-
amined, and some were positive
for ova whose similar horizontal
16
WISCONSIN MEDICAI.JOURNAI., APRIL 1985: VOL. 84
CLONORCHIS SINENSIS INFECTION-Drinka and Sheehy
SCIENTIFIC MEDICINE
and vertical dimensions were
more consistent with C. sinensis
than with Opisthorchis felineus
or O. viverrini.
Ultrasound again showed gen-
eralized dilatation of the intra-
hepatic ductal system. Trans-
hepatic cholangiogram confirmed
massive dilatation of these ducts,
and contrast material did not pass
into the common bile duct on im-
mediate or delayed films.
Surgical exploration revealed a
2-cm mass in the gallbladder just
distal to the cystic duct. The apex
of the gallbladder was flaccid.
The distal common bile duct was
small, rigid, and fibrotic. Bead-
like dilatation of the proximal
common duct was noted. Biliary
dilatation was very prominent at
the porta hepatis and proximal to
it.
A cholecystectomy was per-
formed. Examination of frozen
sections revealed no carcinoma.
Because of the proximal biliary
dilatation and the appearance of
the distal common bile duct, a
bypass procedure was per-
formed. The dilated proximal
hepatic duct was opened. It was
impossible to pass a probe down
the distal common bile duct. The
jejunum was attached to the
common hepatic duct proximal to
the mass, and an end-to-side
jejunojejunostomy was per-
formed. No large biliary calculi
were encountered. Carcinoma
was not suspected at the time
of surgery.
Pathological examination of
biliary fluid revealed ova con-
sistent with C. sinensis. Perma-
nent histologic sections demon-
strated an adenocarcinoma of the
gallbladder neck and cystic duct,
infiltrating the entire thickness
of the wall. There was no evi-
dence of the adult worm in any of
the sections.
Postoperatively, the patient
was treated with 4000 rad to the
gallbladder bed and completed
five of eight cycles of FAM
(5-fluorouracil, adriamycin, and
mitomycin-C). Fourteen months
after diagnosis he was without
signs of tumor recurrence and
was working full-time. Subse-
quently, he was lost to followup.
DISCUSSION. Infection with C.
sinensis is common in Southeast
Asia, southern China, and Korea.
A large autopsy series from Hong
Kong, published in 1964, placed
the prevalence of 65% in indi-
viduals over one year of age.^
Many infected individuals are
asymptomatic.
The parasite's life cycle cannot
be completed in North America
because the intermediate host is
absent. The adult flatworm in-
habits the biliary system. Eggs
are passed in human feces and
ingested by suitable snails. In
the snail the parasite matures to
the free-swimming cercaria stage,
which penetrates the skin of a
suitable fish and encysts in
muscle. Uncooked fish, a deli-
cacy in the Orient, is the source
of human infection. Encysted
parasites are released as metacer-
caria in the duodenum and mi-
grate up the ampulla of Vater into
the small biliary radicles where
they mature. Adult flukes
measure approximately 15 mm;
they may live up to 20 years. ^
They may be carried downward
into the common bile duct. Hou“^
reports that:
At autopsy as well as surgical
operations one finds the common
duct and hepatic ducts filled with
worms. In cases of heavy in-
festation the number in the com-
mon bile ducts may exceed a
hundred.
In one postmortem study, 28
out of 300 individuals infected
with Clonorchis had flukes in the
gallbladder. 2 In another study
flukes were found in the gall-
bladder in 11 cases, but in only
one were they living.^
Flukes anchor themselves to
the biliary epithelium and can
pull themselves forward. ^ Their
presence in the intrahepatic bile
ducts results in epithelial des-
quamation, excess mucus pro-
duction, and eventual adenoma-
tous hyperplasia and abundant
connective tissue formation.'*
Development of biliary obstruc-
tion and adenocarcinoma may
be related to this process. Clon-
orchis infection has been asso-
ciated with ductal carcinoma in
animals.^ A human postmortem
study of 30 cases of exclusively
mfrahepatic ductal adenocarci-
noma without cirrhosis showed
multiple independent foci of
tumor origin and varying degrees
of histological differentiation.
This process was superimposed
Table 1: Serial laboratory data related to hepatobiliary system
Dale
SCOT
(0-50)
mU/ml
Lactic dehy-
drogenase
(100-225)
mU/ml
Gamma
glutomyl
transferase
(0-60)
mU/ml
Alkaline
phosphatase
(15-100)
mU/ml
Total
bilirubin
(0,1-1 1)
mg%
Amylase
(5-81)
I^/L
FIRST ADMISSION
11/19/81
530
431
560
167
1.3
90
11/20/81
231
240
650
227
3.6
—
11/21/81
79
174
578
206
1.9
-
SECOND ADMISSION
12/22/81
45
206
209
185
7.4
96
12/24/81
38
175
174
192
7.6
—
WI.SCONSIN MEDICAL JOURNAL, APRIL 1985: VOL. 84
17
SCIENTIFIC MEDICINE
CLONORCHIS SINENSIS INFECTION-Drinka and Sheehy
on the ductal hyperplasia pre-
sumably induced by mechanical
and chemical irritation from
Clonorchis. Flukes were iden-
tified in 93% of these cases.®
Belamaric, in a postmortem
pathological study from Hong
Kong, demonstrated that 18 of 19
patients with well-differentiated
adenocarcinoma of the intra-
hepatic biliary system, without
cirrhosis, had adenomatous
hyperplasia and grossly visible
fibrosis and dilatation of the bile
ducts, as is seen in severe Clon-
orchis infection. Flukes were
found in 15 of these cases. Such
gross ductal changes were ob-
served in only one-third of con-
trol patients without bile duct
carcinoma.^ Gibson reported
that in 17 cases of intrahepatic
adenocarcinoma from Hong
Kong, Clonorchis flukes were
noted in 65%, as compared to
38% of controls.® Thus, in-
dividuals infected with C. sinensis
are apparently at higher risk of
hifrahepatic ductal adenocarci-
noma than uninfected individ-
uals.
The parasite has also been
associated with a noncarcinoma-
tous entity known as "Oriental
cholangitis." Oriental cholangitis
has been reported as the third
most common cause of acute ab-
domen in the Hong Kong area,
exceeded only by appendicitis
and peptic ulcer disease.® The
characteristic presentation is
the acute onset of right upper
quadrant pain associated with
fever and jaundice. Attacks may
be recurrent. In the majority of
cases, enteric bacteria can be
cultured from the bile.
In the usual case of cholangitis
in the western world, the gall-
bladder is the nidus for obstruc-
tive cholesterol stone formation.
Oriental cholangitis, in contrast,
is a disease of the bile ducts as-
sociated primarily with bilirubin
stone formation, strictures, and
abscesses.® Obstruction to
bile flow in Clonorchis infection
may be caused by at least four
entities; carcinoma, mechanical
effects of the flukes themselves,
adenomatous hyperplasia,"* or
bilirubin stones. Microscopic ex-
amination of pigment stones from
42 patients from Hong Kong with
Oriental cholangitis revealed
morphological elements of as-
caris lumbricoides from 16 and
Clonorchis in 8.'® Parasites that
can invade the biliary system
[A. lumbricoides and C. sinensis]
were identified in 7 of 14 patients
with Oriental cholangitis in a
series from Los Angeles.’® In the
case of Clonorchis infection, rates
of stool isolation may be lowered
by the toxic effects of Gram-nega-
tive bacterial biliary infection
and Hypaque® on the fluke.
10,17
Our patient's first admission
illustrates the association be-
tween Clonorchis infection and
biliary pain, fever, and elevated
bilirubin, and may have been an
episode of Oriental cholangitis.
The transient nature of the pain
and initial improvement in
chemical parameters suggest
transient obstruction precipi-
tated by a stone, worms, or tumor
tissue that was subsequently
sloughed. The development of
painless jaundice five weeks
later proved to be secondary to
extensive fibrosis and/or obstruct-
ing carcinoma. Based on the as-
sociation of Clonorchis and intra-
hepatic biliary carcinoma,® '’ ® we
questioned the role Clonorchis
may have played in our patient's
adenocarcinoma of the gallblad-
der and cystic duct. The studies
of intrahepatic adenocarcinoma
and Clonorchis did comment on
extrahepatic biliary carcinoma.
Hou's study excluded adenocarci-
noma originating in the gallblad-
der and stated that "the gall-
bladders of this series failed to
show either hyperplasia or ana-
plasia of the epithelial cells"
—presumably the premalignant
lesion;® Belamaric' s study found
involvement of the extrahepatic
bile ducts in 2 of 19 cases;’’ and
Gibson stated that "carcinoma of
the extrahepatic or major bile
ducts, although not uncommon in
Hong Kong, is less clearly asso-
ciated with clonorchiasis than
is cholangiocarcinoma arising
within the liver itself."®
In summary, Clonorchis is as-
sociated with intrahepatic ductal
adenocarcinoma and possibly
with extrahepatic ductal adeno-
carcinoma. Clonorchis may be
found in the gallbladder, but in
one series gallbladder epithelial
hyperplasia was not seen. Al-
though the literature does not
strongly support an association
between adenocarcinoma of the
gallbladder and cystic duct with
Clonorchis infection, our case
raises the possibility of such an
association. We report this case
in the hope of raising physicians'
awareness of Clonorchis-asso-
ciated biliary disease.
Any patient with biliary signs
and symptoms who gives a
history of residence in an en-
demic area should be evaluated
with multiple stool examinations
for ova and parasites. Unfor-
tunately, there is no approved
medical treatment for Clonorchis
infection, although praziquantel
is promising.’® ’® ®® Appropriate
antibiotics are indicated for
superimposed Oriental cholan-
gitis caused by enteric organisms.
A surgical approach is considered
necessary to relieve biliary ob-
struction and should include a
drainage procedure.® ’®” ’®
Patients infected with Clonorchis
should be considered at risk for
development of biliary carci-
noma.
REFERENCES available upon request
to the authors.*
8
WISCONSIN MEDICAL JOURNAL, APRIL 1985: VOL. 84
SCIENTIFIC MEDICINE
Clinical and laboratory findings in ten
Milwaukee patients with the acquired
immunodeficiency syndrome or pro-
dromal syndromes
Paul A Turner, MD; Kari S Larratt, MS;
Timothy R Franson, MD; and Michael W Rytel, MD
Milwaukee, Wisconsin
ABSTRACT. Three patients meeting the Centers for Disease Control's defini-
tions of acquired immunodeficiency syndrome (AIDS) and seven with findings
suggestive of impaired cellular immunity were studied for early laboratory
markers of AIDS. The three AIDS patients had Pneumocystis carinii pneu-
monia and other opportunistic infections and had T-lymphocyte subset ratios
^0.5. Of the seven patients with prodromal syndromes, three had ratios <1.0.
In vitro interferon response to mitogens and antigens was impaired in all AIDS
patients, and only this group had an unusual acid-labile interferon alpha
detectable in their serum. We conclude that of all parameters studied, only
interferon responses may serve as a useful marker of AIDS, and that interferon
may play an important role in AIDS pathophysiology.
Key words: Acquired immunodeficiency syndrome (AIDS); Acid-labile interferon;
Pneumocystis carinii pneumonia; T-lymphocyte subsets
A.S OF January 1985, the
Centers for Disease Control
(CDC) in Atlanta have received
nearly 7,700 reports of cases of
the acquired immunodeficiency
syndrome (AIDS) in the United
States. 1 First described in mid-
1981, the syndrome is character-
ized by the development of op-
portunistic infections and/or
malignancies in previously
healthy patients secondary to a
From the Division of Infectious Diseases,
Medical College of Wisconsin, Milwau-
kee. Doctor Turner is a Fellow and Ms
Larratt is a Research Associate, Division
of Infectious Diseases; Doctor Franson is
an Assistant Professor of Medicine and
Hospital Epidemiologist; and Michael W
Rytel, MD is Professor of Medicine and
Head, Division of Infectious Diseases, all
from the Medical College of Wisconsin.
Reprint requests to; Paul A Turner, MD,
Division of Infectious Diseases, Milwau-
kee County Medical Complex, 8700 West
Wisconsin Ave, Milwaukee, Wis 53226
(phone: 414/257-6151). Copyright 1985 by
the State Medical Society of Wisconsin.
selective depletion of a specific
group of T-lymphocytes known
as helper or inducer cells. This
depletion may occur as a result
of infection of these helper cells
with a human T-cell lympho-
tropic virus. 2 The disease has
been reported in certain popu-
lation groups, primarily homo-
sexual males, intravenous drug
abusers, and hemophiliacs. Epi-
demiologic data suggest that
transmission of the agent occurs
in a similar fashion to transmis-
sion of the hepatitis B virus,
through contact with blood and
blood products and through inti-
mate personal contact. AIDS has
also been reported in Haitian
immigrants and heterosexual
partners of patients with the
disease. 3
Opportunistic organisms com-
monly found in AIDS patients
include but are not limited to
Pneumocystis carinii, Candida albi-
cans, herpes simplex, Mycobac-
terium avium intracellulare, Cryp-
tosporidia, cytomegalovirus, and
Toxoplasma gondii. Kaposi's sar-
coma is the most frequent malig-
nancy found in these patients
with or without an opportun-
istic infection, but malignant
lymphomas of several histologic
types also have been described.
Several immunologic ab-
normalities have been reported
in AIDS patients including
lymphopenia, suppression of cell-
mediated immunity, hypergam-
maglobulinemia, and the pres-
ence of circulating immune
complexes. Other abnormalities
that have recently been described
include the detection of an un-
usual form of leukocyte inter-
feron alpha (IFN-a) in the serum
of patients with AIDS and
with prodromal AIDS syn-
dromes.5®
In an attempt to identify any
early markers of AIDS, we
studied the clinical and immuno-
logic abnormalities in ten Mil-
waukee patients with AIDS or
syndromes suggestive of im-
paired cellular immunity.
METHODS
Patient selection. Between Janu-
ary 1983 and June 1984, ten pa-
tients were interviewed and
examined in order to obtain a
consistent clinical data base, in-
cluding demographic infor-
mation, past illnesses, number
of sexual contacts, and prior anti-
biotic use. Routine laboratory
studies were obtained including
hepatitis B markers, immuno-
globulins, and antigen skin test-
ing. Three of the ten met the
CDC's case definition for AIDS.'^
The remaining seven patients
were grouped together as having
prodromal syndromes of AIDS.
One of these patients had the
syndrome of AIDS related com-
plex (ARC), defined as the pres-
WISCONSIN MEDICAL JOURNAL, APRIL 1985: VOL, 84
9
SCIENTIFIC MEDICINE
AIDS— Turner, Larratt, Franson, and Rytel
Table 1: Clinical and laboratory findings
CASE
AGE
NO, OF
SUBSET
OTHER LAB
DIAG-
NOSTIC
CATE-
NO,
(yrs|
CONTACTS"
CLINICAL DIAGNOSESt
RATIOSJ
DATAS
GORYII
1 40 >100 Pneumocystis carinii pneumonia
Cytomegalovirus colitis
Disseminated herpes zoster
Possible tuberculous
meningitis
2 33 >100 Pneumocystis carinii pneumonia
Mycobacterium avium-intra-
cellulare and cytomegalovirus
duodenitis
Perirectal herpes simplex
3 31 <50 Pneumocystis carinii pneumonia
Candidal esophagitis
0.25 Anergic AIDS
Elevated immuno-
globulins
HBcAb -r , Reactive
lymphnode
0.30 Anergic AIDS
HBsAg-, HBsAb-i-,
HBcAb -t-
0.51 Anergic AIDS
Elevated immuno-
globulins
HBsAg-, HBsAb-t-,
HBcAb -r
4 29 >2000 Fever, diarrhea, adenopathy,
weight loss, fatigue
5 30 >1500 Adenopathy, fatigue, hepato-
splenomegaly
0.36 Anergic ARC
HBsAg-, HBsAb-,
HBcAb +
Reactive lymphnode
0.60 Anergic LAS
Elevated immuno-
globulins
HBsAg-, HBsAb -r,
HBcAb -t
6 25 <50 Adenopathy
0.45 Elevated immuno- LAS
globulins
Normal skin testing
HBsAg-, HBsAb-,
HBcAb -
Reactive lymphnode
7 28 < 100 Mycoplasma pneumonia with 0.70 Normal
respiratory failure
SC
27 >100 Disseminated atypical
mycobacteriosis
1.2 Normal skin testing SC
HBsAg-, HBsAb -r,
HBcAb -t
9 22 <10 Recurrent localized herpes
zoster
1.3 Normal
SC
10 39 >1500 Intermittent adenopathy
2.3 Normal skin testing SC
Elevated immuno-
globulins
HBsAg-, HBsAb -t,
HBcAb -r
‘Number of life-time sexual contacts.
tSpecific conditions frequently associated with AIDS (see text).
tT-lymphocyte subset ratios (OKT4/OKT8).
SHBsAg = Hepatitis B surface antigen; HBsAb = Hepatitis B surface antibody;
HBcAb = Hepatitis B core antibody.
IlSee text for definitions.
ence of two or more clinical signs
(fever, lymphadenopathy, diar-
rhea, fatigue, night sweats, or
weight loss) plus two or more
laboratory abnormalities (re-
versed helper/ suppressor ratios,
decreased helper T-lymphocyte
count, leukopenia, hypergamma-
globulinemia, or decreased pro-
liferative response of lympho-
cytes to mitogens). Two had per-
sistent generalized lymphadeno-
pathy syndrome (LAS), or
lymphadenopathy present for at
least three months involving two
or more extra-inguinal sites, and
four had diseases strongly sug-
gestive of an abnormality in im-
munity, either because of
severity or type of disease, but
did not fall into any of the above
categories. These were col-
lectively called suggestive cases
(SC). The controls were healthy
hospital personnel with no
known underlying immunode-
ficiency.
Immunologic studies. Peripheral
T-lymphocyte subsets were de-
termined using monoclonal anti-
bodies to helper (OKT4) and sup-
pressor (OKT8) cells as pre-
viously described.® Circulating
IgG antibodies to cytomegalo-
virus (CMV) and herpes simplex
types 1 and 2 (HSV-1, HSV-2)
were measured using a com-
mercially available enzyme-
linked immunosorbent assay
(ELISA), (M.A. Bioproducts,
Walkersville, MD).
Mononuclear cells were ob-
tained from heparinized venous
blood; lymphocyte proliferation
activity was measured after in-
cubation with phytohemag-
glutinin (PHA), staphylococ-
cal enterotoxin B (SEB), HSV-1,
CMV and varicella zoster (VZ)
using [^HJ-thymidine incorpor-
ation.®
Interferon production by
lymphocytes after exposure to
mitogens (PHA, SEB) and anti-
gens (HSV-1, CMV, VZ) and
measurement of circulating inter-
feron from patients' serum was
20
WISCONSIN MEDICAL JOURNAL, APRIL 1985: VOL. 84
AIDS— Turner, Larratt, Franson, and Rytel
SCIENTIFIC MEDICINE
determined by an encephalo-
myocarditis virus hemagglutina-
tion yield-reduction assay using
WISH cells. >0
Statistical analysis. For each
study group (AIDS, prodromal
AIDS, normal controls), geo-
metric means were compared
using one-way analysis of var-
iance, and multiple comparisons
were performed with the least
significant difference test.i‘
RESULTS
Clinical features. All ten study
patients were male homosexuals
between 22 and 40 years of age
(Table 1). One patient (patient
5) also had a history of intra-
venous drug abuse. All patients
had been treated with various
antibiotics and six have had
multiple episodes of sexually
transmitted diseases (data not
shown). All three AIDS patients
developed Pneumocystis carinii
pneumonia and had evidence of
other opportunistic infections as
well. Two of these patients have
died from overwhelming in-
fections. None has developed
Kaposi's sarcoma or other malig-
nancies. The remaining seven
patients have had several clinical
syndromes (Table 1). All AIDS
patients, the patient with ARC,
and one patient with LAS were
anergic on multiple antigen skin
testing and seven had evidence
of prior hepatitis B virus in-
fection.
One patient originally fol-
lowed with LAS (patient 5) has
recently developed AIDS. He has
been found to have Pneumocystis
carinii pneumonia and nephrotic
syndrome. Of the other patients
in the prodromal group, none has
developed AIDS.
Lymphocyte subsets. Two AIDS
patients and one patient with
LAS had peripheral white blood
cell counts less than 4,000 per
cu mm. All AIDS patients and
four patients with prodromal
syndromes had decreased
numbers of helper T-lympho-
cytes with helper/suppressor
ratios (OKT4/OKT8) less than
1.0. The range for normal con-
trols was between 1.3 and 1.7
(Table 1).
IgG antibody determination. The
ten study patients generally had
higher levels of IgG antibodies as
determined by ELISA than nor-
mal controls, particularly to CMV
(mean absorbance value 0.87
±0.32 for study patients versus
0.24 + 0.31 for controls, p<0.01
and HSV-2 (0.90 + 0.49 for study
patients versus 0.34 + 0.30 for con-
trols, p<0.01) indicating more fre-
quent exposure to these agents.
Antibody levels to HSV-1 tended
to be low in the study patients and
controls (0.57 versus 0.36, p>
0.05). There were no significant
differences between AIDS pa-
tients and patients with pro-
dromal syndromes for any of the
antibodies tested.
Lymphocyte proliferation ac-
tivity. Lymphocyte proliferation
response to mitogens and micro-
bial antigens was significantly
impaired in the three AIDS pa-
tients and in several of the pa-
tients with prodromal syndromes
as compared with controls. The
differences were generally
greater for antigen peak re-
sponses (data available on re-
quest).
Interferon production and cir-
culating interferon. In response
to PHA and SEB, lymphocytes
from two AIDS patients pro-
duced no IFN, and only small
amounts were produced by cells
from the third patient (data avail-
able on request). No IFN was
produced by lymphocytes from
the AIDS patients exposed to
antigens HSV-1, CMV, and VZ.
Prodromal AIDS group and
normal controls did not differ
in IFN response to mitogens or
antigens. Of interest, all three
AIDS patients had detectable
amounts of circulating IFN in
their serum whereas none of the
other study patients or controls
had IFN present. Patient 5 did not
have IFN present in his serum
when first studied in the group of
LAS patients. He has subse-
quently developed AIDS with
Pneumocystis carinii pneumonia
Table 2: Characterization of interferon
ANTIVIRAL ACTIVITY NEUTRALIZATION INACTIVATION
SOURCE TITER ON FACTOR’ FACTORt
OF TITER ON HUMAN CELLS/
INTER- PATIENT HUMAN CELLS TITER ON ANTIBODY TO
FERON NO, |IU/mI| BOVINE CELLS IFN-o IFN-/J IFN-y pH 2 56 C
Patient's
Serum
1
25
<1
>10
1
1
21
21
2
98
<1
58
1
1
2
82
3
48
<1
20
1
1
40
40
IFN
Standards^
5f
25
<1
40
4
4
2
21
IFN-o
5,000
<1
42
1
1
1
1
IFN-/?
2,100
1
1
42
1-2
1
3,500
IFN-y
1,680
2,800
1-2
1-2
50
2,800
2,800
’Neutralization factor = Titer of IFN in medium controls/titer of IFN plus antibody.
A neutralization factor of 1 denotes no neutralization,
tinactivation factor = Titer of IFN in control samples/titer in samples incubated at pFI 2
for 24 hours, or 56 C for 1 hour. An inactivation factor of 1 denotes no inactivation.
fPatient 5 studied after the development of AIDS (see text).
§The source of IFN standards and antibodies to IFN-o and IFN-/3 was the NIH.
The source of antibodies to IFN-y was the Meloy Corporation.
WISCONSIN MEDICAL JOURNAL, APRIL 1985: VOL. 84
21
SCIENTIFIC MEDICINE
AIDS— Turner, Larratt, Franson, and Rytel
and on repeat testing, his serum
demonstrated measurable circu-
lating IFN-a (Table 2).
Interferon characterization.
To further characterize the cir-
culating IFN found in the three
AIDS patients and patient 5 (after
developing AIDS), we performed
neutralization studies according
to the method of Preble, et al.‘^
As seen in Table 2, IFN in serum
of all four patients with AIDS ful-
filled the characteristics of acid
labile IFN-o as described previ-
ously in sera of patients with
AIDS by DeStefano, et al.®
Specifically, its activity in human
and bovine cells was approxi-
mately equal, it was neutralized
by anti-lFN-a antibody, and it
was inactivated at pH 2 (unusual
for IFN-a). In addition, the IFN
was heat labile at 56 C for 60
minutes, and as such is similar to
IFN-a reported by Preble in pa-
tients with systemic lupus erythe-
matosus.^^ Since none of the pa-
tients with AIDS prodrome or
normal control subjects had dem-
onstrated serum IFN activity in
our study, this acid-labile IFN-a
appears to be a useful marker of
AIDS.
Interferon produced in re-
sponse to mitogens and viral
antigens was interferon gamma
(IFN-y) in that it was more active
in human than bovine cells,
was inactivated by anti-IFN-y
antibodies, and was pH 2 and
heat labile (data not shown).
DISCUSSION
Three patients with AIDS and
seven patients with ARC, LAS, or
syndromes suggestive of im-
paired cellular immunity (SC)
were seen in Milwaukee during
1983-1984. As is characteristic of
such patients elsewhere, all were
male homosexuals; and while the
three AIDS patients developed
multiple opportunistic infec-
tions, there were no differences
among the study patients with
regard to number of sexual part-
ners, prior sexually transmitted
diseases or antibiotic usage, prior
hepatitis B infections or other
clinical findings.
The results in our study indi-
cate that both AIDS patients and
those with prodromal syndromes
had abnormalities of the immune
system. Most of the patients in
both groups had abnormal T-
lymphocyte ratios and abnormal
peripheral leukocyte counts as
compared to normal controls.
AIDS patients demonstrated a
decrease in lymphocyte prolifer-
ation to mitogens and antigens.
The most striking difference,
however, between the AIDS
group and the other patients and
controls was the absence of
IFN-y production by lympho-
cytes in response to herpesvirus
antigen stimulation and the pres-
ence of an unusual circulating
IFN-a in the serum of the former
group.
Other investigators have shown
similar findings. Murray, et al'^
found impaired IFN-y produc-
tion in 11 of 16 AIDS patients
in response to mitogens and 14 of
14 in response to microbial
antigens. DeStefano, et al® found
acid-labile IFN-a in the serum of
63% of male homosexuals with
AIDS and Kaposi's sarcoma but
in only 29% of homosexuals with
lymphadenopathy and in none of
22 normal controls. Eyester®
has demonstrated the presence
of acid-labile IFN-a in hemophilia
patients with AIDS, two of whom
developed circulating IFN-a 3 to
10 months prior to the appear-
ance of opportunistic infections.
Hooks, et al detected circulating
IFN-a in 80% of AIDS patients
and observed deficient IFN-y
production in cells from 9 of 10 of
these patients (unpublished ob-
servations). Other studies support
these findings.
It is well known that inter-
ferons are involved in immuno-
regulation.^® Interferons aug-
ment activity of natural-killer
cells and T-lymphocyte cytotoxi-
city'71® and play a pivotal role in
activating the antimicrobial
mechanisms of macrophages and
inducing the release of other
lymphokines.'® Interferons have
also been shown to impair the
immune response.®® It is possible
that several of the immune
derangements leading to im-
paired cellular immunity in
AIDS patients are related to a
decreased production of IFN-y
by lymphocytes in response to
a microbial antigen. The rela-
tively high levels of circulating
IFN-a found in the serum of
AIDS patients may also play a
role in immunosuppression.
Further studies are needed to
elucidate the role(s) of IFN in the
pathogenesis of AIDS. Since this
unusual IFN-a has been found in
the blood of AIDS patients in our
study and in homosexuals with
prodromal syndromes reported
by other investigators, acid-
labile IFN-a serves as a possible
marker for AIDS and may play a
role with other interferons in the
impairment of immunity found
in these patients.
Addendum. As of January 1985,
thirty (30) cases of AIDS have
been reported to the State Health
Department in Madison (H
Dowling, personal communi-
cation). Sixteen of these cases
have been acquired within the
state of Wisconsin, while the
remainder have been acquired in
other cities. Eighteen of the 30
patients are dead. Besides the
four cases reported here, we have
seen an additional seven cases of
AIDS at the Medical College of
Wisconsin (three of whom are
still alive) and are following 12
patients with prodromal findings
of AIDS.
ACKNOWLEDGMENT: The authors
wish to thank John H Kalbfleisch, PhD for
his assistance with the statistical analyses.
REFERENCES available upon request to
the authors. ■
22
WISCONSIN MEDICAL JOURNAL, APRIL 1985: VOL. 84
ORGANIZATIONAL
SMS Annual Meeting focuses
on critical medical issues
From start to finish, the State
Medical Society of Wisconsin's
Annual Meeting this year will be
sharply focused on the issues
most important to the practice of
medicine in the mid-1980s. Physi-
cians attending will have excellent
opportunities to learn, listen, and
debate at this major meeting of the
year.
The 1985 Annual Meeting, to
which all SMS members are in-
vited, will take place Thursday,
April 25, through Saturday, April
11 , at the La Crosse Center and
Radisson La Crosse Hotel.
The theme for the meeting is
"Cost-effective Care of the Geria-
tric Population." This three-part
program will examine economic
and ethical considerations of ra-
tioning geriatric care. The final
part of the series will look at the
prevention and treatment of os-
teoporosis.
A diversified scientific program
sponsored by specialty sections
and societies will cover a wide set
of medical interests on Friday and
Saturday, April 26 and 27. These
Dr Pomainville resigns
CESF treasurer post
After nearly 18 years of service
as treasurer of the Charitable,
Educational and Scientific Foun-
dation, Leland Pomainville, MD,
Wisconsin Rapids, has announced
his resignation. Elected to fill the
unexpired term of treasurer is
Richard Edwards, MD, Richland
Center. Doctor Edwards is cur-
rently chairman of the Founda-
tion's Managing Committee for
the Fort Crawford Medical Mu-
seum. ■
programs offer Category I Con-
tinuing Medical Education credit.
The SMS House of Delegates
will begin its annual deliberations
at 9:00 am Thursday, April 25, at
the La Crosse Center. Resolutions
to be presented to the entire
House for action will be debated
at reference committee sessions
following the opening House ses-
sion Thursday at 1:00 pm at the
Radisson La Crosse Hotel. (A list-
ing of resolution summaries is
contained in the March 13 issue of
Medigram and also this issue of
the Wisconsin Medical Journal.)
The second session of the House
will begin at 1:45 pm.
"Drugs and the Geriatric Popu-
lation—A Masquerade" will be
discussed at a special panel pre-
sentation on Thursday, April 25,
at 12 noon. The program will fea-
ture physician experts in the fields
of geriatrics and addictive dis-
eases.
Thursday evening, April 25,
SMS President Timothy Flaherty,
MD and Auxiliary President
Roberta Baldwin invite physicians
and their spouses to attend the
Presidents' Dinner at the Radisson
La Crosse. Featured entertain-
ment will be the La Crosse Sing-
ers performing "The Best of
Broadway— A Revue." The fast-
paced show incorporates "The
Best" in musical theatre music,
ranging from the early 1900s
through the 1980s. With such
musical theatre greats as: Porter,
Gershwin, Sondheim, Loesser,
Rodgers and Hammerstein, and
Herbert, the musical revue is
guaranteed to delight and enter-
tain.
"A Native American View of
Medicine and Religion" is the title
of this year's program at the Medi-
cine and Religion Breakfast at 7:00
am, Friday, April 26. The featured
speaker will be the Rev Gary
Turner of the Episcopal Diocese of
Eau Claire.
Later Friday at 1 1:45 am is the
Socioeconomic Luncheon spon-
sored by WISPAC. Washington
Post columnist Mark Shields will
be on hand to discuss "Presiden-
tial Politics: 1984 and Beyond." A
political analyst who has covered
elections for both CBS and NBC,
Shields has been described as a
"walking almanac of American
politics." ■
Biomedical ethics
conference coming
up June 6 and 7
The State Medical Society and
the Wisconsin Hospital Associa-
tion are sponsoring a Biomedical
Ethics Conference for physicians
and hospital administrators on
June 6 and 7, 1985 at the Amer-
ican Club in Kohler, Wisconsin.
The conference will examine
topics such as "How does ration-
ing affect the ethics of medical
care decision-making?" and
"Medical Ethics and the Media."
Nationally noted speakers will be
featured including: Dr William
Schwartz, coauthor of The Painful
Prescription and Dr Joanne Lynn,
staff to the President's Commis-
sion on Bioethical Decision-
making. This promises to be an
important and timely program for
physicians in all specialties.
Members will be receiving regis-
tration materials soon. For further
information contact Michelle
Scoville at SMS. ■
WISCONSIN MEOICAL JOURNAL, APRIL 1985: VOL. 84
23
ORGANIZATIONAL
ANNUAL MEETING
Professional liability, emergency
medical services, and government
regulations are key issues for '85
House of Delegates
The House of Delegates will
consider resolutions ranging in
subject matter from profes-
sional liability and emergency
medical services to government
regulations when it convenes at
the State Medical Society's An-
nual Meeting in La Crosse April
25-27.
The following resolutions
were received in the Secretary's
office by the February 25 dead-
line. Members are urged to
express their opinions to their
delegates and participate at the
Annual Meeting Reference
Committee hearings where
resolutions are discussed. A list
of county medical society of-
ficers appeared in the February
issue and a list of delegates
and alternate delegates ap-
peared in the March issue.
Members are reminded that
the first session of the House
will start at 9:00 am Thursday,
April 25, with the second and
third sessions scheduled for
1:45 pm Friday, April 26. Regis-
tration precedes both sessions.
Resolutions 1 -5 referred to:
National Issues
1. Federal nursing home
code (Lincoln County
Medical Society)
"Whereas, Rigid interpreta-
tion of obscure and petty regu-
lations, especially when surveys
are conducted in the spirit of an
adversary examination, threatens
the nursing home, its adminis-
tration, and the nursing staff . . .
"RESOLVED, That the State
Medical Society of Wisconsin
request the American Medical
Association to approach the Fed-
eral Government toward a re-
evaluation of the rules and en-
forcement mechanisms for nurs-
ing homes, in conjunction with
medical and nursing home rep-
resentation."
2. Health care banks/ IRAs
(Medical Society of
Milwaukee County)
"Whereas, The Health Care
Banks/ IRA concept is a method
of providing health care cover-
age by private savings . . .
"RESOLVED, That SMS sup-
port the Health Care Banks/ IRA
concept and seek more informa-
tion about such a concept and the
logistical problems associated
with it and submit a report to the
House of Delegates on its ad-
vantages and disadvantages."
3. Reduction of nuclear
armaments (Committee
on Environmental
and Occupational Health)
"Whereas, the risk of nuclear
war in our lifetime is consid-
erable (consistent with 5.8 per-
cent annual risk of major war);
and
"Whereas, the State Medical
Society of Wisconsin is fully com-
mitted to prevention of death and
disease and the promotion of
public health . . .
"RESOLVED, That the State
Medical Society of Wisconsin
hereby proposes that the United
States of America and the Union
of Soviet Socialist Republics
reduce nuclear armaments;
"RESOLVED, That the United
States of America and the Union
of Soviet Socialist Republics seek
to increase communication be-
tween their governments in
respect to nuclear armaments;
"RESOLVED, That they
formulate a more compre-
hensive, verifiable nuclear test
ban treaty and an effective world-
wide policy of nonproliferation
of nuclear armaments."
4. Safe transport of
hazardous materials
(Committee on
Environmental and
Occupational Health)
"Whereas, the State Medical
Society's Committee on Environ-
mental and Occupational Health
has concluded that a sufficient
number of hospitals is not pre-
pared to treat radiologically con-
taminated patients due to an ac-
cident, that voluntary participa-
tion by additional hospitals is
inadequate to assure safe treat-
ment, and that voluntary par-
ticipation is not practical or
cost-effective . . .
"RESOLVED, That the State
Medical Society encourage the
enactment of legislation which
will clearly designate state de-
partmental responsibility to
assure hospital preparedness to
safely treat radiologically con-
taminated patients in the event of
a minor spent fuel accident while
protecting other patients, hospital
personnel, and the public from
contamination and, in the interim
that the Governor direct state
officials to assure preparedness
by identifying hospitals located
ideally 40-50 miles from each
2*
WISCONSIN MEDICAL JOURNAL, APRIL 1985: VOL. 84
RESOLUTIONS
ORGANIZATIONAL
Other along shipment routes,
train personnel in the use of the
Radiation Accident Protocol,
provide funds for equipping these
hospitals, and periodically con-
duct emergency drills to assure
continued preparedness;
"RESOLVED, That the State
Medical Society encourage the
state Legislature to initiate a
study of hazardous materials
transport in Wisconsin and en-
act appropriate legislation to
assure hospital preparedness to
respond to accidents in a manner
which protects the public."
5. Cost containment at
AMA functions (Carl
Eisenberg, MD, Alternate
Delegate, Milwaukee
County)
"Whereas, We as members of
the American Medical Asso-
ciation are concerned about the
cost of our memberships . . .
"RESOLVED, That the House
of Delegates of the State Medical
Society of Wisconsin instruct the
Wisconsin AMA Delegation to
pursue a resolution within the
AMA which would have as its ef-
fect the emphasizing of cost con-
tainment at every possible AMA
function."
Resolutions 6-8 referred to:
Organization and Finances
6. Unified membership
(Waukesha County)
Medical Society)
"Whereas, The AMA (Report
DD-1984 Interim Meeting) has
now offered incentives to unified
membership, ie,
"Recommendation 1: Com-
mendation to unified state,
county and specialty societies.
"Recommendation 2: That the
AMA establish an 'ombudsman'
for members of unified societies.
"Recommendation 3: That 1st
year in practice, 2nd year in prac-
tice, military, and full dues-pay-
ing AMA members who are
members of unified societies re-
ceive a 10% discount on AMA
dues, effective for the 1985 mem-
bership year.
"Recommendation 4: That the
AMA provide unified state socie-
ties with reimbursement for col-
lection of AMA dues at a rate of
3% of dues received by Janu-
ary 15, 2.5% of dues received by
February 15, and 2.0% of dues
received by March 15 of each
year, beginning in 1985.
"Recommendation 5: That,
effective immediately, the AMA
extend to unified societies the ser-
vices of its staff on special proj-
ects which are mutually agree-
able to the unified society and the
AMA, within the limits of staff
and resource availability.
"Recommendation 6: That no
later than February 1985, the
AMA establish a new Unified
Societies Advisory Committee
consisting of representatives from
all unified societies.
"Recommendation 7: That, be-
ginning in 1985, a special AMA
briefing be provided annually
to the officers of unified societies.
"Recommendation 8: That a
summary of the benefits accruing
to unified medical societies be
sent to all state, county, and na-
tional medical specialty societies
in the United States, and that the
same information be dissemi-
nated to all members of unified
medical societies . . .
"RESOLVED, That the State
Medical Society of Wisconsin
again become a unified state."
7. Establishment of Section
on Therapeutic Radiology
[Radiation Oncology]
(Duane W Taebel, MD)
"Whereas, Therapeutic Ra-
diology (Radiation Oncology) is
recognized as a distinct disci-
pline, separate from Diagnostic
Radiology, and requiring a com-
pletely different examination for
certification by the American
Board of Radiology; and
"Whereas, More than pne-
half of all medical schools in the
United States have forn^d de-
partments of Therapeutic/ Radiol-
ogy (Radiation Oncolp^), sepa-
rate and distinct from depart-
ments of Diagnidstic Radiol-
ogy. ■ • /
"RESOI^ED, That the House
of Delegates of the State Medical
Society of Wisconsin establish a
specialty Section on Therapeutic
Radiology (Radiation Oncology)
and that a delegate and alternate
delegate to the House of Dele-
gates be elected by the SMS
members of that group acting as
a section of the State Medical
Society."
8. Establishment of Section
on Gastroenterology
(Wisconsin Society of
Gastrointestinal
Endoscopy)
"Whereas, The American
Medical Association has recog-
nized the specialty of Gastroen-
terology with three representa-
tives in the House of Delegates.
These delegates represent the
American Society for Gastroin-
testinal Endoscopy, the Ameri-
can Gastroenterological Asso-
ciation, and the American Col-
lege of Gastroenterology. Mem-
bers of these organizations in-
clude both medical gastroenter-
ologists and surgeons interested
in gastrointestinal diseases . . .
"RESOLVED, That the House
of Delegates of the State Medical
Society of Wisconsin establish a
specialty Section on Gastroen-
terology and that a delegate and
alternate delegate to the House of
Delegates be elected by the SMS
WISCONSIN MEDICAL JOURNAL, APRIL 1985: VOL. 84
25
ORGANIZATIONAL
RESOLUTIONS
members of that group acting as
a section of the State Medical
Society."
Resolutions 9-16 referred to;
Scientific Activities
9. Boxing (La Crosse County
Medical Society)
"Whereas, The medical pro-
fession has an obligation to pro-
mote and encourage the health
and well-being of the American
population . . .
"RESOLVED, That the State
Medical Society of Wisconsin
1) Educate the public con-
cerning the dangerous
aspects of boxing.
2) Insist on closer medical
supervision of boxing
bouts, both amateur and
professional, now being
held in the confines of
Wisconsin.
3) Encourage the state
legislature to enact laws to
insure closer medical
supervision of boxing
and/or the elimination of
boxing."
10. Boxing (Section on
Family Practice)
"Whereas, The risks of box-
ing to its participants far out-
weigh any benefits . . .
"RESOLVED, That the State
Medical Society of Wisconsin re-
affirm its opposition to boxing to
the media and inform the Gover-
nor of Wisconsin and all mem-
bers of the State Legislature of its
stand; and be it further
"RESOLVED, That the So-
ciety through elected represen-
tatives introduce legislation sup-
porting the abolition of amateur
and professional boxing in the
state of Wisconsin."
11. Boxing (Committee
on School Health)
"Whereas, Existing medical
controls and safety measures
have not been successful in pre-
venting chronic brain damage in
boxers . . .
"RESOLVED, That the State
Medical Society of Wisconsin en-
courage the elimination of boxing
at the amateur and professional
level in Wisconsin."
12. Smokeless tobacco
(Medical Society of
Milwaukee County)
"Whereas, The American
Medical Association plans to
evaluate scientific evidence on
'. . . the possible carcinogenic
and other deleterious effects
resulting from the use of smoke-
less tobacco' . . .
"RESOLVED, That SMS
review the recommendations
and, if the report shows con-
clusively that smokeless tobacco
is harmful to one's health, that
SMS support the placement of an
appropriate 'injurious to health'
message on the smokeless tobac-
co package."
13. Happy hours and other
inducements to the
consumption of alcohol
(La Crosse County
Medical Society)
"RESOLVED, That the State
Medical Society of Wisconsin
encourage the legislature to en-
act laws which would prohibit
drinking establishments from
offering inducements to excessive
alcohol consumption."
14. Mandatory continuing
medical education
(Medical Society of
Milwaukee County)
"Whereas, Continuing medi-
cal education is a mandatory pro-
gram for physicians in Wis-
consin . . .
"RESOLVED, That SMS con-
tinue its support of such a re-
quirement."
15. Medical Examining
Board (Medical Society
of Milwaukee County)
"Whereas, The Wisconsin
Medical Examining Board re-
quires additional funds to ex-
pand its staff in order to provide
competent trained investi-
gators . . .
"RESOLVED, That SMS sup-
port adequate funding for the
Medical Examining Board to ful-
fill its responsibility; and be it
further
"RESOLVED, That the as-
sistance of SMS be offered for
consultation purposes whenever
questions of incompetence arise
and that specialty societies in
the state of Wisconsin be asked to
cooperate in like manner."
16. Home health agencies
(Medical Society of
Milwaukee County)
"RESOLVED, That SMS in-
vite representatives of the Home
Health Care Association, Wis-
consin Nurses Association, and
the Wisconsin Hospital Associa-
tion to explore and establish
minimum criteria for an effective
quality assessment and quality
control program for home health
care agencies in Wisconsin."
Resolutions 17-27 referred to:
Socioeconomic Activities
17. Professional liability
[Expert witnesses]
(La Crosse County
Medical Society)
"RESOLVED, That the State
Medical Society of Wisconsin
continue its efforts to maintain
the requirement for expert wit-
nesses at panel hearings . . .
26
WISCONSIN MEDICAL JOURNAL, APRIL 1985: VOL. 84
RESOLUTIONS
ORGANIZATIONAI,
"RESOLVED, That a joint
State Medical Society-Wisconsin
Bar Association committee es-
tablish criteria to qualify phy-
sicians as experts for purposes of
testimony in a particular field."
18. Professional liability
[physician countersuits]
(Waukesha County
Medical Society)
"Whereas, The frequency of
professional liability claims
against physicians continues to
escalate; and
"Whereas, In Wisconsin (one
of 15 states) it is impossible to
win a countersuit under mali-
cious prosecution because of a
fifth element of 'special injury'
(interference with one's person or
property) . . .
"RESOLVED, That the State
Medical Society of Wisconsin
support the principle that the
'special injury' element required
to win a malicious prosecution
countersuit in Wisconsin be
eliminated; and be it further
"RESOLVED, That legis-
lation be pursued as early as pos-
sible to correct this element in the
Wisconsin tort system."
19. Professional liability
[countersuits] (Medical
Society of Milwaukee
County)
"Whereas, The American
Medical Association plans to
draft model legislation to elimi-
nate 'special injury' as a require-
ment in malicious prosecution
suits; and
"Whereas, The principle of
'special injury' is a requirement
in Wisconsin . . .
"RESOLVED, That SMS ac-
quire and study the model legis-
lation and, after study of it, pre-
pare and introduce similar legis-
lation to the State Legislature to
eliminate this requirement in
Wisconsin."
20. Professional liability
International Scope Study
(Carl Eisenberg, MD,
Alternate Delegate,
Milwaukee County)
"RESOLVED, That the State
Medical Society of Wisconsin
through its Medical Liability
Committee undertake a study of
how the liability situation is
handled on an international scope
to include, but not be limited to,
English speaking countries."
21. Appeal and monitoring
mechanism for patients
and their physicians
(Polk County
Medical Society)
"RESOLVED, That the
House of Delegates of the State
Medical Society of Wisconsin
request the Board of Directors
and staff to study and, if found
feasible, to establish an appeal
and monitoring mechanism for
patients and their physicians
when fair and equal access to
adequate health care is denied
or restricted by a governmental
regulatory body, a health mainte-
nance organization, or health in-
surance company."
22. Emergency Department
reimbursement for
treatment of HMO/AFDC
patients (Emergency
Medical Services
Committee, Medical
Society of
Milwaukee County)
The Department of Health
and Social Services is attempting
to contain medical costs gener-
ated by AFDC recipients in Mil-
waukee and Dane Counties by
mandating these citizens enroll-
ment in Health Maintenance
Organizations. The administra-
tion rules used in this effort place
the hospital's emergency medical
physician in conflict with a state
statute, place the patient in an
increased category of medical
risk, and the hospital in increased
financial jeopardy.
"Whereas, Wisconsin Stat-
utes 146.301 (2) and (3) state:
"(2) No hospital providing emer-
gency services may refuse emer-
gency treatment to any sick or
injured person; (3) No hospital
providing emergency services
may delay emergency treatment
to a sick or injured person until
credit checks, financial informa-
tion forms or promissory notes
have been initiated, completed
or signed if, in the opinion of one
of the following, who is an em-
ployee, agent or staff member of
the hospital, the delay is likely to
cause increased medical compli-
cations, permanent disability,
or death:" and
"Whereas, Emergency medi-
cal physicians cannot determine
if a patient presenting himself in
a hospital emergency depart-
ment has a true medical emer-
gency until that person is eval-
uated by the physician at a cost of
time and materials to the hos-
pital; and
"Whereas, Contracts signed
between the DHSS and Mil-
waukee County HMOs for the
treatment of AFDC Title 19 re-
cipients direct the patient to
receive care at his or her as-
signed HMO facility unless,
'The time (needed) to get to the
HMO facilities or providers
would risk permanent damage to
(the patient's) health'*; and
"Whereas, There are numer-
ous medical situations in which
no individual can reasonably be
expected to know if symptoms
are a permanent threat to his or
her health; and
*Froin "Standard Language" definitions
employed by the DHSS for HMO/AFDC
contracts.
WISCONSIN MEDICAL JOURNAL, APRIL 1985: VOL. 84
27
ORGANIZATIONAL
RESOLUTIONS
"Whereas, Hospitals which
refuse to evaluate an AFDC/
HMO patient until preauthoriza-
tion is received from the patient's
HMO place themselves in a
greatly increased risk of liability;
and
"Whereas, AFDC patients
have historically used hospital
emergency departments as their
gatekeepers to the healthcare
system; and
"Whereas, the DHSS con-
tract with HMOs for the care of
AFDC patients provides no in-
centives for the HMO or patient
to change this pattern of be-
havior; and
"Whereas, DHSS contract
language uses a retrospective
definition of emergency . . .
"RESOLVED, That the
House of Delegates of the State
Medical Society be on record as
opposing any attempt to modify
Wisconsin Statutes 146.301 in
any effort to correct the dilemma
described in this resolution; and
that it be known that this oppo-
sition is based on the highest
standards of professional medical
ethics; and be it further
"RESOLVED, That the
House of Delegates of the SMS
direct staff to negotiate with the
DHSS to have the definition of
Bona Fide Medical Emergency,
as printed in the June 22, 1984
Congressional Record (copied
below), accepted by the Ameri-
can College of Emergency Phy-
sicians and the Health Care
Financing Administration,
adopted by the department as its
definition of emergency for
AFDC/HMO patients; and be
it further
"RESOLVED, That the
DHSS enter into contractual ar-
rangements with hospital emer-
gency departments in areas of the
siat® where there exist contracts
with HMOs for the care of
AFDC patients; that these con-
tracts between the DHSS and
hospital emergency departments
provide a payment schedule for
the evaluation of AFDC patients
who present themselves; and be
it further
"RESOLVED, That the SMS
is cognizant of the state's desire
to reduce its Medicaid costs by
decreasing utilization of health
care services by AFDC patients."
AMERICAN COLLEGE OF
EMERGENCY PHYSICIANS
Definition of Bona Fide
Emergency Services®
Sec. 2318. (a) Section 1861 (v) (1)
(K) of the Social Security Act is
amended by inserting "(i)" after
"(K)" and by adding at the end
thereof the following new clause:
"(ii) For purposes of clause (i),
the term 'bona fide emergency
services' means services provided
in a hospital emergency room
gfter the sudden onset of a medi-
cal condition manifesting itself by
acute symptoms of sufficient
severity (including severe pain)
such that the absence of immedi-
ate medical attention could
reasonably be expected to result
in—
"(I) placing the patient's health
in serious jeopardy:
"(II) serious impairment to
bodily functions: or
"(III) serious dysfunction of
any bodily organ or part."
®"As published in the June 22,
1984 Congressional Record-
House.
23. Repeal of Certificate-
of-Need/Capital
Expenditure Review Law
(Medical Society of
Milwaukee County)
"Whereas, The Certificate
of Need (CON) law was enacted
to prevent duplication of health
care services and constraining
construction of new health care
facilities; and
"Whereas, Prospective rate
review, capitalization controls,
and competition in the health
care marketplace would appear
to eliminate any continuing need
for CON . . .
"RESOLVED, That the SMS
review and evaluate current
studies that question the ability
of CON to contain costs and pre-
sent the results of such a review
to the Legislature to bring about
the repeal of this law."
24. Mandatory surgical
second opinion
(Medical Society of
Milwaukee County)
"Whereas, The Wisconsin
Department of Health and Social
Services has mandated a second
surgical opinion program for
select operations on Medicaid
patients; and
"Whereas, The Center for
Health Systems Research and
Analysis of the University of Wis-
consin has a study approved by
DHSS . . .
"RESOLVED, That SMS urge
the Secretary of the Department
of Health and Social Services to
fund this study."
25. Decentralization of health
care (Medical Society
of Milwaukee County)
"Whereas, Little data is avail-
able on the cost of decentraliza-
tion of health care; and
"Whereas, Such decentrali-
zation is being developed rapidly
through the introduction of home
health care agencies, surgi-
centers, and emergi-centers . . .
"RESOLVED, That the Task
Force on Medical Care of SMS
study the cost of decentralization
of health care in Wisconsin and
report back to the House of Dele-
gates."
28
WISCONSIN MEDICAL JOURNAL, APRIL 1985: VOL. 84
RESOLUTIONS
ORGANIZATIONAL
26. HMOs and physician
input (Medical Society
of Milwaukee County)
"Whereas, The citizens of
Wisconsin are served by many
Health Maintenance Organiza-
tions and other new health care
delivery systems; and
"Whereas, These systems in-
clude delivery of physician ser-
vices, reimbursement of phy-
sicians, quality control, utliza-
tion review, and other physician
services . . .
"RESOLVED, That SMS pro-
mote physician input into these
systems and also consider the
establishment of a unit within
the Society for physicians to con-
tact for advice and counsel re-
garding these new systems."
27. WiPRO (Medical
Society of Milwaukee
County)
"Whereas, Organized Medi-
cine in Wisconsin is concerned
about the activities of WiPRO
and their impact upon the prac-
tice of medicine and the quality
of care for patients; and
"Whereas, No mechanism
exists in organized medicine to
monitor WiPRO's activities . . .
"RESOLVED, That SMS
create such a mechanism within
the State Medical Society with
representation from county medi-
cal societies, and require such
a monitoring group to submit an
annual assessment of WiPRO and
its activities and recommenda-
tions for consideration by the
SMS House of Delegates and the
general membership." ■
SMS Toll-free
number in Wisconsin
1-800-362-9080
Have you paid your 1985 membership dues?
Final dues statements were sent in mid-April . Regular member dues of $455 must
be paid in full no later than May 15, 1985 to continue as a member. See further
details on page 34.
AMA Physician's Recognition
Award Recipients
Listed below are those physicians in Wisconsin who have earned the
AMA Physician's Recognition Award in recent months. The State
Medical Society of Wisconsin congratulates these physicians who have
distinguished themselves and their profession by their commitment to
continuing education:
JANUARY 1985
*Algan, Ahmet M, Madison
‘Arvold, David S, Shawano
*Austad, William R, Monroe
‘Benish, George A, Madison
‘Bogost, Bruce R, Milwaukee
*Chou, Clarence P, Whitefish Bay
*De Arteaga, Julio C, Brillion
‘Forkner, William A, Kohler
"Fritz, Richard D, Milwaukee
Glazier, Edward H, Wautoma
Gokulananda, Thimapalah,
Brookfield
"Goldberg, Henry M, Milwaukee
Hahn, Michael F, Janesville
"Janssen, Martin L, Friendship
Jones, Ethelene J C, Milwaukee
Kampschroer, Bernard H,
Milwaukee
"Ketterhagen, James P, Wauwatosa
Kochar, Arvind, Elkhorn
"Kochar, Mahendra S, Milwaukee
"Kutter, Ursula Anna-Maria,
Milwaukee
"Lewan, Richard B, Waukesha
Liedtke, Arthur J, Madison
"Lubing, Harold N, Madison
"Martinetti, Dominic J, Hurley
"Maski, Ravikant, Platteville
"Page, Robert W, Marshfield
" Pagels, George A, Marshfield
Patel, Piyush D, West Allis
"Piper, Philip G, Janesville
Pratt, Craig T, Glendale
"Reinhart, Richard A, Marshfield
Roth, Donald A, Brookfield
"Scheibel, William R, Verona
"Semler, William L, Milwaukee
"Settimi, Albino L, Elm Grove
"Shehab, Naglaa, Marshfield
Shetty, K Rajmohan, Wood
"Members of the State Medical Society
of Wisconsin
"Stoerker, Ruth A, Madison
Thomas, John P, Wauwatosa
"Todd, Paul C, Menomonee Falls
"Troup, Richard H, Green Bay
"Wegenke, John D, Madison
Weinman, Mary S, Madison
"Willson, D Maclean, Milwaukee
"Winston, Frank, Madison
"Wynn, Sidney K, Milwaukee
"Young, Laurens D, Milwaukee
"Yuska, Kenneth H, Marinette
FEBRUARY 1985
"Biros, Dennis G, La Crosse
"Budzak, Kathryn S, Madison
Dhamee, Mohammed S, Milwaukee
Divgi, Ajit B, New Berlin
"Engstrom, Denton P, Appleton
" Flygt, Thomas R, Baraboo
"Francisco, Orlando M, Tomahawk
Glazier, Edward H, Wautoma
Hartwick, John P, Wauwatosa
Hecht, Rudolph C, Madison
"Hyndiuk, Robert A, Milwaukee
"Kelley, William B, Milwaukee
Kolesari, Gary L, Milwaukee
Laird, Anna K, Madison
Magnino, James J, Kenosha
* March, Jack F, Algoma
"Melvin, John L, Milwaukee
"Nordby, Eugene J, Madison
"Reinhard, Harold J, Green Bay
"Rounds, Wayne M, Madison
"Sazama, Richard C, Eau Claire
Schulz, Robert W, Stoughton
"Sherkow, Larry H, Milwaukee
"Short, Howard W, Racine
"Stemper, John A, Milwaukee
"Tsuchiya, Goro, Racine
"Turski, Deborah M, Madison
* Wepfer, Joseph F, Wauwatosa
Wilson, Stuart D, Milwaukee
" Wunsch, Charles A, MilwaukeeH
WISCONSIN MEDICAL JOURNAL, APRIL 1985: VOL. 84
29
ORGANIZATIONAL
SMS launches campaign to improve communications
The State Medical Society of Wisconsin is implementing a special program in 1985 to improve communica-
tions between physicians and the public. REACH— Resource for Education and Awareness of Community
Health is designed to go beyond current SMS public relations activities. The new program will "tell medicine's
story" on the professional liability issue, alcohol abuse, and a broad array of socioeconomic issues. The first step
in this program is a special public information program on medical liability. The goal is to
inform the public of the
malpractice insur-
several phases
nature of the problem to seek their support for reducing
ance costs. The Medical Liability program consists of
including: • Purchase media advertisements de-
signed to tell the story of medical progress and
what the application of those advances by
physicians means to the public health
and well-being. On March 10, a
newspaper advertisement
addressing mal-
practice
was
run m
eight
Sunday
editions of
state and
papers.
dertake
news-
• Un-
media
Nowadays, people live much
longer Thanks to wonderful
advances in drugs, equipment,
public health, and medical skills.
With such gcKxl medical care, it's
hard to understand whv Wisconsin
physicians are being asked to pay
malpractice premiums from $.S,00()
to$Sl,CXX) more than double
last year's premium Those costs
will be passed on to patients.
Is modem medicine so successful
that many people sue if there isn't a
perfect result with every treatment’
That's unrealistic, but it may be a
trend Physicians can indeed do
many great things But they are not
perfect Science isn't perfect either
Neither are patients
We think you want quality care
at reasonable cost. We do too But
our present malpractice system
threatens that goal
There ARE better ways to deal
with this problem Talk it over
with your doctor and your legis-
lator.
The State Medical Society of Wisconsin
■ ■ I’O Hn\ IW9 • MciJlsim, U7 HJlai
campaigns on spe-
cific medical liabil-
ity proposals to set
the stage for later
voting in both houses of
the Legislature. • Prepare and distribute special
literature on the medical liability problem and SMS
proposals for solution. This includes an Update on
medical liability in Wisconsin as well as a patient
brochure explaining the malpractice crisis and how
it affects costs. This new brochure, called Health-
watch, is designed to be used as a handout in physi-
cians' offices or waiting rooms, or as a statement
jeontinued on next page}
WISCONSIN MEDICALJOURNAL, APRIL I985:VOL. 84
SMS LAUNCHES CAMPAIGN
ORGANIZATIONAL
stuffer. Healthwatch also will be
published six times a year on such
topics as DRGs, preadmission
screening, medical care costs, and
health legislation.
• Undertake intensive grass
roots physician contacts with
legislators on the critical issue of
liability and its effects on avail-
ability of medical care as well as
quality and cost. Special member-
ship mailings will be going out to
physicians identifying the issues
and requesting legislative con-
tacts.
Other components of the
newly-approved REACH program
include:
• Increasing public speaking by
Society officers who will visit
every major media market in Wis-
consin in 1985. These media tours
will involve prearranged meetings
with newspaper editors and TV
and radio news directors to dis-
cuss organized medicine's con-
cerns on current issues and to
communicate personally the
desire of SMS to work with media
on health and medical stories.
• Syndicating a television
health education program pro-
duced by family practitioner Alan
Cherkasky, MD of Kaukauna.
The purpose of these medical
news features will be to: (1) edu-
cate Wisconsin citizens on how
they can lead healthier lives; and
(2) to promote the physician as the
patient's best source of medical
care. Each segment will credit
both Doctor Cherkasky and SMS.
• Continuing its production of
public service announcements on
the dangers of alcohol abuse. The
first set of these PSAs, which are
produced and distributed in con-
junction with the Wisconsin
Broadcasters Association, feature
well-known Wisconsin athletes
discussing responsible alcohol
use. Future PSAs on this topic will
be aimed specifically at pregnant
women discussing fetal alcohol
syndrome; parents and their
responsibility for educating their
children to develop responsible
drinking habits; and young adults
ages 18-25 pointing out that
drinking isn't funny.
• Instituting a speakers bureau
in Fall 1985 which will arrange for
physician speakers to appear
before civic groups, service clubs,
and community organizations.
The speakers' presentations will
focus on socioeconomic issues
facing medicine and society as a
whole.
The REACH program also em-
phasizes long-range planning for
promoting the public image of
physicians. These and other ele-
ments of the program are con-
tained in a special Update publi-
cation entitled, "REACH— Re-
source for Education and Aware-
ness of Community Health: A Pro-
gram to Improve Physician-Public
Communications. All SMS mem-
bers will be receiving a copy of
Update in their mail soon. ■
Court halts
attempt to get
SMS records
After several months of legal ac-
tion by a Milwaukee plaintiff at-
torney firm to get SMS records
relating to medical liability. Judge
Moria Krueger of Dane County
Circuit Court has ruled that the
Patients Compensation Panel
chairperson "abused his discre-
tion" in requesting discovery as
urged by the plaintiff attorney.
The allegation that SMS records
might bear upon the creation of
bias among panel members was
rejected. The judge said that if the
plaintiff attorneys suspect preju-
dice among panel members, they
should conduct a voir dire (ques-
tioning) under procedures set
forth in the panel law. ■
Child abuse conference
May 18 in Madison
Prevention, diagnosis and treat-
ment of child abuse will be the
focus of a special conference for
physicians the State Medical So-
ciety is sponsoring May 18, 1985
at the Sheraton Inn in Madison.
Aimed at primary care physicians,
the conference will address how
physicians can work with county
social service /protection agencies
in dealing with the diagnosis and
treatment of child abuse and
neglect victims and perpetrators.
For further information, contact
Deborah Powers at SMS. ■
Radio
dispatched
truck fleet
for
INDUSTRY, INSTITUTIONS,
SCHOOLS, ETC.
AUTHORIZED PARTS
AND SERVICE FOR
CLEAVER-BROOKS
Throughout Wisconsin
and Upper Michigan
SALES
Boiler room accessories
O2 trims
Cleveland controls
and Car automatic bottom
blowdown systems
SERVICE-CLEANING
ON ALL MAKES
Complete Mobile Boiler Room
Rentals
Stevens Point— 715/344-7310
Green Bay— 414/494-3675
Madison— 608/249-6604
PBBS EQUIPMENT CORP.
5401 N Park Dr
PO Box 365
Butler, WI 53007
Phone: 414/781-9620
WISCONSIN MEDICAL JOURNAL, APRIL 1985: VOL. 84
3
ORGAMZATIONAL
Membership Directory— Update
The following information is being provided from Membership reports and from individual members for updating the
1984 Membership Directory as published in the July 1984 issue of the Wisconsin Medical Journal. Because of space limi-
tations address changes and phone numbers will not be included in this Update; however, they will be changed in
Membership records. County transfers will be included when processing has been completed by the Membership
Department.
New, reelected, or reinstated members
(complete information!
Changes in specialties and/or Board certification!*)
(changes only with member's name!
By county medical society
BARRON W ASH BURN
BURNETT
FP*
Borman, Joel .A (DOl
Rte 1 , Box 146
Cumberland W1 54829
R*
Pclant, Thomas M
1 13 N Main St
Rice Lake W1 54868
DR R*
Swanson, Richard \V
1502 West Marshall
Rice Lake W1 54868
BROWN
HEM IM*
Blank, Jules H
1551 Dousman St
Green Bay WI 54303
IM
Koehler, Thomas P
1751 Deckner Ave
Green Bay Wl 54302
U GS
Samuel, David L
1551 Dousman St
Green Bay Wl 54303
DANE
OBG
Calhoun, Barbara 1.
4344 Hillcrest Circle
Madison WI 53705
PD
Ellis, Richard L
3206 Cedar Trail
Middleton WI 53562
.Muecke, Maureen
2921 S Fish Hatchery, #102
Madison WI 53713
U
Rodriquez, Paul N
1727 Norman Way
Madison WI 53705
Schwartz, Robert 1.
1117 Catalpa Circle
Madison \VI 53713
FP
Self ridge, Nancy J
1270 West Main St
Sun Prairie WI 53590
IM*
Sheehy, Gregory I.
1205 Canterbury Circle
Middleton WI 53562
GE IM*
A'amamoto, Dennis T
20 South Park St, #355
Madison WI 53715
DOOR KEWAUNEE
FP*
Gaertner, William J
PO Box 447
Sturgeon Bay WI 54235
EALI CLAIRE DUNN
PEPIN
AN
Bowman, Daniel J
727 Kenney Ave
Eau Claire Wl 54701
OPH
Lange, Ronald H
2302 Hendrickson Dr
Eau Claire WI 54701
IM GE
Sultan, Michel N
900 W Clairemont Ave
Eau Claire WI 54701
LA CROSSE
FP*
Beyer, .MarshaJ
815 South 10th St
La Crosse WI 54601
MARINETTE FLORENCE
PD
Wong, Kevin P
1510 Main St
Marinette WI 59143
MILWAUKEE
Oren, Gideon A
3975 North 68th St
Milwaukee WI 532 1 6
Wisniewski, Peter P
5164 S Mallard Circle
Milwaukee WI 53221
OUTAGAMIE
PD* PDA
Merrick, James G
401 N Oneida St
Appleton WI 54911
SHEBOYGAN
IM* HEM
Beatty, Peter A
ion North 8th St
Sheboygan WI 53081
FP OBG
Cowan, Karen K
635 Paine St
Kiel WI 53042
U
Fisher, Dirk T
101 1 North 8th St
Sheboygan WI 53081
OPH
Green, Kathryn A
1442 North 31st St
Sheboygan Wl 53081
WAUKESHA
PD
Biagtan, Juan T
17000 West North Ave
Brookfield WI 53005
PD
De Angelis, Alan A
N84 W1684 Menomonee Ave
Menomonee Falls WI 53051
OBG
Harstad, Timothy W
N84 W 16889 Menomonee Ave
Menomonee Falls WI 53051
OBG* END
Katayama, K Paul
725 American Ave
Waukesha WI 53186
N
Shaenboen, MichaelJ |DO)
W180N7950 Town Hall
Menomonee Falls WI 53051
FP*
W'iener, Marvin
12500 W Bluemound Rd
Elm Grove WI 53211
PD
VVessling, Mark R
915 East Summit Ave
Oconomowoc WI 53066
WAUPACA
FP*
Dent, Robert A
710 Riverside Dr
Waupaca WI 54981
FP*
Pfarr, Paul A
Box 146
King WI 54946
continued
32
WISCONSIN ,\1EDICAL JOURNAL, APRIL 1985: VOL. 84
MEMBERSHIP DIRECTORY-UPDATE
ORGANIZATIONAL
continued
County society transfers
KENOSHA
PORTAGE
WOOD
FOND DU LAC
(from Racine)
Bass Jr, James
6924 Hoods Creek Rd
Franksville Wl 53126
OUTAGAMIE
(from Wood)
Paulson, John K
3504 E Maria Dr
Stevens Point WI 5448 !■
PD‘ NPM
Gross, Jody R
1000 North Oak Ave
Marshfield W1 54449
(from Outagamiel
Strong, Jeffrey A
229 S Morrison St
Appleton WI 54915
(from Portage)
Harman, Jill P
1830 W Meade St
Appleton WI 5491 1
AM A Physician's Recognition Award Recipients
Listed below are those physicians in Wisconsin who have earned the AMA Physician's Recognition Award in
recent months. The State Medical Society of Wisconsin congratulates these physicians who have distinguished
themselves and their profession by their commitment to continuing education:
NOVEMBER 1984
* Adamkiewicz, Joseph], Milwaukee
Adib, Khosro, Madison
*Ahmad, Muhammad Y, Merrill
‘Ancheta, Valentino S, Algoma
Bamrah, Virinderjit S, Wood
’Behling, Ronald E, Madison
‘Belgea, Kathy P, Wausau
Cabatingan, Jaime D, Cedarburg
‘Chang, Henry Ta-Shen, Fonddu Lac
‘Chelius, Carl-Juergen W H, Cudahy
•Cunningham, James A, Milwaukee
•Cushman, Stephen M, Racine
•Dasler, Herbert A, Amery
•Daugherty, Donald A, Madison
•Djokovic, Jovan L, Janesville
•Elias, Sharon L, Milwaukee
•Finucanc, Patrick], Eau Claire
•Fruchtman, Martin Z, Waukesha
*Fuh, Yen-Jen, Wauwatosa
Gapinski, Peter V, Hales Corners
•Geigler, James E, Milwaukee
Glasser, David B, Wauwatosa
Goodman, Lawrence R, Milwaukee
Gross, Jody R, Marshfield
Gross, Richard A, Milwaukee
•Guzzetta, Paul M, Milwaukee
•Han, Paul Zung-Ying, Wausau
Harris, Gerald], Milwaukee
•Hoehne, Kurt A K, Oshkosh
•Hogan, John P, Milwaukee
•Houser, John W, Racine
•Jachowicz, Robert B, Hales Corners
•Johnson, Samuel B, Green Bay
•Kanemoto, Henry H, Wausau
•Kindschi, George W, Monroe
•Kirchner, John P, Marshfield
Klewin, Kristine M, Oconomowoc
•Knechtges, Thomas E, Elm Grove
•Knuteson, Edward L, Monroe
Members <jf the State Metiicul Society of Wisconsin
•Lehman, Roger H, Wood
•Lindgren, Richard D, Madison
•Martens, William E, Wauwatosa
•Mayhew, Duane G, Mequon
•Mendeloff, Gale L, Milwaukee
•Merkow, Alan], Madison
Miller, Joel A, Madison
•Molina, Rodolfo, Beaver Dam
•Myers, Franklin L, Madison
•Nemec, George, Woodruff
•Nolan, James L, Waukesha
•Paquette, Camille A, Union Grove
•Peterson, Thomas H, Wausau
•Pinkus, Walter H, Racine
•Ravin, ErlingO, Merrill
•Rawlins, Steven J, Beaver Dam
•Samadani, Ayaz M, Beaver Dam
•Schmidt, Lou R, Sparta
•Sinclair, Eugene P, Elm Grove
•Strohm, John M, Madison
Sufit, Robert L, Verona
•Tange, David B, Mosinee
•Thompson, John E, Nekoosa
•Wadina, Gerald W, West Allis
Wahlberg, Neil E, Milwaukee
•Woeste, David M, River F’alls
Wolter, Robert K, Elkhorn
DECEMBER 1984
• Aaberg, Thomas M, Milwaukee
•Barthelemy, Carl R, Wood
•Basich, John E, Hales Corners
Baumann, Michael A, Brookfield
*Bcdi, Ashok R, Milwaukee
•Bockelman, Henry W, Racine
•Brown, Jack D, Sparta
•Bush, Robert D, Manitowoc
Bush, Robert K, Madison
•Campbell, Richard L, Sheboygan
•Chang, Hark C, Racine
•Cline, Ross L, Monroe
•Eckstam, Eugene E, Monroe
•Effenhauser, Manfred, Lake Mills
•Erickson, Norman W, Beaver Dam
Fink, Jordan N, Milwaukee
•Frazin, Lawrence], Milwaukee
•Gehl, Gerald A, Neenah
•Gerndt, Harold L, Manitowoc
•Gold, Kenneth I, Beloit
•Hanson, John P, Milwaukee
•Hathway, Stephen D, Green Bay
•Hermann, John P, Sheboygan
•Holzgrafe, Robert E, Waukesha
•Jacobi, Michael A, Manitowoc
•Janowak, Michael C, Oconomowoc
•Khan, Wagar A, Beaver Dam
•Khanna, Trilok S, Janesville
•Kirn, Zaezeung, Milwaukee
•Markson, John W, Milwaukee
•Martin, Carroll M, Kenosha
•Mikkelson, Michael K, Merrill
•Ness, Dennis K, Mauston
•Nordholm, Vincent W, Stoughton
•Olson, Carl Erling, Mequon
Pearlman, Mary, Madison
•Peterson, Douglas B, Marshfield
•Raettig, James A, Monroe
•Rammer, Martin A, Sheboygan
Rohloff, Robert T, Milwaukee
•Sager, Mark A, Manitowoc
•Scott, Robert], Sheboygan
*Seno, Louis S, Milwaukee
•Shaffer, Richard L, Green Bay
•Shenefelt, Philip D, Oregon
•Siegel, Lawrence K, Waukesha
•Silbar, John D, Milwaukee
•Smirl, Warren G, Waukesha
Soifer, Morton M, Milwaukee
•Stevens, Michael L, Marshfield
•Stone, Richard, Milwaukee
•Strain, Thomas W, Marshfield
Vinograd, Sherman P, Madison
•Weisenthal, Charles L, Milwaukee
•Whaley, Ralph C, Barron
•Wiviotl, Wilbert, Milwaukee
•Zastrow, Raymond C, Milwaukee*
WISCONSIN MEDICAL JOURNAL, APRIL 1985 : VOL. 84
33
ORGANIZATIONAL
Membership facts
Whether you’re just starting medical school, maintaining a
full-time practice, or retiring, SMS has a membership classi-
fication to fit your individual needs. Election to membership
by the County Medical Society in which your principal place
of practice is located carries with it membership in the State
Medical Society of Wisconsin and, if you wish, the American
Medical Association. If you qualify for resident membership
at the time of your election, your membership dues are
greatly reduced. This may also qualify you for reduced dues
the first two years of your practice. Dues for regular mem-
bership in 1985 are $455 for SMS, $330 for AMA, and county
society dues vary. A more detailed listing of SMS member-
ship classifications and their corresponding dues follows;
State Medical Society of Wisconsin
DESCRIPTION OF MEMBERSHIP
CLASSIFICATIONS
Regular Member in active practice. Some are regular mem-
bers that have reduced SMS and/or AMA dues because they
are new practitioners (first year or two out of residency).
Resident: Physician who at January 1 of dues year is in an
approved training program as a hospital resident or research
fellow who is licensed to practice medicine and surgery in
Wisconsin
Military Service; Members who are serving in the U S. armed
forces (generally not to exceed five years).
Associate: Member whose dues are waived because of fi-
nancial hardship due to illness or disability. This classifica-
tion is temporary and is reviewed on an annual basis.
Life: Member who has held membership in a state medical
society for 50 years or is a Past President of the State Med-
ical Society of Wisconsin.
Honorary: Member who was named by the Board of Direc-
tors In recognition of long and distinguished service to the
cause of medicine.
Your membership in organized medicine will help insure
the continued “safety" of your practice and quality care
for all patients. Your voice will be heard through par-
ticipation. Dues statements for 1985 membership in
the State Medical Society of Wisconsin (county medi-
cal society membership also required; AMA member-
ship optional but encouraged) are being mailed in Novem-
ber with subsequent reminder notices. For Regular,
Part-time Practice, or Over Age 70 membership classifi-
cations, dues may be paid in one lump sum or in two
equal installments: one-half of the total payable by Jan-
uary 1, the other half not later than May 15, 1985 which is
the removal date for those members who have not com-
pleted payment. You are urged to renew your membership.
Reti'^ed: Member who has completely retired from practice
(works less than 240 hours per year). All dues are waived
unless county society indicates they wish to charge county
dues.
Part-time Practice: Physician, regardless of age, who prac-
tices 1.000 hours or less during the calendar year but does
not qualify for retired membership.
Over Age 70; Member in active practice who is over 70 years
of age as of January 1 ,
Candidate; Member attending a medical school in Wiscon-
sin or fulfilling a postgraduate obligation prior to eligibility
for licensure.
Scientific Fellow: The Board of Directors may by invitation
and unanimous consent confer upon any person engaged in
teaching of or research in one or more of the basic sciences
at an accredited college or university, and not holding the
degree of Doctor of Medicine or Osteopathy, the status of
Scientific Fellow.
Emeritus: Retired members who have chosen not to renew
their license.
1985 DUES AMOUNTS FOR THESE
CLASSIFICATIONS
SMS
AMA
COUNTY
Regular
$455
$330
Normal County Dues
Resident
45.50
45
Varies
Military Service
-0-
220 or 45
-0-
Associate
-0-
-0-
-0-
Life
-0-
-0-'
-0-
Honorary
-0-
-0-'
-0-
Retired
-0-
-0--
-0-
Part-time Practice
227.50
330-
Normal County Dues
Over Age 70
227.50
-0--
Normal County Dues
Scientific Fellow
-0-
.-0-
Emeritus
-0-
-0-'
Candidate-
Freshman Year
Medical Student
-0-
20
Varies
Sophomore and
Succeeding Medical
Student Years
10
20
Varies
Postgraduate — One
10
45
Varies
■physicians in the following categories may be eligible for exemption from
paying AMA dues: (1) Financial hardship and/or disability, (2) Age 65^9 and
retired from the practice of medicine, (3) Over age 70 regardless of retirement
status.
State Society dues are prorated on a monthly basis for
those elected to membership July 1 through September 30.
Those elected after September 30 have no dues payable for
the balance of the year in which they are elected. AMA dues
follow the same pattern except prorating is on a semiannual
basis rather than monthly basis.
To begin the membership process, if your practice is or will
be located in Wisconsin, or you have any questions, you may
contact your local county society or call the Membership
and Communications Division of the State Medical Society,
if in Wisconsin: 1-800-362-9080 (Madison area number;
257- 6781 ).■
34
WISCONSIN MEDICALJOI RNAI.. APRIL l985;\OL. 84
UUhEn does
tujo equal four?
UJhen you prescribe
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(Cephnadine Capsules LISP)
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can be as effective as 250 mg
□ID — four capsules — of the
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Velosef provides BID effectiveness in upper
and lower respiratory tract infections ... in uri-
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tatitis. . . in skin/skin structure infections when due
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Please see prescribing information that follows.
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(1 .) On an official entry form handprint your name, address and zip code.
You may also enter by handprinting your name, address and zip code and
the words "Velosef -Computers in Health Care" on a 3" x 5" piece of paper.
Entry forms may not be mechanically reproduced. (2.) Enter as often as
you wish, but each entry must be mailed separately to: "COMPUTERS IN
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must be received by September 9, 1985. (3.) Winners will be selected
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VELOSEF® CAPSULES
Cephradine Capsules USP
VELOSEF® FOR ORAL SUSPENSION
Cephradine for Oral Suspension USP
DESCRIPTION; Velosef '250' Capsules and Velosef '500' Capsules
(Cephradine Capsules USP) provide 250 mg and 500 mg cephradine,
respectively, per capsule. Velosef '125' for Oral Suspension and Velosef ‘250’
for Oral Suspension (Cephradine for Oral Suspension USP) after constitution
provide 125 and 250 mg cephradine, respectively, per 5 ml teaspoonful.
INDICATIONS AND USAGE: These preparations are indicated for the
treatment of infections caused by susceptible strains of designated
microorganisms as follows: Respiratory Tract Infections (e.g., tonsillitis,
pharyngitis, and lobar pneumonia) due to S. pneumoniae (formerly D. pneu-
moniae) and group A beta-hemol^ic strepfococci [penicillin is the usual drug
of choice in the treatment and prevention of streptococcal infections, includ-
ing the prophylaxis of rheumafic fever; Velosef (Cephradine, Squibb) is
generally effective in the eradication of streptococci from fhe nasopharynx;
substantial data establishing the efficacy of Velosef in the subsequent preven-
tion of rheumafic fever are not available at present]; Otitis Media due to group
A beta-hemolytic streptococci, H. influenzae, staphylococci, and S. pneu-
moniae-, Skin and Skin Structures Infections due to staphylococci and beta-
hemolytic streptococci; Urinary Tract Infections, including prostatitis, due to
E. coli, R mirabilis, Klebsiella species, and enterococci (S. laecalis).
Note; Culture and susceptibility tests should be initiated prior to and dur-
ing therapy.
CONTRAINDICATIONS: In patients with known hypersensitivity to the
cephalosporin group of antibiotics.
WARNINGS: Use cephalosporin derivatives with great caution in penicillin-
sensitive patients since there is clinical and laboratory evidence of partial
cross-allergenicity of the two groups ol antibiotics: there are instances of
reactions to both drug classes (including anaphylaxis alter parenteral use).
In persons who have demonstrated some form of allergy particularly to
drugs, use antibiotics, including cephradine, cautiously and only when abso-
lutely necessary.
Pseudomembranous colitis has been reported with the use of
cephalosporins (and other broad spectrum antibiotics); therefore,
it is important to consider its diagnosis in patients who develop
diarrhea in association with antibiotic use. Treatment with broad spec-
trum antibiotics alters normal flora of the colon and may permit overgrowth of
closfridia. Studies indicate a toxin produced by Clostridium difficile is one
primary cause of antibiotic-associafed colitis. Cholestyramine and colestipol
resins have been shown to bind the toxin in vitro. Mild cases of colitis may
respond to drug discontinuance alone. Manage moderate to severe cases
with fluid, electrolyfe and profein supplementation as indicated. Oral vanco-
mycin is the treatment of choice for antibiotic-associafed pseudomembra-
nous colifis produced by C. diflicile when the colitis is severe or is not
relieved by drug discontinuance; consider other causes of colifis.
PRECAUTIDNS: General: Follow patients carefully fo delect any side
effects or unusual manifestations of drug idiosyncrasy. If a hypersensifivify
reacfion occurs, discontinue the drug and treat the patient with the usual
agents, e.g., pressor amines, antihistamines, or corticosteroids. Administer
cephradine with caution in the presence of markedly impaired renal function.
In patients with known or suspected renal impairment, make careful clinical
observation and appropriate laboratory studies prior to and during therapy as
cephradine accumulates in the serum and tissues. See package insert for
information on treatment of pafients with impaired renal function. Prescribe
cephradine with caution in individuals with a history of gastrointestinal dis-
ease, particularly colitis. Prolonged use of antibiotics may promote the over-
growth of nonsusceptible organisms. Take appropriate measures should
superinfection occur during therapy. Indicated surgical procedures should be
performed in conjuncfion wifh antibiotic therapy.
Information for Patients; Caution diabetic patients that false resulls
may occur with urine glucose tests (see PRECAUTIONS, Drug/Laboratory
Test Interactions). Advise the patient to comply with the full course of fherapy
even if he begins fo feel better and to take a missed dose as soon as possible.
Tell the patient he may take this medication with food or milk since G.l. upsef
may be a factor in compliance with the dosage regimen. The patient should
report current use of any medicines and should be cautioned not to take other
medications unless the physician knows and approves of fheir use (see
PRECAUTIONS, Drug Interactions).
Laboratory Tests: In patients with known or suspected renal impair-
ment, it is advisable to monitor renal function.
Drug Interactions; When administered concurrently, the following drugs
may interact with cephalosporins;
Other antibacterial agents — Bacteriostats may interfere with the bacterici-
dal action of cephalosporins in acute infection; other agents, e.g., amino-
glycosides, colistin, polymyxins, vancomycin, may increase the possibility of
nephrotoxicity.
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VELOSEF^ Capsuies (Cephradine Capsuies USP)
"Computers in Health Care DraLuing.”
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500 mg and enter my name in the “Computers in Health
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Please type or print clearly.
Name
Address
City
State
Zip
Signature
MD
SQUIBB
□ I do not wish to receive a trial supply of Velosef Capsules at
this time, but please enter my name in the “Computers in
Health Care Drawing.”
ALL ENTRIES MUST BE RECEIVED BY SEPTEMBER 9. 1985.
© 1985 E.R. Squibb & Sons, Inc , Princeton, NJ 08540 785-501A Issued; Jan. 1985 Printed in U S. A.
VELOSEFcapsules
(Cephradine Capsules USP)
BID
Diuretics (potent “loop diuretics," e g., furosemide and ethacrynic acid)
— Enhanced possibility for renal toxicity.
Probenecid — Increased and prolonged blood levels of cephalosporins,
resulting in increased risk of nephrotoxicity.
Drug/Laboratory Test Interactions: After treatment with cephradine, a
false-positive reaction for glucose in the urine may occur with Benedict’s
solution, Fehling's solution, or with Clinitest® tablets, but not with enzyme-
based tests such as Clinistix® and Tes-Tape®. False-positive Coombs test
results may occur in newborns whose mothers received a cephalosporin prior
to delivery. Cephalosporins have been reported to cause false-positive reac-
tions in tests for urinary proteins which use sulfosalicylic acid, false
elevations of urinary 17-ketosteroid values, and prolonged prothrombin
times.
Carcinogenesis, Mutagenesis: Long-term studies in animals have not
been performed to evaluate carcinogenic potential or mutagenesis.
Pregnancy Category B: Reproduction studies have been performed in
mice and rats at doses up to 4 times the maximum indicated human dose and
have revealed no evidence of impaired fertility or harm to the fetus due to
cephradine. There are, however, no adequate and well-controlled studies in
pregnant women. Because animal reproduction studies are not always predic-
tive of human response, use fhis drug during pregnancy only if clearly
needed.
Nursing Mothers: Since cephradine is excreted in breast milk during
lactation, exercise caution when administering cephradine to a nursing
woman.
Pediatric Use: Adequate information is unavailable on the efficacy of
b.i.d. regimens in children under nine months of age.
ADVERSE REACTIONS: Untoward reactions are limited essentially to G.l.
disturbances and, on occasion, to hypersensitivity phenomena. The latter are
more likely to occur in persons who have previously demonstrated hypersen-
© 1985 E.R. Squibb & Sons, Inc.
sitivity and those with a history of allergy, asthma, hay fever, or urticaria.
The following adverse reactions have been reported following use of
cephradine: G.l. — Symptoms of pseudomembranous colitis can appear dur-
ing antibiotic therapy; nausea and vomiting have been reported rarely. Skin
and Flypersensitivity Reactions — mild urticaria or skin rash, pruritus, joint
pains. Flematologic — mild transient eosinophilia, leukopenia and neutrope-
nia. Liver — transient mild rise of SGOT, SGPT, and total bilirubin with no
evidence of hepatocellular damage. Renal — transitory rises in BUN have
been observed in some patients treated with cephalosporins; their frequency
increases in patients over 50 years old. In adults lor whom serum creatinine
determinations were performed, the rise in BUN was not accompanied by a
rise in serum creatinine. Others — dizziness, tightness in the chest, and
candidal vaginitis.
DOSAGE: Adults — For respiratory tract infections (other than lobar
pneumonia) and skin and skin structure infections: 250 mg q. 6 h or 500 mg
q. 12 h. For lobar pneumonia: 500 mg q. 6 h or 1 g q. 12 h. For uncompli-
cated urinary tract infections: 500 mg q. 12 h; for more serious UTI, including
prostatitis, 500 mg q. 6 h or 1 g q. 12 h. Severe or chronic infections may
require larger doses (up to 1 g q. 6 h). For dosage recommendations in
patients with impaired renal function, consult package insert.
Children over 9 months of age — 25 to 50 mg/kg/day in equally divided
doses q. 6 or 12 h. For otitis media due to H. inlluenzae: 75 to 100 mg/kg/day
in equally divided doses q. 6 or 12 h but not to exceed 4 g/day. Dosage for
children should not exceed dosage recommended for adults. There are no
adequate data available on efficacy of b.i.d. regimens in children under 9
months of age.
For full prescribing information, consult package insert.
HDW SUPPLIED: 250 mg and 500 mg capsules in bottles of 24 and 100
and Unimatic® unit-dose packs of 100. 125 mg and 250 mg for oral suspen-
sion in bottles of 100 ml and 200 ml.
785-501 Issued: Jan. 1985
NO POSTAGE
NECESSARY
IF MAILED
IN THE
UNITED STATES
BUSINESS REPLY MAIL
First Class Permit No. 99, Syosset, New York 11791
Postage will be paid by
“Computers in Health Care Drawing”
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Syosset, New York 11775
BALAIffCED
CALCIUM
BT
Low incidence of side effects
CARDIZEM® (diltiazem HCl)
produces an incidence of adverse
reactions not greater than that
reported with placebo therapy,
thus contributing to the patient’s
sense of well-being.
‘CaLTdlzem is indicated in the treatment of angina pectoris due to
coronaiy artery spasm and in the management of chronic stable
angina (classic effort-associated angina) in patients who cannot
tolerate therapy with beta-blockers and/or nitrates or who remain
symptomatic despite adequate doses of these agents.
References:
1. Strauss WE, McIntyre KM, Parisi AF, et ai: Safety and efficacy
of diltiazem hydrochloride for the treatment of stable angina
pectoris: Report of a cooperative clinical trial. Am J Cardiol
49:560-566, 1982. '
2. Pool PE, Seagren SC, Bonanno JA, et aJ: The treatment of exercise-
inducible chronic stable angina with diltiazem: Effect on treadmill
exercise. Chest 78 (July suppl):234-238, 1980.
Beduces angina attack frequency
42% to 46% decrease reported in
multicenter study
Increases exercise tolerance*
In Bruce exercise test,^ control
patients averaged 8.0 minutes to
onset of pain; Cardizem patients
averaged 9.8 minutes (P<.005).
CAHDIZEM
Cdiltiazem HCl)
THE BALANCED
CALCIUM CHAHHEL BLOCKER
Please see full prescribing information on following page.
PROFLSSIONAL USE INFORMATION
cordizem,
(dilhozem HCI)
^0 and 60 mg tablets
DESCRIPTION
CAROIZEM' (dlltlazem hydrochloride) is a calcium ion Influx
Inhibitor (slow channel blocker or calcium antagonist). Chemically,
dlltlazem hydrochloride Is 1,5-Benzothlazepin-4(5H)one,3-(acetyloxy)
■5-[2-(dimethylamlno)ethyl|-2,3-dihydfo-2-(4-methoxyphenyl)-.
monohydrochlorlde,(+) -cIs-, The chemical structure is
CHjCHjNICHjIj
Dlltlazem hydrochloride is a white to off-white crystalline powder
with a bitter taste. It is soluble in water, methanol, and chloroform
It has a molecular weight ot 450.98, Each tablet of CARDIZEM
contains either 30 mg or 60 mg dlltlazem hydrochloride for oral
administration
CLINICAL PHARMACOLOGY
The therapeutic benefits achieved with CARDIZEM are believed
to be related to its ability to inhibit the Influx of calcium Ions
during membrane depolarization of cardiac and vascular smooth
muscle.
Mechanisms of Action. Although precise mechanisms of Its
antianglnal actions are still being delineated, CARDIZEM is believed
to act in the following ways
1 . Angina Due to Coronary Artery Spasm' CARDIZEM has been
shown to be a potent dilator of coronary arteries both epicardlal
and subendocardial. Spontaneous and ergonovine-induced cor-
onary artery spasm are inhibited by CARDIZEM,
2, Exertional Angina: CARDIZEM has been shown to produce
increases in exercise tolerance, probably due to Its ability to
reduce myocardial oxygen demand This is accomplished via
reductions in heart rate and systemic blood pressure at submaximal
and maximal exercise work loads
In animal models, dlltlazem interferes with the slow inward
(depolarizing) current in excitable tissue. It causes excitation-contraction
uncoupling In various myocardial tissues without changes In the
configuration of the action potential. Diltiazem produces relaxation
of coronary vascular smooth muscle and dilation of both large and
small coronary arteries at drug levels which cause little or no
negative inotropic effect The resultant increases in coronary blood
flow (epicardlal and subendocardial) occur In ischemic and nonischemic
models and are accompanied by dose-dependent decreases in sys-
temic blood pressure and decreases in peripheral resistance.
Hemodynamic and Electrophyslologic Effects. Like other
calcium antagonists, diltiazem decreases sinoatrial and atrioventricu-
lar conduction in isolated tissues and has a negative inotropic effect
In isolated preparations. In the Intact animal, prolongation of the AH
interval can be seen at higher doses.
In man, diltiazem prevents spontaneous and ergonovine-provoked
coronary artery spasm. It causes a decrease in peripheral vascular
resistance and a modest fall in blood pressure and. In exercise
tolerance studies in patients with Ischemic heart disease, reduces
the heart rate-blood pressure product for any given work load.
Studies to date, primarily In patients with good ventricular function,
have not revealed evidence of a negative inotropic effect; cardiac
output, ejection fraction, and left ventricular end diastolic pressure
have not been affected. There are as yet few data on the interaction
of diltiazem and beta-blockers. Resting heart rate Is usually unchanged
or slightly reduced by dlltlazem
Intravenous diltiazem in doses of 20 mg prolongs AH conduction
time and AV node functional and effective refractory periods approxi-
mately 20%. In a study involving single oral doses of 300 mg of
CARDIZEM in six normal volunteers, the average maximum PR
prolongation was 14% with no instances of greater than first-degree
AV block. Diltiazem-assoclated prolongation of the AH interval Is not
more pronounced in patients with first-degree heart block In patients
with sick sinus syndrome, dlltlazem significantly prolongs sinus
cycle length (up to 50% in some cases).
Chronic oral administration of CARDIZEM in doses of up to 240
mg/day has resulted in small increases In PR interval, but has not
usually produced abnormal prolongation. There were, however, three
instances of second-degree AV block and one insfance of third-
degree AV block in a group of 959 chronically treated patients.
Pharmacokinetics and Metabolism. Diltiazem Is absorbed
from the tablet formulation to about 80% of a reference capsule and
is subject to an extensive first-pass effect, giving an absolute
bioavailability (compared to Intravenous dosing) of about 40%. CARDIZEM
undergoes extensive hepatic metabolism in which 2% to 4% of the
unchanged drug appears in the urine. In vitro binding studies show
CARDIZEM is 70% to 80% bound to plasma proteins. Competitive
ligand binding studies have also shown CARDIZEM binding is not
altered by therapeutic concentrations of digoxin, hydrochlorothiazide,
phenylbutazone, propranolol, salicylic acid, or warfarin. Single oral
doses of 30 to 120 mg of CARDIZEM result in detectable plasma
levels within 30 to 60 minutes and peak plasma levels two to three
hours after drug administration. The plasma elimination half-life
following single or mulfiple drug administration Is approximately 3.5
hours. Desacetyl diltiazem is also present in the plasma at levels of
10% to 20% of the parent drug and is 25% to 50% as potent a
coronary vasodilator as diltiazem. Therapeutic blood levels of
CARDIZEM appear to be in the range of 50 to 200 ng/ml. There is a
departure from dose-linearity when single doses above 60 mg are
given; a 120-mg dose gave blood levels three times that of fhe 60-mg
dose. There Is no information about the effect of renal or hepaflc
impairment on excretion ot metabolism of diltiazem.
INDICATIONS AND USAGE
1 Angina Pectoris Due to Coronary Artery Spasm. CARDIZEM
is indicated in the treatment of angina pectoris due to coronary
artery spasm, CARDIZEM has been shown effective In the
treatment of sponfaneous coronary artery spasm presenting as
Prinzmetal's variant angina (resting angina with ST-segment
elevation occurring during attacks),
2 Chronic Stable Angina (Classic Eltort-Assoclated Angina).
CARDIZEM is indicated in the management of chronic stable
angina CARDIZEM has been effective in controlled trials in
reducing angina frequency and increasing exercise tolerance
There are no controlled studies of the effectiveness of the concomi-
tant use of diltiazem and beta-blockers or of the safety ot this
combination in patients with impaired ventricular function or conduc-
tion abnormalities.
CONTRAINDICATIONS
CARDIZEM is contraindicated in (1) patients with sick sinus
syndrome except in the presence of a functioning ventricular pacemaker.
(2) patients with second- or third-degree AV block except in the
presence of a functioning ventricular pacemaker, and (3) patients
with hypotension (less than 90 mm Hg systolic).
WARNINGS
1 Cardiac Conduction. CARDIZEM prolongs AV node refrac-
tory periods without significantly prolonging sinus node recov-
ery time, except in patients with sick sinus syndrome This
effect may rarely result in abnormally slow heart rates (particularly
in patients with sick sinus syndrome) or second- or third-degree
AV block (six of 1243 patients for 0.48%). Concomitant use of
dlltlazem with beta-blockers or digitalis may result In additive
effects on cardiac conduction. A patient with Prinzmetal's
angina developed periods of asysfole (2 fo 5 seconds) after a
single dose of 60 mg of diltiazem.
2 Congestive Heart Failure. Although diltiazem has a negative
inotropic effect in isolated animal tissue preparations, hemodynamic
studies in humans with normal ventricular function have not
shown a reduction in cardiac index nor consistent negative
effects on contractility (dp/dt). Experience with the use of
CARDIZEM alone or in comblnafion wlfh beta-blockers in patients
with impaired ventricular function Is very limited. Caution should
be exercised when using the drug ih such patients
3 Hypotension. Decreases in blood pressure associated with
CARDIZEM therapy may occasionally result in symptomatic
hypotension.
4 Acute Hepatic Injury. In rare Instances, patients receiving
CARDIZEM have exhibited reversible acute hepatic injury as
evidenced by moderate to extreme elevations of liver enzymes.
(See PRECAUTIONS and ADVERSE REACTIONS.)
PRECAUTIONS
General. CARDIZEM (diltiazem hydrochloride) is extensively metab-
olized by the liver and excreted by the kidneys and in bile As with any
new drug given over prolonged periods, laboratory parameters should
be monitored at regular intervals. The drug should be used with
caution in patients with impaired renal or hepatic function. In sub-
acute and chronic dog and rat studies designed to produce toxicity,
high doses of diltiazem were associated with hepatic damage. In
special subacute hepatic studies, oral doses of 125 mg/kg and
higher in rats were associated with histological changes in the liver
which were reversible when the drug was discontinued. In dogs,
doses of 20 mg/kg were also associafed wlfh hepatic changes;
however, these changes were reversible with continued dosing.
Drug Interaction. Pharmacologic studies indicate that there
may be additive effects in prolonging AV conduction when using
beta-blockers or digitalis concomitantly with CARDIZEM. (See
WARNINGS).
Controlled and uncontrolled domestic studies suggest that con-
comitant use of CARDIZEM and beta-blockers or digitalis is usually
well tolerated. Available data are not sufficient, however, to predict
the effects of concomifant treatment, particularly in patients with left
ventricular dysfunction or cardiac conduction abnormalities. In healthy
volunteers, diltiazem has been shown to increase serum digoxin
levels up to 20%
Carcinogenesis, Mutagenesis, impairment of Fertility. A
24-month study in tats and a 21-month study in mice showed no
evidence of carcinogenicity. There was also no mutagenic response
in in vitro bacterial tests No intrinsic effect on fertility was observed
in rats
Pregnancy. Category C Reproduction studies have been con-
ducted in mice, rats, and rabbits. Administration of doses ranging
from five to ten times greater (on a mg/kg basis) than the daily
recommended therapeutic dose has resulted in embryo and fetal
lethality These doses, in some studies, have been reported to cause
skeletal abnormalities. In the perinatal/postnatal studies, there was
some reduction in early individual pup weights and survival rates.
There was an increased Incidence of stillbirths at doses of 20 times
the human dose or greater.
There are no well-controlled studies in pregnant women; therefore,
use CARDIZEM in pregnanf women only if fhe pofential benefit
justifies the potential risk to the fetus.
Nursing Mothers. It Is not known whether this drug Is excreted
in human milk. Because many drugs are excreted in human milk,
exercise caution when CARDIZEM is administered to a nursing
woman if the drug's benefits are thought to outweigh its potential
risks in this situation.
Pediatric Use. Safety and effectiveness in children have not
been established,
ADVERSE REACTIONS
Serious adverse reactions have been rare in studies carried out to
date, but it should be recognized that patients with impaired ventricu-
lar function and cardiac conduction abnormalities have usually been
excluded.
In domestic placebo-controlled trials, the incidence of adverse
reactions reported during CARDIZEM therapy was not greater than
that reported during placebo therapy
The following represenf occurrences observed in clinical studies
which can be at least reasonably associated with the pharmacology
of calcium influx inhibition. In many cases, the relationship to
CARDIZEM has not been established. The most common occurrences,
as well as their frequency of presenfation, are; edema (2.4%),
headache (2.1%), nausea (1,9%), dizziness (1.5%), rash (1.3%),
asfhenia (1.2%), AV block (1.1%), In addition, the following evenfs
were reported infrequently (less than 1%) with the order of presenfa-
flon corresponding to the relative frequency of occurrence.
Cardiovascular;
Nervous System;
Gastrointestinal
Dermatologic:
Other
Flushing, arrhythmia, hypotension, bradycar-
dia, palpitations, congestive heart failure,
syncope
Paresthesia, nervousness, somnolence,
tremor, insomnia, hallucinations, and amnesia
Constipation, dyspepsia, diarrhea, vomiting,
mild elevations of alkaline phosphatase, SCOT
SGPT, and LDH
Pruritus, petechiae, urticaria, photosensitivity.
Polyuria, nocturia
The following addifional experiences have been noted:
A patient with Prinzmetal's angina experiencing episodes of
vasospastic angina developed periods of transient asymptomatic
asystole approximately five hours after receiving a single 60-mg
dose of CARDIZEM
The following postmarkefing events have been reported infre-
quently in patients receiving CARDIZEM: erythema multiforme; leu-
kopenia; and extreme elevations of alkaline phosphatase, SCOT,
SGPT, LDH, and CPK. However, a definitive cause and effect between
these events and CARDIZEM therapy is yet to be established.
OVERDOSAGE OR EXAGGERATED RESPONSE
Overdosage experience with oral diltiazem has been limited
Single oral doses of 300 mg of CARDIZEM have been well folerafed
by healfhy volunfeers In the event of overdosage or exaggerated
response, appropriate supportive measures should be employed in
addition to gastric lavage. The following measures may be considered;
Bradycardia
High-Degree AV
Block
Cardiac Failure
Hypotension
Administer atropine (0.60 to 1.0 mg). If there
is no response to vagal blockade, administer
isoproterenol cautiously.
Treat as tor bradycardia above. Fixed high-
degree AV block should be treated with car-
diac pacing.
Administer inotropic agents (isoproterenol,
dopamine, or dobutamine) and diuretics.
Vasopressors (eg, dopamine or levarterenol
bitartrate).
Actual treatment and dosage should depend on the severity of the
clinical situation and the judgment and experience ot the treating
physician.
The oral/LDjo's in mice and rats range from 415 to 740 mg/kg
and from 560 to 810 mg/kg, respectively. The intravenous LD^'s in
these species were 60 and 38 mg/kg, respectively. The oral L'Dsj in
dogs is considered to be in excess ot 50 mg/kg. while lethality was
seen in monkeys at 360 mg/kg. The toxic dose in man is not known,
but blood levels in excess of 800 ng/ml have not been associated
with toxicity
DOSAGE AND ADMINISTRATION
Exertional Angina Pectoris Due to Atherosclerotic Coro-
nary Artery Disease or Angina Pectoris at Rest Due to Coro-
nary Artery Spasm. Dosage must be adjusted to each patient's
needs Starting with 30 mg four times daily, before meals and at
bedtime, dosage should be increased gradually (given in divided
doses three or four times daily) at one- to two-day intervals until
optimum response is obtained. Although individual patients may
respond to any dosage level, the average optimum dosage range
appears to be 180 to 240 mg/day. There are no available data concern-
ing dosage requirements in patients with impaired renal or hepatic
function. It the drug must be used in such patients, titration should be
carried out with particular caution.
Concomitant Use With Other Antianglnal Agents:
1 Sublingual NTG may be taken as required to abort acute
anginal attacks during CARDIZEM therapy.
2 Prophylactic Nitrate Therapy -CARDIZEM may be safely
coadministered with short- and long-acting nitrates, but there
have been no controlled studies to evaluate the antianglnal
effectiveness of this combination.
3. Beta-blockers. (See \«ARNINGS and PRECAUTIONS.)
HOW SUPPLIED
Cardizem 30-mg tablets are supplied in bottles of 100 (NDC
0088-1771-47) and in Unit Dose Identification Paks ot 100 (NOC
0088-1771-49). Each green tablet is engraved with MARION on one
side and 1771 engraved on the other, CARDIZEM 60-mg scored
tablets are supplied in bottles of 100 (NDC 0088-1772-47) and in Unit
Dose Identification Paks of 100 (NDC 0088-1772-49). Each yellow
tablet is engraved with MARION on one side and 1772 on the other
Issued 4/1/84
Another patient benefit product from
PHARMACEUTICAL DIVISION
MARION
LABORATORIES, INC
KANSAS CITY, MISSOURI 64137
Turn of the century
trephine forcranial surgery
and tonsillotome for
removing tonsils.
We’ve been defending
doctors since
these were the
state of the art.
These instruments were the best available at
the turn of the century. So was our professional
liability coverage for doctors. In fact, we
pioneered the concept of professional
protection in 1899 and have been providing
this important service exclusively to doctors
ever since.
You can be sure we’ll always offer the most
complete professional liability coverage you
can carry. Plus the personal attention and
claims prevention assistance you deserve.
For more information about Medical
Protective coverage, contact your Medical
Protective Company general agent.
f M H tci u' ^ V t */ s!
William E. Herte, Jerry E. Kronsnoble, 850 North Elm Grove Road, Elm Grove, Wisconsin 53122, 414/784-3780
C E S
Foundation
of the State Medical
Society of Wisconsin
The Charitable. Educational and Scientific Foundation
of the State Medical Society of Wisconsin recognizes
the generosity of the following individuals and organi-
zations who have made contributions during the
month of January 1985.
VOLUNTARY
DONATIONS
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DeLore Williams, MD
Earl B Williams, MD
Thomas H Williams, MD
L M Williamson, MD
Warren H Williamson, MD
Edward RWingra, MD
John H Wishart, MD
Raymond W Witt, MD
Robert G Wochos, MD
Carol E Young, MD
Charles W Young, MD
F Frank Zboralske, MD
Clarence E Zenner, MD
Richard C Zimmerman, MD
GENERAL GIFTS
Brown UniTrust
L Wayne and Marion Brown
30th
ANNIVERSARY
DONATIONS
Donald R Beaver, DO
Robert M Boex, MD
John F KreuI, MD
John T Mendenhall, MD
Donald Temby
Kenneth M Viste, Jr, MD
AESCULAPIAN
SOCIETY
REGULAR
Cecil A Bemis
Richard J Thurreli, MD
SUSTAINING
Dr and Mrs William C Janssen
Timothy T Flaherty, MD
IN MEMORIAM
Mrs William Ford
Stanley S Dixon
Judith M Endicott
MEMORIAL
CONTRIBUTORS
Mrs A Burr (Dorothy) Be Dell
Brown County
Medical Society Auxiliary
Agatha C Burdon
Mrs John P Burnham
Michael and Eleanor Dockry
Dr and Mrs Richard Edwards
Dr and Mrs Ben Erickson
Lee and Mary Erickson
Mr and Mrs E L Everson
Jean A Farrell
Mr Richard Farrell
Dr William W Ford
Farrell F Golden, MD
J B and Julianne Grace
Zella Hannas
Mr and Mrs S D Hastings
Alvina S Hawley
Dr and Mrs Oliver Hitch
Mr and Mrs Robert L Hoffmann
Mrs Emmett Killeen
Mr and Mrs George Kress
Helen S Miller
Richard L Myers
Joseph A Neufeld
Nancy Ott Trainor
Mr and Mrs Peter J Schumacher
Dr and Mrs Daniel Shea
Mary E Vanderheyden
Dr and Mrs B P Waidkirch
Dr and Mrs Ray Waidkirch
Gordon and Irene Ware
PHYSICIANS
BENEVOLENT
ASSISTANCE
FUND
Marck W Jeffries, MD
STUDENT LOAN
FUNDS
Richard A Collins, MD
BROWN COUNTY
BEAUMONT 500 LOAN FUND
Roy Selby, MD Mrs A Burr(Dorothy) Be Dell
Dr and Mrs Roger von Heimburg Brown County
Dr and Mrs Bertram H Dessel Medical Society Auxiliary
continued next page
CES FOUNDATION
CONTRIBUTIONS
continued
Agatha C Burden
Mrs John P Burnham
Michael and Eleanor Dockry
Dr and Mrs Ben Erickson
Lee and Mary Erickson
Mr and Mrs E L Everson
Jean A Farrell
Mr Richard Farrell
Dr William W Ford
J B and Julianne Grace
Zella Flannas
Mr and MrsS D Hastings
Alvina S Hawley
Dr and Mrs Oliver Hitch
Mr and Mrs Robert L Hoffmann
Mrs Emmett Killeen
Mr and Mrs George Kress
Helen S Miller
Richard L Myers
Joseph A Neufeld
Mr and Mrs Peter J Schumacher
Dr and Mrs Daniel Shea
Mary E Vanderheyden
Dr and Mrs B P Waidkirch
Dr and Mrs Ray Waidkirch
Gordon and Irene Ware
RACINE COUNTY
LOAN FUND
Racine County Medical
Society Auxiliary
POPP STUDENT
LOAN FUND
Albert Popp, MD
BUILDING AND
EQUIPMENT
Palmer Kundert, MD
Executive Director
K L Bjurstrom
CES Foundation
330 E Lakeside St
PO Box 1 109
Madison, Wl 53701
800/362-9080
608/257-6781
The Charitable, Educational and Scientific Foundation
of the State Medical Society of Wisconsin recognizes
the generosity of the following individuals and organi-
zations who have made contributions during the
month of February 1 985.
VOLUNTARY
DONATIONS
Robin N Allin, MD
Charles H Altschuler, MD
Edward A Bachhuber, MD
John M Bareta, MD
Stephen A Bernsten, MD
Kristin L Bjurstrom
Enzo F Castaldo, MD
Richard W Clasen, MD
John J Czajka, MD
Joel R De Koning, MD
Steven D Driggers, MD
William A Fischer, MD
Rocco S Galgano, MD
David N Goldstein, MD
David C Grout, MD
Gretchen Guernsey, MD
Thoralf E Gundersen, MD
John E Hamacher, MD
George R Hammes, MD
John A Harris, MD
John R Haselow, MD
Robert D Heinen, MD
N Alfred Hill, MD
Charles E Holmburg, MD
John S Honish, MD
Elmore P Huth, MD
Michael T Jaekels, MD
Walter H Jaeschke, MD
J Howard Johnson, MD
Thomas S Josephson, MD
Robert N JustI, MD
David A Kasuboski, MD
Nevenka T Kevich, MD
Leslie G Kindschi, MD
George F Kroker, MD
Robert M Krout, MD
Jerome J Luy, MD
Paul B Mason, MD
Charles T Meyer, MD
Jane M Moir, MD
Harvey Monday, MD
David L Morris, MD
Naghi Motamedi, MD
James L Murphy, MD
George Nadeau, MD
Moktar Najafzadeh, MD
Louis G Nezworski, MD
Steven D O'Marro, MD
Jose M Palisoc Jr, MD
Jung Kyun Park, MD
Sverre Quisling, MD
Ralph T Rank, MD
Raymond J Rogers, MD
William R Rose, MD
Vijay K Sabnis, MD
Sally M Schlise, MD
Hwe Jae Song, MD
Jaswinderjit S Sundlass, MD
Alan L Taber, MD
John A Thranow Jr, MD
Clarence A Topp, MD
Jeffrey M Weber, MD
Richard J Wittchow, MD
Gerhard L Witte, MD
James R PWong, MD
AESCULAPIAN
SOCIETY
SUPPORTING
Mary Lou Short
Earl R Thayer
BEAUMONT 500
Roy Selby, MD
BROWN COUNTY
LOAN FUND
Brown County Medical
Society Auxiliary
John M Guthrie, MD
Dr and Mrs Stuart Milson
Dr and Mrs Robert T Schmidt
MARATHON
COUNTY MEDICAL
SOCIETY
STUDENT
LOAN FUND
Marathon County
Medical Society Auxiliary
IN MEMORIAM
Ralph G Burnett, MD
Mary Markey Burns
Nicholas Demeter, MD
T A Duckworth
Thelma Ford
Stephen E Gavin, Jr
Richard E Jensen, MD
Raul M Lagman, MD
John Kerwin
Mrs Margaret Magnus
Paul B Mason, MD
Oscar Steinnon, MD
Bernard A Trimborn, MD
Mari Francis Verderzanden
William N Young, MD
MEMORIAL
CONTRIBUTORS
Arnold E Biebel
Dr and Mrs David N Goldstein
John M Guthrie, MD
Dr and Mrs Stuart Milson
Mrs Catherine Niles
Dr and Mrs E J Nordby
Mrand Mrs John L Ross
Drand Mrs Robert T Schmidt
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V
[ PUBLIC HEALTH )
Wisconsin and Soviet physicians meet in Chicago
When a Soviet physician takes
the Hippocratic Oath, he or she
recites an amended text that in-
cludes the sentence: "recognizing
the threat to health and life repre-
sented by nuclear weapons, I will
do all in my power to prevent
nuclear war."
This is just one of the facts
learned by three State Medical
Society of Wisconsin physicians
February 11 when they met with
a group of Soviet physicians in
Chicago to discuss the medical
dimensions of nuclear war.
John K Scott, MD, president-
elect of the State Medical Society,
said the meeting "was an impor-
tant first step in creating a dia-
logue with our Soviet counter-
parts so that each of us can reach
out to our respective peoples and
gather support for doing some-
thing about the nuclear weapons
threat."
"Nuclear war is the most impor-
tant medical and social issue of
our time, and we as physicians
have an obligation to do some-
thing to prevent it," he said. "A
physician becomes obsolete in
nuclear war."
Other Madison physicians who
met privately with the Soviet
delegation were Jack S Westman,
MD and Marc Hansen, MD, the
latter being a member of the So-
ciety's Ad Hoc Committee on the
Public Health Consequences of
Nuclear War. Doctor Westman is
the author of a 1982 Society
resolution which says the Society
"encourages efforts to provide
reliable scientific information to
the profession and the public re-
garding the medical consequences
of nuclear weapon explosions,
and requests our public and pro-
fessional representatives at the
state, national, and international
levels to take whatever carefully
considered steps are necessary to
reduce the likelihood of nuclear
weapon explosions." According to
Bernard Town, MD, copresident
of the International Physicians for
Prevention of Nuclear War
(IPPNW), the State Medical So-
ciety of Wisconsin was the first
medical society in the nation to
take such an action.
The meeting in Chicago was the
first stop for the Soviet physicians
in a five-city US tour organized by
IPPNW. Soviet physicians present
were Evgueni I Chazov, MD,
director general of the National
Cardiological Research Center for
the USSR, and copresident of the
IPPNW; Mikhail Kuzin, director
of the Vishenevsky Surgical Insti-
tute, and Nikolai Trapeznikov,
deputy director of the USSR On-
cology Research Center. Other
American physicians present
were Sidney Alexander, MD,
president of Physicians for Social
Responsibility, and Bernard
Town, MD, copresident of the
IPPNW.
During the meeting, the Wis-
consin physicians invited their
Soviet colleagues to visit Madison
during a US tour planned for next
fall. The visit would include a
meeting with local physicians to
exchange scientific information as
well as to discuss what can be
done to prevent nuclear war.
Before ending the meeting the
physicians shared photographs of
their grandchildren with each
other. "Afterall," said Doctor
Scott, "it's because of them that
we're doing this."
—Prepared by Diane Upton
SMS Communications Coordinator ■
I-cfl to right: Jack S Westman, MD, Madison: John K Scott, MD, Madison; Mikhail Kuzin, MD, director of the X’ishenevsky Surgical Institute, I’SSR; Marc Hansen,
•MD, .Madison; \ikolai Trapeznikov, .MD, deputy director of the I’SSR Oncology Research Center; Bernard l.own, .MD. Boston, Mass, copresident of International
IMiysicians for the Prevention of \uclear War (1 PP\W); and Evgueni I Chazov, MD, director general of the National Cardiological Research Center, I'SSR, and
copresident of IPPXW. (Staff photos by Diane Upton)
46
WISCONSIN MEDICAL JOURNAL, APRIL 1985: VOL. 84
IT PAYS
TO BE A
MEMBER
SMS Services, Inc.
Doctor — Who can you trust
when you buy your personal or business insurance?
THE STATE MEDICAL SOCIETY recommends
SMS Services, Inc.
A licensed insurance agency, wholly owned by your
State Medical Society . . . offering
• Top quality, competitively priced insurance products, designed
especially for physicians
• Highly trained and qualified insurance professionals who
specialize in physicians’ insurance needs
• Coverage through over a dozen of the most reputable
insurance companies in America
• Business and personal insurance • And much more
Over 2,500 physicians purchase over $7,000,000 of insurance coverage each year
through SMS Services, Inc. Another reason why SMS Serviees, Inc. is a name
you ean trust!
WATCH FOR VARIOUS OFFERINGS IN THE MAIL . . . Also please welcome your
AUTHORIZED SMS Services, Inc. INSURANCE REPRESENTATIVE into your office.
SMS Services, Inc., a SAFE and SENSIBLE way for you to purchase insurance
“We’re working full-time for you ”
P.O. BOX 1109, MADISON, WI 53701 • PHONE 608/257-6781 OR TOLL-FREE 1-800-362-9080
SOCIOECONOMICS
SMS speaks out on mandated benefits,
involuntary commitment laws
Mandated benefits for alcohol-
ism, drug abuse, and mental
health services along with invol-
untary commitment proceedings
were discussed at legislative com-
mittee meetings at which SMS
spokespersons testified in March.
The 1985-87 biennial budget in-
cludes an amendment to state
laws pertaining to mandated in-
surance benefits. Under the pro-
posal, required inpatient coverage
would be reduced from 30 days to
the lesser of $6,300 or 25 days,
with a 10 percent copayment by
the recipient. Outpatient coverage
requirements would be increased
from $500 to $1,000, with a 10
percent copayment; also a re-
quirement is added for $1,000
worth of coverage for day treat-
ment/partial hospitalization, with
a 10 percent copayment. Total an-
nual coverage (inpatient, out-
patient, and day treatment) would
not have to exceed $7,000.
At a hearing held by the Joint
Finance Committee March 5, SMS
objected to these proposed
changes and called for repeal of
the current mandated benefits.
SMS charged that the effect of
state mandates in this area has
been to increase the cost of health
insurance, to reduce the pur-
chasers' and consumers' ability to
choose policies which reflect their
needs, and to increase the incen-
tive to move to self-insurance,
which is not subject to these man-
dates.
"The State Medical Society op-
poses discrimination against par-
ticular disease entities in insur-
ance policies; but mandated bene-
fits have not proved to be an effec-
tive or appropriate route to pre-
venting such discrimination or en-
couraging the provision of cover-
age for cost-effective care," SMS
said.
The next day on March 6, SMS
testified in support of a bill which
is designed to improve the hand-
ling of involuntary commitment
proceedings. The bill would pro-
vide that both sides in a proceed-
ing notify the other of proposed
witnesses; v/ould allow petitions
at the probable-cause stage to be
more easily switched between
alcoholism grounds and drug
dependence or mental illness
grounds; and would allow the use
of outpatient treatment records, as
well as inpatient treatment
records, in determining danger-
ousness when a person has re-
ceived such treatment under a
court-ordered commitment. The
bill would also allow proceedings
A bill which would require all
malpractice claims to be referred
to the State Medical Examining
Board would put an unrealistic
caseload on the Board, Gerald
Kempthorne, MD, told a Senate
Committee March 12.
Speaking on behalf of the State
Medical Society and its Commis-
sion on Mediation and Peer Re-
view, Doctor Kempthorne said
that SMS strongly agrees with the
intent of Senate Bill 75 that there
must be a mechanism for peer
review of cases involving negli-
gence on the part of the physicians
whether the case is settled, or
tried to verdict.
"However, it must be under-
stood," Doctor Kempthorne said,
"that physicians have no voice in
settlement decisions, and there-
fore it is inappropriate to initiate
an investigation of unprofessional
conduct based solely on an insur-
for involuntary commitment,
when a person agrees to voluntary
treatment, to be held open for 30
days rather than 14 days; and pro-
vides that when a person is taken
into custody pending involuntary
commitment, a preliminary hear-
ing must be held within 72 hours
of the time they are taken into
custody, rather than 48 hours
after receipt of a petition.
SMS pointed out to the commit-
tee that these changes address
oversights in the current law as
technical problems which should
be rectified. "However," SMS
stressed, "we should not assume
that passage of this bill will solve
all of the problems that exist with
the current mental commitment
laws . . . the adoption of an addi-
tional commitment standard is
necessary now which would
allow treatment of persons who
will suffer substantial mental
deterioration of informed consent
or refusal of treatment." ■
ance company's economically-
motivated settlement practices."
SMS proposes referral of all
negligence findings, all claims
settled (without a negligence find-
ing) for more than $25,000, and all
claims settled which involve the
death of a patient. SMS has also of-
fered to serve as a resource to the
MEB for screening panel cases
and making recommendations re-
garding prioritization of these new
referrals. This recommendation
has been adopted by the Legisla-
tive Council's Special Committee
on Medical Malpractice as part of
a comprehensive package to deal
with the medical liability situation
in Wisconsin.
SB 75 has been recommended
for passage by the Senate Agricul-
ture, Health and Human Services
Committee and is now in the Joint
Finance Committee. ■
SMS testifies on peer review legislation
48
WISCONSIN MEDICAL JOURNAL, APRIL 1985:VOL. 84
SOCIOECONOIVIICS
Malpractice premiums to rise 106%
The Board of Governors of the
Wisconsin Health Care Liability
Insurance Plan (WHCLIP) and Pa-
tients Compensation Fund voted
on February 25 to increase medi-
cal malpractice insurance rates as
of July 1, 1985/
69% for WHCLIP, and
160% for the Fund
The combined effect of these in-
creases is an overall rate increase
of approximately 106 percent.
Below is a chart comparing cur-
rent rates to the proposed July 1,
1985 rates.
Total
Class
(WHCLIP & Fundj Premium
1984
1985
1
2,323
4,806
2
4,646
9,613
3
5,976
12,363
4
7,170
14,834
5
11,950
24,724
6
14,340
29,668
7
16,730
34,613
8
1,162
2,404
9
25,096
51,921
In order to determine the im-
pact of these rate increases on the
availability and cost of healthcare,
all SMS members are being asked
to respond to a one-page, mini-
survey. The survey seeks physi-
cian views on the impact of the
medical liability climate on prac-
tice patterns and charges to pa-
tients and on prioritization of
reforms needed in Wisconsin. The
results will be communicated to
the Legislature. Prompt attention
to this matter is critical. ■
SMS asks business
leaders' help on
malpractice problem
SMS President Timothy
Flaherty, MD has called upon the
business community to assist
physicians in resolving the medi-
cal malpractice problem in the
state. In a letter to the chief execu-
tive officers of the 500 largest cor-
porations in the state. Doctor
Flaherty said that professional
liability constituted a major and
unnecessary component in
healthcare costs, and that em-
ployers pay the bill for these costs
through employee health insur-
ance premiums. Included with
the letter was a copy of an Update
on "Medical Liability in Wiscon-
sin: Problems and Recommenda-
tions for Change." The report,
which has been sent to legislators
and all Wisconsin physicians, out-
lines the crisis on medical mal-
practice and the Society's recom-
mendations for action. Doctor
Flaherty asked the executives to
make their opinions on the subject
known to their legislators, as the
"Legislature holds the key to
some short-term solutions to this
problem." ■
Joint Finance
Committee considers
healthcare regs
The Joint Finance Committee's
health discussion group is taking
up the question of changes in
Wisconsin's healthcare regula-
tions, specifically the repeal or
modification of the Capital Expen-
diture Review (CER) program and
the Hospital Rate-Setting Com-
mission. The State Medical So-
ciety, along with such legislators
as Senators John Norquist (D-Mil-
waukee), advocated for a compe-
titive approach toward controlling
healthcare costs. One of the most
important steps in moving from a
regulatory to a competitive envi-
ronment is the elimination of the
Capital Expenditure Review.
Under this program, state ap-
proval is needed for capital expen-
ditures over $600,000, including
purchases of clinical equipment
for physicians' offices and for a
change in a hospital's service
which increases revenue by more
than $200,000. State approval is
also needed for such things as am-
bulatory surgery centers and
home health agencies. An increas-
ing number of legislators are con-
sidering elimination or reduction
of the CER program and the Hos-
pital Rate-Setting Commission.
This will be voted on within the
next couple of weeks by the
health discussion group (co-
chaired by Senator John Norquist)
of the Joint Finance Committee.
However, the Governor and the
Department of Health and Social
Services are lobbying to save their
regulatory clout. They claim that
the CER program and the Hospital
Rate-Setting Commission have
worked to control healthcare
costs, and that we should not
"tamper" with them. ■
Malpractice seminar
scheduled for May 1 1
"Malpractice: Can the Picture
Be Changed" is the subject for a
two-day conference the State
Medical Society is sponsoring for
physicians at the Hyatt Regency
Hotel, Milwaukee, May 10 and
11.
A project of the Society's Medi-
cal Liability Committee, the con-
ference will focus on how mal-
practice incidents can be reduced
as well as what medical-legal steps
can be taken to improve the medi-
cal liability situation.
Topics will include: "Malprac-
tice: What It Is, How It Happens";
"What Is Malpractice"; "What
Gets Physicians Into Malpractice
Trouble"; and "How to Minimize
Your Risk of a Lawsuit."
Registration is $70 for SMS
members and $150 for nonmem-
bers. For further information to
register, contact Deborah Powers
at the SMS Physicians Alliance
Division in Madison. ■
WISCONSIN MEDICAL JOURNAL, APRIL 1985: VOL. 84
49
SOCIOECONOMICS
A brief profile of the 1985
Wisconsin State Legislature
• The new State Assembly will
feature more Republicans thaii
any session since 1969, the last
year they held the majority. In-
creasing their ranks in the
Assembly from 40 to 47 in the
fall elections, Republicans will
still be the minority party with
Democrats controlling both
houses— 52 to 47 in the Assem-
bly and 19 to 14 in the Senate.
• This year there are 25 women
in the Legislature— 3 senators
and 22 representatives— which
equals the record high. In the
early 1970s there were as few
as four women legislators, all
in the Assembly.
• There are five new members in
the Senate and 24 first-term As-
sembly members. Fred Risser,
a Madison Democrat, has
seniority in the Senate. He was
‘Statistics provided by the Wisconsin
Legislative Reference Bureau.
elected in 1962 after serving six
years in the Assembly.
Earl McEssy, a Fond du Lac
Republican, is dean of the As-
sembly. He has been reelected
14 times since first becoming a
member of the Legislature in
1956.
The WISPAC-sponsored
socioeconomic luncheon at
the SMS Annual Meeting in
La Crosse is scheduled for
Friday, April 26, from 11:45
am to 1:30 pm
This year, the guest speaker
will be Mark Shields, a
political columnist for the
Washington Post. He also has
done special election cover-
age for NBC and CBS, and
for sometime he hosted "In-
side Washington," a PBS
weekly television show.
The luncheon is open to
everyone, however, tickets
should be ordered as soon as
possible.
• The average age of state sena-
tors is 42.8, compared with
41.6 in the Assembly. The
range is 24 to 72 years of age.
• Law and farming are predomi-
nant current occupations in
the Legislature— with 23 at-
torneys and 18 farmers. Nine-
teen legislators list teaching as
a former career. Other Senate
occupations range from retired
naval officer and telephone
cable splicer to such businesses
as electrical contracting, metal
recycling, property manage-
ment, and communications
consulting. In the Assembly,
employment has included such
activities as investment broker,
insurance agent, public re-
lations consultant, part-time
sports announcer, feed dealer,
land surveyor, pharmaceutical
consultant, and community
volunteer.
Eight senators and 19 repre-
sentatives list previous employ-
ment in a legislative staff po-
sition.
• Twenty-six senators and 73 rep-
resentatives, or 75 percent of
the Legislature, have graduated
from college. The breakdown
includes 23 law degrees, 1 PhD
degree, and 18 Master's de-
grees.
• Legislators elected in 1984 will
draw $27,202 a year in salary.
Holdover senators will still
receive $22,632. Besides their
salaries, legislators outside
Dane County may receive up
to $41.63 a day in living ex-
penses while they are in
Madison on state business.
Members of the Dane County
delegation are allowed up to
$20.81 in expenses. ■
50
WISCONSIN .MEDICAL JOL’RNAL, APRIL 1985: VOL. 84
Herman P Musch, MD, Baraboo,
recently began his medical prac-
tice in Baraboo. Doctor Musch
graduated from Mayo University
of San Simon in Bolivia, South
America. He spent two years
practicing in a rural area in South
America as a government-ap-
pointed physician. For three
years Doctor Musch directed a re-
search program on nutrition for
the Patino Foundation of Bolivia.
He completed his internship at
Mercy and Raymond Blank
Memorial Hospital for Children
in Des Moines.
Joseph E Powell, MD,* New
Richmond, is among eight rural
Wisconsin, Minnesota, and North
Dakota physicians selected for a
Bush Clinical Fellowship Award.
Doctor Powell, a family prac-
titioner at Holy Family Hospital
and at New Richmond Clinic,
will spend nine months during a
three-year period using the award
for advanced study in critical
care medicine and geriatrics. The
"Clinical Fellow" awards, made
by the Bush Foundation of St
Paul, allow the selected rural
physician to spend from three
months to a year learning new
clinical and leadership skills.
Doctor Powell has been in medi-
cal practice in New Richmond for
the past 13 years.
George R Thuerer, MD, * Rhine-
lander, after 36 years of medical
service in the community, retired
in December 1984. Doctor
Thuerer came to Rhinelander in
1949 after completing four years
of surgical residency at Univer-
sity of Wisconsin Hospital in
Madison. He had been in the
United States Army Medical
Corps for 54 months during
World War II, including 39
months in the South Pacific
Theater. Doctor Thuerer has
PHYSICIAN BRIEFS
served as an associate preceptor
for the University of Wisconsin-
Madison Medical School and is
a fellow of the American College
of Surgeons.
Melvin F Huth, MD,* Baraboo,
received the Wisconsin Athletic
Director Association's Distin-
guished Service Award during
ceremonies held at the Marc
Plaza Hotel in Milwaukee. The
awards are presented annually as
an expression of appreciation for
years of distinguished service to
high school athletics. In present-
ing the award. Bob Roloff, Bara-
boo High School Athletic Di-
rector, said, "Doctor Huth has
touched many people in Baraboo.
He plays a vital and active role in
the athletic program and serves
as physician in attendance at
nearly all home games. He has a
personal appreciation of continu-
ing education and believes that
participation in athletics teaches
effort, and that effort is the fore-
runner of success in all later life
endeavors." Doctor Huth has
donated his services to high
school athletes by providing
WIAA physical examinations and
other services to local athletic
programs for some 38 years.
Moe L Chin, MD,* Watertown,
has become medical director of
the Beverly Terrace Nursing
Home in Watertown. Doctor
Chin graduated from the Univer-
sity of Washington School of
Medicine and completed his
family practice residency at St
Michael's Hospital in Mil-
waukee. Board certified. Doctor
Chin has been in private prac-
tice in Watertown since 1980.
Joyce A Ycrex, MD,* Kenosha,
has been elected president of the
Kenosha Memorial Hospital
medical staff for 1985. Doctor
Yerex, a radiologist on the medi-
cal staff since 1977, graduated
from the University of St An-
drews in Scotland and served
residencies at Milwaukee
County and Columbia hos-
pitals in Milwaukee.
Susan F Behrens, MD, * Beloit,
has been elected to fellowship in
the American College of Sur-
geons. Doctor Behrens is on the
medical staff of the Beloit Clinic
and is chairman of the Wisconsin
Medical Examining Board. She
also is a member of the Long
Range Planning Committee for
the National Federation of State
Medical Boards and has been
asked to serve on a Task Force for
the National Board of Medical
Examiners to rewrite Part III of
the examination.
Kathryn A Green, MD, Sheboy-
gan, has opened her medical
practice in ophthalmology in
Sheboygan. Doctor Green grad-
uated from the Indiana Uni-
versity School of Medicine and
served her internship in Portland,
Ore. Her residency training was
completed at the Eye Institute
at Milwaukee County Medical
Complex. Doctor Green is on the
medical staff at St Nicholas and
Sheboygan Memorial hospitals.
William Odette, MD, Edgerton,
recently became associated with
the medical staff of the Edgerton
Clinic. Doctor Odette graduated
from Wayne State University
School of Medicine, Detroit, and
completed his residency at the
Southwestern Michigan Health
Education Center in Kalamazoo,
Mich.
WISCONSIN MEDICALJOURNAL, APRIL 1985:VOL. 84
PHYSICIAN BRIEFS
David G Crawford, MD,* (above),
Madison, has been appointed in-
structor of psychiatry at the Uni-
versity of Wisconsin Medical
School. He joins the staff of UW
Hospital and Clinics' Center for
Affective Disorders and director
of the inpatient unit. Doctor
Crawford graduated from the
University of Oklahoma School
of Medicine and completed his
residency at the University of
Wisconsin, Madison.
Doctor Watts Doctor Crawford
Doctor Cohen Doctor Soderquist
David Cohen, MD (above), Madi-
son, recently was appointed
assistant professor of surgery at
the University of Wisconsin
Medical School. Doctor Cohen
graduated from Washington
University School of Medicine,
St Louis, Mo, and completed his
residency at Johns Hopkins Hos-
pital and the University of Wash-
ington Affiliated Hospitals. He
also completed a residency in
cardiothoracic surgery at the
University of Pennsylvania.
Doctor Cohen previously held
positions in the department of
cardiovascular physiology at
Walter Reed Army Institute of
Research and in cardiothoracic
surgery at Brooke Army Medical
Center.
David T Watts, MD (above),
Madison, recently was appointed
assistant professor of medicine
at the University of Wisconsin
Medical School. He joined the
medical staff of the UW Hos-
pital's geriatric clinic and the UW
Hospital Middleton Clinic.
Doctor Watts graduated from the
University of Washington School
of Medicine and served a fellow-
ship at the VA Medical Center,
Portland, Ore.
Catherine Soderquist, MD
(above), recently joined the
medical staff of the DeForest
Area Medical Clinic. Doctor
Soderquist graduated from the
University of Minnesota School
of Medicine and completed her
family practice residency at the
University of Wisconsin Medical
School, Madison. She was in pri-
vate practice in Eagan, Minn, a
suburb of Minneapolis, until
joining the DeForest Clinic.
Joseph H Evans, MD, Marshfield,
has joined the medical staff of the
Marshfield Clinic. Doctor Evans
graduated from Jefferson Medical
College in Philadelphia and
served his internship and com-
pleted his residency at the Uni-
versity of Wisconsin Hospital
and Clinics in Madison. He also
completed a fellowship at In-
diana University Hospital in
Indianapolis.
Paul Groben, MD, Platteville,
recently joined the medical staff
at the Southwest Health Center.
Doctor Groben graduated from
the University of Iowa School of
Medicine and completed his ro-
tating internship at Doctors' Hos-
pital in Columbus, Ohio. His
residency in radiology was com-
pleted at Grandview Hospital in
Dayton, Ohio. Doctor Groben
has practices in Platteville and
Cuba City and is a faculty mem-
ber at the University of Wis-
consin in Madison.
Bruce E Brink, MD, Marshfield,
has joined the medical staff of the
Marshfield Clinic. Doctor Brink
graduated from the University of
Michigan Medical School, Ann
Arbor, and completed his intern-
ship and residency at University
Hospital in Ann Arbor. Prior to
joining the Clinic, Doctor Brink
was an associate professor and
vice chairman of the Department
of Surgery at the University of
Texas Southwestern Medical
School in Dallas.
Terrance J Wilkins, MD, * who
currently has offices in Mil-
waukee and Mequon, has estab-
lished an office at the Marsho
Medical Clinic in Sheboygan.
Doctor Wilkins graduated from
the Medical College of Wiscon-
sin and completed his internship
at St Joseph Hospital in Denver.
His residency training was com-
pleted at St Joseph's and the
Medical College of Wisconsin
Hospitals in Milwaukee. He also
completed training at Indiana
University Hospital in Indianapo-
lis.
Kathleen Farah, MD, who is com-
pleting her residency at St Paul
Ramsey Medical Center in St
Paul, Minn, is joining the medical
staff of the Curtis Medical Clinic,
Baldwin, this summer. Doctor
Farah graduated from the Uni-
versity of Minnesota Medical
School.
Kita Patel, MD, recently joined
the medical staff of the Hartford
Memorial Hospital. Doctor Patel
served her internship at St Fran-
cis Hospital, Pittsburgh, Pa, and
her residency in anesthesiology at
the Medical College of Wiscon-
sin, Milwaukee. Doctor Patel
has served as acting director of
anesthesiology at Mount Sinai
Medical Center and has also
served as assistant professor of
anesthesiology at the Medical
College of Wisconsin.
52
WISCONSIN MEDICAL JOURNAL, APRIL 1985: VOL. 84
PHYSICIAN BRIEFS
John D Silbar, MD,* Milwaukee,
was elected president of the
North Central Section of the
American Urological Association
at its Annual Meeting. The North
Central Section is one of the
largest sections of the American
Urological Association and con-
sists of 1200 practicing urologists
in the North Central United
States and parts of Canada. Doc-
tor Silbar is a clinical professor
at the Medical College of Wis-
consin and is on the medical staff
of the Clinic of Urology, SC, in
Milwaukee.
Robert Braastad, MD, Eau Claire,
has joined the medical staff at
Sacred Heart Hospital in Eau
Claire. Doctor Braastad grad-
uated from the Emory University
School of Medicine, Atlanta,
Ga, and completed a three-year
residency at the Gundersen
Clinic and Lutheran Hospital,
La Crosse. He is associated with
Group Health Cooperative in
Eau Claire and for the past two
years he was at the Alexandria
Clinic in Alexandria, Minn.
J Gregory Hoffmann, MD, re-
cently became associated with
the medical staff at Hartford
Memorial Hospital. Doctor Hoff-
man served a family practice
residency at St Mary of Nazareth
Hospital in Chicago, and also at
the University of Health Science
of the Chicago Medical School.
He is affiliated with the Hart-
ford-Parkview Clinic.
Francis Wolf, MD, has become a
member of the medical staff at
Hartford Memorial Hospital.
Doctor Wolf served his intern-
ship at Roger Williams Hospital
of Brown University in Provi-
dence, RI and his residency and
fellowship were completed at
Mount Sinai Medical Center in
Milwaukee. Doctor Wolf is af-
filiated with the Hartford-Park-
view Clinic.
Randall W Lewis, DO,* Menom-
inee, has been named medical
director at Woodland Village
Nursing Home in Suring. Doctor
Lewis graduated from the Uni-
versity of Health Sciences in Kan-
sas City, Mo, and served a rotat-
ing internship at Lakeview Hos-
pital in Milwaukee. He was as-
sociated with the Pound Com-
munity Clinic before opening
his own practice in Crivitz. He is
on the medical staff of Marinette
General Hospital and Menomi-
nee County Lloyd Hospital.
Joseph J Grimm, MD,* Mil-
waukee, retired from his medical
practice after 50 years of practice.
Doctor Grimm was a barber be-
fore graduating from Loyola
Medical School in Chicago in
1928. He served an internship
at St Mary's Hospital in Mil-
waukee and later did postgrad-
uate studies in Austria for train-
ing as an eye, ear, nose, and
throat specialist.
James Byrd, MD, Wauwatosa,
recently was appointed assistant
professor of medicine at the
Medical College of Wisconsin in
Milwaukee. Doctor Byrd grad-
uated from the University of
Minnesota Medical School in
1978. He completed a fellowship
at the Boston University School
of Medicine and also received a
master's degree from the Boston
University School of Public
Health.
William J Maurer, MD,* Marsh-
field, was reelected president of
the Marshfield Clinic medical
staff. Cesar N Reyes, MD,* was
reelected as vice president, John
P Milbauer, MD,* was named
secretary, and Richard H Ulmer,
MD* is treasurer. Doctor Mau-
rer, a graduate from the Mar-
quette University Medical
School, will be serving his third
successive term. He has been a
member of the Clinic medical
staff since 1968.
James Williams, MD, Onalaska,
recently was certified as a diplo-
mate of the American Board of
Emergency Medicine. Doctor
Williams is a graduate from the
University of Iowa College of
Medicine, Iowa City. A member
of the Gundersen Clinic and La
Crosse Lutheran Hospital
medical staff. Doctor Williams is
chairman of the Department of
Trauma and Emergency Medi-
cine.
George V Murphy, MD, * South
Milwaukee, recently was
honored for his 17 years of ser-
vice as medical director of Fran-
ciscan Villa Nursing Home. He
served as medical director from
1967-1984. Antonio A Malapira,
MD is the new medical director.
Doctor Schrocdcr
Jack D Schroeder, MD, * (above)
Janesville, recently retired from
his medical practice of 38 years.
Doctor Schroeder graduated from
the University of Wisconsin
Medical School after serving in
the United States Army Air
Corps during World War II. He
was on the medical staff of the
Janesville Medical Center of
which he was a founding mem-
ber in 1958. (Photo courtesy of
Janesville Gazette )
WISCONSIN MEDICAL JOURNAL, APRIL 1985: VOL. 84
53
NEWS HIGHLIGHTS
Milwaukee Psychiatric Hospital,
Wauwatosa, recently announced
the opening of the McBride Cen-
ter for the Impaired Professional.
The Center will provide a full-
range of inpatient and outpatient
services for physicians, nurses,
pharmacists, business executives,
dentists, lawyers, and other pro-
fessionals who are experiencing
substance abuse disorders, ac-
cording to Center director, Roland
E Herrington, MD.* A full multi-
disciplinary staff, including physi-
cians, nurses, counselors, clergy,
and activity therapists is involved
in the conduct of the program.
Arthur G Morris, MD is medical
director of psychiatric services for
Milwaukee Psychiatric Hospital
and the McBride Center. He is
joined in this special effort at the
McBride Center by three other
specialists in addictive disease
medicine, Richard L Hauser,
MD,* David Benzer, DO, and
Charles H Engel, MD.* Nancy
Cervenansky, RN coordinates the
treatment program for nurses.
Sauk-Prairie Memorial Hospital
medical staff has elected new of-
ficers for 1985. They are MDs
Arnold N Rosenthal,* president;
Ihor A Galarnyk, * vice-president,
and Matthew Grade, secretary-
treasurer.
Holy Cross Hospital medical
staff, Merrill, has elected Jerome
S Mayersak, MD* as president
of the medical staff for 1985.
Doctor Mayersak has practiced
in the Merrill area since 1971.
Other 1985 Holy Cross Hospital
medical staff officers include
MDs Donald L Evans,* vice
president, and Jack D Millen-
bah,* secretary-treasurer, all
from Merrill.
UW Hospital and Clinics, Madi-
son, medical staff has elected staff
officers and at-large members of
the medical board for 1985 and
1986. They are MDs Dolores A
Buchler,* president, OB/GYN;
Thomas A Duff,* vice president,
surgery/neurosurgery; Louis
Chosy, secretary-treasurer, medi-
cine. At-large members are MDs
Carolyn Bell, medicine; Andrew B
Crummy,* radiology; Thomas
Davis, oncology; Jonathan Einlay,
pediatrics; Norman M Jensen,*
medicine; Eberhard Mack, sur-
gery; Guillermo Ramirez, oncol-
ogy; and Sander S Shapiro,* OB/
GYN.
The American Cancer Society/
Wisconsin Division has award-
ed $75,000 professorship of clini-
cal oncology to the University of
Wisconsin Medical School. Ernest
C Borden, MD, professor of hu-
man oncology and medicine, re-
ceived the three-year grant, which
is aimed at strengthening collab-
orative efforts in cancer control
between ACS and the UW Medi-
cal School. Doctor Borden has
been medical director-at-large on
the ACS/ Wisconsin Division
board of directors since 1979.
Sheboygan Memorial Hospital
recently announced the election
of Paschal A Sciarra, MD* as
president of the medical staff for
1985. Wendelin W Schaefer,
MD* was elected vice president
and Jonathan V Moulton, MD*
was elected secretary-treasurer.
Doctor Sciarra has practiced
medicine in Sheboygan since
1958 and succeeds Martin A
Rammer, MD.* Doctor Sciarra
is a member and past president of
the Wisconsin Otolaryngological
Society and member of the Mil-
waukee Society of Otolaryn-
gology-Head and Neck Surgery.
He is currently an associate
clinical professor at the Medical
College of Wisconsin, Milwau-
kee, a position he has held since
1959.
De Paul Rehabilitation Hospital,
Milwaukee, has maintained an
Impaired Physician Program
since 1977. It has been expanded
to include other professionals, in-
cluding dentists, nurses, lawyers,
pharmacists, and business execu-
tives. The Hospital's Impaired
Professional Program is under the
direction of William McDaniel,
MD as medical director. Mark D
Biehl, MD* and August D Kropp,
MD* are co-medical directors.
Director of the Impaired Profes-
sional Program is Carrie Weddle,
RN, BSN with Brinda Adams, RN
as nurse manager of the Impaired
Nurse Program. Staff physician is
James Zarzynski, MD.
Elmbrook Memorial Hospital,
Brookfield, has announced the
appointment of two new depart-
ment chairmen. Lawrence L
Poster, MD,* Brookfield is chair-
man of the Department of Ortho-
paedic Surgery and Peter T Han-
sen, MD,* Brookfield is chairman
of the Department of In-Hospital
Service. Other physicians to con-
tinue as department chairmen
are John P Walsh, MD,* Surgery;
Michael F Banasiak, MD,* Medi-
cine; Herbert C White, DO,*
Family Practice; and James A
Stadler, MD,* Obstetric/Gyne-
cology; John J Vondrell, MD,*
chief-of-staff; Robert S Pavlic,
MD,* chief-of-staff-elect, and
Robert O Buss, MD,* secretary-
treasurer. ■
54
WISCONSIN MEDICAL JOURNAL, APRIL 1985: VOL. 84
ISCONSIN GAZETTE
TAI-WIN‘Nx...BUIl.T-l
PROTECTION AGAINST
MISUSE BY INJECTION
Major Analgesic
Reformulated
Now contains naloxone,
a potent narcotic antagonist
Extra security added
to proven efficacy and safety
No longer do doctors have to deny patients the
benefit of an effective oral analgesic for fear of its
misuse by injection.
Winthrop-Breon Laboratories has met a nagging
problem by reformulating TALWIN® 50 (pentazo-
cine HCl tablets) with the addition of naloxone,
equivalent to 0.5 mg base. The reformulated
product is called TALWIN® Nx.
The oririnal formulation had been subject to a
form of misuse among street abusers known as
“T’s and Blues.” TALWIN 50 and PBZf an anti-
histamine, would be ground up together, put into
solution, and injected intravenously. The combi-
nation produced a heroin-like high. Because
naloxone is a narcotic antagonist when injected
intravenously, it acts to nullify any high a “T’s and
Blues” addict might expect from the pentazocine
in a combination of TALWIN Nx and PBZ. \^en
taken as directed orally, the naloxone component
of TALWIN Nx is inactive. Thus, TALWIN Nx
continues to be a safe, effective, oral analgesic for
the relief of moderate to severe pain, now provid-
ing added security against misuse.
•Registered trademark of Ciba-Geigy Corp for tripelennamine.
Tnlwiif^
©Each tablet contains pentazocine HCI, USR
equivalent to 50 mg base and naloxone
HCI, USR equivalent to 0.5 mg base.
40 NDC 0024-1951-04
100 tablets \j}L^
Ikilwir^AiZ:?
T-$40
is
-
cacti tablet contains pentazocine
'hydrochloride. USP, equivalent to 50 mg das'
and naloxone hydrochloride, USP, 0.5 mg-
Caution; Federal law prohibits f«'
dispensing without prescription. ff
W/nfhrop
The reformulation of Talwin 50 to Talwin Nx
involved the addition of 0.5 mg naloxone to
help prevent misuse by injection.
Hv/nfhrop-Breon
® 1984 Winthrop-Breon Laboratories
Please see following page for Brief Summary.
IV.
Each tablet contains pentazocine HCI, USR equivalent to
50 mg base and naloxone HCI, USR equivalent to 0 5 mg base
Analgesic for Oral Use Only
Contraindications: Hypersensitivity to either pentazocine or
naloxone
TALWIN" Nx IS intended for oral use only Severe, potentially
lethal, reactions may result from misuse of TALWIN' Nx by
injection either alone or in combination with other substances
(See Drug Abuse and Dependence section |
Warnings: Drug Dependence Can cause physical and psycho-
logical dependence (See Drug Abuse and Dependence ) Head
Injury and Increased Intracranial Pressure As with other potent
analgesics, respiratory depressant effects of the drug may elevate
cerebrospinal fluid pressure due to COj retention, these effects may
be markedly exaggerated in the presence of head injury other
intracranial lesions, or a preexisting increase in intracranial pres-
sure Can obscure the clinical course of patients with head injuries,
in such patients, use with extreme caution and only if deemed
essential Usage with Alcohol Due to potential for increased CNS
depressant effects, alcohol should be used with caution Patients
Receiving Narcotics Rentazocine is a mild narcotic antagonist
Withdrawal symptoms have occurred in patients previously given
narcotics, including methadone Certain Respiratory Conditions
Should be administered with caution in respiratory depression from
any cause, severely limited respiratory reserve, severe bronchial
asthma and other obstructive respiratory conditions, or cyanosis
Precautions: CNS Effect Use cautiously in patients prone to
seizures, seizures have occurred though no cause and effect
relationship has been established Therapeutic doses have in rare
instances, resulted in hallucinations (usually visual), disorientation,
and confusion, which cleared spontaneously within a period of
hours Such patients should be very closely observed and vital signs
checked, if the drug is reinstituted, it should be done with caution
since the acute CNS manifestations may recur Impaired Renal or
Hepatic Function Decreased metabolism of pentazocine in exten-
sive liver disease may predispose to accentuation of side effects, it
should be administered with caution in renal or hepatic impairment
In long-term use, precautions should be taken to avoid increases in
dose by the patient Biliary Surgery Some evidence suggests that
unlike other narcotics pentazocine causes little or no elevation in
biliary tract pressures, the clinical significance of these findings is
notyet known Information for Patients Since sedation, dizziness,
and occasional euphoria have been noted, ambulatory patients
should be warned not to operate machinery, drive cars, or unneces-
sarily expose themselves to hazards May cause physical and
psychological dependence taken alone and may have additive CNS
depressant properties in combination with alcohol or other CNS
depressants Myocardial Infarction Use with caution in patients
with myocardial infarction who have nausea or vomiting Drug
Interactions Usage with Alcohol SeeWatnings. Carcinogen-
esis. Mutagenesis. Impairment of Fertility No longderm studies
in animals to test for carcinogenesis have been performed Preg-
nancy Category C Should be given to pregnant women only if
clearly needed Labor and Delivery Use with caution in women
delivering premature infants Effect on mother and fetus, duration of
labor or delivery need for forceps delivery or other intervention or
resuscitation of newborn, or later growth, development, and
functional maturation of the child is unknown Nursing Mothers
Caution should be exercised when administered to a nursing
woman Pediatric Use Safety and effectiveness in children below
the age of 12 years have not been established
Adverse Reactions: Cardiovascular Hypotension, tachycar-
dia, syncope Respiratory Rarely, respiratory depression CNS
Acute CNS Manifestations In rare instances, hallucinations
(usually visual), disorientation, and confusion which have cleared
spontaneously within a period of hours, may recur if drug is
reinstituted Other CNS Effects Dizziness, lightheadedness, seda-
tion, euphoria, disturbed dreams, hallucinations, irritability excite-
ment, tinnitus, tremor Gastrointestinal Nausea, vomiting, con-
stipation, diarrhea, anorexia, rarely abdominal distress Allergic
Edema of the face, dermatitis, including pruritus, flushed skin, includ-
ing plethora Ophthalmic Visual blurring and focus'itq difficulty
Hematologic Depression of white blood cells (especially granulo-
ses), which IS usually reversible, moderate transient eosinophilia
Other Headache, chills, insomnia, weakness, urinary retention
Drug Abuse and Dependence: Controlled Substance
TALWIN Nx IS a Schedule IV controlled substance
Dependence and withdrawal symptoms have been reported with
orally administered pentazocine Patients with a history of drug
dependence should be under close supervision Rossible abstinence
syndromes in newborns after prolonged use of pentazocine during
pregnancy have been reported In prescribing for chronic use, the
physician should take precautions to avoid increases in dose by the
patient Tolerance to the analgesic effect is rarely reported, there is
no long-term experience with oral use of TALWIN Nx
The amount of naloxone present (0 5 mg per tablet) has no action
when taken orally and will not interfere with the pharmacologic
action of pentazocine, however, this amount of naloxone given by
injection has profound antagonistic action to narcotic analgesics
TALWKM Nx has a lower potential for parenteral misuse than the
previous oral pentazocine formulation, but is still subject to patient
misuse and abuse by the oral route
Severe, even lethal, consequences may result from misuse of tablets
by injection either alone or in combination with other substances,
such as pulmonary emboli, vascular occlusion, ulceration and absces-
ses, aniJ withdrawal symptoms in narcotic dependent individuals
Overdosage: Treatment Oxygen, intravenous fluids, vasopres-
sors, and other supportive measures should be employed as indi-
cated Assisted or controlled ventilation should also be considered
For respiratory depression, parenteral naloxone is a specific and
effective antagonist
Please consult full product information before prescribing
Winthrop-Breon Laboratories
Division of Sterling Drug Inc
WIN4-41415FR New York, NY 10016
\^/7f^rop-Breo/7
PUBLICATION INFORMATION
MANUSCRIPTS. Manuscripts will be accepted for con-
sideration with the understanding that they are original,
have never before been published, and are contributed
solely to the Wisconsin Medical Journal. The Editorial Board
reserves the right to limit manuscripts to two printed pages,
with additional pages to be subsidized by the author(s) on
the basis of $ TOO per page. A maximum of four illustrations
and/or tables may be included; additional ones will be
charged to author(s| at cost. Address manuscripts to Medical
Editor, Wisconsin Medical Journal, Box 1109, Madison, Wis
53701.
Rejected manuscripts are returned by regular mail. Ac-
cepted manuscripts become the property of the Journal and
are not returned. Submit one original and two photocopies.
Author should retain one photocopy. Format and style
should follow that of the AMA Style Book and Editorial
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and such revisions as bring them into conformity with
Journal style.
Contributors will be sent a copy of their article after it has
been edited and set in type for final approval before publica-
tion. A form for ordering reprints will accompany the
article.
Under ordinary circumstances manuscripts are published
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in which they are received.
COPYRIGHT. Material that is published in the Wisconsin
Medical Journal is protected by copyright and may not be
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RESPONSIBILITY. Publication of the Wisconsin Medical
Journal is under the direction of the Editorial Board whose
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ADVERTISEMENTS. The acceptance of advertising in the
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CIRCULATION. Members of the State Medical Society of
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INDEXING. The Wisconsin Medical Journal is indexed in
"Index Medicus," "Hospital Literature Index,” and "Cam-
bridge Scientific Abstracts." ■
Motrin
600 mg Tablets
Upjohn
j-4044 January 1984
:>1984 The Upiohn Company
The Upjohn Company • Kalamazoo, Michigan 49001 USA
“When it comes to cardiovascular
medicine, I like to know exacdy
what my patients are swallowing.”
There are doctors who say that generic drugs have a place in their
practice— but not necessarily in the treatment of serious or potentially
life-threatening disease. And when they consider that the average
patient pays only about 45<t a day for INDERAL (propranolol HCl)
Tablets, there’s not much left to discuss.
When it’s INDERAL Tablets you want for the treatment of hyperten-
sion, angina, arrhythmias, or post-MI patients, make sure you specify
“Dispense As Written” (DA5^), “Do Not Substitute,” or whatever is
required in your State. That way, you’ll know exactly what your
patients will get.
Please see next page for brief summary of prescribing information.
“When it comes to cardiovascular
medicine, I like to know exactly
what my patients are swallowing.”
INDERAL'-
BRAND OF PROPRANOLOL HCI
<»«>«> ® <H>
10 mg 20 mg 40 mg 60 mg 80 mg 90 mg*
BRIEF SUMMARY (FOR FULL PRESCRIBING INFORMATION. SEE PACKAGE CIRCULAR )
INDERAL® (propranolol hydrochloride) Tablets
CONTRAINDICATIONS
INDERAL IS contraindicated in 1) cardiogenic shock, 2) sinus bradycardia and greater than
first degree block, 3) bronchial asthma, 4) congestive heart failure (see WARNINGS) unless
the failure is secondary to a tachyarrhythmia treatable with INDERAL
WARNINGS
CARDIAC FAILURE Sympathetic stimulation may be a vital component supporting circula-
tory function in patients with congestive heart failure, and its inhibition by beta blockade may
precipitate more severe failure Although beta blockers should be avoided in overt conges-
tive heart tailure. if necessary they can be used with close follow-up ih patients with a history
of failure who are well compensated and are receiving digitalis and diuretics Beta-
adrenergic blocking agents do not abolish the inotropic action of digitalis on heart muscle
IN PATIENTS WITHOUT A HISTORY OF HEART FAILURE, continued use of beta blockers
can, in some cases, lead to cardiac failure Therefore, at the lirst sign or symptom of heart
failure, the patient should be digitalized and/or treated with diuretics, and the response
observed closely, or INDERAL should be discontinued (gradually, if possible)
IN PATIENTS WITH ANGINA PECTORIS, there have been reports of exacerbation of
angina and. in some cases, myocardial infarction, following abrupt discontinuance of
INDERAL therapy Theretore, when discontinuance of INDERAL is planned the dosage
should be gradually reduced over at least a lew weeks and the patient should be cau-
tioned against interruption or cessation of therapy without the physician's advice If
INDERAL therapy is interrupted and exacerbation of angina occurs, it usually is advis-
able to reinstitute INDERAL therapy and take other measures appropriate for the man-
agement of unstable angina pectoris. Since coronary artery disease may be
unrecognized, it may be prudent to follow the above advice in patients considered at risk
of having occult atherosclerotic heart disease who are given propranolol for other
indications
Nonallergic Bronchospasm (e.g., chronic bronchitis, emphysema) PATIENTS WITH
BRONCHOSPASTIC DISEASES SHOULD IN GENERAL NOT RECEIVE BETA BLOCKERS
INDERAL should be administered with caution since it may block bronchodilation produced
by endogenous and exogenous catecholamine stimulation of beta receptors
MAJOR SURGERY The necessity or desirability of withdrawal of beta-blocking therapy
prior to mapr surgery is controversial. It should be noted, however, that the impaired ability of
the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia
and surgical procedures
INDERAL. like other beta blockers, is a competitive inhibitor of beta-receptor agonists and
Its effects can be reversed by administration of such agents, e g . dobutamine or isopro-
terenol However, such patients may be subject to protracted severe hypotension Difficulty in
starting and maintaining the heartbeat has also been reported with beta blockers
DIABETES AND HYPOGLYCEMIA Beta-adrenergic blockade may prevent the appear-
ance of certain premonitory signs and symptoms (pulse rate and pressure changes) of acute
hypoglycemia in labile insulin-dependent diabetes In these patients, it may be more difficult
to ad|ust the dosage of insulin
THYROTOXICOSIS Beta blockade may mask certain clinical signs of hyperthyroidism
Theretore abrupt withdrawal of propranolol may be followed by an exacerbation of symp-
toms of hyperthyroidism, including thyroid storm Propranolol does not distort thyroid function
t€StS
IN PATIENTS WITH WOLFF-PARKINSON-WHITE SYNDROME, several cases have been
reported in which, after propranolol, the tachycardia was replaced by a severe bradycardia
requiring a demand pacemaker In one case this resulted after an initial dose of 5 mg
propranolol
PRECAUTIONS
General Propranolol should be used with caution in patients with impaired hepatic or renal
function INDERAL is not indicated for the treatment ot hypertensive emergencies
Beta-adrenoreceptor blockade can cause reduction of intraocular pressure Patients
should be told that INDERAL (propranolol hydrochloride) may interfere with the glaucoma
screening test Withdrawal may lead to a return of increased intraocular pressure
Clinical Laboratory Tests Elevated blood urea levels in patients with severe heart disease,
elevated serum transaminase, alkaline phosphatase, lactate dehydrogenase
DRUG INTERACTIONS Patients receiving catecholamine-depleting drugs such as reser-
pine should be closely observed if INDERAL is administered The added catecholamine-
blocking action may produce an excessive reduction of resting sympathetic nervous activity
which may result in hypotension, marked bradycardia, vertigo, syncopal attacks, or ortho-
static hypotension
Carcinogenesis. Mutagenesis. Impairment ot Fertility Long-term studies in animals have
been conducted to evaluate toxic effects and carcinogenic potential In 18-month studies in
both rats and mice, employing doses up to 150 mg/kg/day. there was no evidence of signifi-
cant drug-induced toxicity. There were no drug-related tumorigenic effects at any of the dos-
age levels Reproductive studies in animals did not show any impairment of fertility that was
attributable to the drug.
Pregnancy Pregnancy Category C INDERAL has been shown to be embryotoxic in animal
studies at doses about 10 times greater than the maximum recommended human dose
There are no adequate and well-controlled studies in pregnant women INDERAL should
be used during pregnancy only if the potential benefit justifies the potential risk to the fetus
Nursing Mothers INDERAL is excreted in human milk Caution should be exercised when
INDERAL IS administered to a nursing woman
Pediatric Use Safety and effectiveness in children have not been established
ADVERSE REACTIONS
Most adverse effects have been mild and transient and have rarely required the withdrawal of
therapy.
Cardiovascular bradycardia, congestive heart failure, intensification of AV block, hypoten-
sion, paresthesia of hands, thrombocytopenic purpura; arterial insufficiency, usually of the
Raynaud type
Central Nervous System Lightheadedness, mental depression manifested by insomnia,
lassitude, weakness, fatigue, reversible mental depression progressing to catatonia, visual
disturbances, hallucinations, an acute reversible syndrome characterized by disorientation
tor time and place, short-term memory loss, emotional lability slightly clouded sensorium.
and decreased performance on neuropsychometrics
Gastrointestinal nausea, vomiting, epigastric distress, abdominal cramping, diarrhea,
constipation, mesenteric arterial thrombosis, ischemic colitis
Allergic pharyngitis and agranulocytosis, erythematous rash, fever combined with aching
and sore throat, laryngospasm and respiratory distress
Respiratory bronchospasm.
Hematologic agranulocytosis, nonthrombocytopenic purpura, thrombocytopenic
purpura
Auto-Immune In extremely rare instances, systemic lupus erythematosus has been
reported.
Miscellaneous alopecia, LE-like reactions, psoriasiform rashes, dry eyes, male impo-
tence, and Peyronie s disease have been reported rarely Oculomucocutaneous reactions
involving the skin, serous membranes and conjunctivae reported for a beta blocker (practo-
lol) have not been associated with propranolol.
•The appearance of INDERAL tablets is a registered trademark of Ayerst Laboratories
9429/185
Copyright © 1985 Ayerst Laboratories
AYERST LABORATORIES
New York, N.Y 10017
Ayersfe
Before prescribing, see complete prescribing information in SK&F CO.
literature or PDR. The following is a brief summary.
*
WARNING
This drug is not indicated tor initial therapy of edema or hypertension.
Edema or hypertension requires therapy titrated to the individual. If this
combination represents the dosage so determined, its use may be
more convenient in patient management. Treatment of hypertension
and edema is not static, but must be reevaluated as conditions in
each patient warrant
Contraindications: Concomitant use with other potassium-sparing agents
such as spironolactone or amiloride. Further use in anuria, progressive
renal or hepatic dysfunction, hyperkalemia. Pre-existing elevated serum
potassium. Hypersensitivity to either component or other sulfonamide-
derived drugs.
Warnings: Do not use potassium supplements, dietary or otherwise, unless
hypokalemia develops or dietary intake of potassium is markedly Impaired.
If supplementary potassium is needed, potassium tablets should not be
used. Hyperkalemia can occur, and has been associated with cardiac irregu-
larities. It is more likely in the severely ill, with urine volume less than
one liter/day, the elderly and diabetics with suspected or confirmed renal
insufficiency. Periodically serum K+ levels should be determined. If hyper-
kalemia develops, substitute a thiazide alone, restrict K'*' intake Asso-
ciated widened QRS complex or arrhythmia requires prompt additional
therapy. Thiazides cross the placental barrier and appear in cord blood.
Use in pregnancy requires weighing anticipated benefits against possible
hazards, including fetal or neonatal iaundice, thromboc^openia, other
adverse reactions seen in adults. Thiazides appear and triamterene may
appear in breast milk. If their use is essential, the patient should stop
nursing. Adequate information on use in children is not available. Sensitivity
reactions may occur in patients with or without a history of allergy or
bronchial asthma. Possible exacerbation or activation of systemic lupus
erythematosus has been reported with thiazide diuretics.
Precautions: The bioavailability of the hydrochiorothiazide component of
Dyazide' is about 50% of the bioavailability of the single entity. Theoreti-
cally, a patient transferred from the single entities of Dyrenium (triamterene.
SK&F CO.) and hydrochlorothiazide may show an increase in blood pressure
or fluid retention. Similarly, it is also possible that the lesser hydro-
chlorothiazide bioavailability could lead to increased serum potassium levels.
However, extensive clinical experience with Dyazide’ suggests that these
conditions have not been commonly observed in clinical practice. Do
periodic serum electrolyte determinations (particularly important in patients
vomiting excessively or receiving parenteral fluids, and during concurrent
use with amphotericin B or corticosteroids or corticotropin [ACTH]).
Periodic BUN and serum creatinine determinations should be made,
especially in the elderly, diabetics or those with suspected or confirmed
renal insufficiency. Cumulative effects of the drug may develop in patients
with impaired renal function. Thiazides should be used with caution in
patients with impaired hepatic function. They can precipitate coma in
patients with severe liver disease. Observe regularly for possible blood
dyscrasias, liver damage, other idiosyncratic reactions. Blood dyscrasias
have been reported in patients receiving triamterene, and leukopenia,
thrombocytopenia, agranulocytosis, and aplastic and hemolytic anemia
have been reported with thiazides. Thiazides may cause manifestation of
latent diabetes mellitus. The effects of oral anticoagulants may be
decreased when used concurrently with hydrochlorothiazide: dosage adjust-
ments may be necessary. Clinically insignificant reductions in arterial
responsiveness to norepinephrine have been reported. Thiazides have also
been shown to Increase the paralyzing effect of nondepolarizing muscle
relaxants such as tubocurarine. Triamterene is a weak folic acid antagonist.
Do periodic blood studies in cirrhotics with splenomegaly. Antihypertensive
effects may be enhanced in post-sympathectomy patients. Use cautiously
in surgical patients. Triamterene has been found in renal stones in asso-
ciation with the other usual calculus components. Therefore, Dyazide'
should be used with caution in patients with histories of stone formation.
A few occurrences of acute renal failure have been reported in patients on
'Dyazide' when treated with indomethacin. Therefore, caution is advised in
administering nonsteroidal anti-inflammatory agents with Dyazide'. The
following may occur: transient elevated BUN or creatinine or both, hyper-
glycemia and glycosuria (diabetic insulin requirements may be altered),
hyperuricemia and gout, digitalis intoxication (in hypokalemia), decreasing
alkali reserve with possible metabolic acidosis. Dyazide' interferes with
fluorescent measurement of quinidine. Hypokalemia is uncommon with
Dyazide’, but should it develop, corrective measures should be taken such
as potassium supplementation or increased dietary intake of potassium-
rich foods Dorrecfive measures should be instituted cautiously and serum
potassium levels determined. Discontinue corrective measures and
Dyazide' should laboratory values reveal elevated serum potassium.
Dhloride deficit may occur as well as dilutional hyponatremia. Doncurrent
use with chlorpropamide may increase the risk of severe hyponatremia.
Serum FBI levels may decrease without signs of thyroid disturbance, Dal-
cium excretion is decreased by thiazides. 'Dyazidfe' should be withdrawn
before conducting tests for parathyroid function.
Thiazides may add to or potentiate the action of other antihypertensive
drugs.
Diuretics reduce renal clearance of lithium and increase the risk of lithium
toxicity.
Adverse Reactions: Muscle cramps, weakness, dizziness, headache, dry
mouth: anaphylaxis, rash, urticaria, photosensitivity, purpura, other dermat-
ological conditions: nausea and vomiting, diarrhea, constipation, other
gastrointestinal disturbances: postural hypotension (may be aggravated by
alcohol, barbiturates, or narcotics). Necrotizing vasculitis, paresthesias,
icterus, pancreatitis, xanthopsia and respiratory distress including pneu-
monitis and pulmonary edema, transient blurred vision, sialadenitis, and
vertigo have occurred with thiazides alone. Triamterene has been found in
renal stones in association with other usual calculus components. Rare
incidents of acute interstitial nephritis have been reported. Impotence has
been reported in a few patients on Dyazide', although a causal relationship
has not been established.
Supplied: 'Dyazide' is supplied as a red and white capsule, in bottles of
1000 capsules: Single Unit Packages (unit-dose) of 100 (intended for
insNtutional use only); in Patient-Pak™ unit-of-use bottles of 100.
BRS-DZ:L39
In Hypertension*...
When ^)u Need to
Conserve K+
Remember the Unique
Red and White Capsule:
^ur Assurance of
SK&F Quality
Potassium- Sparing
nvAzror
25 mg Hydrochlorothiazide/50 mg Triamterene/SKF
Over 19 Years of Confidence
The unique
red and white
Dyazide* capsule:
'feur assurance of
SK&F quality.
a product of
SKGF CO.
Carolina, P R 00630
©SK&F Co . 1983
On nitrates,
but angina still
strikes...
Aftera mtrafee,
add ISOFnN^
(verapamil HCl/Knoll)
To protect your patients, as well as their quality of life,
add Isoptin instead of a beta blocker.
First, Isoptin not only reduces myocardial oxygen demand
by reducing peripheral resistance, but also increases coro-
nary perfusion by preventing coronary vasospasm and
dilating coronary arteries — both normal and stenotic.
These are antianginal actions that no beta blocker
can provide.
Second, Isoptin spares patients the
beta-blocker side effects that may
compromise the quality of life.
With Isoptin, fatigue, bradycardia and mental
depression are rare. Unlike beta blockers,
Isoptin can safely be given to patients with
asthma, COPD, diabetes or peripheral
vascular disease. Serious adverse
reactions with Isoptin are rare
at recommended doses; the
single most common side
effect is constipation (6.3%).
Cardiovascular contra-
indications to the use of
Isoptin are similar to those
of beta blockers: severe
left ventricular dysfunction,
hypotension (systolic pres-
sure <90 mm Hg) or cardio-
genic shock, sick sinus syndrome
(if no artificial pacemaker is present)
and second- or third-degree AV block.
So, the next time a nitrate is not enough, add
Isoptin ... for more comprehensive antianginal
protection without side effects which may
cramp an active life style.
ISOPTIN. Added
antianginal protection
without beta-blocker
side effects.
Please see brief summary on following page
ISOPTIN TABLETS
(verapamil HCl/Knoll)
80 mg and 120 mg
Contraindications: Severe left ventricular dysfunction (see Warn-
ings), hypotension (systolic pressure <90 mm Hg) or cardiogenic
shock, sick sinus syndrome (if no pacemaker is present), 2nd- or 3rd-
degree AV block. Warnings: ISOPTIN should be avoided in patients
with severe left ventricular dysfunction (e.g., ejection fraction <30%)
or moderate to severe symptoms of cardiac failure. Control milder
heart failure with optimum digitalization and/or diuretics before
ISOPTIN IS used. ISOPTIN may occasionally produce hypotension
(usually asymptomatic, orthostatic, mild, and controlled by decrease
in ISOPTIN dose). Occasional elevations of liver enzymes have been
reported; patients receiving ISOPTIN should have liver enzymes moni-
tored periodically. Patients with atrial flutter/fibrillation and an acces-
sory AV pathway (e g., W-P-W or L-G-L syndromes) may develop a
very rapid ventricular response after receiving ISOPTIN (or digitalis).
Treatment is usually D.C. -cardioversion. AV block may occur (3rd
degree, 0.8%). Development of marked 1 st-degree block or progres-
sion to 2nd- or 3rd-degree block requires reduction in dosage or,
rarely, discontinuation and institution of appropriate therapy. Sinus
bradycardia, 2nd-degree AV block, sinus arrest, pulmonary edema,
and/or severe hypotension were seen in some critically ill patients
with hypertrophic cardiomyopathy who were treated with ISOPTIN.
Precautions: ISOPTIN should be given cautiously to patients with
impaired hepatic function (in severe dysfunction use about 30% of
the normal dose) or impaired renal function, and patients should be
monitored for abnormal prolongation of the PR interval or other
signs of overdosage. Studies in a small number of patients suggest
that concomitant use of ISOPTIN and beta blockers may be beneficial
in patients with chronic stable angina. Combined therapy can also
have adverse effects on cardiac function. Therefore, until further
studies are completed, ISOPTIN should be used alone, if possible. If
combined therapy is used, patients should be monitored closely.
Combined therapy with ISOPTIN and propranolol should usually be
avoided in patients with AV conduction abnormalities and/or de-
pressed left ventricular function or in patients who have also recently
received methyidopa. Chronic ISOPTIN treatment increases serum
digoxin levels by 50% to 70% during the first week of therapy, which
can result in digitalis toxicity. The digoxin dose should be reduced
when ISOPTIN is given, and the patient carefully monitored. ISOPTIN
may have an additive hypotensive effect in patients receiving blood-
pressure-lowering agents. Disopyramide should not be given within
48 hours before or 24 hours aher ISOPTIN administration. Until fur-
ther data are obtained, combined ISOPTIN and quinidine therapy in
patients with hypertrophic cardiomyopathy should probably be
avoided, since significant hypotension may result. Adequate animal
carcinogenicity studies have not been performed. One study in rats
did not suggest a tumorigenic potential, and verapamil was not
mutagenic in the Ames test. Pregnancy Category C. There are no
adequate and well-controlled studies in pregnant women. This drug
should be used during pregnancy, labor, and delivery only if clearly
needed. It is not known whether verapamil is excreted in breast milk;
therefore, nursing should be discontinued during ISOPTIN use.
Adverse Reactions: Hypotension (2.9%), peripheral edema (1.7%),
AV block: 3rd degree (0.8%), bradycardia: HR<50/min (1 .1 %), CHF
or pulmonary edema (0.9%), dizziness (3.6%), headache (1.8%),
fatigue (1.1%), constipation (6.3%), nausea (1.6%). The following
reactions, reported in less than 0.5%, occurred under circumstances
where a causal relationship is not certain: confusion, paresthesia,
insomnia, somnolence, equilibrium disorders, blurred vision, syncope,
muscle cramps, shakiness, claudication, hair loss, maculae, and spotty
menstruation. Overall continuation rate of 94.5% in 1,166 patients.
How Supplied: ISOPTIN (verapamil HCI) is supplied in 80 mg and
120 mg sugar-coated tablets. July 1982 2068
O. KNOLL PHARMACEUTICAL COMPANY
Knotl 30 NORTH JEFFERSON ROAD, WHIPPANY NEW JERSEY 07981
2195
KiNORANa
BNO
DOSE
America's declining
productivity is serious
business.
It's about time we all
got serious about it.
\ productivity- 1 America's productivity
\ TheCtisiv 1 growth rate hos been
1 1 slipping badly for sev-
1 1 eral years now, com-
1 ^ \ pared to that of other
I ' ' f^of'ons. And it's ad-
1 Mm 1 versely affecting each
1 every one of us.
' — ■ We've all seen
plants and businesses close down.
Tens of thousands of jobs lost. Prices
rising, quality deteriorating. A flood
of foreign-made products invading
our shores. It's all part of our declin-
ing productivity rate.
We've simply got to work it out —
and we've got to work together to do
it. But first, we need to know more
about the problem and the possible
solutions so we can act intelligently
and effectively.
That's why you should send for
this informative new booklet. It hasn't
got all the answers — there are no
quick and easy ways out — but it's a
very good place to start the produc-
tivity education of yourself, your
associates and your workers. It's free
for the asking — and in quantity. Mail
the coupon right away. Ignorance is
no excuse.
A public service of this publication
and the American Productivity Center.
America.
Let's work together.
I NMion.l Productivity Awotonett Compaigit
I P.O. Box 480, Lorton, VA 22079
Yes, I would like to improve my company's
productivity. Please send me o free copy of
"Productivity, the crisis that crept up on us."
(Quantities ovoiloble at cost from above
address.)
Name.
Title.
Company.
I City State Zip.
I Pleose allow 4-6 weeks for delivery.
J
HELPWISPAC.. .
TO HELP YOU.
William Treacy, MD, Milwaukee
Jay Schamberg, MD, Menomonee Falls
DeLore Williams, MD, West Allis
Irvin Bruhn, MD, Walworth
Carl Eisenberg, MD, Milwaukee
LaVern Herman, MD, Waukesha
William Listwan, MD, West Bend
Daniel Forward, MD, Wauwatosa
Thomas Dehn, MD, Bayside
Charles Pechous, MD, Kenosha
Donald Vangor, MD, Baraboo
John K Scott, MD, Madison
Glenn Seager, MD, La Crosse
Bruce Hertel, MD, Rhinelander
Michael Mehr, MD, Marshfield
Kenneth Day, MD, Wausau
Henry Chessin, MD, Appleton
Melvin Blumenthal, MD, Monroe
Robert McDonald, MD, Madison
Sandra Osborn, MD, Madison
Michael Tieman, MD, Berlin
John Beck, MD, Sturgeon Bay
James Mattson, MD, Green Bay
Paul Haskins, MD, River Falls
Arlyn Koeller, MD, Ashland
Chesley Erwin, MD, Milwaukee
Timothy Flaherty, MD, Neenah
Kenneth Viste, MD, Oshkosh
J D Kabler, MD, Madison
Charles Picard, MD, Superior
Mrs. Bea Kabler, Madison
Mrs. Jeri Cushman, Racine
Mrs. Roberta Baldwin, Watertown
Mrs. Ann Shea, DePere
These individuals serve on the Board of Directors for the Wisconsin Physicians Political Action
Committee. They believe that as one voice, through WISPAC, physicians can make a difference
in the political process.
In 1984, a record number of physicians added their voices, and their support to WISPAC, but much
more needs to be done, beginning today, to ensure success in the future. Help WISPAC, to help
you. Join today!
a small price to pay for political
,wispac:
P.O. BOX 2595, MADISON, Wl 53701
effectiveness
(608) 257-6781
Wisconsin Physicians Political Action Committee
WISPAC and AMPAC poirtical contributions are voluntary and not tax*deductible. If your practice is incorporated, WISPAC and AMPAC dues should be written on a PERSONAL check.
Copies of the WISPAC reports are filed with the Wisconsin State Elections Board. AMPAC reports are available for purchase from the Federal Election Commission. Washington. D C. 20463.
OBITUARIES
William N Young, MD, 60, Mil-
waukee, died Dec 18, 1984 in
Milwaukee. Born Dec 1, 1924
in Chelsea, Mass, Doctor Young
graduated from Tufts University
Medical School, Boston, Mass,
and completed his internship at
Great Lakes Naval Hospital,
Great Lakes, 111. His residency
was completed at Affiliated Hos-
pitals in Massachusetts. He re-
tired from medical practice in
1984. He was a member of The
Medical Society of Milwaukee
County, the State Medical Society
of Wisconsin, and the American
Medical Association.
Richard E Jensen, MD, 61, Green
Bay, died Nov 29, 1984 in Green
Bay. Born Oct 11, 1923 in
Duluth, Minn, Doctor Jensen
graduated from the University
of Minnesota School of Medicine
and served his internship at St
Mary's Hospital in Duluth, Minn.
He served in the United States
Navy during World War II and
the Korean War. Doctor Jensen
had practiced medicine in Green
Bay since 1951. He was a mem-
ber of the medical staff of St
Mary's, St Vincent, and Beilin
hospitals, and had served as
president of St Mary's and had
served as chief of the Department
of Family Medicine at St Vincent
Hospital. Doctor Jensen was a
member of the Brown County
Medical Society, the State Medi-
cal Society of Wisconsin, and
the American Medical Asso-
ciation. Surviving are his widow,
Molly, and ten children; Mrs
Terry (Kathleen) Kuehne, Sey-
mour; Mrs Ben (Rose) Kreilkamp,
Minneapolis, Minn; Dr Richard
Jensen Jr, DePere; Mrs Dennis
(Martha) Duffy, Green Bay;
Christopher and Paul, Green
Bay; Elizabeth, Austin, Tex;
Suzanne, Sarah, and Michael, all
at home.
Albert P Hable, MD, 76, Marsh-
field, died Dec 30, 1984 in Marsh-
field. Born Jan 2, 1908 in Bloom-
er, Doctor Hable graduated from
Marquette University School of
Medicine in 1931 and served his
internship at Milwaukee County
General Hospital. Doctor Hable
practiced medicine in Loyal for
over 42 years. He was a member
of the Clark County Medical So-
ciety, the State Medical Society of
Wisconsin, and the American
Medical Association. Surviving
are his widow, one son, Paul, Ft
Atkinson; four daughters, Mrs
Luke (Mary) Eiche, Slinger; Mrs
Oliver (Dr Kathleen) Rhodes,
Rochester, Minn; Mrs James (Dr
Jane) Etner, Binghamton, New
York, and Miss Ann Hable of
Milwaukee.
Donald F Jarvis, MD, 68, Toma-
hawk, died Jan 23, 1985 in Toma-
hawk. Born Jan 28, 1916 in
Tomahawk, Doctor Jarvis grad-
uated from Marquette University
School of Medicine in 1944 and
completed his internship at Mil-
waukee County General Hos-
pital. Doctor Jarvis began his
medical practice in Tomahawk in
1950 and retired in 1983. He
served as city health officer from
1968-1983. He had been a mem-
ber of the medical staff of Sacred
Heart Hospital and also a mem-
ber of the board of directors. Sur-
viving are his widow, Ruth; three
sons, Charles, Tomahawk; Don-
ald, Deerfield; James, Rhine-
lander; and four daughters,
Heidi, Tomahawk; Janis, Wau-
sau; Mrs Jeffrey (Jean) Dean,
Marshfield; and Holly of Seattle.
Nicholas D Dcmeter, MD, 89,
Wauwatosa, died Jan 25, 1985 in
Wauwatosa. Born Dec 15, 1895
in Vissani, Greece, Doctor De-
meter graduated from the Uni-
versity of Illinois Medical School
and completed his internship at
St Joseph Hospital in Marshfield.
He served in the United States
Army during World War I and
World War II. He received the
Certificate of Merit in 1950 for
his wartime service with the
Selective Service System. He
served as a trustee for the Mil-
waukee Public Museum from
1941 to 1949 and with the Mil-
waukee Public Library from 1949
to 1962. He was a member of
The Medical Society of Mil-
waukee County, the State Medi-
cal Society of Wisconsin, and the
American Medical Association.
Surviving are his widow, Dena;
one son, James, Chicago; three
daughters, Mary Thurrell,
Madison; Constance Caranasos,
Gainesville, Fla; and Lela, a
medical student in Greece.
Russell C Darby, MD, 75, Osh-
kosh, died Jan 27, 1985 in
Neenah. Born June 14, 1909,
Doctor Darby graduated from
Loma Linda Medical School,
California, and served his intern-
ship at St Agnes Hospital in Fond
du Lac. Doctor Darby completed
his residency at Good Samaritan
Hospital, Phoenix, Ariz. He had
practiced in Wautoma for a
number of years and retired in
1982. Doctor Darby served in
the United States Army Medical
Corps from 1942-1946. Surviv-
ing are his widow, Gladys; one
daughter, Nadine Hanneman,
Appleton; and one son, Roderick
of Oak Brook, 111.
William H Studiey, MD, 81,
Shorewood, died Feb 3, 1985 in
Shorewood. Born Feb 7, 1903 in
Milwaukee, Doctor Studiey grad-
uated from Columbia University
Medical School in 1929 and
served his internship at St Mary's
66
WISCONSIN MEDICAL JOURNAL, APRIL 1985 . VOL. 84
WILLIAM H STUDLEY, MD
OBITUARIES
Hospital in Milwaukee. He joined
the medical staff of the Shore-
wood Hospital and in 1934 be-
came medical director of the
facility. The hospital was sold to
Columbia Hospital in 1969 and
Doctor Studley remained the di-
rector until 1978 when he retired.
He was on the board of the State
Public Welfare Department from
1949 until it became part of the
Department of Health and Social
Services in 1967. He then be-
came the first board chairman
and served for five years. Doctor
Studley was awarded an honor-
ary membership in 1971 by the
International Institute for his help
in supporting a family of Viet-
namese immigrants. He was an
associate in Neurology on the
Marquette University School of
Medicine (now the Medical
College of Wisconsin) faculty
from 1937 to 1959 and associate
clinical professor from 1959 until
retirement. He was a member of
The Medical Society of Mil-
waukee County, the State Medi-
cal Society of Wisconsin, and the
American Medical Association.
Surviving are his widow, Frieda;
a daughter, Elizabeth Carlson,
Boulder, CO, and a son, William
F of Los Angeles, CA.
[A close friend and colleague of
Doctor Studley, Dr George
Moore of Ashland, Illinois, gave
the eulogy which was published
in the March issue of the Journal.]
Paul B Mason, MD, 78, a She-
boygan physician for 41 years,
died Feb 8, 1985 in Sheboygan.
Born Jan 14, 1907 in Chippewa
Falls, Doctor Mason graduated
from Northwestern University
School of Medicine and com-
pleted his internship at Passavant
Hospital, Chicago. His residency
was served at the Mayo Clinic in
Rochester, Minn. Doctor Mason
had been associated with the She-
boygan Clinic from 1936 until his
retirement in 1977. He was presi-
dent of the Sheboygan Clinic As-
sociation from 1955- 1972. Doctor
Mason was a member of the
medical staff at St Nicholas and
Memorial hospitals and served
as president of St Nicholas from
1973-74. At the 25th Annual
Meeting of the Wisconsin Heart
Association in 1971, Doctor
Mason was presented with the
association's medallion in recog-
nition of his contribution to the
association's founding. In 1973
he was the recipient of the Uni-
versity of Wisconsin Medical
School's Max Fox Preceptor
Award and in 1978 Doctor Mason
was given the Civic Leadership
award of the State Medical So-
ciety in recognition of his out-
standing dedication to the
progress of medicine and involve-
ment in the democratic process.
The Wisconsin Professional Re-
view Organization recognized
him in 1980 for "his rare fore-
sight and restraint in directing the
development of a more sophisti-
cated peer review methodology"
through the Peer Review Com-
mittee of the State Medical
Society for his encouragement
and aid in the development of
WisPRO as the first president of
Wisconsin Health Care Review
Inc. In 1982 he became a member
of the "50 Year Club" of the
State Medical Society. He was
a member and served as presi-
dent of the Sheboygan County
Medical Society and also was a
member of the American Medical
Association. He was a member of
the American College of Phy-
sicians and the American College
of Cardiology. Surviving are his
widow, Mollie; a daughter, Mary
Lou Smith, and a son, Paul B
Mason, Jr.
Philip W Limberg, MD, 67, Glen-
wood City, died Feb 9, 1985 in
Eau Claire. Born Oct 21, 1917
in Greenbush, Doctor Limberg
graduated from the University of
Wisconsin Medical School, Madi-
son, in 1942. His internship was
served at Christ Hospital, Cincin-
nati, Ohio, and his surgical resi-
dency was completed at Deacon-
ess Hospital, Milwaukee. He
served in the United States Army
Medical Corps from 1943-45
during World War II. In 1946 he
moved to Glenwood City to begin
his medical practice. For the past
three and a half years. Doctor
Limberg had served as a phy-
sician at UW Stout Student
Health Service. He was a mem-
ber of the Pierce-St Croix County
Medical Society, the State Medi-
cal Society of Wisconsin, and the
American Medical Association.
Surviving are his widow, Ro-
berta, one son, Philip, Lake
Tomahawk; and three daughters,
Mrs Howard (Gail) Leafblad,
Prairie Farm; JoEllen Limberg,
Iowa City, LA; and Mrs Patrick
(Sheila) Barber of Rhinelander.
Harry Gonlag, MD, 61, Eau
Claire, died Feb 13, 1985 in Eau
Claire. Born Dec 23, 1923 in Har-
vey, 111, Doctor Gonlag graduated
from Indiana University School
of Medicine, Indianapolis, and
served his internship at Luther
Hospital in Eau Claire. His resi-
dency was completed at the Uni-
versity of Wisconsin Hospital in
house of
BIDWELL, inc.
7954 West Harwood
and Watertown Plank Road
Milwaukee, Wisconsin 53213
#ORTHOTIC
AND
PROSTHETIC
SERVICES
1-414-744-6250
WISCONSIN MEDICAL JOURNAL, APRIL 1985: VOL. 84
67
OBITUARIES
HARRY GONLAG, MD
Madison. Doctor Gonlag served
in the United States Navy during
World War II and also in the
Korean Conflict. He was af-
filiated with the Midelfort Clinic
for 18 years and was a pathologist
at Luther Hospital. He was a
former chief-of-staff at Luther
Hospital in Eau Claire. He was a
charter fellow of the American
Academy of Family Physicians, a
member of the Eau Claire-Dunn-
THE NAVY SEARCH
FOR EXCELLENCE
The United States Navy Medical
Command desires physicians who
want to practice medicine . . . not
be business managers. The Navy
offers specialists quality clinical ex-
perience and professional growth,
a very comfortable lifestyle with-
out financial and administrative
worries, and the valuable time to
spend with family and friends
while planning the future.
• Flight Surgery • Orthopedic
• Anesthesiology Surgery
• Otolaryngology • General
• Neurology Surgery
• Psychiatry • Neurosurgery
LOCATIONS: 23 modern medical
facilities located along the east and
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overseas, including those in Japan,
Spain, Italy and the Philippines.
BENEFITS: Varied clinical exper-
ience: 30 days annual vacation;
world travel benefits; full malprac-
tice, medical/dental coverage:
net starting salaries from $40,000
to $55,000; non-contributive
retirement package which yields
approximately $20,000 a year
after 20 years of service, or
$30,000 a year after 30 years.
MINIMUM QUALIFICA
TIONS: State license; US citizen;
excellent professional references.
For complete details, call or send
Curriculum Vitae to: Lt Nancy Hill,
Henry S Reuss Federal Plaza, 310
W Wisconsin Ave, Suite 450, Mil-
waukee, WI 53203; 414/291-1529
(Call Collect)
Pepin County Medical Society,
the State Medical Society of Wis-
consin, and the American Medi-
cal Association. Surviving are
his widow, Ruth; a daughter,
Mari, Wilmore, Ky; and a son,
Dan of Alpine, Calif.
Walter E Clasen, MD, 64, Wau-
watosa, died Feb 19, 1985 in
Wauwatosa. Born Mar 19, 1920
in Milwaukee, Doctor Clasen
graduated from Marquette Uni-
versity School of Medicine and
served his internship at St Jo-
seph's Hospital, Milwaukee. His
residency was completed at Mil-
waukee County General Hos-
pital. Doctor Clasen retired from
medical practice in 1984. He was
a member of The Medical Society
of Milwaukee County, the State
Medical Society of Wisconsin,
and the American Medical As-
sociation. Surviving are his
widow, Lois, and two sons.
Jerry W McRoberts, MD, 79, She-
boygan physician for 38 years,
died Feb 20, 1985 in Sheboygan.
Born Dec 23, 1905 in Moose Jaw,
Saskatchewan, Canada, Doctor
McRoberts graduated from
McGill University, Montreal in
1929 and served his internship at
Royal Victoria Hospital in Mon-
treal. He completed his residency
at the Mayo Clinic in Rochester,
Minn. After postgraduate studies
in European hospitals and schools
in 1934-35, Doctor McRoberts re-
turned to the United States and
came to Wisconsin where he be-
came a member of the Sheboygan
Clinic in 1937. He retired from
medical practice in 1975. Doctor
McRoberts served in the United
States Army Medical Corps in
World War II from 1942-45. Ac-
tive in the State Medical Society
of Wisconsin's affairs. Doctor
McRoberts served a ten-year
term as the Sheboygan County
delegate to the Society, became a
councilor for the Fifth District,
and in 1969 served as president-
elect and in 1970 as president of
the Society. He was a member of
the Executive Committee of the
Sheboygan Clinic from 1947
through 1969 serving as president
from 1950-54. Doctor McRoberts
was president of the Sheboygan
County Medical Society in 1953,
the St Nicholas Hospital medical
staff in 1957, and the Sheboygan
Memorial Hospital medical staff
in 1950. In 1967 he was elected
president of the Wisconsin
Division of the International Col-
lege of Surgeons, the same year
he became president of the
American Association of Railway
Surgeons. From 1969-73, he was
a member of the board of di-
rectors of the Wisconsin Regional
Medical Program. A founder of
the Wisconsin Surgical Society,
Doctor McRoberts also was af-
filiated with the American Col-
lege of Surgeons, The Mayo
Foundation, American Geriatric
Society, Western Surgical As-
sociation, and the American
Medical Association. He was a
life member of the Pan American
Medical Association. Surviving
are his widow, Ruth; Two sons, J
William McRoberts, MD, and
Robert L McRoberts, MD; and
a daughter, Mrs Patricia Carton. ■
International Childbirth
Education Association
to host 1985 Conference
in cooperation with Methodist Hos-
pital who will coordinate the local
planning committee.
in Madison, June 20-23
at the Sheraton Inn and Conference
Center
The four-day conference is expected to
draw 400 to 500 persons from across
the nation.
Persons interested in assisting with the
conference or learning more details
can call Methodist Hospital, Madison,
at 608/258-3290.
68
WISCONSIN MEDICAL JOURNAL, APRIL 1985: VOL. 84
who is number 1
in medical
office computer
systems in
Wisconsin?
HDX Clinical Hanagenent Systen
1) Financial Accounting
2) Insurance Claifi Tracking
6) Appointnent Scheduling
7) Hedical History
Not IBM nor Apple nor any other nationally-known
computer name. The answer is Advanced Technology
Associates. Number 1 means the most complete systems; the
most logical match of hardware, software and services. ATA is
the source for total packages — computers, terminals, printers,
special medical programs, careful installation, training for
your people and after-sale support.
Considering the scope of our Wisconsin experience, it
should not surprise you that ATA is endorsed by the State
Medical Society.
May we send you information listing your benefits from
a strictly medical office computer system? Call or write.
Endorsed by SMS Services, Inc For members of the State Medical Society of Wisconsin.
<■ liISS 1 jfeSp;m. Iir.
Abbott Northwestern Hospital introduces
The Accommodations Center, a lodging facility
located directly on the hospital campus.
Its 125 rooms are comfortable and budget
priced. But their primary purpose is to reduce
patient anxiety by keeping the family close by.
The facility is connected to Abbott North-
western, Sister Kenny Institute and Minneapolis
Children’s Medical Center. So the patients’ relatives
and friends Ccin stay a short, indoor wcdk away.
The Accommodations Center also offers
economical rooms for patients before and after
certain procedures— thus avoiding unnecessary
hospitalization.
some beds for the family
Of course, we don’t expect you to send
patients to our medical campus just because we
built a few guest rooms. Our reputation as a
regional referral center is based on clinical excel-
lence, the full range of specialties, alternative
care programs and competitive prices.
Our perinatal, cardiovascular and rehabil-
itation programs have earned national
recognition.
When you need to refer patients for
tertiary care, you can trust us. We’re as concerned
about their total well-being as you are.
Abbott Northwestern Hospital ^
Over 17 years and untold
manhours. That’s what CyCare has
invested in the study of health care.
We've long since earned our
diploma. While many aspiring com-
petitors failed to make the grade.
VVe chose one specialty. The
delivery of health care is a specializ-
ed business. Your data processing
company should understand it
thoroughly. That’s tough to do if
they’re also marketing to banks, fac-
tories and the like.
From the beginning. CyCare
decided to commit only to the
medical industry. Our staff of over
600 has been living and breathing it
ever since.
Experience only CyCare can
claim. CyCare has studied with
thousands of physicians, ad-
ministrators. and nurses. We’ve
worked with nearly 850 clients of all
specialties and size. In 17 years,
we’ve treated data processing
challenges of every kind.
You know experience is the best
teacher. So choose a company that’s
been around long enough to learn.
Our knowledge benefits you. Our
experience taught us that each client
is different. We designed systems
that easily accomodate any type of
ca.se. We learned you didn’t want
useless “bells and whistles’’, so we
developed practical .software that
enhances the delivery of patient
care. We discovered the fear of
system obsolescence. So we created
modular systems that can be expand-
ed at any time.
Learning never stops. Like you,
we never stop learning. We invest
more in research each year than
most of our competitors gross in
sales. We listen to your ideas, look
for new ways to improve your prac-
tice, and stay abreast of industry
needs. It’s the only way to take the
lead.
Compare our credentials. Ex-
amine CyCare thoroughly. Demand
as much from us as you demand
from yourself. Look at our ex-
perience, our financial stability. Ex-
amine our products and talk to our
clients. Find out why CyCare is the
leading supplier to medical group
practices, HMOs and ambulatory
care facilities nationwide.
Put us to the test. We’re prepared.
Ask about CyCare ’s Cl 00
APPOINTMENT SCHEDULING. The
physician time management system
for small and medium size practices.
□ Rush free details to me about
CyCare.
□ Have a representative contact me.
My business card/letterhead is
attached.
No. of Phys.
Mail to: CyCare, 520 Dubuque
Building Dubuque, Iowa 52001
319/556-3131
WM 4/85
Sales and Service Offices:
Atlanta. GA; Cherry Hill, NJ; Chicago, IL; Dallas,
TX; Denver, CO; Miami, FL: Minneapolis, MN;
New York, NY; Portland, OR; San Diego. CA;
Spokane, WA; Canada: Toronto, Ont.
Authorized National ISO
rare
a step ahead. . .
Acme
Laboratoriesy Inc
Qualified, competent professionals are the
trademark of Acme Laboratories. For 35
years, our certified orthotists and prosthetists
have earned a reputation for excellence,
helping people improve their lives.
Acme Laboratories serves Wisconsin from
offices in Milwaukee, Green Bay, Fond du
Lac and Woodruff. We're pleased to be a
designated HMO facility for southeastern
Wisconsin. Acme Laboratories accepts all
insurance, including Medicare and Medicaid.
10702 W. Burleigh St., Milwaukee, Wl 53222
414-259-1090
GREEN BAY ORTHOPEDIC
Division of Acme Laboratories, Inc.
428 S. Adams St., Green Bay, Wl 54301
414-435-1461
525 E. Division St., Fond du Lac, Wl 54935
414-923-6676
Affiliated with Northwoods Rehabilitation
Box LOA, Woodruff, Wl 54568
715-356-8000 Ext. 8872
Acme Laboratories — where quality of
life is our main concern
YOU CAN HELP
STOP BEDWEniNG
For a large majority of
your Enuretic patients
• Ethical — prescription only
• Professional — you supervise
treatment
• Approximately 90 percent effective
• Proven reliable and dependable
bell, pad, and light system
• Low cost rental service — $14.00
per week (avg. 6-week treatment)
• Convenient mall order service
to the 48 states
For more information, caii or write:
S. & L. SIGMAL COMPANY
Helping Enuretic Ciients
Since 1950
1142 Fieetwood Ave. Madison, Wi 53716
Phone: 608-222-7939
Accepted for advertising In the AMA Journal
MEDICAL
COLLEGE OF
WISCONSIN
Microcomputers
in Medicine
June 28, 1985 • 8 am - 5 pm
Milwaukee
WHAT: A one-day computer seminar and ex-
position for health care professionals featur-
ing health science information specialists
and computer hardware/software exhibitors.
Topics include choosing a system; office prac-
tice management; computer-aided diagnosis.
AMONG rBATURNO SPEAKERS: Peter W.
lolos, PhO, Stanford Medical School and
Howard L. Bleich, MD, Harvard Medical
School.
REGISTRATION: $60 fee before May 16 In-
cludes admission, lunch and reception.
CONTACT: Micros in Medicine, MOW
Libraries, 8701 Watertown Plank Rd,
Milwaukee, WI 63226 (414) 267-8323.
Sponsored by MOW Libraries.
CARE FOR YOUR
COUNTRY.
As an Army Reserve physician, you can serve
your country and community with just a small invest-
ment of your time. You will broaden your professional
experience by working on ,
interesting medical projects
in your community. Army
Reserve service is flexible, so it
won't interfere with your practice.
You’ll work and consult with top
physicians during monthly Reserve
meetings. You'll also attend funded
continuing medical education pro-
grams. You will all share the bond of ^
being ci\’ic-minded physicians who are also commis-
sioned officers. One important benefit of being an officer
is the non-contributory retirement annuity you will get
when you retire from the Army Reserve. To find out
more, simply call the number below.
ARMY RESERVE.
BEALLYOUCANBE.
MAJOR DAVIDS BARRIE
COLLECT: (312) 926-3161
MEDICAL YELLOW PAGES
V.
PHYSICIANS EXCHANGE
Dallas/Fort Worth needs physician.
Full-time physician positions for Gen-
eral Practice/Internal Medicine clinics.
Partnership available in one year. Ex-
cellent opportunity. Write or call S K
Kechejian, MD, 609 South Main St,
Duncanville, TX 75116; ph 214/780-
0093. 4/85
OB/GYN, and internist to join seven-
doctor family practice clinic in Cloquet,
Minnesota, a community of 14,000 (30,
000) service area, located 20 minutes
from Duluth-Superior. Clinic facility is
located one block from modern, well-
equipped, 77-bed hospital. Cloquet
enjoys a stable economy (forest
products). Additionally our community
is noted for its excellent school system.
First-year salary guarantee; paid mal-
practice, health, and disability insur-
ance; vacation and study time. Con-
tact John Turonie, Administrator,
Raiter Clinic Ltd, 417 Skyline Blvd, Clo-
quet, Minnesota 55720. Telephone
218/879-1271. 4-6/85
Group Health Inc of Minneapolis/
St Paul seeks associates in Allergy,
Family Practice, Internal Medicine,
Endocrinology, Obstetrics and Gyne-
cology, Child Psychiatry, General
Surgery and Urgent Care. Must be
Board certified or eligible. Excellent
facilities, comprehensive benefits,
highly competitive earnings. Send cur-
riculum vitae to: Paul] Brat, MD, Medi-
cal Director, 2829 University Avenue
South East, Minneapolis, Minnesota
55114. An equal opportunity employer.
4-5/85
Family Practice physician, BE/BC,
needed to provide primary outpatient
care in a free-standing student health
service with its own lab facilities for a
student population of 11,000 at the Uni-
versity of Wisconsin-Eau Claire. Nine
month plus opportunity for summer
appointment. Attractive salary and fringe
RATES: 50<t per word, with a minimum
charge of $20.00 per ad. BOXED AD
RATES: $25.00 per column inch.
DEADLINE: Copy must be received by the
15th of the month preceding month of issue;
e.g., copy for the August issue is due July 15.
Send copy to: Wisconsin Medical Journal,
Box 1109, Madison, Wisconsin 53701; or
phone (area code 608) 257-6781; or toll-free
in Wisconsin: 800/362-9080.
benefit package, including malpractice
insurance. Contact: Shelley Bratholdt,
RNC, ANP, Director, Health Services,
University of Wisconsin-Eau Claire,
Eau Claire, WI 54701; ph 715/836-4311.
4/85
Internist/Family Practice: Board
Certified or board eligible. Established
50-doctor multispecialty group practice
located in the Milwaukee, Wisconsin
metropolitan area. Expanding practice
needs 2 internists and a family prac-
titioner. Competitive salary and ex-
cellent fringe benefits. Address inquiries
and curriculum vitae to Medical Di-
rector, PO Box 427, Menomonee Falls,
Wisconsin 53051 . p4-5/85
Family Practitioner needed to join two
FPs at the Ellsworth, Wisconsin office
of a progressive eleven-physician group.
Liberal fringes and financial package.
Forty miles from metropolitan Min-
neapolis/St Paul. Contact R M Hammer,
MD, River Falls, WI 54022; ph 715/425-
6701 or 612/436-8809. 4tfn/85
Family Practitioner. The Racine Medi-
cal Clinic, a progressive cluster corpor-
ation of 31 -physicians is currently seek-
ing a family practitioner. Full benefits,
unlimited earnings, and a full and ex-
citing practice are offered. Please contact
Roger D Lacock, Administrator, Racine
Medical Clinic, 5625 Washington Ave,
Racine, WI 53406; ph 414/886-5000.
4tfn/85
Family Doctor to serve Omro: 8 miles
west of Oshkosh. Modern well-equip-
ped facility available to lease or buy.
Financial assistance available. Hos-
pital 330-bed— 20 minutes. Contact
Elaine Peck, 521 East Ontario, Omro,
Wisconsin 54963. 414/685-2228 or
Mercy Medical Center, Oshkosh, Wis-
consin, Public Relations 414/236-
2101. p4-5/85
Physicians needed full or part-time to
perform light physicals. Milwaukee area.
Professional liability provided. Phone
414/344-2100, Ms Jenkins. lOtfn/84
Wanted —Qualified physician to prac-
tice emergency medicine in southeastern
Wisconsin. Our group is small and flexi-
ble. Salary is negotiable. If interested, send
CV to Associated Emergency Room Phy-
sicians, SC, 1131 Sherwood Lane, Cale-
donia, Wis 53108; ph 414/835-4489.
4-6/85
The Racine Medical Clinic, a progres-
sive cluster corporation of 31 physicians
is currently seeking an Obstetrician / Gyn-
ecologist physician. Full benefits, un-
limited earnings and a full and exciting
practice are offered. Please contact: Roger
D Lacock, Administrator, Racine Medical
Clinic, 5625 Washington Ave, Racine, WI
53406; ph 414/886-5000. 12tfn/84
The Racine Medical Clinic, a progres-
sive cluster corporation of 31 physicians
is currently seeking an Internist-Infectious
Disease physician. Full benefits, un-
limited earnings and a full and exciting
practice are offered. Please contact: Roger
D Lacock, Administrator, Racine Medical
Clinic, 5625 Washington Ave, Racine, WI
53406; ph 414/886-5000. 12tfn/84
Family Practice physician needed to join
five family practitioners and a general
surgeon. Immediate opportunity in west
central Wisconsin near La Crosse. $45,000
first year guarantee plus incentive. Excel-
lent recreational area. Community Hos-
pital. Send CV to: Jerrold L Kamp, Ad-
ministrator, PO Box 250, Sparta, WI
54656; or phone 608/269-6731. 6tfn/84
Immediate opportunities for qualified
physicians who possess excellent clinical
and communication skills to join long-
standing group of Emergency Physicians.
Positions available in a popular Wiscon-
sin area bordering Illinois. If interested,
send resume to Barbara Wilczynski,
Medical Emergency, Service Associates
(MESA), SC, 15 S McHenry Road, Suite 2,
Buffalo Grove, IL 60090 or call collect
312/459-7304. 6tfn/83
Internist or Family Practitioner to join
two Internists and General Surgeon in
growing, established. Green Bay area
practice. Send CV to John Brusky, MD,
1203 South Military Ave, Green Bay, WI
53404. 7tfn/84
Wanted Board Certified Otolaryngol-
ogist. Head and neck surgeon. Join active
one-man practice. General otolaryngol-
ogy, head and neck surgery, facial plastic
surgery, nasal allergy. Computerized of-
fice with x-ray, audiologist, and hearing
aid dispensing. Northern Wisconsin near
Apostle Islands National Lakeshore. Con-
tact James A Hamp, MD, ENT Profes-
sional Associates, SC, 2101 Beaser Ave,
Suite 1, Ashland, WI 54806; ph 715/ 682-
9311. 4-9/85
Family Practice Physician to share fully
equipped medical office in central Wis-
consin city. Opportunity for partnership
and eventual purchase of practice. Excel-
lent recreational, educational, hospital,
and civic advantages. Send curriculum
vitae to Dept 503 in care of the Journal.
6tfn/82
74
WISCONSIN MEDICAL JOURNAL, APRIL 1985: VOL. 84
MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
continued
Wanted— Board qualified— board cer-
tified obstetrician-gynecologist as an
associate. Modern well equipped facility.
Excellent starting salary and benefits in-
cluding profit sharing plan. Please contact
Elizabeth Allen Steffen, MD, 734 Lake
Ave, Racine, Wis 54303. 9tfn/83
Second Family Practitioner needed to
staff a satellite of a 38-physician multi-
specialty group in Kiel, a beautiful small
community in East Central Wisconsin. At-
tractive income arrangements, association
membership possible after one year, pen-
sion and profit sharing, extensive fringe
benefits. Contact R B Windsor, MD, 1011
North 8 St, Sheboygan, W1 53081: ph 414/
457-4461. c2tfn/85
General Surgeon. Board certified or eli-
gible to replace retiring surgeon in 16-
physician multispecialty group practice (2
surgeons, 2 Ob/Gyn, 6 internists and 6
pediatricians). Two-year salary guarantee
with full partnership available at begin-
ning of third year. Send CV to T E Flood,
Administrator, Beaumont Clinic, Ltd,
1821 So Webster Ave, Green Bay, W1
54301. p2-4/85
Orthopedic Surgeon. An excellent op-
portunity is available for two orthopedic
surgeons to join a progressive Medical
Group in Central Minnesota. The com-
munity serves a population base of
225,000 individuals and is an excellent
base for an orthopedic surgeon. St Cloud,
Minnesota is the hub of the State and is
home to three major colleges. It is geo-
graphically located to provide quick ac-
cess to the Metropolitan-Twin Cities area.
FAMILY PRACTITIONERS
INTERNISTS, OB/GYN
The UW Office of Rural Health is seek-
ing primary care specialists for more
than 50 communities throughout Wis-
consin. Opportunities are available
throughout Wisconsin for Board certi-
fied physicians trained in US medical
schools and residencies.
H
CONTACT:
Laurie Glowac or Fred Moskol
New Physicians for Wisconsin
University of Wisconsin
Department of Family Medicine
777 S Mills St, Madison, WI 537 1 5
Phone: 608/263-4095 7/84;6/85
The St Cloud community has a 500-bed
hospital with all the latest medical and
technological advancements to assist the
practicing orthopedic surgeon. If inter-
ested in this excellent opportunity, please
call collect either Dr LaRue Dahlquist,
President, and/or Daryl Mathews, Ad-
ministrator, at 612/251-8181 and/or send
curriculum vitae to St Cloud Medical
Group, 1301 West St Germain Street, St
Cloud, Minnesota 56301. 2-5/85
Family Physician and Internist, Pedi-
atrician, OB/GYN, Board eligible /certi-
fied. Full or part-time, to join a busy,
established group of physicians in Mil-
waukee. Attractive income. Send cur-
riculum vitae to PO Box 17366, Milwau-
kee, WI 53217. 2-7/85
Family Practitioner, General Surgeon,
Neurologist and Pediatrician /Central
Wisconsin. Excellent opportunity for
Board certified /eligible physician to join
26-physician multispecialty group.
180-bed modern hospital. Plentiful recrea-
tional, cultural, and educational oppor-
tunities. Unique, attractive financial ar-
rangements. Contact: Administrator, Rice
Clinic, 2501 Main St, Stevens Point, WI
54481: ph 715/344-4120. ltfn/85
Internal Medicine— Board certified or
eligible, to join 17-physician multi-
specialty clinic with 7-physician internal
medicine department. Located in beauti-
ful Wisconsin lakeshore community of
35,000. Competitive salary, complete
fringe benefits, generous vacation time.
Send CV to: Administrator, Manitowoc
Clinic, SC, PO Box 3008, Manitowoc, WI
54220. 1-5/85
Madison, Wisconsin. Experienced phy-
sician for ambulatory care center. Medic-
Wisconsin-BC/BE Pediatrician to
assume an established position of a
pediatrician leaving. Join a three-man
pediatric department. Call or write:
David L Lawrence, MD, 92 E Division
St, Fond du Lac, WI 54935: ph 414/
921-0560. p3-8/85
East, first and only independent ACC in
Madison. Now well established. Located
in heart of Eastside of Madison. Appli-
cants BC/BE demonstrated experience in
primary care, well-developed com-
munication skills. Competitive salary, ex-
cellent benefits, attractive practice setting.
Contact David A Goodman, MD, Medic-
East, 2810 E Washington, Madison, WI
53704: ph 608/244-1213. ltfn/85
Family Practitioner needed to join
established Family Practice group in East
Central Wisconsin city of 50,000 on
beautiful Lake Winnebago. Competitive
salary, fringes, excellent recreation area.
Send CV to MS Knier, MD, 555 S Wash-
burn, Oshkosh, Wis 54901: 414/426-0265.
lOtfn/84
Board Eligible Orthopedic Surgeon to
join established orthopedic practice in
East Central Wisconsin. Contact Dept 553
in care of the Journal. 2tfn/85
Family Practitioners needed to staff
satellite locations and Urgent Care
Centers located in Northeast Wisconsin.
Please send CV to Dept 554 in care of the
Journal. 2-5/85
Internists— BC / BE Internist needed to
join five general internists in multi-
specialty group practice in north-central
Wisconsin. Competitive salary and bene-
fits. General medicine training required.
Cosmopolitan community and excellent
recreational area. Send CV to D K Augen-
baugh, MD, 2727 Plaza Dr, Wausau, WI
54401; or phone 715/847-3328. ltfn/85
Physicians: US Air Force Medical
Corps is currently accepting appli-
cants tor physicians in the following
specialties: Aerospace Medicine; Or-
thopedics: Ear, Nose, and Throat;
Obstetrics/Gynecology: General
Surgeons: Family Practitioners: Inter-
nal Medicine, and Pediatrics. For more
information call: 414/258-2430.
2-4/85
Staff Psychiatrist. Full-time staff psychiatrist position is available at
De Paul Rehabilitation Hospital, Milwaukee, Wisconsin. Board eligible
or certification required. Position requires several years of general psy-
chiatric experience with evaluations, differential diagnosis, and treat-
ment of general psychiatric disorders. Sincere interest and/or experience
in substance abuse diagnosis and treatment is desirable but not re-
quired. Please submit application and curriculum vitae to Dr William
McDaniel, Medical Director, De Paul Rehabilitation Hospital, 4143
South 13th St, Milwaukee, WI 53221. 4/85
WISCONSIN MEDICAL JOURNAL, APRIL 1985: VOL. 84
75
MEDICAL YELLOW PAGES
MEDICAL FACILITIES
Family Practice for sale in Milwaukee.
Ideal starter or satellite office. Excellent
patient goodwill. Fully equipped and fur-
nished three examining rooms, waiting
room, and office. Approximately 900 sq
ft. Contact Greg Rodenbeck, DDS, 1200
E Oklahoma Ave, Milwaukee, Wis 53207;
414/481-8111. glOtfn/84
Family Practice office available in
south central Wisconsin. Contact Dept
555 in care of the Journal. 4-5/85
For Sale. Like-new medical office fur-
niture for sale— desks, chairs, examining
tables, typewriters, file cabinets, x-ray
viewers, computer (Victor 9000), and
miscellaneous items. Phone 715/369-
1261. p4-5/85
Madison, West Side. Hilldale Profes-
sional Building. Deluxe office suites, 1200-
1700 sq ft. Full service— undercover park-
ing. Call Ralph at office 608/273-5800 or
home 608/ 836-3586. 2tfn/85
MISCELLANEOUS
Physicians Signature Loans to $50,000.
Up to 7 years to repay. Competitive fixed
rate, with no points, fees, or charges of any
kind. No prepayment penalties. Prompt,
courteous service. Physicians Service
Assn, Atlanta, GA. Toll-Free (800) 241-
6905. lOeom/83
For physicians, hospital
administrators
Biomedical ethics conference
June 6-7, American Club, Kohler
Sponsored by State Medical Society
of Wisconsin and Wisconsin Hos-
pital Association
For further info contact SMS offices
in Madison; Michelle Scoville
ADVERTISERS
Abbott Northwestern Hospital . .70, 71
Acme Laboratories 73
Advanced Technology Associates,
Inc 69
Medical Computer Systems
Army National Guard 8
Ayerst Laboratories 58, 59, 60
Inderal®
Berkeley Biologicals 45
Histolyn-CYL®
Centralized Billing Systems 45
CyCare 72
Dista Products Co (Div of Eli Lilly
& Co) 12
Ceclor®
House of Bidwell 67
Knoll Pharmaceutical Co ... .62, 63, 64
Isoptin®
Marion Laboratories 39, 40
Cardizem®
Medical College of Wisconsin 73
Microcomputers in Medicine
Medical Protective Company 41
Navy Medical Programs 68
PBBS Equipment 31
Peppino's 7
Professionals Insurance
Company, The 4
Roche Laboratories 81, BC
Dalmane®
S & L Signal Company 73
Smith Kline Beckman 61
Dyazine®
SMS Services, Inc 47
Squibb & Sons,
Inc, E R 35, 36, 37, 38
Velosef®
United States Army Reserve 73
Upjohn Company, The 57
Motrin®
Winthrop Breon Laboratories . . .55, 56
Talwin® Nx
WISPAC 65 ■
Prevention-Diagnosis-Treatment
Child abuse conference
May 18, Sheraton Inn, Madison
Aimed at physicians in primary
care, the conference will address
how physicians can work with
county social service /protection
agencies in dealing with the diag-
nosis and treatment of child abuse
and neglect victims and perpetra-
tors.
Sponsored by the State Medical
Society of Wisconsin
For further info contact SMS offices
in Madison: Deb Powers
MEDICAL MEETINGS-
CONTINUING MEDICAL
EDUCATION
WISCONSIN
MAY 3, 1985: Adolescents and Sub-
stance Abuse, Conference Center, Men-
dota Mental Health Institute, Madison.
Faculty: Joe E King, MD, Keynote
Speaker. Fee: $38. Approved for six
hours AMA/PRA Category I credit. Info:
Joan Graber, MMHI, 301 Troy Dr, Madi-
son, Wis 53704; ph 608/244-2411. 4/85
MAY 9-11, 1985: Wisconsin Chapter,
American Academy of Pediatrics, Pioneer
Inn, Oshkosh. glltfn/84
MAY 9-10, 1985: Methodist Hospital
presents its 4th annual Problem Solving in
Emergency Care, symposium, Madison.
Physician, nurse, paramedic and EMT
tracks. Tuition: $25-$ 150. Accreditation:
14 hours AMA Category I, App ACEP
Category I. Contact: Mark Olsky, MD
(Director), Methodist Hospital, 309 West
Washington Ave, Madison, WI 53703; ph
608/251-2371, ext 3015. 3-4/85
MAY 17, 1985; Plastic Surgery in Pri-
mary Care, University of Wisconsin
Clinical Science Center, Madison. Spon-
sored by University of Wisconsin
THIS LISTING is compiled by the State
Medical Society of Wisconsin in coopera-
tion with others who wish to maintain a
centralized schedule of meetings and
courses of interest to Wisconsin physicians
and to avoid scheduling programs in conflict
with others. Hospitals, Clinics, Specialty
Societies, and Medical Schools are par-
ticularly invited to utilize this listing service.
There is a nominal charge for listing of Con-
tinuing Medical Education courses at the
following rates: SOt per word, with a mini-
mum charge of $20.00 per listing.
BOXED LISTINGS: $25.00 per column
inch. Listings of other scientific meetings
will be included at the discretion of the
editors.
COPY DEADLINE tor listings is 15th of the
month preceding the month of publication;
e.g., copy for the August issue is due by July
15. Address communications to: Wisconsin
Medical Journal, Box 1109, Madison, Wis-
consin 53701; or phone (area code 608)
257-6781; or toll-free in Wisconsin: 800/
362-9080.
FOR LISTING of other meetings see the
January 4, 1985 issue of the Journal of the
American Medical Association: Continuing
Education Opportunities for Physicians for
period January 1985 through December
1985.
76
WISCONSIN MEDICAL JOURNAL, APRIL 1985: VOL. 84
MEDICAL YELLOW PAGES
MEDICAL MEETINGS-
CONTINUING MEDICAL
EDUCATION
continued
Division of Plastic and Reconstructive
Surgery and University of Wisconsin-
Extension, Continuing Medical Educa-
tion. AMA Category 1, AOA, AAFP,
University of Wisconsin-Extension
CEUs— all 6 hours. Contact: Sarah
Aslakson, UW-Extension, Continuing
Medical Education, Room 465B, 610
Walnut St, Madison, Wis 53705; ph
608/263-2856. 4/85
MAY 21-22, 1985: Controversies in Fam-
ily Medicine: Low Intervention Obstetrics,
Sheraton Hotel, Madison. Sponsored
by University of Wisconsin School of
Medicine, Department of Family Medi-
cine and Practice and University of
Wisconsin - Extension Department of
Continuing Medical Education. AMA
Category 1, AAFP prescribed, AOA
Category 2-D, University of Wis-
consin-Extension CEUs— all 1 1 hours.
Contact: Sarah Aslakson, University of
Wisconsin, Continuing Medical Educa-
tion, Room 465B, 610 Walnut St, Madi-
son, Wis 53705; ph 608/263-2856. 4/85
JUNE 3-8, 1985: 18th Annual Postgrad-
uate Course in Gynecological Pathology, En-
docrinology, and Maternal-Fetal Medicine,
presented by the Department of Gyn-
ecology and Obstetrics of the Medical Col-
lege of Wisconsin. The course will be held
at Olympia Resort, Oconomowoc. The six-
day course includes an up-to-date review
of endocrinology, maternal-fetal medi-
cine, and cytogenetics in addition to a
thorough resume of gynecologic path-
ology. Registration is limited. Course ap-
proved for 46 cognates, Formal Learning,
by the American College of Obstetricians
and Gynecologists and 46 credit hours,
Category I, PRA/AMA. Eighty selected
35-mm slides will be available for pur-
chase to all participants. Contact Richard
F Mattingly, MD, The Medical College of
Wisconsin, 8700 West Wisconsin Ave,
Milwaukee, WI 53226; tel 414/257-5560.
p3-5/85
JUNE 6-7, 1985: Prediction of Drug
Levels and Monitoring, Madison. Spon-
sored by University of Wisconsin School
of Medicine, Department of Medicine
and University of Wisconsin-Extension,
Department of Continuing Medical
Education. Credit: AMA Category 1,
AAFP, AOA Category 2-D, University of
Wisconsin-Extension CEUs. Contact:
Sarah Aslakson, University of Wis-
consin-Extension, Continuing Medical
Education, 610 Walnut St, Room 465B
WARF, Madison, Wis 53705; ph 608/
263-2856. 4/85
JUNE 12-15, 1985: 37th Annual Scientific
Assembly of the Wisconsin Academy of
Family Physicians, Americana Resort
Hotel, Lake Geneva, Wisconsin. Info:
WAFP, 850 Elm Grove Road, Elm Grove,
WI 53122; ph 414/784-3656.
12/84;l-5/85
JUNE 14-15, 1985: A Medical and
Surgical Review of Reflux Esophagitis and
the Angelchik Prosthesis, Concourse
Hotel, Madison. Sponsored by Depart-
ment of Surgery, University of Wisconsin
School of Medicine, and University of
Wisconsin-Extension Continuing Medi-
cal Education. AMA Category 1 and Uni-
versity of Wisconsin-Extension CEUs,
both 11 hours. Contact: Sarah Aslakson,
University of Wisconsin-Extension,
Continuing Medical Education, Room
465B, 610 Walnut St, Madison, Wis
53705; ph 608/263-2856. 4/85
State Medical Society
of Wisconsin
Dates and locations of
ANNUAL MEETINGS
1985-1992
All meetings will be held in Milwau-
kee at the Milwaukee Exposition and
Convention Center and Arena
(MECCA) and the new Hyatt Regency
as the headquarters hotel with the ex-
ception of 1985, when the meeting will
be held at the La Crosse Convention
Center.
1985- April 25-27
1986- April 17-19
1987- March 26-28
1988- April 28-30
1989- April 13-15
1990- April 26-28
1991- April 18-20
1992- April 23-25
Meeting days will be Thursday and
Friday; the first session of the House
of Delegates will convene on Thurs-
day, the second and third on Friday.
Scientific programming will be on Fri-
day and Saturday.
Further information: Commission on
Continuing Medical Education, State
Medical Society of Wisconsin, Box
1 109, Madison, Wis 53701. Local tele-
phone: 257-6781; toll-free in Wiscon-
sin: 1-800/362-9080.
JUNE 28, 1985: Microcomputers in Medi-
cine, Milwaukee. A one-day computer
seminar and exposition for health care
professionals. Topics include choosing a
system; office practice management,
computer-aided diagnosis. Fee: $50 before
May 15 includes admission, lunch, and
reception. Info: Micros in Medicine,
MCW Libraries, 8701 Watertown Plank
Rd, Milwaukee, WI 53226; ph 414/257-
8323. g3-4/85
JULY 18-20, 1985: Wisconsin Society of
Obstetrics & Gynecology, Olympia Re-
sort, Oconomowoc. g2-6/85
SEPTEMBER 13-14, 1985: Wisconsin
Surgical Society, Paper Valley Hotel &
Conference Center, Appleton. g2-8/85
SEPTEMBER 13-15, 1985: Wisconsin
Society of Anesthesiologists, American
Club, Kohler. g2-8/85
Wisconsin Specialty
Society Meetings
• Wisconsin Urological Society,
April 19-20, 1985, Pfister Hotel,
Milwaukee
• Wisconsin Chapter: American
Academy of Pediatrics, May 9-11,
1985, Pioneer Inn, Oshkosh
• Wisconsin Academy of Family
Physicians, June 12-15, 1985,
Americana Resort, Lake Geneva
* * *
Specialty Society Meetings
to be held in conjunction
with SMS Annual Meeting,
April 25-27, 1985, La Crosse
• Wisconsin Society of Anesthesiolo-
gists
• Wisconsin Dermatological Society
• Wisconsin Chapter, American Col-
lege of Emergency Physicians
• Wisconsin Academy of Family
Physicians
• Wisconsin Society of Internal
Medicine
• Wisconsin Academy of Ophthal-
mology
• Wisconsin Otolaryngological
Society
• Wisconsin Society of Pathologists
• Wisconsin Society of Physical
Medicine & Rehabilitation
• Wisconsin Society of Plastic Sur-
geons
• Wisconsin Society for Preventive
Medicine
• Wisconsin Society of Radiation
Oncologists
• Wisconsin Surgical Society
WISCONSIN MEDICAL JOURNAL, APRIL 1985: VOL. 84
77
MEDICAL YELLOW PAGES
OTHERS
JUNE 5-8, 1985 (Alaska): Alaska State
Medical Association Annual Convention
in Haines. Info: Alaska State Medical
Association, 4107 Laurel St, Ste #1,
Anchorage, Alaska 99508; ph 907/
562-2662. g2-5/85
JUNE 22-23, 1985 (Minnesota): Ma«-
agemenl of Common Psychiatric Problems in
Primary Care, Breezy Point Resort, Brain-
erd. Info: St Paul-Ramsey Medical Center,
Continuing Medical Education, 640 Jack-
son St, St Paul, MN 55101: ph 612/221-
3977. g3-85
AUGUST 1-4, 1985: Second Annual St
Paul-Ramsey Trauma Conference (Fishing
& Family Recreation), Fox Hills Resort,
Mishicot. Info: St Paul-Ramsey Medical
Center, Continuing Medical Education,
640 Jackson St, St Paul, MN 55101; ph
612/221-3977. g3/85
AUGUST 1-4, 1985 (Georgia): Inter-
national Doctors in Alcoholics Anonymous
Annual Meeting. Hyatt Regency Hotel,
Savannah. Reservations may be made at
a later date when specific details and in-
structions are published. For further infor-
Syniposium on Epilepsy Diagnosis & Management:
May 20, 1985. UHS/Chicago Medical School, Department of Neurology.
Epilepsy Update: 85. Presentors; Drs G Celesia, A V Delgado-Escueta, J A
Ferrendelli, R L Macdonald & J Kiffin Penry. For information: Office of Con-
tinuing Medical Education, 3333 Green Bay Road, North Chicago, IL 60064.
Ph 312/578-3215. Fee $50. Five credit hours. 4/85
Management of
common psychiatric
problems in
primary care
June 21-23, 1985
Breezy Point Resort
Brainard, Minnesota
Content will focus on newer ap-
proaches in the diagnosis and
management of psychiatric prob-
lems commonly encountered by
primary care physicians. Edu-
cational formal will include lec-
tures, informal discussion,
video tape sessions, and "hands
on" participation in an interactive
computer-assisted program. A
variety of recreational and sport-
ing activities including golf,
tennis, swimming, boating, fish-
ing, and horseback riding will be
available during leisure time, with
many points of interest nearby.
Sponsored by Dept of Psychiatry
and Continuing Medical Educa-
tion, St Paul-Ramsey Medical
Center, St Paul, Minnesota.
Accreditation: 10‘/2 AMA Cate-
gory I hours, 10'/2 AAFP pre-
scribed hours.
Information and registration:
See info at right
Second Annual
St Paul-Ramsey
Trauma Conference
(fishing and family recreation)
August 1-4, 1985
Fox Hills Resort
Mishicot, Wisconsin
(Lake Michigan)
This program will combine a
high quality educational pro-
gram with summertime leisure ac-
tivities on Lake Michigan. The
educational component is de-
signed to update physicians on
current procedures for initial
assessment and appropriate man-
agement of adult and pediatric
trauma injuries. Time will be set
aside for information learning
through discussion and video-
tape sessions. In addition to recre-
ational and sporting activities at
the resort, charter fishing will
be available on Lake Michigan.
Sponsored by Burn Center and
Continuing Medical Education,
St Paul-Ramsey Medical Center,
St Paul, Minnesota.
Information and registration:
Bonnie Young, CME, St Paul-
Ramsey Medical Center, 640
Jackson St, St Paul, Minn
55101; ph 612/221-3977. 4/85
mation contact: Information Secretary,
IDAA, 1950 Volney Road, Youngstown,
Ohio 445 1 1 : ph 2 1 6 / 782-62 16. g 1 2tfn / 84
SEPTEMBER 5-7, 1985 (Texas): Amer-
ican Cancer Society, Second National Con-
ference on Diet, Nutrition and Cancer,
Shamrock Hilton, Houston. Info:
American Cancer Society, Second Na-
tional Conference on Diet, Nutrition and
Cancer, 90 Park Ave, New York, NY
10016. g3-8/85
SEPTEMBER 17-18, 1985 (Illinois):
Medical Practice and Hospital Privileges, at
Chicago Marriott O' Hare, Chicago. Info:
American Board of Medical Specialties,
One American Plaza, Suite 805, Evanston,
IL 60201; phone 312/491-9091.
gl2/84;l-8/85
1985 CME Cruise /Conferences on
Selected Medical Topics— Caribbean,
Mexican, Hawaiian, Alaskan, Medi-
terranean. 7-14 days year-round. Ap-
proved for 20-24 CME Category I credits
(AMA/PRA) & AAFP prescribed credit.
Distinguished professors. Fly roundtrip
free on Caribbean, Mexican, & Alaskan
Cruises. Excellent group fares on finest
ships. Registration limited. Prescheduled
in compliance with present IRS require-
ments. Info: International Conferences,
189 Lodge Ave, Huntington Station, NY
11746; ph 516/549-0869.
p9-ll/84;l, 3,4/85
AMA
JUNE 16-20, 1985: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 8-11, 1985: Interim AMA
House of Delegates, Washington, DC,
JUNE 15-19, 1986: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 7-10, 1986: Interim AMA
House of Delegates, Las Vegas, NV.
JUNE 2 1-25, 1987: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 6-9, 1987: Interim AMA
House of Delegates, Atlanta, GA.
JUNE 26-30, 1988: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 4-7, 1988: Interim House
of Delegates, Dallas, TX. ■
78
WISCONSIN MEDICAL JOURNAL, APRIL 1985: VOL. 84
NEWS YOU CAN USE
DOCTOR UNION EXECUTIVE SPEAKS TO DANE COUNTY MEDICAL SOCIETY. Donald C Meyer, DDS,
Executive Director, Doctors Council of New York City, a union representing about 3,000 physicians and
dentists in that city, spoke to members of the Dane County Medical Society March 27 in a program entitled
"Has the Time Come for Doctors' Unions?" Doctor Meyer's answer to the question posed by the program's
title was "no;" the time for physicians to unionize came 20 years ago, but that it is not too late to do so now.
Doctor Meyer stated that physicians need a negotiating agent in their increasingly greater role as employes,
representation that cannot by reason of law and economics be supplied by medical societies. Doctor Meyer
emphasized that unionization is not enough and that physicians must resolve to work together to solve the
problems facing most medical practices today.
In response, SMS Secretary Earl Thayer spoke on the history of unions in Wisconsin and the development
of the SMS's Physicians Alliance Division over ten years ago as an answer to unionization. SMS Assistant
Secretary and Corporate Counsel HB Maroney briefed the audience on the antitrust considerations, namely,
that physicians do not necessarily enjoy the same exemption from federal and state antitrust law as do other
trade unions. JD Kabler, MD, Chairman of the SMS Commission on Governmental Affairs, completed the
speakers' presentations with his cogitations on the subject of unionization from his perspective as a physi-
cian employe, manager, and private practitioner. The presentation ended with an informal discussion between
the speakers and the audience with SE Sivertson, MD, Vice President (now President) of Dane County Medical
Society acting as moderator. ■
AMA GUIDE FOR HOSPITAL MEDICAL STAFF BYLAWS AVAILABLE. Due to the overwhelming demand
by hospital medical staffs for guidelines on how to rewrite bylaws to reflect the change in the hospital environ-
ment, the AMA developed a monograph entitled "Bylaws— A Guide for Hospital Medical Staffs." This publica-
tion can be ordered through the AMA for $15 a copy ($13.50 for AMA members) plus $3.50 handling and
delivery by writing:
American Medical Association
Order Department, OP-351
P.O. Box 10946 In addition to this AMA guidebook, SMS legal staff reviews
Chicago, IL 60610 hospital medical staff bylaws as a membership service. ■
HAVE YOU BEEN RECEIVING COMPLAINTS FROM PATIENTS ABOUT DRGs? As one of its directives, the
SMS Hospital Medical Staff Section is responsible for monitoring DRG implementation in Wisconsin. If you
have been receiving complaints from your patients about their own or family member's treatment under the
DRG prospective payment system, you can relay this sentiment (preferably written) along to;
State Medical Society of Wisconsin
Hospital Medical Staff Section
P.O. Box 1109
Madison, WI 53701 ■
ALL PHYSICIANS! PLAN TO PARTICIPATE IN THE 1985 PPA CENSUS. In February 1985 all physicians in
the US were mailed a Physicians' Professional Activities Census form. Completion of the form assures accurate
classification in official AMA records and in the American Medical Directory. The PPA Census is conducted
by the AMA every four years for the purpose of identifying the practice specialties and current professional
activities of every physician in the country. All physicians— AMA members and nonmembers— are listed in
the Directory, as well as those who are no longer in active practice. Not completing the Census form may
result in inaccurate classification in AMA records and in the Directory. Moreover, these classifications usually
serve as the basis for the distribution of educational information from the AMA as well as complimentary
journals and materials from pharmaceutical companies. ■
continued next page
WISCONSIN MEDICAL JOURNAL. APRIL 1985:VOL. 84
79
NEWS YOU CAN USE
GOVERNOR'S BUDGET BILL. Legislative activity now is concentrated on the budget bill AB 85. Of special
importance to SMS is an attempt to change the mandated insurance benefits for mental and nervous disorders.
The attempt is to increase the mandatory outpatient benefit from $500 to $ 1000 and to remove the mandated
30-day inpatient hospital benefit. The bill would require the inpatient benefit for nervous and mental condi-
tions for the lesser of 25 days or $6300. SMS believes the outpatient benefit gives encouragement to "sham"
clinics and that the proposed inpatient benefit discriminates against patients who truly need hospital care.
Both the SMS and the Wisconsin Psychiatric Association oppose these changes in principle and urge the total
elimination of mandated benefits in insurance policies. See further details in the SOCIOECONOMIC section
of this issue. ■
ALSO IN THE LEGISLATURE. The Legislature is debating changes in the Capital Expenditure Review (CER)
program (successor to Certificate-of-Need). SMS feels that the CER program is no longer necessary in view
of the competitive atmosphere and the development of a Hospital Rate Setting Commission. See further details
in the SOCIOECONOMIC section of this issue. ■
AMA HELPING STATES TRACK PHYSICIAN LICENSING ACTIONS. State licensing boards are now being
alerted by the American Medical Association when a physician has had a licensure action taken against him
or her in other states. The new procedure identifies physicians who, having been disciplined in one state,
may attempt to practice in another jurisdiction where they hold a license. The AMA uses its computerized
Physician Masterfile to speed communications among licensing bodies. State boards currently notify the Federa-
tion of State Medical Boards (FSMB) in Fort Worth, Texas, of actions they have taken against physicians. The
FSMB reports the actions in a monthly summary. Because the FSMB summary lists only the jurisdiction that
took the disciplinary action, each state licensing board must review the summary to determine if it has issued
licenses to any of the named physicians. Under the new procedure, the AMA checks the FSMB summary
against the Masterfile, and informs each state board by letter when one of its licentiates has had his license
revoked, suspended, or limited. The AMA Masterfile is the only data base that can identify all the states in
which a physician is licensed. "This action is being taken in the wake of national disclosures and concerns
regarding credentialing abuses, ' ' according to James H Sammons, MD, AMA Executive Vice President. ' 'The
AMA is cooperating with the FSMB by providing information to help strengthen the physician credentialing
process," Doctor Sammons says. In addition to its collaborative effort with the FSMB, the AMA works with
state and federal agencies to identify "physicians" who have obtained their credentials fraudulently, such
as individuals who may have picked up the credentials of a deceased physician. Last year, the AMA assisted
the US Inspector General in investigations of illegal trafficking in medical credentials, and helped the Educa-
tional Commission for Foreign Medical Graduates determine the validity of credentials from three schools
in the Dominican Republic. ■
MALPRACTICE CONFERENCE, MAY 10 11, MILWAUKEE, HYATT REGENCY HOTEL. Sponsored by the State
Medical Society of Wisconsin, Medical Liabihty Committee, the conference will focus on how malpractice inci-
dents can be reduced as well as what medical-legal steps can be taken to improve the medical liability situa-
tion. Registration: $70 for SMS members; $150 for nonmembers. Further info: SMS staff Deborah Powers,
SMS Physicians Alliance Divison. ■
BIOMEDICAL ETHICS CONFERENCE, JUNE 6-7, AMERICAN CLUB, KOHLER. For physicians and hospital
administrators, this conference is sponsored by the State Medical Society of Wisconsin and the Wisconsin Hospital
Association. For further info contact SMS offices in Madison: Michelle Scoville, Physicians Alliance Division
staff. ■
CHILD ABUSE CONFERENCE, MAY 18, SHERATON INN, MADISON. Aimed at physicians in primary care,
the conference will address how physicians can work with county social service /protection agencies in deal-
ing with the diagnosis and treatment of child abuse and neglect victims and perpetrators. Sponsored by the State
Medical Society. Further info: Deborah Powers, SMS Physicians Alliance staff. ■
80
WISCONSIN MEDICAL JOURNAL, APRIL 1985: VOL. 84
COMPLETE
LABORATORY
DOCUMENTATION . . . EXTENSIVE
CLINICAL PROOF
FOR THE PREDIQABILITY
CONFIRMED BY EXPERIENCE
DlMMAHEis
flurozepom HCI/Roche
THE COMPLETE HYPNOTIC
PROVIDES ALL THESE BENEFITS:
• Rapid sleep onset' "
• More total sleep time' "
• Undiminished efficacy for at least
28 consecutive nights^ "
• Patients usually awake rested and refreshed'®
• Avoids causing early awakenings or rebound
insomnia after discontinuation of therapy^""”'
Caution patients about driving, operating hazardous machinery or drinking
alcohol during therapy. Limit dose to 15 mg m elderly or debilitated patients.
Contraindicated during pregnancy.
DALMAHE's
flurozepom HCI/Poche
References: 1. Kales J ef a/: Clin Pharmacol Ther
72:691-697, Jul-Aug 1971. 2. Kales A ef al: Clin Phar-
macol Ther 78:356-363, Sep 1975 3. Kales A etal
Clin Pharmacol Ther 79:576-583, May 1976. 4. Kales A
et al: Clin Pharmacol 7fier32:781-788, Dec 1982.
5. Frost JD Jr, DeLucchi MR: J Am Geriatr Soc
27:541-546, Dec 1979. 6. Kales A, Kales JD: J din
Pharmacol 3:140-150, Apr 1983. 7. Greenblatt DJ,
Allen MD. Shader Rl: Clin Pharmacol Ther 27:355-361,
Mar 1977 8. Zimmerman AM: Curr Ther Res
73:18-22, Jan 1971. 9. Amrein R ef al: Drugs Exp Clin
Res 9(1):85-99, 1983 10. Monti JM: Methods Find Exp
Clin Pharmacol 3:303-326, May 1981. 11. Greenblatt DJ
etal: Sleep 5(Suppl 1):S18-S27, 1982. 12. Kales A
etal: Pharmacology 26 :'\2t-t37, 1983.
DALMANE« @
flurazepam HCI/Roche
Before prescribing, please consult complete
product information, a summary of which follows:
Indications: Effective In all types of insomnia charac-
terized by difficulty in falling asleep, frequent nocturnal
awakenings and/or early morning awakening; in
patients with recurring insomnia or poor sleeping hab-
its; in acute or chronic medical situations requiring
restful sleep. Objective sleep laboratory data have
shown effectiveness for at least 28 consecutive nights
of administration. Since insomnia is often transient
and intermittent, prolonged administration is generally
not necessary or recommended. Repeated therapy
should only be undertaken with appropriate patient
evaluation.
Contraindications: Known hypersensitivity to fluraze-
pam HCI; pregnancy. Benzodiazepines may cause
fetal damage when administered during pregnancy.
Several studies suggest an increased risk of congeni-
tal malformations associated with benzodiazepine use
during the first trimester. Warn patients of the potential
risks to the fetus should the possibility of becoming
pregnant exist while receiving flurazepam. Instruct
patient to discontinue drug prior to becoming preg-
nant. Consider the possibility of pregnancy prior to
instituting therapy.
Warnings: Caution patients about possible combined
effects with alcohol and other CNS depressants. An
additive effect may occur if alcohol is consumed the
day following use for nighttime sedation. This potential
may exist for several days following discontinuation.
Caution against hazardous occupations requiring
complete mental alertness (e g,, operating machinery,
driving). Potential impairment of performance of such
activities may occur the day following ingestion Not
recommend^ for use in persons under 15 years of
age. Though physical and psychological dependence
have not been reported on recommended doses,
abrupt discontinuation should be avoided with gradual
tapering of dosage for those patients on medication
for a prolonged period of time. Use caution in adminis-
tering to addiction-prone individuals or those who
might increase dosage.
Precautions: In elderly and debilitated patients, it is
recommended that the dosage be limited to 15 mg to
reduce risk of oversedation, dizziness, confusion and/
or ataxia. Consider potential additive effects with other
hypnotics or CNS depressants. Employ usual precau-
tions in severely depressed patients, or in those with
latent depression or suicidal tendencies, or in those
with impaired renal or hepatic function.
Adverse Reactions: Dizziness, drowsiness, light-
headedness, staggering, ataxia and falling have
occurred, particularly in elderly or debilitated patients.
Severe sedation, lethargy, disorientation and coma,
probably indicative of drug intolerance or overdosage,
have been reported. Also reported: headache, heart-
burn, upset stomach, nausea, vomiting, diarrhea,
constipation, Gl pain, nervousness, talkativeness,
apprehension, irritability, weakness, palpitations, chest
pains, body and joint pains and GU complaints. There
have also been rare occurrences of leukopenia, gran-
ulocytopenia, sweating, flushes, difficulty in focusing,
blurred vision, burning eyes, faintness, hypotension,
shortness of breath, pruritus, skin rash, dry mouth,
bitter taste, excessive salivation, anorexia, euphoria,
depression, slurred speech, confusion, restlessness,
hallucinations, and elevated SGOT, SGPT, total and
direct bilirubins, and alkaline phosphatase: and para-
doxical reactions, e.g., excitement, stimulation and
hyperactivity.
Dosage: Individualize for maximum beneficial effect.
Adults: 30 mg usual dosage; 15 mg may suffice in
some patients. Elderly or debilitated patients: 15 mg
recommended initially until response is determined.
Supplied: Capsules containing 15 mg or 30 mg
flurazepam HCI.
Roche Products Inc.
Manati, Puerto Rico 00701
DOCUMENTED PROVEN IN
IN THE SLEEP THE PATIENT'S
LABORATORY"... HOME
FOR A COMPLEX
DAL
flurozepQ
STANDS
See preceding page for references and summary of product information
Copyright © 1984 by Roche Products Inc. All nghts reserved
15-MG/30-MI
WISCONSIN
MEDICAL JOURNAL
ISSN 0043-6542 /Established 1903
Owned and published by
State Medical Society of Wisconsin
Medical Editor
Victor S Falk MD, Edgerton
Editorial Board
Victor S Falk MD, Edgerton Chairman
Melvin F Fluth MD. Baraboo
M C F Lindert MD, Milwaukee
Andrew B Crummy Jr MD. Madison
Richard D Sautter MD. Marshfield
Dean M Connors MD. Madison
George W Kindschi MD, Monroe
Charles H Raine MD. Racine
Darrell L Witt MD, Wausau
Garrett A Cooper MD, Madison Emeritus
Editorial Director
Wayne J Boulanger MD, Milwaukee
Editorial Associates
R Buckland Thomas MD, Monroe
Russell F Lewis MD. Marshfield
Raymond A McCormick MD, Green Bay
Victor S Falk MD, Edgerton
Medical Editor
Staff
Earl R Thayer, Madison
Secretary-General Manager
State Medical Society of Wisconsin
FI B Maroney II, Madison
Assistant Secretary -Corporate Counsel
State Medical Society of Wisconsin
Mrs Mary Angeii, Madison
Managing Editor
Mrs Marjorie Stafford, Madison
Publications Assistant
Mrs Diane Upton, Madison
Editorial Assistant
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TIVE: State Medical Journal Advertising
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LOCAL (WISCONSIN) ADVERTISING: Con-
tact; Mrs Mary Angell, Wisconsin Medical
Journal, Box 1109. Madison, Wis 53701. Ph
608/257-6781.
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per year (included in dues): nonmembers,
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vious years, $3.00. SPECIAL RATES: Foreign
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Membership Directory issue, $15.00.
SECOND CLASS POSTAGE PAID at
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munications to THE WISCONSIN MEDICAL
JOURNAL. Street address: 330 East Lakeside
Street. Mailing address: Box 1 109, Madison,
Wis 53701.
POSTMASTER: Send address changes to
Wisconsin Medical Journal, PO Box 1109,
Madison, Wis 53701
COPYRIGHT 1985
State Medical Society of Wisconsin
CONTENTS
1
May 1985
SPECIAL FEATURES
SCIENTIFIC MEDICINE
President's Page
7
Outpatient management of
4 The new president: John K
chronic pain: long-term results
Scott, MD
Sridhar V Vasudevan, MD
Timothy Lynch, MD
Editorials
Brad K Grunert, PhD
5 Too late
John L Melvin, MD
Victor S Falk, MD
Stephen E Abram; MD
Edgerton
Milwaukee
5 Some thoughts about
10
Hazards of blood and blood
"The Fund"
products; case report of post-
Wayne J Boulanger, MD
transfusion Hepatitis-B
Milwaukee
Charles E Wirtz, MD
John P Kirchner, MD
Special
Patrick M Maloney, MD
6 AMA Physician's Recognition
Marshfield
Award Recipients
11
Abstract: Postoperative sur-
23 We are in an era of many
veillance: An effective means
changes
of detecting correctable lesions
Lucille B Glicklich, MD
that threaten graft patency
Milwaukee
William D Turnipseed, MD
38 Statewide pneumoconosis
Charles W Archer, MD
radiologic consultation program
Madison
begins June 1
12
Absent serum thyroxine in a
State Division of Health
hypothyroid man with severe
nonthyroidal illnesses
Socioeconomics
Gary G Wickus, PhD
43 WISPAC: Some basic rules to
Robert H Caplan, MD
follow when writing to your
La Crosse
legislator
14
Leptospirosis in Wisconsin:
Report of a case associated
News you can use
with direct contact with
57 Health trends as reported by
raccoon urine
the National Health Lawyers
Victor S Palk, MD
Association
Edgerton
I
WISCONSIN MEDICAL JOURNAL (ISSN 0043-6542) is the official publication of the State Medical
Society of Wisconsin, devoted to the interests of the medical profession and health care in Wisconsin.
Its affairs are handled by the Editorial Board, subject to policy direction of the Society's Board of
Directors. The Managing Editor is responsible for the production, business operation, and coor-
dination of contents as well as the final responsibility of the entire publication. The Editorial Director
IS responsible for Editorials. Unsigned Editorials express views consistent with the policies of the
State Medical Society of Wisconsin. Signed Editorials express personal views of the author for which
the Society takes no responsibility. Neither the Editors nor the State Medical Society will accept
responsibility for statements made or opinions expressed in the pages of the Journal. Indexed in
I'Tndex Medicus,” "Hospital Literature Index," and "Cambridge Scientific Abstracts."
v
CONTENTS
Vol. 84, No. 5
N
16 Mannitol-induced renal
insufficiency
Peter W Gutschenritter, MD
Kermit L Newcomer, MD
Philip J Dahlberg, MD
La Crosse
ORGANIZATIONAL
28 Doctor Scott installed as presi-
dent; Doctor Landis elected
president-elect
29 Membership Directory— Update
36 CES Foundation: Contribu-
tions during the month of
March 1985
DEPARTMENTS
35 Physician Briefs
37 News Highlights
38 County Societies: Clark . . .
Sauk . . . Winnebago
44 Obituaries
Joseph D Bonan, MD
Wauwatosa
Gerard J Biedlingmaier, MD
Wauwatosa
Edwin P Bickler, MD
Wauwatosa
Stella I Burdette, MD
Amery
Richard W Farnsworth, MD
Janesville
52 Medical Yellow Pages: Physi-
cians exchange . . . Medical
facilities . . . Miscellaneous . . .
Medical Meetings— Continuing
Medical Education . . . Adver-
tisers ■
Officers
President: John K Scott. MD, Madison
President-Elect: Charles VJ Landis,
MD. Milwaukee
Secretary-General Manager:
Earl R Thayer, Madison
Treasurer: John J Foley. MD
Menomonee Falls
Board of Directors
Chairman: Darold A Treffert, MD
Fond du Lac
Vice Chairman: Roger L
von Heimburg. MD, Green Bay
First District
Jerome W Fons Jr, MD, Cudahy
Carl S Eisenberg, MD, Milwaukee
Thomas A Hofbauer, MD.
Menomonee Falls
Wayne FI Konetzki, MD. Waukesha
Fredrick Wood Jr, MD. Kenosha
William L Treacy, MD, Milwaukee
Richard D Fritz, MD, Milwaukee
William J Listwan, MD, West Bend
Glenn H Franke. MD. Milwaukee
Lucille B Glicklich. MD. Milwaukee
Second District
J D Kabler, MD, Madison
Cyril M Hetsko, MD, Madison
James J Tydrich. MD, Richland Center
Alwin E Schultz, MD. Madison
Kenneth I Gold, MD, Beloit
Third District
Pauline M Jackson. MD, La Crosse
Fourth District
John J Kief, MD. Rhinelander
Jung K Park, MD. Wisconsin Rapids
W George Locher, MD, Wausau
Fifth District
Darold A Treffert. MD, Fond du Lac
Kenneth M Viste Jr, MD. Oshkosh
C William Freeby, MD. Appleton
Sixth District
Roger L von Heimburg, MD. Green Bay
Joseph C DiRaimondo, MD. Manitowoc
Seventh District
Marwood E Wegner. MD. St Croix Falls
Philip J Happe, MD. Eau Claire
Eighth District
Joseph At Jauquet, AID, Ashland
THE STATE MEDICAL SOCIETY OF WISCONSIN, created by the Territorial Legislature in 1841,
represents over 5600 member physicians in Wisconsin, comprising 55 county medical societies
and 25 medical specialty sections. The purpose of the Society is to "bring together the physicians
of the State of Wisconsin to advance the science and art of medicine and the better health of the
people of Wisconsin, and to secure the enactment and enforcement of just medical laws. " The major
activities of the Society include continuing medical education, peer review, legislation, community
health education, scientific affairs, socioeconomics, health planning, services for physicians, opera-
tion of a Charitable, Educational and Scientific Foundation, and publication of the Wisconsin Medical
Journal.
President: Doctor Scott
President-Elect: Doctor Ixmdis
Past President: Timothy T Flaherty,
MD, Neenah
Speaker: Duane W Taebel. AID.
La Crosse
Vice Speaker: Vernon At Griffin, AID,
Mauston
A.
[president S PAGE
John K Scott, MD
The new president: John K Scott, MD
John K Scott, MD, a Madison otolaryngologist, head and
neck surgeon, was installed as the 130th president of the
State Medical Society of Wisconsin at its Annual Meeting
April 25-27, 1985 in La Crosse.
A native of Massillon, Ohio, Doctor Scott is associated
with the Madison Ear-Nose-Throat Associates in
Madison and is a member of the medical staffs of St
Marys, Madison General, and Methodist hospitals, and
University Hospital and Clinics, Madison. He is clinical
professor of surgery at the University of Wisconsin
Medical School and is a preceptor for the fourth-year
residency program at Madison General Hospital.
After graduating from Ohio State University College
of Medicine in 1954, Doctor Scott served an internship
at White Cross Hospital, Columbus, Ohio, and completed
his otolaryngology residency at University Hospitals in
Columbus. In 1959 he was certified by the American
Board of Otolaryngology and became a fellow of the
American College of Surgeons.
Doctor Scott has been active in organized medicine at
county, state, and national levels. He is a past president
of the Dane County Medical Society and has served as
a Dane County delegate to the State Medical Society's
House of Delegates since 1972. He has participated on
several state society committees including serving as
chairman of the SMS Committee on Cancer and as a
member of the SMS Committee on Medicine and
Religion.
At the national level. Doctor Scott has been either an
alternate delegate or a delegate to the American Medical
Association since 1977, and is currently vice chairman
of the Wisconsin delegation to the AMA. In 1984 he
served as president of the North Central Medical Con-
ference.
Long interested in the field of cancer. Doctor Scott is
a former president of the Wisconsin Division— American
Cancer Society, and was a member of the National Board
of the American Cancer Society for thirteen years.
He is a past president of the Wisconsin Otolaryngology
Society, the Wisconsin Chapter of the American College
of Surgeons, and the Wisconsin Professional Review
Organization (WIPRO). He also is a member of the
Triologic Society, the American Academy of Ophthal-
mology and Otolaryngology, and the Society of Head and
Neck Surgeons.
Doctor and Mrs Scott (Louise) have four children;
Susan, Kim, Carol, and Sally. ■
4
WISCONSIN MEDICAL JOURNAL, MAY I985:VOL. 84
Wayne J Boulanger, MD, Editorial Director
EDITORIALS
Unsigned editorials express views consistent with the policies of the State Medical Society of Wisconsin.
Signed editorials express personal views of the author for which the Society takes no responsibility.
Too late
The March issue of the Journal in-
cluded a poignant editorial and an
even sadder comment. The sub-
ject was in regard to the "rights”
of mental patients. Here is an-
other example.
A Sheboygan family sought help
for a schizophrenic son. They
were told repeatedly that they
"would have to wait until he got
in trouble with the law."
Well, he stabbed his 75-year-old
father to death and wounded his
mother. He was then declared by
the judge to be "not mentally
competent to stand trial.”
It was the murderer's "right to
refuse help.” He had elected to
discontinue the medications pre-
scribed for him.
It is too late to help this troubled
family, but this example should
stimulate changes in legislation to
prevent more of these tragedies.
— Victor S Falk, MD, Edgerton
Some thoughts
about "The Fund"
There is only one topic of conver-
sation for Wisconsin doctors this
year. DRGs, which occupied so
much attention recently, have
been driven into the background.
Now the proposed malpractice in-
surance premium increases oc-
cupy all of our attention. We seem
to hear two key questions over
and over:
1. How is the State Medical So-
ciety going to deal with the
situation?
2. How is the inevitable in-
crease in the cost of doing
business going to be ab-
sorbed?
The answer to the first question
is easy. The State Medical Society
has brought all of its considerable
forces to bear upon the problem,
disseminating information to its
membership and to the public,
and working to achieve legislative
relief, much as it did ten years ago
during the first malpractice crisis.
Then, too, there was much em-
phasis on legislative relief; ulti-
mately the Patients Compensation
Fund was created. It seemed at
the time to be a logical and fair
system, and we all breathed more
easily. It took a few years to recog-
nize our mistake. We now find
that the Fund has become an alba-
tross which has virtually des-
troyed solo practice as an option
for a surgeon completing his resi-
dency or a surgeon who would at
age 60 like to cut back his practice
a bit.
On March 28 our president.
Doctor Flaherty, chaired a meet-
ing of specialty society represen-
tatives and county medical society
leaders during which those in at-
tendance were briefed by him and
by our Physicians Alliance direc-
tor, Brian Jensen and his staff,
detailing the efforts of the State
Medical Society in the malpractice
arena. All were impressed with
the intensity and the quality of the
effort expended. And at the end
everyone had an opportunity to
ask questions and make sugges-
tions. No one left the meeting feel-
ing good about the situation.
After all, time is not on our side.
The situation is reminiscent of
those old Saturday afternoon
movies— if we don't pay off the
mortgage by July 1, the bank will
foreclose and we'll lose the farm—
and we don't have a Little Nell to
offer the villain as a bribe, either.
Regardless of what we do, the
Fund deficit has to be made up.
While there may be some argu-
ment with the actuaries as to the
amount of the deficit, even the
most optimistic prediction places
our assessment increase at around
100 percent. Any appeals we
make for legislative relief won't
change the situation this July
1985, or 1986 for that matter.
There is a Special Committee of
the Legislative Council working
on medical malpractice. The Med-
ical Society has submitted many
recommendations to them de-
signed to secure relief. The com-
mittee has indicated support for
some of these, and has rejected
others. Many have to do with caps
on awards, methods of pay out,
and so forth. One idea seems
promising: to increase the Fund
threshold above the $200,000
limit. If the base carrier were
responsible for the first $500,000
instead of $200,000, a huge
burden would be lifted from the
Fund. In the old days of basic
coverage and an umbrella pro-
vided by the same carrier, the in-
surance company had a much
greater incentive to defend its
clients in situations where large
awards were a possibility. Today,
base carriers are disinclined to of-
fer more than token defense in
cases where large awards are
likely, since they know their limit
is $200,000.
Perhaps the thought ought to be
developed even further. What
about closing out the Fund alto-
gether? For the next few years we
would have to pay off the current
awards, but in the long run we
would save because:
1. Individual physicians would
be free to negotiate their own
packages, and premiums
would be based on their own
track records.
2. Repetitive offenders would
be forced out of business
without their colleagues hav-
ing to drag them through tor-
turous peer review mechan-
isms that have never worked.
But what if private insurance
companies back out and umbrella
WISCONSIN MEDICAL JOURNAL, MAY 1985: VOL. 84
5
EDITORIALS
"THE FUND"— Boulanger
coverage isn't available? That
won't happen, but if it did, we
would all have to stop practice,
since our hospitals require evi-
dence of adequate malpractice in-
surance. How long do you think
the public would tolerate that?
There might be some upheaval for
a time, but we would come out
ahead in the long run.
Understandably, the level of
physician interest in the problem
varies depending upon the spe-
cialty and the class of risk as-
signed. Those in the less expen-
sive classes might be tempted to
ignore the problem because a 100
percent increase in a $2,000 pre-
mium won't break the bank. That
security won't last long, though, if
that nearly $10,000,000 award
against an internist in Green Bay
is an indication of things to come.
And no discussion on malprac-
tice in the United States can be
complete without comment on
the farcical situation in Obstetrics.
The anticipated Wisconsin annual
premium of $34,613 ought to be
an embarrassment to the legal
profession and to the courts. One
can only hope that the women of
this country will get together
behind their obstetricians and say:
"Enough is enough!" Then ra-
tionality will be restored.
— Wayne J Boulanger, MD, Milwaukee
Editorial Board comment: While
whole-heartedly in agreement with Doc-
tor Boulanger's comments above, we feel
it should be emphasized that other phy-
sicians, as well as surgeons, do recognize
the medical malpractice crisis and clearly
feel its effects if not equally financially,
certainly in regard to the previously
respected traditions and humanitarian
philosophies of medicine. Our devoted
and trustworthy patients will ultimately
suffer and are beginning to indicate con-
cern. No answers, but great doubts in
proposed solutions. ■
AMA Physician's Recognition
Award Recipients
Listed below are those physicians in Wisconsin who have earned the
AMA Physician's Recognition Award in recent months. The State
Medical Society of Wisconsin congratulates these physicians who have
distinguished themselves and their profession by their commitment to
continuing education:
MARCH
’Abrams, Julian E, Wood
’Beecher, Ann C, Mequon
’Beltran, Luciano R, Elm Grove
’Bodecker, Robert A, Brookfield
’Brown, Jack D, Sparta
’Bulgarin, Nunilo L, Tomahawk
’Buhl, John L, Waukesha
’Clothier, W J Kilburn, Waukesha
’Cody, Edward F, Beaver Dam
’Cowle, Arch E, Verona
’Cummens, Michael L,
Genesee Depot
’Damiano, Nicholas F, Hales Corners
’Dibbell, David G, Madison
’Downs, David R, Dodgeville
’Edland, Robert W, La Crosse
’Edwards, Richard W,
Richland Center
Eichelman, Burr S, Madison
’Elias, Sharon L, Milwaukee
’Finch, David R, Appleton
’Fownes, Douglas R, Fond du Lac
’Garber, Bradley G, Osseo
’Garman, John S, Waterloo
’Gray, Roger S, Evansville
’Guevara, Esteban, Brown Deer
’Heinzl, GlenJ, Oconto
’Heyerdahl, Dan L, Appleton
’ Hogan, John P, Milwaukee
’Homburg, Nancy J, Appleton
’Honish, John S, Oconto
’Horwitz, S Fredric, Mequon
Icken, James N, Columbus
’Ives, Donald G, Whitefish Bay
Jackson, Edgar B, Milwaukee
Jefferson, James W, Madison
’Johnson, Robert B, River Falls
Kaufman, Kiesl K, Milwaukee
’Kempthorne, Gerald C,
Spring Green
’Kloehn, Ralph A, Wauwatosa
* Knavel, James L, Lake Geneva
’Members of the State Medical Society
of Wisconsin
’Knier, Michael S, Oshkosh
’Kobelt, Carl C, Manitowoc
’Korkos, George J, Milwaukee
Kretchmar, Joseph S, Milwaukee
’Kuter, David P, Baraboo
’Leasum, Robert N, Osseo
’Mayer, Vicki L, Hudson
’Miller, Owen E, Waukesha
’Milson, Stuart E, Green Bay
’Mol, Henry R, Elkhorn
’Myers, Wilbert E, Fond du Lac
’Nemec, George, Woodruff
’Nietert, William C, Mosinee
’Nogler, Robert A, Baldwin
Offenkrantz, William C,
Milwaukee
’Oujiri, John C, Ashland
’Pavelsek, Joseph W, Portage
’Pawlak, James R, Sheboygan
*Pohl, Alan L, Milwaukee
’Pope, George M, River Falls
Reinardy, Michael J, Antigo
Reinighaus, Carl H, Florence
*Ruch, Donald M, Milwaukee
’Salibi, Bahij S, Marshfield
Sanfelippo, Michael, Milwaukee
’Schleper, Albin J, Racine
’Schneider, George R, West Allis
’Schwarz, Robert L,
Menomonee Falls
’Skupniewicz, Raymond E, Racine
’Steidinger, Charles L, Platteville
Strube, Roger H, Milwaukee
’Stuff, Patricia J, Bonduel
’Teasley, Jack L, Milwaukee
’Thompson, John E, Nekoosa
’Thompson, Teddy L, La Crosse
Tomlinson, Carol, Janesville
’Towne, Jonathon B, Milwaukee
’Urbanek, Robert E, Beaver Dam
’Vergara, Victorino G, Reedsburg
’Wilkins, Terrence J, Milwaukee
’Williams, Thomas H, Mukwonago
’Wilson, Louis J, Eau Claire
’Wiviott, Wilbert, Milwaukee
’Wright, William E, Mondovi
’Yllas, Santiago L, RacineB
Have you paid your
1985 membership dues?
Regular member dues of $455 must
be paid in full no later than May 15,
1985 to continue as a member.
Membership Records as of May 31,
1985 will be used in preparation of
the Membership Directory to be
published in the July issue. See fur-
ther details on pages 32 and 33,
6
WISCONSIN MEDICAL JOURNAL, MAY 1985: VOL. 84
Victor S Falk, MD, Medical Editor
SCIENTIFIC MEDICINE
Outpatient management of chronic
pain: long-term results
Sridhar V Vasudevan, MD
Timothy Lynch, PhD
Brad K Grunert, PhD
John L Melvin, MD
Stephen E Abram, MD
Milwaukee, Wisconsin
ABSTRACT. An outpatient chronic
pain management program utilizing
interdisciplinary behavioral and
medical treatment has been in oper-
ation since May 1977 in a large medical
complex setting. Components of this
program included multidisciplinary
medical evaluation, chemical detoxifi-
cation, physical, occupational and re-
laxation therapies as well as group
meetings and family therapy. The first
78 patients to complete the program
achieved 85% success in eliminating
further hospitalization for pain-related
complaints for at least one year fol-
lowing treatment. These patients also
experienced decreases in self ratings of
pain intensity and increases in physical
activity and endurance. A one year
followup shows many have returned to
work and also shows maintenance of
improvement.
Key words: Chronic pain; Pain clinics;
Rehabilitation: Outpatient
JVT UCH HAS BEEN written on the
subject of chronic pain and its
treatment in the last ten years.
Furthermore, much of the litera-
ture on pain management has
focused on inpatient treatment at
From the Department of Physical Medi-
cine and Rehabilitation, Medical Col-
lege of Wisconsin. Reprint requests to:
Curative Rehabilitation Center, De-
partment of Physical Medicine and
Rehabilitation, 1000 North 92nd St, Mil-
waukee, Wis 53226 (SVV). Phone:
414/259-1414. Copyright 1985 by the
State Medical Society of Wisconsin.
a time when nationally, both
within health insurance carrier
circles and within the medical
profession itself, increased em-
phasis is being placed on out-
patient care.i The total financial
cost of chronic pain in this
country has been estimated at
nearly $50 billion per year re-
flecting medical costs, compensa-
tion, lost wages, and the like. A
significant contribution to these
costs is the recent proliferation of
inpatient pain management pro-
grams. Unfortunately, the long-
term efficacy of behaviorally
oriented pain programs has yet to
be firmly established. ^ ^
Assessment of the effectiveness
of pain programs is complicated
by the definition of chronic pain
itself. Chronic pain is defined as
persistent pain of six months dur-
ation or longer which has not
responded to medical or surgical
treatment and for which con-
tinued medical/surgical treat-
ment is not considered appro-
priate. These are patients who
have continued to have pain
despite the best efforts of medical
care. They are often unemployed
and are dependent upon medica-
tions with frequent family stress
and associated affective conse-
quences such as depression. Be-
cause of the complexity of
chronic pain, the need for in-
patient pain programs has been
emphasized.^
Assessment of treatment ef-
fectiveness, whether outpatient
or inpatient, has frequently fo-
cused on the following: medica-
tion use, activity levels, and em-
ployment.^ Unfortunately, assess-
ment of the effectiveness of pain
management programs has been
mitigated by three method-
ological shortcomings which in-
clude: (1) inadequate controls,
(2) self selection biases at follow-
up, and (3) the use of question-
able dependent measures as well
as significant differences in types
of treatment. The first two of
these criticisms are exceedingly
difficult to eliminate for ethical
reasons.
METHODS. The first 78 patients
to be treated for chronic pain in
a rehabilitation program as out-
patients at the Curative Rehabili-
tation Center in Milwaukee,
Wisconsin, were studied. The
dependent measures utilized to
assess effectiveness included: use
of medication, physical activity,
and employment as well as sub-
jective pain report. The chronic
pain management program on an
outpatient basis met the standards
for accreditation under the criteria
outlined by the Commission on
Accreditation of Rehabilitation
Facilities (CARF).^ After an
initial screening on an outpatient
basis by the multidisciplinary
team, an appropriate diagnosis
was made and appropriate out-
patient treatment program pre-
scribed. The program was eight
weeks in duration and patients
were seen three times each week.
None of these patients was treated
on an inpatient basis. Patients'
subjective assessment of depen-
dent variables was obtained at
time of admission and one year
after completion of the program.
ADMISSION CRITERIA. Admis
sion criteria for the pain man-
agement program were similar to
those utilized in other pain pro-
grams.'^
1. Chronic pain of six months
duration or more.
WISCONSIN MEDICAL JOURNAL, MAY 1985: VOL. 84
7
SCIENTIFIC MEDICINE
CHRONIC PAIN— Vasiidevan el al
2. Nonmalignant pain.
3. Inappropriate for further
medical/surgical interven-
tion.
4. Observable pain behavior
thought to be in excess of or-
ganic pathology.
5. Availability of the spouse or
significant other person to
assist.
6. No psychiatric disturbance
of the schizophrenic or de-
lusional nature.
Of the 78 patients referred for
pain management, eight were un-
able to complete treatment but
were retained in the followup
study. All patients were treated in
a multidisciplinary manner as
outlined under the pain clinic
standards provided by the Com-
mission on Accreditation of Re-
habilitation Facilities.^
The mean age of patients was
42 years (range of 21-63 years).
There were 46 women and 32
men. In 80.5% of these cases, the
pain was located in the back area
with the remaining percentage
being distributed in the head,
neck, hip, arms, or legs. Litiga-
tion was pending in 21% of the
cases, with litigation defined as
having retained a lawyer for pur-
poses for pursuing worker's com-
pensation or third-party insur-
ance benefits related to an ac-
cident. The average duration of
pain was 4.5 years. In all cases
an organic basis related to the
initial pain complaint. Employ-
ment history and work status on
admission varied considerably by
case and at the time of admission
only 19% of the patients were
employed either on a part-time or
full-time basis.
Medication in the form of
nonnarcotic and narcotic anal-
gesics was seen in 92% of the
patients. These included muscle
relaxants, nonnarcotic analgesics,
and tricyclic antidepressants.
PROGRAM DESCRIPTION. The
program is located at the Curative
Rehabilitation Center, an out-
patient rehabilitation facility, part
of the Milwaukee Regional Medi-
cal Complex. All patients were
evaluated by a physiatrist (special-
ist in physical medicine and re-
habilitation), and correctable
medical as well as surgical prob-
lems were ruled out. Patients
were admitted after an evaluation
by a team including physical ther-
apist, occupational therapist,
social worker, and psychologist.
All patients admitted to the pro-
gram received the services three
half days per week for eight
weeks. The following were the
stated major goals:
1. Decrease subjective pain.
2. Increase physical activity
levels.
3. Reinstate employment.
4. Decrease use of non-essential
medications.
Treatment consisted of physical
conditioning in occupational
therapy as well as physical
therapy focusing on increased sit-
ting and standing tolerance, in-
creased activity levels, increased
endurance, and understanding of
their illness and application of
proper body mechanics in daily
living activities. Psychological ap-
proaches included cognitive cop-
ing instruction, group therapy,
breathing techniques, relaxation,
and biofeedback training. Social
service contact dealt with educa-
tion of other members of the
family with regard to principles of
chronic pain management. Medi-
cation reduction was accom-
plished through weekly titration
done voluntarily by the patient.
Medication detoxification did not
utilize the "pain cocktail."'^ The
home program activities consti-
tuted a major aspect of treatment
in that patients were given exer-
cise quotas to be performed at
home as well as additional exer-
cises to be performed under the
supervision of therapists on an
outpatient basis. Home programs
also included walking quotas, ex-
ercise quotas, and home relaxa-
tion training. Medical staffing
with the interdisciplinary team to
discuss the patient's progress was
held upon initiation of the pro-
gram, at midpoint and upon dis-
charge. Staff treating these pa-
tients regardless of disciplinary
orientation cooperated in treat-
ment and exchanged information
on patients' progress under an ad-
ministrative management system
referred to as matrix manage-
ment. All patients were given
basic instruction in the principles
of pain management as well as
educational lectures on the uses
and abuses of medication and the
role of the family in rewarding
pain behaviors. Staff was trained
to ignore pain behaviors and re-
ward healthy behavior.
RESULTS. Variables analyzed in
this study consistent with the ob-
jectives of the program included
subjective pain ratings, employ-
ment status, and use of medica-
tions. The means for each of these
variables at pretreatment and one
year followup appear in Table 1.
The data were analyzed by
means of a multivariate analysis
of variance (MANOVA). This al-
lowed for the comparison of the
pretreatment and followup pro-
files at a given level of significance
using pre- and posttreatment
scores as a repeated measurement
variable. The results of the
MANOVA were significant (F =
4.457; P < .01). Significant differ-
ences were found between the
pretreatment variables profile and
the followup variables profile as
shown in Table 1.
As indicated in Table 1, the pa-
tient's subjective report of pain
perception on a behaviorally an-
chored 10-point scale decreased
from 8.3 to 5.4 indicating a sig-
nificant improvement at follow-
up. Similarly, the number of pa-
tients employed increased sig-
nificantly from a pretreatment
8
WISCONSIN MEDICAL JOURNAL, MAY 1985: VOL. 84
CHRONIC PAIN— Vasudevan et al
SCIENTIFIC MEDICINE
level of only 19% to more than
50% at followup. Medication
usage was reduced from 92% to
45% and was also significant at
the 0.01 level.
DISCUSSION. Data collected for
this outpatient pain management
program compare favorably with
outcomes of inpatient treatment.
There was a significant reduction
in subjective pain perception, but
more importantly there was an in-
crease in employment reflecting
the overall activity level of the pa-
tient. Medication reduction is
often one of the major reasons for
inpatient treatment. In that, it is
apparent from the data collected
that outpatient treatment may not
be as successful as inpatient with
regard to medication reduction.
However, further long-term fol-
lowup studies on these patients
will be necessary to adequately
compare inpatient versus out-
patient treatment.
Admittedly "very few chronic
pain patients are ever cured, most
having learned to manage their
pain."i Given the cost compari-
sons between outpatient and in-
patient if outpatient treatment can
approximate the results of in-
patient care, it would seem appro-
priate to choose the former except
in those cases where significant
medication abuse /dependence,
excess pain behavior, or out-of-
town living arrangements require
consideration.
The advantages of outpatient
treatment for the management of
chronic pain are that of low cost,
brief duration, and use of the out-
patient setting. Such programs
permit the patient and the family
to work actively on making
changes in the home environment
and responding differently to pain
behaviors, while the patient is still
actually in the home. Previous
research has emphasized this
aspect of outpatient treatment and
noted that patients in outpatient
programs do not consider them-
selves "sick" and can continue
their usual activities and perhaps
more easily generahze their newly
learned focus on healthy be-
havior.®
All studies reporting long-term
results of chronic pain manage-
ment programs have limitation of
being retrospective and lacking
control groups. Furthermore it is
difficult to ascertain which of the
multiple treatment modalities
used in interdisciplinary treat-
ment programs is responsible for
the changes that occur.
The results mentioned above in-
dicate a degree of success in the
treatment of persistent pain on an
outpatient basis, but many further
questions are left unanswered.
Additional experience and inves-
tigation of longer followup is still
needed. In addition, future studies
should include detailed planning
and followup with regard to ef-
forts to promote generalization
and maintenance of treatment.
Adequate planning for generaliza-
tion of treatment results is most
likely to effect long-term main-
tenance and should be included in
future studies.
REFERENCES
1. Timming RC, et al: Inpatient treatment pro-
gram for chronic pain. Wisconsin Med J 1980:
(May);79:23-26.
2. Dolce JJ: Pain management— a reaffirmation.
The Behavior Therapist 1984;7:38-50.
3. Turk DC, et al: Pain and Behavioral Aledi-
cine—A Cognitive Behavioral Perspective. New
York: Gilford, 1983.
4. Fordyce WE: Behavioral Methods for Chronic
Pain and Illness. St Louis, MO: CV Mosby Co,
1976.
5. Commission on Accreditation of Rehabilita-
tion Facilities: Standards Manual for Facilities
Serving People with Disabilities, 1 984;pp 42-46.
6. Chapman SL, et al: Treatment outcome in a
chronic pain rehabilitation program. Pain
1981:11:225-268. ■
Consensus on tuberculosis treatment
Public health officials should be provided with the legal means
to confine noncooperative sputum-positive tuberculosis patients
at public expense, according to a consensus report appearing in
the April Archives of Internal Medicine. Developed by a national
conference on tuberculosis, the report identifies high-risk
groups, including newly arrived immigrants, nursing home resi-
dents, and nursing home and hospital employees. It recom-
mends continued surveillance of these groups, but says surveil-
lance of the general community should be discontinued, in-
cluding chest x-ray screening programs. Treatment of choice is a
nine-month regimen of isoniazid and rifampin, supplemented by
ethambutol, streptomycin sulfate or pyrazinamide.B
Table 1: Comparison of pre-
treatment and followup data
Pre-
treatment Followup
Pain (0-10
subjective
scale)
8,3 5.4*
Employment
(% employed)
19.0% 52.0%*
Medication
(% utilizing
nonnarcotic
and narcotic
analgesics)
92.0% 45.0%*
•P < ,01
WISCONSIN MEDICAL JOURNAL, MAY 1985: VOL. 84
9
SCIENTIFIC MEDICINE
Hazards of blood and blood products
Case report of post-transfusion Hepatitis-B
Charles E Wirtz, MD
John P Kirchner, MD
Patrick M Maloney, MD
Marshfield, Wisconsin
ABSTRACT. Post-transfusion Hepa-
titis-B is now an infrequent sequela to
transfusion of blood and blood products
in central Wisconsin; however, it still oc-
curs frequently enough that screening for
post-transfusion Hepatitis-B is war-
ranted. A case is discussed in which a pa-
tient acquires post-transfusion Hepa-
titis-B from the transfusion of a single
unit of packed red blood cells. It is evi-
dent that the use of the radioimmunoas-
say for Hepatitis-B surface antigen and
the elimination of donors from lower
socioeconomic groups has had great im-
pact on the reduction of the disease. The
use of "risk free" blood and blood prod-
ucts has not contributed as much as
originally thought to the reduction of the
disease. It is imperative all possible post-
transfusion hepatitis patients be evalu-
ated.
Key words: Transfusion; Hepatitis-B;
Single unit
PosT-TRANSFUSiON Hcpatitis-B is
now a rare sequela to transfu-
sional blood and blood products.*
The following is a case discussion
of post-transfusion associated
Hepatitis-B that demonstrates the
difficulty in the prevention of this
particular malady.
CASE REPORT. A 67-year-old
white male underwent medias-
Reprint requests to: Charles E Wirtz, MD,
1000 North Oak Ave, Marshfield, Wis
54449. Phone: 715/387-5511. Copyright
1985 by the State Medical Society of Wis-
consin.
tinoscopy in April 1982 for bi-
lateral hilar adenopathy. Post-
operatively the patient did well,
and in August of 1982 the patient
presented with jaundice, weak-
ness, and malaise. Transaminases
done at that time showed an
aspartate transaminase (AST) of
1761 (normals 8-36), gamma glu-
tomyl transferase (GGT) of 238
(normals 0-62), total bilirubin of
25.5 with 20.5 units being uncon-
jugated (normals 0-1.3), and glu-
tamic pyruvic transaminase (GPT)
of 1230 (normal 0-32). A hepatitis
screen was performed which
demonstrated Hepatitis-B surface
antigen and antiHepatitis-B core
antibody in the patient's serum.
Physical examination was re-
markable for the patient's severe
jaundice; however, no other ab-
normalities were noted.
Upon interviewing the patient,
the only risk factor for Hepatitis-
B infection elicited was the ad-
ministration of one unit of packed
red blood cells during his medias-
tinoscopy.
COMMENT. Our patient presents
one of the rare cases of post -trans-
fusion associated Hepatitis-B at
the Marshfield Clinic. Hepatitis-B
post-transfusion hepatitis ac-
counts for about 10% of post-
transfusion hepatitis^ and it is fre-
quently anicteric and asympto-
matic.^
Efforts at decreasing post -trans-
fusion Hepatitis-B are aimed at
secreting donor blood for evi-
dence of contamination with
Hepatitis-B or using "low risk"
blood products for transfusion.
Screening of donor blood by using
a radioimmunoassay sensitive for
Hepatitis-B surface antigen has
improved the ability of blood
banks to reject units that are posi-
tive for Hepatitis-B surface anti-
gen."* Yet, Cossant, et al® demon-
strated three cases of post-trans-
fusion Hepatitis-B from blood that
was negative by radioimmunoas-
say for Hepatitis-B surface anti-
gen. To detect contaminated
blood. Lander, et al® advocated the
use of screening for antiHepatitis-
B core antibody in addition to sur-
face antigen screening. Other
authors*' also have noted that the
use of antiHepatitis-B core anti-
body screening of donor units
would result in fewer cases of
non-A, non-B post-transfusion
hepatitis as well.
Another factor in the reduction
of post-transfusion Hepatitis-B is
the gradual elimination of com-
mercial donors. However, as
pointed out by Aach,* one cannot
assume blood products are en-
tirely without risk just because
they are drawn from "volunteer"
donors. In particular, Aach* felt
that the socioeconomic status of
the donor was more important
than the volunteer or nonvolun-
teer status of the donor unit of
blood. He concluded careful selec-
tion of donors rather than blind
reliance on volunteers should be
emphasized.*
Also used to decrease the inci-
dence of post-transfusion Hepa-
titis-B is the use of "low risk"
blood products. Prebil,® in 1974,
described 100 patients who re-
ceived no whole blood during cor-
onary artery bypass graft surgery
and received only washed red
blood cells and synthetic plasma
expanders. In these patients he
documented no cases of post-
transfusion hepatitis. However,
Haugen,® in 1979, documented
cases of post-transfusion Hepa-
titis-B in which the patient re-
ceived only frozen or wa,shed
10
WISCONSIN MEDICAL JOl'RNAL, MAY I985:\'OL. 84
BLOOD PRODUCTS-Wirtz et al
SCIENTIFIC MEDICINE
cells. Thus, both whole blood and
packed cells carry the risk of
transmitting post-transfusion
associated Hepatitis-B.
Autologous transfusion also can
be considered low risk. It has been
shown to decrease the risk of post-
transfusion associated Hepatitis-
B.io However, because of the low
inherent risk of post-transfusion
associated Hepatitis-B, it has not
become as popular as expected.
The use of immune serum glob-
ulin and Hepatitis-B immune
globulin has been investigated in
regards to prophylaxis of post-
transfusion hepatitis. Knodel“
found a benefit from gamma glob-
ulin for prophylaxis for post-trans-
fusion hepatitis; however, Con-
rad^ and Mintz^^ recommended
gamma globulin only for patients
exposed to known Hepatitis-B sur-
face antigen contaminated prod-
ucts and do not recommend it for
routine transfusion prophylaxis.
Other donor risk factors which
increase post-transfusion associ-
ated hepatitis include the use of
first-time donors, use of donors
between the ages of 20 and 50, use
of male donors, and use of black
and Oriental donors, regardless of
sex or age.^ It is interesting to note
the risk for post-transfusion asso-
ciated Hepatitis-B is independent
of the volume of blood or blood
products transfused if this blood is
derived from volunteer sources.^
Although the advent of blood
transfusion has saved innumer-
able lives in the past, it is not
without risk. The above case and
discussion show that while post-
transfusion associated Hepatitis-B
has been decreased, it has not
been eliminated from the practice
of medicine in central Wisconsin.
Practitioners should suspect trans-
fusion associated hepatitis in any
patient exposed to blood or blood
products with elevated trans-
aminases post-transfusion. It is
also important for the practitioner
to report any case of suspected
post -transfusion associated hepa-
titis so the appropriate donors can
be screened and eliminated from
the donor pool.
REFERENCES
1. Aach RD, Cahn RA; Post-transfusion hepa-
titis, current prospectives. Ann Intern Med
1980;92:539-546.
2. Conrad ME: Diseases transmissible by
blood transfusion. Viral hepatitis and other
infectious disorders. Seminars in Hematology
1981(Apr):18(2|.
3. Barker LF. Post-transfusion hepatitis. Epi-
demiology experimental studies in US per-
spective. Bibltha Haemat 1980;46:3-14.
4. Alter HJ, Holland PV, Morrow AG, et al:
Clinical and serological analysis of transfu-
sion associated hepatitis. Lancet 1975
(Nov 11:2:838-841.
5. Cossant YE, Kirsch S, Ismay SL: Post-trans-
fusion hepatitis in Australia. Lancet 1982
(Jan 231:1:208-213.
6. Lander JL, Gitnick GL, et al: Anti-core anti-
body screening of transfused blood. Vox
sang 1978:34:77-80.
7. Stevens E: Hepatitis-B virus antibody in
blood donors and the occurrence of non-A,
non-B hepatitis in transfusion recipients.
Ann Intern Med 1984;101:733-737.
8. Prebil KJ, Diethrich EB: Cardiac surgery
using blood components without whole
blood transfusion. Heart & Lung 1979(Sept-
Oct|;3(5).
9. Haugen, RK: Hepatitis after the transfusion
of frozen red cells and washed red cells. N
Engl J Med 1979:30 1(8):393-395.
10. Silver H: Autologous transfusion. JAMA
1976(Apr 121:235(15).
11. Knodel RG, Ginsberg AL, et al: Efficacy of
prophylactic gamma globulin in preventing
non-A, non-B post-transfusion hepatitis.
Lancet 1976(Mar 13|; 1:557-561.
12. Mintz, PD: Strategies for the prevention of
post-transfusion hepatitis. Ann Clin Lab Sci
1984:14(31:198-207. ■
ABSTRACT
Postoperative surveillance: An effective means of detecting
correctable lesions that threaten graft patency
WILLIAM D TURNIPSEED, MD; CHARLES W ARCHER, MD, Department of
Surgery, University of Wisconsin Hospital (Dr Turnipseed) and the Veterans Ad-
ministration Hospital (Dr Archer), Madison, Wis: Arch Surg 1985 (Mar); 120:324-
328.
Thirteen patients with recurrent ischemia following previous
vascular surgery and 13 patients with primary ischemia were pros-
pectively evaluated with segmental Doppler pressure indices and
selective intravenous digital subtraction angiography. Ten patients
with recurrent postoperative ischemia had thrombosed bypasses,
and three had stenosed but patent grafts. Eight (62%) of the 13 pa-
tients had successful vascular repair, the rest had amputations. All
patients with previous vascular surgery and those with primary
bypasses were prospectively followed up with segmental Doppler
pressure indices. Falling segmental Doppler pressure index values
occurred in eight patients and in six patients prior to onset of recur-
rent ischemia. Intravenous digital subtraction angiography demon-
strated correctable stenotic lesions in the six asymptomatic patients
and untreatable host vessel occlusion in two symptomatic patients.
Corrective surgery successfully preserved patency of all stenosed
grafts. In summary, postoperative surveillance can detect occlusive
changes before recurrent symptoms occur. Repair of stenosed
grafts is more successful than repair of occluded grafts. ■
1 1
WISCONSIN MEDICAL JOURNAL, MAY 1985: VOL. 84
SCIENTIFIC MEDICINE
Absent serum thyroxine in a hypothyroid
man with severe nonthyroidal illnesses
Gary G Wickus, PhD and Robert H Caplan, MD
La Crosse, Wisconsin
ABSTRACT. We studied a hypothyroid
patient with severe postoperative com-
plications. Thyroxine therapy was dis-
continued after surgery. After the onset
of the critical nonthyroidal illnesses, the
patient's thyroxine fell more rapidly than
expected to undetectable levels. The insti-
tution of intravenous thyroxine therapy
did not produce the anticipated rise in
serum thyroxine. Since the metabolism of
iodothyronines can be markedly altered
during nonthyroidal illnesses, we suggest
that hypothyroid patients should have
frequent measurements of serum thy-
roxine performed during serious non-
thyroidal illness.
Key words: Hypothyroidism; Thyroxine
therapy: lodothyronine metabolism in
nonthyroidal illness
Patients with a variety of non-
thyroidal illnesses have decreased
levels of thyroxine (T4), 3,5,3'-tri-
iodothyronine (T3), and the re-
spective free hormone indices.' ^
These patients display normal
levels of thyrotropin (TSH) and
are believed to be clinically euthy-
roid. A low thyroid hormone
status, however, which may ini-
tially be adaptive may eventually
compromise cellular function.^
We report herein a hypothyroid
patient in whom the serum T4
concentration rapidly fell to un-
detectable levels after he devel-
oped critical postoperative com-
From the Departments of Internal Medi-
cine and Clinical Laboratories, Gundersen
Clinic Ltd and La Crosse Lutheran Hos-
pital, La Crosse. Reprint requests to:
Robert H Caplan, MD, 1836 South Ave, La
Crosse, Wis 54601. Phone: 608/782-7300.
Copyright 1985 by the State Medical
Society of Wisconsin.
plications. Intravenous thyroxine
therapy did not result in the ex-
pected increase in serum T4.^
CASE REPORT. After coronary
artery bypass surgery a 69-year-
old diabetic man suffered multiple
pulmonary emboli and developed
Staphylococcus aureus infections of
the incision, pleural space, and
blood. On the 8th postoperative
day he sustained a cardiopul-
monary arrest and developed per-
sistent hypotension, progressive
renal failure, and hepatic failure.
Despite treatment with dopamine
infusions, renal hemodialysis, and
other intensive supportive meas-
ures, his clinical status progres-
sively deteriorated.
Two years prior to coronary
artery bypass surgery the patient's
serum T4 was 3.2 pg/dL (expected
range, 5.0-12.5 pg/dL) and the
serum TSH was 27 pU/ml (ex-
pected range, 0-9 pU/ml). A diag-
nosis of primary hypothyroidism
was made, and he was treated
with oral thyroxine (0.15 mg/day).
On the day of surgery he was clin-
ically euthyroid, and his T4 was
normal (Fig 1). Thyroxine was not
restarted immediately after sur-
gery. Fifteen days after surgery
we could not measure serum T4
(minimum detectable level, 0.1
pg/dL).
A retrospective analysis of pre-
served serum samples revealed
that a rapid drop in T4 concentra-
tion occurred between the 12th
and 15th postoperative day (Fig 1).
We added known amounts of thy-
roxine to samples of the patient's
serum which contained no detec-
table hormone, and total recovery
of the added thyroxine confirmed
that the absence of thyroxine in
the patient's serum was not an
artifact due to an interfering
agent.
Postoperatively, the serum T3
concentration (expected range,
75-165 Pg/dL) also dropped to
almost undetectable levels, and
rTs (expected range, 5.8-19.4
Pg/dL) was elevated (Fig 1). Ex-
cept for values of 57% and 51% on
the days when T4 was not detec-
table, the T3 uptake values ranged
from 47% to 50% (expected range,
34-44%).
The serum albumin fell from
4.2 to 1.9 g/dL during his illness,
but the level of the thyroxine
Figure 1— Effects of severe nonthyroidal
disease on serum levels of thyroxine (T^j,
triiodothyronine (T3), reverse triiodothy-
ronine (rTsj, and thyrotropin (TSH) in a
hypothyroid patient without thyroid hor-
mone replacement. Hormone levels after
intravenous administration of thyroxine
are also shown. Expected ranges: T4,
5.2-11.2 pg/dL; T3, 75-165 pg/dL; rTs,
5.8-19.4 Pg/dL; TSH, 0-9pU/ml.
Intravenous
0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30
Days
12
WISCONSIN MEDICAL JOURNAL, MAY 1985: VOL. 84
NONTHYROIDAL ILLNESSES-Wickus & Caplan
SCIENTIFIC MEDICINE
binding globulin remained within
normal limits (13 jLig/ml; expected
range, 12-28 pg/ml). Serum TSH
remained within the expected
range (Fig 1).
From the 16th postoperative
day the patient was treated with
intravenous thyroxine; the rise in
serum iodothyronines (Fig 1) was
modest and less than expected/
Because of the patient's moribund
condition, we were not able to
judge clinically his thyroid status.
He died on the 29th postoperative
day.
DISCUSSION. Patients with a var-
iety of nonthyroidal illnesses fre-
quently show reductions in the
serum T3 concentration resulting
from impaired T4 to T3 conver-
sion* ^ The diminished 5'-mono-
deiodination of T4 often results in
an elevation of rT3. Severely ill,
often moribund patients may also
display reductions in serum
T4.* 23 The mechanism for T4
reduction in critically ill patients
is not completely known. The re-
duction of T4 binding proteins
present in our patient was not suf-
ficient to produce the marked re-
duction of T4. The more rapid
than expected decline of T4 in our
patient suggests accelerated T4
clearance, a mechanism demon-
strated by others in severely ill
patients with the low T4 syn-
drome®® The less than expected
rise in T4 during intravenous thy-
roxine therapy is also consistent
with increased T4 clearance as a
cause of the undetectable T4 in our
patient. Dopamine infusion sub-
stantially reduces serum TSH and
thereby T4 and T3 secretion in
both euthyroid and hypothyroid
patients’" and probably also con-
tributed to the low levels of
iodothyronine concentrations in
our patient.
The T3 uptake values were not
markedly elevated as might be ex-
pected if an inhibitor of T4 binding
to serum proteins was present.®
Falsely low T3 uptake values that
do not reflect the altered state of
serum T4 binding, however, may
be caused by serum T4 binding
inhibitors that also prevent the
ability of the secondary binding
agents in the T3 uptake assay to
bind T3.2
The therapeutic implications
are not clear. Lowered thyroid
hormone concentration in a pre-
viously euthyroid patient may
represent, at least at early stages,
an adaptation to severe illness,
and some authorities do not
recommend thyroid hormone
treatment.® On the other hand, as
the amount of thyroid hormone
falls to extremely low levels, even
euthyroid patients may suffer
detrimental effects on cell func-
tion.® We believe that hypothy-
roid patients should have frequent
serum T4 measurements per-
formed during serious nonthy-
roidal illness, especially if thy-
roxine supplementation is tem-
porarily stopped. Further studies,
however, are needed to determine
whether hypothyroid patients
during severe illness would bene-
fit from larger than usual replace-
ment doses.
Acknowledgments: The authors wish to
thank the Department of Special Chemis-
try of the La Crosse Lutheran Hospital for
expert technical assistance, and Janet Potts
and Patti Bieber for secretarial assistance.
This work was supported in part by a
grant from the Trane Company Founda-
tion administered through the Gundersen
Medical Foundation.
REFERENCES
1. Wartofsky L, Burman KD: Alterations in
thyroid function in patients with systemic ill-
ness. Euthyroid sick syndrome, Endo Rev
1982;3:164-217.
2. Chopra IJ, Hershman JM, et al: Thyroid func-
tion in nonthyroidal illnesses. Ann Int Med
1983:98:946-957.
3. Baue AE, Gunther B, Hard W, et al: Altered
hormonal activity in severely ill patients after
injury or sepsis. Arch Surg 1984,119:1125-
1132.
4. Ladenson PW, Goldenheim PD, Cooper DS,
et al: Early peripheral responses to intra-
venous L-thyroxine in primary hypothyroid-
ism. Am J Med 1982;73:467-474.
5. Kaptein EM, Robinson WJ, et al: Peripheral
serum thyroxine, triiodothyronine and re-
verse triiodothyronine kinetics in the low
thyroxine state in acute nonthyroidal ill-
nesses: Noncompartmental approach./ Clin
Invest 1982;69:526-535,
6. Stockigt JR, Barlow J W, Lim CF, et al: Rapid
decline in serum T4 during severe nonthy-
roidal illness with altered relationship be-
tween immunoreactivity and binding capa-
city of thyroxine binding globulin. Program
of the 59th Annual meeting of the American
Thyroid Association, New Orleans, LA, Oct
5-8, 1983, T 34, abs 66.
7. Kaptein EM, Spencer CA, et al: Prolonged
dopamine administration and thyroid hor-
mone economy in normal and critically ill
patients. J Clin Endocrinol Metab 1980;51:
387-393.
8. Frankenfeld E, Green WL, Kenny MA: Low
T4 levels, hypoalbuminemia and altered
binding to serum proteins in the critically ill.
Program of the 59th Annual meeting of the
American Thyroid Association, New
Orleans, LA, Oct 5-8, 1983, T 34, abs 67. ■
WISCONSIN MEDICAL JOURNAL, MAY 1985: VOL. 84
13
SCIENTIFIC MEDICINE
Leptospirosis in Wisconsin: Report
of a case associated with direct
contact with raccoon urine
Victor S Falk, MD, Edgerton, Wisconsin
ABSTRACT. Two cases of leptospirosis
were reported in Wisconsin in 1 984. The
confirmed case, reported here, was attri-
buted to raccoon urine being precipitated
into the patient's upturned face. Lepto-
spirosis is a worldwide zoonosis. The ini-
tial phase is characterized by headaches,
severe muscular aches, chills, and fever.
Fever and meningismus may occur with
the second phase. Weil's syndrome is a
form of severe leptospirosis with jaundice
and usually azotemia, hemorrhages,
anemia, disturbances of consciousness,
and continued fever. Man is actually an
accidental host, becoming infected
through occupational exposures, inva-
sion of wildlife environment, and through
close contact with infected pets. All
mammals are capable of becoming in-
fected. The diagnosis in this case was
established serologically at the Centers
for Disease Control in Atlanta.
Key words: Leptospirosis: Weil's syn-
drome
Only two cases of leptospiro-
sis were reported in Wisconsin in
1984. Information from the State
Division of Health indicates that a
probable case occurred in a labor-
atory worker in Madison who
contracted the disease from a dog.
The confirmed case, reported
here, was attributed to a definite
exposure to raccoon urine. There
were also two cases diagnosed in
Reprint requests to: Victor S Falk, MD,
5 West Rollin St, Edgerton, Wis 53534.
Phone: 608/884-3371, Copyright 1985 by
the State Medical Society of Wisconsin.
dogs at the school of Veterinary
Medicine at the University of
Wisconsin-Madison in 1984.
Leptospirosis is a worldwide
zoonosis. The term includes all in-
fections due to organisms of the
genus Leptospira, and 130 to 150
serotypes have been identified.
Leptospires are spirochetes and
thus are related to Trepanema
pallidum. Leptospirosis is found
in several domestic and wild ani-
mal hosts, and the disease varies
from a minor illness to fatal out-
come. Animals may become car-
riers and shed leptospires in their
urine for months. Human infec-
tions may result from direct con-
tact with an infected animal's
urine or tissue or indirectly by
contact with contaminated water
or soil. Minor skin lesions and
mucous membranes and conjunc-
tivae are the common portals of
entry in man. It can occur at any
age, but 75% of those infected are
males. It is seen as an occupa-
tional disease particularly among
farmers, sewer workers, slaugh-
terhouse workers, veterinarians,
and others with frequent ex-
posure with animals; but most
commonly exposure is accidental
in recreational activities. Dogs,
rats, and swimming in contami-
nated water are regarded as the
most frequent sources. From 25 to
145 cases are reported annually in
the United States and these occur
mainly in summer and autumn.
The incubation period varies
from 2 to 20 days and the disease
is usually in two phases. The lep-
tospiremic phase comes on sud-
denly with headaches, severe
muscular aches, chills, and fever.
This may last four to nine days
with recurrence of chills and
fever. After abatement of fever
the second or immune phase oc-
curs from the 6th to 12th day. It is
then the antibodies appear in the
serum. Fever and meningismus
may then recur.
Weil's syndrome is a form of
severe leptospirosis with jaundice
and usually azotemia, hemor-
rhages, anemia, disturbances in
consciousness, and continued
fever. Renal abnormalities result
in proteinuria, pyuria, hematuria,
and azotemia. Hemorrhagic mani-
festations are due to capillary in-
juries. Hepatic damages are mini-
mal, and complete healing usually
occurs. There is no mortality in
anicteric patients, but with the oc-
currence of jaundice the mortality
is about 15%. This rate is doubled
in patients over 60 years of age.i
CASE REPORT. This 22-year-old
white male came to the emer-
gency room at the Edgerton Hos-
pital late in October 1984. He
complained of headache, anor-
exia, photophobia, nausea and
vomiting, and episodes of hema-
temesis. This had begun earlier
that same day and became pro-
gressively worse. The initial im-
pression was that he had an acute
viral syndrome and he was given
erythromycin and sent home. The
following day he called to report
that his temperature was up to
104 F (40 C) and that he had a stiff
neck and backache. Hospitaliza-
tion was advised but he declined
at that time. However, the next
day he returned to the emergency
room because of worsening of the
symptoms including diffuse
myalgia, abdominal tenderness,
and one episode of hematuria. He
then reported that several days
14
WISCONSIN MEDICAL JOI RNAL, MAY 1985: VOL. 84
LEPTOSPIROSIS-Falk
SCIENTIFIC MEDICINE
prior to admission he had been
bitten by a wild raccoon he was
carrying in a burlap bag and also
that he was exposed to raccoon
urine. It was subsequently
learned that the contact with the
raccoon urine was prior to the
capture of the raccoon when it
was still in the tree, and it had
urinated into the upturned face
and mouth of the patient.
Backache was so prominent a
symptom when he was first seen
that the physician in the emer-
gency room had ordered x-ray
studies of the lumbo-sacral spine.
These were read as normal along
with a normal chest x-ray film.
Because of the patient's severe
frontal-parietal headache and stiff
neck when he returned, a lumbar
puncture was done in the emer-
gency room. The spinal fluid was
reported as being entirely normal.
The laboratory returns were in-
teresting and significant. When
the patient was initially seen in
the emergency room, his white
blood cell count was 4,200 per cu
mm with 60 segmented neutro-
phils and 7 band forms. On admis-
sion the WBC count was up to
8,200 per cu mm with 65 seg-
mented neutrophils and 17 band
forms. The urinalysis showed
only a small amount of occult
blood, 1-3 RBCs and 15-20 WBCs
per high-power field and 1 -l- bac-
teriuria. However, a repeat urin-
alysis showed 4-1- urobilinogen
and was positive for bile. The
chemistry panel was significant
for serum glutamic-oxaloacetic
transaminase of 106 (7-27), lactic
dehydrogenase of 162 (50-134),
total bilirubin 4.9 (0.2-1. 5), serum
glutamic-pyruvic transaminase
114 (7-30), alkaline phosphatase
230 (26-99), and globulin of 3.5
(1. 5-3.0). (Normal values are in
parentheses).
Intravenous fluids were started
as the patient was quite dehyd-
rated, and he was given injections
of prochlorperazine (Compazine®)
and meperidine hydrochloride
(Demerol®) for nausea and pain.
Intravenous cefazolin sodium was
also started. Hepatitis A and B
were considered, but there was no
serologic evidence of either.
Three weeks later his chemistry
panel returned to normal except
for a slightly elevated alkaline
phosphatase. At the same time,
the serum was sent to the Centers
for Disease Control in Atlanta.
Using the Microscopic Agglutina-
tion Test, it was positive for three
serovars of leptospirosis whereas
the serum from three weeks be-
fore was entirely negative. The
positive antigens were L. carcicola
(200), L. grippotyphosa (1600) and
L. djasiman (3200). This was con-
sidered diagnostic for leptospiro-
sis.
The patient recovered unevent-
fully and returned to work.
DISCUSSION. Leptospirosis is a
common zoonotic disease of live-
stock, pet animals, and wildlife in
the United States. Man is an acci-
dental host that becomes infected
through occupational exposures,
through invasion of wildlife envi-
ronment, and through close con-
tact with infected pets. The
human infection is exhausted
within itself, and it is only in ex-
tremely rare instances that it is the
cause of fresh cases of the illness.
Apparently all mammals are capa-
ble of becoming infected. In a
survey in Detroit almost 40% of
stray dogs were found to have
significant titers for leptospiral ag-
glutinins and 92% of the rats were
infected. Other surveys showed a
large number of wildlife hosts in-
volved in all regions of the world.
Death resulted in sea lions off the
coast of California when the sea
lions contacted infected surface
water on land. It also has been
estimated that in the United States
15% of the cattle, or 18 million,
and 8% of the swine, or 5 million,
would be positive reactors. This
would be even higher in Central
and South America where the dis-
ease is more extensive.
Because of the widespread pres-
The Editorial Board en-
courages other physicians
to submit interesting and
informative case reports
such as this one.
ence of leptospires and the possi-
ble exposure to humans, physi-
cians must consider leptospirosis
in the differential diagnoses which
would include meningitis, menin-
goencephalitis, influenza, hepa-
titis, acute cholecystitis, and renal
failure. Treatment is with anti-
biotics and penicillin is recom-
mended. Tetracycline is the alter-
native for pencillin-allergic chil-
dren under eight years of age.
Fluid and electrolyte therapy is
necessary for azotemia or jaun-
dice. Isolation is not required
since nosocomial transmission
has not been reported, but care
must be taken in disposing of the
urine.
Prevention of leptospirosis is
difficult because of the extensive
reservoirs in nature. Hygienic
measures in occupational sites are
necessary for those working with
animals. Protective clothing is
recommended for those in contact
with water and soil potentially
contaminated with animal urine.
Rat control programs and the im-
munization of livestock limit ma-
jor animal reservoirs. Swimming
in contaminated water should be
avoided. Prevention by the annual
leptospiral immunization of dogs
is of limited value since the vac-
cine contains only two serovars. ^
REFERENCES
1. The Merck Manual, 14th ed. Rahway, NJ:
Merck Sharp & Dohme Research Labora-
tories, 1982, pp 146-147.
2. Peter G: Leptospirosis: a zoonosis of protean
manifestations. Fed Inf Dis 1982;1(4):282-
287 ■
WISCONSIN MEDICAL JOURNAL, MAY 1985: VOL. 84
5
SCIENTIFIC MEDICINE
Mannitol-induced renal insufficiency
Peter W Gutschenritter, MD
Kermit L Newcomer, MD
Philip J Dahlberg, MD
La Crosse, Wisconsin
ABSTRACT. We present a case of a
young woman who suffered a cerebro-
vascular occlusion and developed
marked intracranial hypertension. After
large doses of mannitol were adminis-
tered, the patient developed acute renal
failure which resolved when the mannitol
was discontinued. We hypothesize high
dose mannitol administration can induce
acute renal failure.
Key words: Mannitol; Acute renal failure
M ANNITOL IS AN osmotic diure-
tic commonly used for the treat-
ment of increased intracranial
pressure. We have recently
treated a young woman who suf-
fered a cerebrovascular occlusion
and subsequently developed ele-
vated intracranial pressure. She
developed acute renal failure
associated with mannitol intoxi-
cation. The renal failure resolved
after discontinuation of the
mannitol.
CASE REPORT. A 23-year-old
white female was brought to the
emergency room after she was
found unresponsive. She was a
two-pack-per-day smoker and was
taking oral contraceptives.
On examination she was awake
but unresponsive to questioning.
She exhibited a flaccid right hemi-
Reprint requests to: Peter W Gutschen-
ritter, MD, Gundersen Clinic Ltd, 1836
South Ave, La Crosse, Wis 54601. Phone:
608/782-7300. Copyright 1985 by the
State Medical Society of Wisconsin.
paresis and vigorously moved her
left extremities. A computed
tomographic scan of the brain
showed a large area of decreased
density in the left frontotemporal
region. Carotid arteriography
demonstrated complete occlusion
of the left internal carotid artery.
She was not felt to be a surgical
candidate. The patient was treated
with 4 mg dexamethasone intra-
venously every four hours. Serum
creatinine on admission was 0.8
mg/dL.
On the 3rd day of her hospitali-
zation, she deteriorated neuro-
logically. She was unresponsive to
painful stimuli and showed no
movement of any extremity. A
computed tomographic scan of
the brain was repeated and dem-
onstrated a shift of the midline to
the right and marked cerebral
edema. Subsequently, the heart
rate dropped to between 30 and
40 beats per minute, but intra-
arterial blood pressure monitoring
showed maintenance of systolic
blood pressure at 120 mmHg. An
intracranial pressure monitor was
placed and initial readings were
between 40 and 50 mmHg. The
patient was intubated and hyper-
ventilated. Intravenous mannitol
was prescribed at 20 Gm every
two hours. When the intracranial
pressure failed to respond to these
doses, the dose was increased to
60 Gm of mannitol every hour.
On the 4th hospital day she re-
ceived a total of 1,095 Gm of intra-
venous mannitol. Over the next
several days the patient demon-
strated no improvement in her
neurologic status.
On the 8th day the patient's
urine output dropped to 14 ml per
hour and the following laboratory
studies were obtained: serum
creatinine 5.2 mg/dL, serum
sodium 127 mmol/L, serum
potassium 6.3 mmol/L, serum
chloride 98 mmol/L, serum car-
bon dioxide 18.6 mmol/L, urine
sodium 20 mmol/L, urine crea-
tinine 48 mg/dL; serum osmolal-
ity was 412 mosm/kg and urine
osmolality 398 mosm/kg. The cal-
culated osmolality* was 87
mosm/L less than measured
osmolality and the estimated
mannitol concentration was 1583
mg/dL.** The mannitol was dis-
continued and intravenous furo-
semide was given. Brisk urine out-
put resumed and the patient's
weight dropped 5.2 kg over the
subsequent two days. On the 10th
day, serum creatinine had fallen
to 2. 1 mg/ dL. Serum sodium rose
to 161 mmol/L. Urine osmolality
was 754 mosm/L at this time.
At this point her clinical exami-
nation showed no evidence of
neurologic activity. An electro-
encephalogram confirmed the
diagnosis of brain death. Respira-
tory support was withdrawn and
the patient died on the 10th day.
DISCUSSION. Temporally this pa-
tient's episode of acute renal
failure was related to severe man-
nitol intoxication. Acute tubular
necrosis secondary to decreased
perfusion is unlikely in the face of
normal continuous intraarterial
blood pressure readings, a frac-
tional excretion of sodium of 1.7,
and no clinical evidence of vol-
*Based on the formula:
2|Na| -I- [glucose] -r [BUN] = serum
osmolality, 18 2.8
“The calculation assumes the 87
mosm/L gap is accounted for by
mmoles/ L of mannitol. The molecular
weight of mannitol is 182 mg/ mmole.
Therefore, the estimated concentration of
mannitol is:
87 mmoles/L x 182 mg/5mmole = 1583 mg/dL.
lOdl/L
16
WISCONSIN MEmC/U.JOliRNAI., MAY 1985: VOL. 84
RENAL INSUFFICIENCY-Gutschenritter et al
SCIENTIFIC MEDICINE
ume depletion. Other medications
received during her hospitaliza-
tion included 10 mg diazepam
intramuscularly four times daily,
10 mg dexamethasone intraven-
ously every four hours, 60 mg co-
deine intramuscularly every six
hours and 30 ml Maalox per naso-
gastric tube every four hours.
Resolution of her renal failure
promptly followed withdrawal of
the mannitol and administration
of furosemide. The abrupt rise in
serum sodium concentration after
discontinuing the mannitol can be
attributed to the diuresis of water
in excess of sodium and the shift
of water from the extracellular
space into the intracellular space.
The infusion of hyperosmotic
agents and their effects on the
renal parenchyma have been
studied by several authors, i
The most consistent finding is
swelling and vacuolization of the
cells lining the proximal con-
voluted tubules. These changes
have been induced in laboratory
animals using mannitol as well as
other hypertonic infusions. Dal-
gaard and Pedersen^ confirmed
similar changes in man when they
performed a renal biopsy on a
man three hours after mannitol in-
fusion. None of these authors re-
lates a decline in renal function to
these histologic changes. Dextran
40, a high molecular weight
plasma expander, has been asso-
ciated with renal failure in some
patients.®'^® Histologically, vacu-
olization of the tubular epithelial
cells has been noted. However,
dextran 40 causes a very viscous
urine and some authors feel that
tubular sludging and obstruction
may account for the renal insuf-
ficiency seen in these patients.
We hypothesize that vacuoliza-
tion and its relationship to renal
function lies on a continuum. The
excessive doses of mannitol used
in our patient may have caused a
degree of tubular change that
compromised renal function. The
renal impairment was rapidly
reversed by stopping the drug.
REFERENCES
1. Stahl WM: Effect of mannitol on the kidney.
N Engl J Med 1965;272:381-386.
2. Taggart WR, Thibodeau GA, Swanson RN:
Mannitol-induced renal alterations in rab-
bits. South Dakota J Med 1968;21:30-34.
3. Maunsbach AB, Madden SC, Latta H: Light
and electron microscopic changes in proxi-
mal tubules of rats after administration of
glucose, mannitol, sucrose or dextran. Lab
Invest 1962;11:421-432.
4. Lindberg HA, Wald MH, Barker MH: Renal
changes following administration of hyper-
tonic solutions. Arch Intern Med 1939:63:
907-918.
5. Dalgaard OZ, Pedersen KJ: Some observa-
tions of the fine structure of human kidney
biopsies in acute anuria and osmotic
diuresis. In: Wolstenholme GEW, Cameron
MP: Renal Biopsy. Boston: Little, Brown &
Co, 1962.
6. Morgan TO, Little JM, Evans WA: Renal
failure associated with low-molecular-
weight dextran infusion. Br Med J 1966;2:
737-739.
7. Maillous L, Swartz CD, Capizzi R, et al:
Acute renal failure after administration of
low-molecular-weight dextran. N Engl J Med
1967:277:1113-1118.
8. Data JL, Nies AS: Dextran 40. Ann Intern
Med 1974:81:500-504.
9. Whelan TV: Acute renal failure associated
with mannitol intoxication. Arch Intern Med
1984:144:2053.
10. Goldwasser P, Fotino S: Acute renal failure
following massive mannitol infusion. Arch
Intern Med 1984:144:2214. ■
Multiple biopsies linked to metastases
Multiple biopsies of pancreatic tumors increase the risk of
rapid intra-abdominal spread of tumor, researchers from the
Thomas Jefferson University Hospital in Philadelphia report in
the April Archives of Surgery. Stephen M Weiss, MD, and col-
leagues, say they reviewed 62 patients with pancreatic cancer
undergoing repeat laparotomy to identify risk factors associated
with metastases. "Patients who underwent two or more opera-
tive biopsy procedures were at a markedly increased risk of de-
veloping intra-abdominal tumor seeding," they say. Among
alternative diagnostic procedures they suggest is percutaneous
fine-needle aspiration biopsy assisted by computed tomography. ■
Recurrent genital herpes a trivial disorder
Genital herpes simplex virus infection can be viewed es-
sentially as a trivial disorder, "causing patients minor physical
discomfort and some alteration in the pattern of their normal
sexual activity," writes Stanley M Bierman, MD, FACP, of
UCLA School of Medicine, in the April Archives of Dermatology.
While it can threaten a fetus at term, "the simple clinical fact
remains that the disease is a benign, self-limiting infection for
most healthy individuals," he adds. Unfortunately, this is not
how most affected inidividuals view the affliction, and psycho-
social issues associated with herpes infection have made it much
more difficult to manage than it should be, he suggests.*
WISCONSIN MEDICAL JOURNAL, MAY 1985: VOL. 84
17
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In patients with known or suspected renal impairment, make careful clinical
observation and appropriate laboratory studies prior to and during therapy as
cephradine accumulates in the serum and tissues. See package insert for
information on treatment of patients with impaired renal function. Prescribe
cephradine with caution in individuals with a history of gastroinfestinal dis-
ease, particularly colitis. Prolonged use of antibiofics may promote the over-
growth of nonsusceptible organisms. Take appropriate measures should
superinfection occur during therapy. Indicated surgical procedures should be
performed in conjunction with antibiotic therapy.
Information for Patients: Caution diabetic patients that false resulfs
may occur wifh urine glucose tests (see PRECAUTIONS, Drug/Laboratory
Test Interactions). Advise the patient to comply with the full course of therapy
even if he begins to feel better and to take a missed dose as soon as possible.
Tell the patient he may take this medication with food or milk since G.l. upset
may be a factor in compliance with the dosage regimen. The patient should
report current use of any medicines and should be cautioned not to take other
medications unless the physician knows and approves of fheir use (see
PRECAUTIONS, Drug Interacfions).
Laboratory Tests: In patienfs with known or suspected renal impair-
ment, it is advisable to monitor renal function.
Drug Interactions: When administered concurrently, the following drugs
may interact with cephalosporins:
Otherantibacterial agents — Qac[ems\a\s may interfere with the bacterici-
dal action of cephalosporins in acute infection; other agents, e g., amino-
glycosides, colistin, polymyxins, vancomycin, may increase the possibility of
nephrotoxicity.
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© 1985E R Squibb & Sons, Inc , Princeton, NJ 08540 785-501 A Issued Jan 1985 Printed in U S A
VELOSEFcapsules
(Cephradine Capsules USP]
BID
Diuretics (potent “loop diuretics," e.g., furosemide and ethacrynic acid)
— Enhanced possibility for renal toxicity.
Probenecid — Increased and prolonged blood levels of cephalosporins,
resulting in increased risk of nephrotoxicity.
Drug/Laboratory Test Interactions; After treatment with cephradine, a
false-positive reaction for glucose in the urine may occur with Benedict’s
solution, Fehling's solution, or with Clinitest® tablets, but not with enzyme-
based tests such as Clinistix® and Tes-Tape®. False-positive Coombs test
results may occur in newborns whose mothers received a cephalosporin prior
to delivery. Cephalosporins have been reported to cause false-positive reac-
tions in tests for urinary proteins which use sulfosalicylic acid, false
elevations of urinary 17-ketosteroid values, and prolonged prothrombin
times.
Carcinogenesis, Mutagenesis: Long-term studies in animals have not
been performed to evaluate carcinogenic potential or mutagenesis.
Pregnancy Category B: Reproduction studies have been performed in
mice and rats at doses up to 4 times the maximum indicated human dose and
have revealed no evidence of impaired fertility or harm to the fetus due to
cephradine. There are, however, no adequate and well-controlled studies in
pregnant women. Because animal reproduction studies are not always predic-
tive of human response, use this drug during pregnancy only if clearly
needed.
Nursing Mothers: Since cephradine is excreted in breast milk during
lactation, exercise caution when administering cephradine to a nursing
woman.
Pediatric Use: Adequate information is unavailable on the efficacy of
b.i.d. regimens in children under nine months of age.
ADVERSE REACTIONS; Untoward reactions are limited essentially to G.l.
disturbances and, on occasion, to hypersensitivity phenomena. The latter are
more likely to occur in persons who have previously demonstrated hypersen-
© 1985 E.R. Squibb & Sons, Inc.
sitivify and those with a history of allergy, asthma, hay fever, or urticaria.
The following adverse reactions have been reported following use of
cephradine: G.l. — Sympfoms of pseudomembranous colifis can appear dur-
ing antibiofic fherapy; nausea and vomiting have been reported rarely. Skin
and Hypersensitivity Reactions — mild urticaria or skin rash, pruritus, joint
pains. Hematologic — mild transient eosinophilia, leukopenia and neutrope-
nia. Liver — transient mild rise of SGOT, SGPT, and total bilirubin with no
evidence of hepatocellular damage. Renal — transitory rises in BUN have
been observed in some patients treated with cephalosporins; their frequency
increases in patients over 50 years old. In adults for whom serum creatinine
determinations were performed, the rise in BUN was not accompanied by a
rise in serum creatinine. Others — dizziness, tightness in the chest, and
candidal vaginitis.
DOSAGE; Adults — For respiratory tract infections (other than lobar
pneumonia) and skin and skin structure infections: 250 mg q. 6 h or 500 mg
q. 12 h. For lobar pneumonia: 500 mg q. 6 h or 1 g q. 12 h. For uncompli-
cated urinary tract infections: 500 mg q. 12 h; for more serious UTI, including
prostatitis, 500 mg q. 6 h or 1 g q. 12 h. Severe or chronic infections may
require larger doses (up to 1 g q. 6 h). For dosage recommendations in
patients with impaired renal function, consult package insert.
Children over 9 months of age — 25 fo 50 mg/kg/day in equally divided
doses q. 6 or 12 h. For otitis media due to H. influenzae: 75 to 100 mg/kg/day
in equally divided doses q. 6 or 12 h but not to exceed 4 g/day. Dosage for
children should not exceed dosage recommended for adults. There are no
adequate data available on efficacy of b i d. regimens in children under 9
months of age.
For full prescribing information, consult package insert.
HOW SUPPLIED: 250 mg and 500 mg capsules in bottles of 24 and 100
and Unimatic® unit-dose packs of 100. 125 mg and 250 mg for oral suspen-
sion in bottles of 100 ml and 200 ml.
785-501 Issued: Jan. 1985
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SPECIAL
FIRST WOMAN PRESIDENT OF THE MEDICAL SOCIETY OF MILWAUKEE COUNTY
We are in an era of many changes . . . Lucille B Glicklich, MD, Milwaukee
It s an honor to stand here as
your first woman president— it' s
a change. We are in an era of
many changes— dramatic, rapid
changes which have taken the
physician from an autonomous
private practice of two or three
decades ago to the present day
when the physician is a member
of the health industry— the sec-
ond largest industry in the
country employing millions of
people and involving billions of
dollars. We could speculate as to
whether this was progress or
regression but it would be to no
avail because this is where we
now are.
For a long while we mourned
the physician who was long on
compassion, courage, and pa-
tience but had little sophistication
and knowledge of the ways of
modern medicine and tech-
Doctor Glicklich, first woman presi-
dent in the history of the Medical
Society of Milwaukee County, pre-
sented this installation address at the
138th Annual Meeting of the Society,
January 17, at the Milwaukee Ath-
letic Club in Milwaukee.
Lucille B Glicklich, MD
nology. Today our physicians are
long on knowledge and skill but
we find ourselves deficient when
it comes to the realms of manage-
ment, marketing, competition,
joint ventures, and all which
comprise the world of business.
No longer can we view our-
selves as the only purveyors of
healthcare but are partners in a
system which consists of hos-
pitals, nurses, administrators,
dentists, pharmacists, third party
payors, business, labor, industry,
and government, to mention a
few. We are all interested in
serving the patient- client- cus-
tomer as the case may be, and all
of us are interested in good out-
comes. We are all also interested
in fair and adequate reimburse-
ment. We may, however, have
different definitions of what is a
good outcome and what is fair
and adequate reimbursement.
We may find many areas in
which our roles as individualist
physicians who practice for the
individual needs of our patients
are threatened. We find ourselves
forced into standards of practice
which are dictated by govern-
ment regulation and by the third
parties who are responsible for
paying the bills for our services.
It makes us very uncomfortable
that our patient's welfare may de-
pend upon decisions made by
nonphysicians.
When faced with such knotty
problems, I find it helpful to go
back to basics and try to clarify
the issues from the standpoint
of 3 "Rs." These are Reality,
Responsibility, and Respect. Let
us first look at Reality. It is clear
that for the time being, the
present governing and control-
ling forces will neither diminish
nor disappear. If anything, they
will increase and multiply.
Second, we have become part
of the business and money world
and as such we have a great deal
to learn from our partners in the
health industry. It is difficult for
us to think in terms of business
and money because of the impli-
cation that perhaps we are not
interested in the welfare of our
patients. At the same time it is a
reality that we have invested
heavily in our education and do
expect to be paid for our services.
We have, however, come a long
way from the day when phy-
sicians were paid directly by the
patient. The third reality is that
our patients have become cus-
tomers of third-party payors and
we no longer deal directly with
our patients. With the advent of
the HMOs, IPAs, etc, we have
learned that we must negotiate,
compromise, and accept con-
tracts for service at fees which
are less than are usual and custo-
mary.
The fourth reality is that we
have come into a world of compe-
tition, another foreign land for
those of us trained in medicine.
New words have come into our
vocabulary, words which are un-
usual and uncustomary such as
marketing and advertising. We
find ourselves competing for
patients with our colleagues on
the basis that we can offer serv-
ices for less money. The advent of
walk-in clinics and surgical
centers has given the concept of
competition a vastly new look.
The fifth reality is that we may
have to scrutinize the way in
which we practice medicine and
WISCONSIN MEDICAL JOURNAL, MAY I985:VOL. 84
23
SPECIAL
ERA OF MANY CHANGES-Glicklich
may have to change. I am refer-
ring to the theories of variations
in practice style proposed by
John Wennberg and quoted by
Representative Richard Gep-
hardt. This theory states that
medicine is practiced differently
in different areas. The variation
in practice styles has been ex-
tensively studied and data are
available which show that there
is considerable cost difference in
various locales. That is to say
that a specific condition treated in
one area may entail greater cost
than when that same condition is
treated in another geographic
area. This is a matter which
needs further study and Doctor
Sammons believes as does Doctor
Wennberg that such studies
could best be conducted by or-
ganized medical societies. The
advent of the DRGs makes such
studies particularly important.
No longer can we view
ourselves as the only
purveyors of healthcare
hut are partners in a sys-
tem which consists of
hospitals, nurses, admin-
istrators, dentists, phar-
macists, third-party
payors, business, labor,
industry, and govern-
ment, to mention a
few."
A sixth reality is that physicians
may become involved in joint
ventures with hospitals. To quote
Glenn Richard, prospective pric-
ing is putting hospitals at risk for
the cost of care, but physicians
determine most of resource con-
sumption. Thus, physicians are
needed by the hospitals. On the
other hand, physicians need hos-
pitals for the care of their patients
because they are part of the
HMO package and because low-
cost alternative providers threat-
en to take away both hospital and
physician business. This places
both physicians and hospitals in
a negotiating stance because or-
ganization is a necessary tool of
efficient operations and such is
available in hospitals. On the
other hand, hospitals are de-
pendent on the physician for
patient supply and must give up
total control of how hospitals are
used. Joint ventures such as those
in Minnesota and Texas, etc are
of note and may be portends of
things to come in any com-
munity.
No discussion of reality is
complete without reference to
our ever-present boogy-man— the
threat of malpractice. We are
aware that we will continue to
have malpractice crises with es-
calating costs until we either
bankrupt the system or legislate
some changes. The contingency
payment system for lawyers pre-
sents serious problems. We have
complained about this and have
developed referenda decrying
the practice— to no avail. We
have decried the huge awards,
even when no negligence is cited
—to no avail. It is true that there
is another side to the coin— the
public needs representation even
when there are no “up-front”
friends— if there has been mal-
practice. It is also true that rea-
sonable restitution should be
made for pain and suffering. It is
also true that we need to be pro-
tected from frivolous, painful
legal suits. There are three parties
all fighting for their truths. Some-
how we must negotiate; we must
cooperate. Sometimes we must
confront and then return to nego-
tiate more. This is one of our
“nuclear weapon" type of prob-
lems. The only role is negotiation
because the alternative is self-
destruction.
The second “R“ is Responsi-
bility. There is little question but
that our primary responsibility is
to our patients. We are responsi-
ble to deliver the highest quality
of care. At the same time, we are
faced with the responsibility to
contain costs.
It is absolutely essential that
we work with third party payors
toward mutual understanding.
Some of the obvious cost-saving
devices and maneuvers are
penny-wise and pound-foolish
(example), whereas others are
wise and judicious. Both phy-
sician providers and third-party
payors may have to change old
established patterns for the bene-
fit of all.
As we grapple with this, we
also have the responsibility to
consider means to provide
medical care to the uninsured,
the unemployed, and the indi-
gent without medical assistance.
Programs such as the Share-
Care concept are a start in this
direction. Donation of physician
services, however, is only one
piece of the total medical needs,
and we must cooperate with
other medical and social services
to meet this void.
As members of hospital staffs
we have responsibilities to sup-
port those institutions while, at
the same time, we are endeavor-
ing to keep costs down by de-
creasing hospital days.
Physicians must increase their
line of communication with hos-
pital administrators and Board of
Directors. Together we must
explore innovative joint ventures
wWch expand quality services at
nominal costs.
Responsibility to our profes-
sion and to each other is obvious.
This may be one of the more dif-
ficult areas because it touches on
peer review which may be
viewed as spying on each other—
it refers to testifying in court
which may be viewed on turning
against each other and involves
recognition of the fact that phy-
sicians are human and may be-
come impaired for many reasons.
We need to find ways in which
24
WISCONSIN MEDICAL JOl'RNAL, MAY 1985 . VOL. 84
ERA OF MANY CHANGES-Glicklich
SI’ECIAI,
we can become more comfort-
able and more adequate in ad-
dressing these problems.
Patients have the ultimate re-
sponsibility for their bodies.
There is only one issued per per-
son. Spare parts are hard to come
by and are not guaranteed. Pa-
tients have long been bringing
their bodies to us saying "you're
the doctor" implying that the
responsibility for health and well-
being was ours. In part, we may
have encouraged that, implying
that the body was ours and we
were leasing it to them as long as
they would return to us for
maintenance and repairs. It is
time all patients (not just the
women of the feminist move-
ment), all people take back their
bodies and assume good dietary
and exercise routine, examine
themselves for various warning
signs, be aware that failure to
cope is as much a disorder as
bleeding, monitor drug/ alcohol
use, and above all, presume life
and health.
As we are in the process of ed-
ucating, we have responsibility to
educate our partners in the health
industry about our profession,
our strengths, limitations. At the
same time, we must learn about
these— the nurses, dentists, phar-
macists, administrators, etc. In
the future, not so distant, we will
together be found with the pros-
pect of rationing of care and the
responsibility of allocating the
health dollar. We will need to do
this in cooperation with our other
health industry professions.
The top of this list is self-
respect.
Somehow this is being threat-
ened by the advent of preauthori-
zation and DRGs. We have all
heard and experienced some
"horror story" about a patient
who was refused treatment or
hospital admission because of
rules and regulations imposed by
one of the "alphabet groups"
such as HMOs, WiPRO, or Medi-
care. We do not want to be
conned into becoming liars
merely to accommodate the Pro-
crustian bed of the DRGs. We
may be forced and tempted to do
so on behalf of our patients or
to obtain payment for services or
admission to hospitals. It is im-
portant that as a group we con-
front the power structure and ad-
vocate the rights of our patients
to appropriate individualized
decisions.
Second on our list is respect
for the patient, and there is much
which can be said but most of it
is obvious for that is what medi-
cine is all about. Respect is pre-
serving the mental and physical
welfare of the patient during life
and in the process of death.
Respect of colleagues is the
third on the list and goes hand in
hand with what I said in regard
to responsibility.
Earlier I made the point that
our practice cohort now includes
many allied healthcare profes-
sions and also business, labor,
lawyers, administrators, etc. It
is important that we make great
efforts to understand these part-
ners. Out of understanding grows
patience, tolerance, and, ulti-
mately, respect. We all have
much to offer each other but
these offerings will not be ac-
cepted unless we respect the
givers.
Last, but most difficult is our
need to respect the Systems in
which we find ourselves.
It is on this note that I would
hke to go into my final remarks.
All the preceding rhetoric is of
no avail if we cannot seek some
solutions. That which I have said
has been iterated far more elo-
quently and colorfully in the
various Doctor's lounges and of-
fices throughout this country.
Often, however, the last line is
that nothing can be done and that
we are glad we shall be retiring
in another few years since Medi-
cine has changed so much it is
not any longer a satisfying pro-
fession.
This is equivalent to picking up
our marbles and going home.
Actually, from the standpoint of
technology and knowledge, we
are in the most exciting moments
of medical history. Our ability to
help patients make their lives
productive and useful has never
been greater. It is true that there
are numerous barriers which
have been erected between these
medical advances and our pa-
tients, but they are not insur-
mountable. It is true that our
knowledge often presents more
problems than it solves— (ethical,
emotional). We must view these
as challenges and have hope that
solutions can be found.
This may mean that we must
compromise, that we must nego-
tiate, that we must take some
financial losses, and that we must
learn many new rules. Although
third parties are paying medical
costs, we must insist on phy-
sician input to their formulas.
This we might accomplish
through legislation, negotiation
with insurance groups, and
through citizen action. If our
Self respect . . . Somehow this is being threatened by the
advent of preauthorization and DRGs ... It is important
that as a group we confront the power structure and
advocate the rights of our patients to appropriate individ-
ualized decisions."
WISCONSIN MEDICAL JOURNAL, MAY 1985: VOL. 84
23
SPECIAL
ERA OF MANY CHANGES-Glicklich
The Medical Society must become the instrument for
change rather than the last bastian for the victims of
change. It is only through coordinated, informed effort that
the positive step I've alluded to can take place. We must
encourage honest, dedicated, outspoken membership
which is willing to act rather than just complain and
capitulate.
patients learn about the limita-
tions of their plans and accept
responsibility for both health and
health costs, they can become
useful allies in changing the
shape of the third-party contracts.
Through legislative action
we can contain our burgeoning
malpractice costs. Here we will
need much help from our state
government officials and in
utopia from the legal profession.
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Through considerate and com-
passionate quality assurance
measures such as utilization re-
view, peer review, incidence re-
porting, etc, we can improve the
practice of medicine and make it
more effective. We need active
physician participation in all
these hospital activities.
These solutions may sound like
platitudinous rhetoric. We have
sounded off long enough. Now is
the time for each of us to take
time to pay attention to the prob-
lems, to seek solutions, to go out
into the wide community which
has become the extended medical
community to learn about that
community and to work toward
mutual goals. We must learn to
listen to and understand our
friends and our adversaries and
we must try to help them to
understand us and most impor-
tant, the needs of our patients.
We must encourage those pa-
tients to use the medical system
economically and to report our
problems to us, the Medical So-
ciety. Individually we can do a
great deal, but ultimately, it is the
organized medicine group.
The Medical Society must be-
come the instrument for change
rather than the last bastian for the
victims of change. It is only
through coordinated, informed
effort that the positive step I've
alluded to can take place. We
must encourage honest, dedi-
cated, outspoken membership
which is willing to act rather
than just complain and capitulate.
Our leadership must be willing to
listen to dissenters for many have
good, rationale ideas which may
be unpopular but worthy of trial.
This next year, during my
tenure in office, I plan to make
many excursions into the com-
munity, to become better ac-
quainted with our "partners in
medicine," and to help them to
understand and to cooperate
with our efforts to bring good
medicine to all. I stand open to
your ideas and encourage you to
take an active role in our Society.
Tell me where you want to grow,
and we shall accommodate
you.B
Have you paid your 1985 membership dues?
Regular member dues of $455 must be paid in full no later than
May 15, 1985 to continue as a member.
Members of record at May 31, 1985 will be included in the 1985
Membership Directory to be published in the July issue of the
Wisconsin Medical Journal. Members are urged to watch their mail
for the Membership Records Verification Form which will be
used in preparation of the Directory.
See pages 32 and 33 for further details.
26
WISCONSIN MEDICAL JOLRNAL, .MAY 1985:VOL. 84
ISCONSIN GAZETTE
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No longer do doctors have to deny patients the
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Winthrop-Breon Laboratories has met a nagging
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The orimnal formulation had been subject to a
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in a combination of TALWIN Nx and PBZ. When
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the relief of moderate to severe pain, now provid-
ing added security against misuse.
'Registered trademark of Ciba-Geigy Corp for tripelennamine.
Each tablet contains pentazocine
’’ydrochlorkJe.USP, equivalent to 50 mO
end naloxone hydrochloride. USP, 0.5 n't)- iji
Caution; Federal law prohibits lif
dispensing without prescription.
Ikilwiit^
©Each tablet contains pentazocine HCI, USR
equivalent to 50 mg base and naloxone
HCI, USR equivalent to 0.5 mg base.
The reformulation of Talwin 50 to Talwin Nx
involved the addition of 0.5 mg naloxone to
help prevent misuse by injection.
lm/T^rop-Breo/7
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Please see following page for Brief Summary.
inilfwily A \ qv/
Each tablet contains pentazocine HCI. USR equivalent to
50 mg base and naloxone HCI. USR equivalent to 0 5 mg base
Analgesic for Oral Use Only
Contraindications: Hypersensitivity to either pentazocine or
naloxone
TALWIN® Nx IS intended for oral use only Severe, potentially
lethal, reactions may result from misuse of TALWIN® Nx by
injection either alone or in combination with other substances
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Warnings: Drug Deper^derice Can cause physical and psycho-
logical dependence (See Drug Abuse and Dependence ) Head
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analgesics, respiratory depressant effects of the drug may elevate
cerebrospinal fluid pressure due to COj retention, these effects may
be markedly exaggerated in the presence of head injury, other
intracranial lesions, or a preexisting increase in intracranial pres-
sure Can obscure the clinical course of patients with head injuries,
in such patients, use with extreme caution and only if deemed
essential Usage with Alcohol Due to potential for increased CNS
depressant effects, alcohol should be used with caution Patients
Receiving Narcotics Rentazocine is a mild narcotic antagonist
Withdrawal symptoms have occurred in patients previously given
narcotics, including methadone Certain Respiratory Conditions
Should be administered with caution in respiratory depression from
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In long-term use, precautions should be taken to avoid increases in
dose by the patient Biliary Surgery Some evidence suggests that
unlike other narcotics pentazocine causes little or no elevation in
biliary tract pressures, the clinical significance of these findings is
not yet known Information for Patients Since sedation, dizziness,
and occasional euphoria have been noted, ambulatory patients
should be warned not to operate machinery drive cars, or unneces-
sarily expose themselves to hazards May cause physical and
psychological dependence taken alone and may have additive CNS
depressant properties in combination with alcohol or other CNS
depressants Myocardial Infarction Use with caution in patients
with myocardial infarction who have nausea or vomiting Drug
Interactions Usage with Alcohol See Warnings. Carcrnopert-
esis. Mutagenesis. Impairment of Fertility No long-term studies
in animals to test for carcinogenesis have been performed Preg-
nancy Category C Should be given to pregnant women only if
clearly needed Labor and Delivery Use with caution in women
delivering premature infants Effect on mother and fetus, duration of
labor or delivery need for forceps delivery or other intervention or
resuscitation of newborn, or later growth, development, and
functional maturation of the child is unknown Nursing Mothers
Caution should be exercised when administered to a nursing
woman Pediatric Use Safety and effectiveness in children below
the age of 12 years have not been established
Adverse Reactions: Cardiovascular Hypotension, tachycar-
dia. syncope Respiratory Rarely, respiratory depression CNS
Acute CNS Manifestations In rare instances, hallucinations
(usually visual), disorientation, and confusion which have cleared
spontaneously within a period of hours, may recur if drug is
reinstituted Other CNS Effects dizziness. Iightheadedness, seda-
tion, euphoria, disturbed dreams, hallucinations, irritability, excite-
ment. tinnitus, tremor Gastrointestinal Nausea, vomiting, con-
stipation. diarrhea, anorexia, rarely abdominal distress Allergic
Edema of the face, dermatitis, including pruritus, flushed skin, includ-
ing plethora Ophthalmic Visual blurring and fncus'iiq difficulty
Hematologic Depression of white blood cells (especially granulo-
cytes), which IS usually reversible, moderate transient eosinophilia
Other Headache, chills, insomnia, weakness, urinary retention
Drug Abuse and Dependence: Controlled Substance
TALVVIN Nx IS a Schedule IV controlled substance
Dependence and withdrawal symptoms have been reported with
orally administered pentazocine Ratier.ts with a history of drug
dependence should be under close supervision Possible abstinence
syndromes in newborns after prolonged use of pentazocine during
pregnancy have been reported In prescribing for chronic use. the
physician should take precautions to avoid increases in dose by the
patient Tolerance to the analgesic effect is rarely reported, there is
no long-term experience with oral use of TALWIN Nx
The amount of naloxone present (0 5 mg pet tablet) has no action
when taken orally and will not interfere with the pharmacologic
action of pentazocine, however, this amount of naloxone given by
injection has orofound antagonistic action to narcotic analgesics
TALWIN Nx has a lower potential for parenteral misuse than the
previous oral pentazocine formulation, but is still subject to patient
misuse and abuse by the oral route
Severe, even lethal, consequences may result from misuse of tablets
by injection either alone or in combination with other substances,
such as pulmonary emboli, vascular occlusion, ulceration and absces-
ses, and withdrawal symptoms in narcotic dependent individuals
Dverdosage: Treatment Dxygen, intravenous fluids, vasopres-
sors. and oiner supportive measures should be employed as indi-
cated Assisted or controlled ventilation should also be considered
For respiratory depression, parenteral naloxone is a specific and
effective antagonist
Please consult full product information before prescribing
Winthrop-Breon Laboratories
Division of Sterling Drug Inc
WIN4-41415FR New York, NY 10016
\W//7/Arop-Breo/7
ORGANIZATIONAL
Doctor Scott installed as
president; Doctor Landis
elected president-elect
John K Scott, MD of Madison was installed as the
1985-86 president of the State Medical Society, succeed-
ing Timothy T Flaherty, MD of Neenah, during the 130th
Annual Meeting April 25-27 in La Crosse.
Charles W Landis, MD of Milwaukee was elected
president-elect.
Duane W Taebel, MD, La Crosse, was reelected vice
speaker of the House of Delegates. John J Foley, MD,
Menomonee Falls, was reelected treasurer.
Reelected to serve as delegates to the AMA for 1986
and 1987 were Henry F Twelmeyer, MD, Wauwatosa;
Richard W Edwards, MD, Richland Center; and Cor-
nelius A Natoli, MD, La Crosse. Timothy T Flaherty,
MD, Neenah, was elected a delegate for 1985.
Reelected to serve as alternate delegates to the AMA
for 1986 and 1987 were J D Kabler, MD, Madison;
Kenneth M Viste Jr, MD, Oshkosh; and Richard H
Ulmer, MD, Marshfield. John P Mullooly, MD, Mil-
waukee, was elected an alternate delegate for 1985 and
1986, and Charles W Landis, MD, Milwaukee, was
chosen to serve as an alternate delegate for 1985.
The House also confirmed the election of 1 1 physicians
to the Society's Board of Directors. Reelected to the Board
were: Jerome W Fons Jr, MD, Milwaukee; Cyril M
Hetsko, MD, Madison; J D Kabler, MD, Madison; James
J Tydrich, MD, Richland Center; Jung K Park, MD,
Wisconsin Rapids, and Darold A Treffert, MD, Fond du
Lac. Elected to the Board were Glenn H Franke, Mil-
waukee (succeeding John P Mullooly, MD, Milwaukee);
Lucille B Glicklich, MD, Milwaukee (succeeding Charles
W Landis, MD, Milwaukee); Kenneth I Gold, MD, Beloit
(succeeding Allen O Tuftee, MD, Beloit); Joseph C
DiRaimondo, MD, Manitowoc (filling the vacancy
created by the resignation of Irvin L Schroeder, MD,
Plymouth, last year); and Philip J Happe, MD, Eau Claire
(an additional director for the Seventh District).
Other elections and appointments will appear in the
June Blue Book issue.
A full summary of the House of Delegates action will
appear in the June Blue Book issue. ■
ORGANIZATIONAL
Membership Directory—
■Update
The following information
is being provided from Membership reports and from individual members for updating the
1984 Membership Directory as published in the July 1984 issue of the Wisconsin Medical Journal. Because of space limi-
tations address changes and phone numbers will not be included in this Update;
however, they will be changed in
Membership records. County transfers will be included when processing has been completed by the Membership
Department.
New, reelected, or reinstated members
FP*
GS
(complete information!
Kamnetz, Sandra A
O'Grady, Martin G
5001 Monona Dr
600 Highland Ave
Changes in specialties and/or Board certification!*)
Madison WI 53716
Madison WI 53792
(changes only with member's name!
PD*
FP*
Katcher, Murray L
Olinger, Mark B
By county medical society
1130 Shorewood Blvd
5001 Monona Dr
Madison WI 53705
Madison WI 5,3716
OBG
CDS IM*
BROWN
EM* PD
Kauma, Scott W
Orie, Judith E
GP
Erskine, C Peter
600 Highland Ave
H6/339 UW CSC
Manabat Jr, Enrique S
718 Oneida PI
Madison WI 53792
600 Highland Ave
812 South Fisk St
Madison WI 5371 1
Madison WI 53792
Green Bay WI 53404
rr UdLi
D
Keepman, Jay P
IM
Falk, David K
3602 Atwood Ave
Robbins, Mark L
345 W Washington Ave
Madison WI 53714
7345 Century PI
DANE
Madison WI 53703
Middleton WI 53562
CHP P
CDS TS*
AN*
Little, Margaret L
Rosenblatt, Amy M
Adib, Khosro
Galvez, Timoleo L
5534 Medical Circle
2924 Harvey St, #58
345 W Washington Ave
POB 5367
Madison WI 53711
Madison WI 53705
Madison WI 53703
Madison WI 53705
PD*
AN
EM IM*
EM
Luyel, Francois M
Schroeder, Mark E
Beckfield, Paul W
Geurkink, Terry F
345 W Washington Ave
B6/373 UW CSC
104 Oak Court
1675 Bartlett Ct
Madison WI 53703
600 Highland Ave
Verona WI 53593
Belleville WI 53508
Madison WI 53792
N PN*
OTO
March, Andrew W
Semans, Bruce E
Britton, Daniel E
Haberman II, Rex S
3301 Harvey St, ih
POB 9872
345 W Washington Ave
717 Bruce Ct
Madison WI 53705
Madison WI 53715
Madison WI 53703
Madison WI 53705
IM*
OTO GS
IM*
EM FP*
Me Aweeney, William J
Shaikh, Arif J
Bridgwater, Gary R
Holt, Michael C
345 W Washington Ave
2060 Allen Blvd, #30
3713 Milwaukee St
502 1 Regent St
Madison WI 53703
Middleton WI 53562
Madison WI 53714
Madison WI 53705
FP* EM
N
EM IM*
FP*
Meyer, Thomas D
Shewmake, Karl E
Bowman, 11 Michael
Hunter, Merle A
707 South Mills St
345 W Washington Ave
B4/341 UW CSC
1 South Park St
Madison WI 53715
Madison WI 53703
600 Highland Ave
Madison WI 53715
Madison WI 53792
OBG FP
FP*
P
Mullins, Maureen A
Soderquist, Catherine
OTO EM
Jackson, Robert D
345 W Washington Ave
777 South Mills St
Campbell, David A
345 W Washington Ave
Madison WI 53703
Madison WI 53715
1 125 Rutledge St, #2
Madison WI 53703
Madison WI 53703
Nettum, Janies C
PD*
EM
2152 Fox Ave
Staats, Patricia \'
Chu, Paul
Jacobson, Steven M
Madison WI 53711
345 W Washington Ave
1530 Adams St
1307 Wyldhaven
Madison WI 53703
Madison WI 5371 1
Monona WI 53716
ORS*
Niedermeier, William R
GS
IM OPH
DR R*
2 West Gorham St
Vega, Roland J
Danisjr, Ronald P
Jensen, Steven R
Madison WI 53713
345 W Washington Ave
600 Highland Ave
600 Highland Ave
Madison WI 53703
Madison WI 53792
Madison WI 53792
continued
WISCONSIN MEDICAL JOURNAL, MAY 1985:VOL. 84 29
ORGANIZATIONAL
DANE continued
EM FP*
Young-Szabo, Cheryl J
7846 W Oakbrook Circle
Madison WI 53717
DODGE
FP*
Timmermans, Peter W
200 E Main St
Waupun WI 53963
DOUGLAS
Doyle, ThomasJ
2626 Ogden Ave
Superior WI 54880
FOND DU LAC
HEM IM*
Frick, Jacob C
80 Sheboygan St
Fond du Lac WI 54935
ORS*
Smith, Donald A
480 E Division St
Fond du Lac WI 54935
GRANT
IM PUD
Gaither, James M
525 North Wisconsin
Muscoda WI 53573
ORS
Mokrohisky III, Stephen M
4513 Gregg Rd
Madison WI 53705
MANITOWOC
IM
Holder, Lynn W
601 N 8th St
Manitowoc WI 54220
MAILATHON
FP’
Moore, Jeffrey L
1924 Eva Rd, #14
Mosinee WI 54455
FP
Rosas, Steven L
995 Campus Dr
Wausau WI 54401
MILWAUKEE
FP*
Adrouny, Salpi
6901 West Edgerton
Milwaukee WI 53220
EM FP*
Anderson, Dennis
2900 W Oklahoma Ave
Milwaukee WI 53215
Austin, Renate
2720 N Frederick Ave, #130
Milwaukee WI 532 1 1
FP
Azeueta, Renato S
8120 N Mohawk Ave
Fox Point WI 53217
OBG*
Babbitz, Allen H
1218 W Kilbourn Ave
Milwaukee WI 53233
Barrow, Linda J
10416 Fisher Parkway
Wauwatosa WI 53226
CD IM
Becker, Michael D
4184 N Bartlett Ave
Milwaukee WI 53211
Benzer, David G (DO)
4385 Rainbow Ct
New Berlin WI 53151
DR R*
Bond, Jeffrey R
8901 W Lincoln Ave
West Allis WI 53227
P*
Currier, George E
2445 North 91
Wauwatosa WI 53226
IM
Dongas, Barbara S
4443 N Frederick Ave
Shorewood WI 53211
PTH* CLP
Eisenstein, Reuben
950 N 12th St
Milwaukee WI 53201
D*
Engel, CharlesJ
5203 Roberts Dr
Greendale WI 53129
AN
Fingard, David H
4870 North Lake Dr
Whitefish Bay WI 53217
AN
Francis, Michael C
2825 N Mayfair Rd
Milwaukee WI 53222
Gillis, Rick D
3462 North 97th St
Milwaukee WI 53222
Gregory, James S
2092 S 102nd St, #314-A
West Allis WI 53227
IM* PUD
Hanson, James C
2901 W KK River Parkway, #516
Milwaukee WI 53215
EM IM
Harkins, HeidiJ
2610 N Murray Ave
Milwaukee WI 532 1 1
GS* CDS
Heber, David L
2040 W Wisconsin Ave, #422
Milwaukee WI 53233
Hegcr, Jiri
1221 N70th St, #4
Wauwatosa WI 53213
EM IM*
Hendley, Gail E
2819 N 55th St
Milwaukee WI 53210
D
Jerofke, Alfred
2505 Almesbury Ave
Brookfield WI 53005
FP
Kalman, Maryann M
4224 WVillard St, #13
Milwaukee WI 53209
Karos, Michael G
2825 N Mayfair Rd
Milwaukee WI 53222
GS
Kispert, John
2524 N 124th St
Wauwatosa WI 53226
La Crosse, Larry E
212 High St
Port Washington WI 53074
FP EM
La Roque, Charles A
2900 W Oklahoma Ave
Milwaukee WI 53215
PM
Lerner, Jerome A
2024 E Marion St
Shorewood WI 53211
FP*
Me Daniel, William P
4517 North Frederick
Whitefish Bay WI 53211
FP
Me Sorley, Brian R
1721 W Oklahoma Ave
Milwaukee WI 53215
Merrill, David C
222 W Hampton Ave, #308
Milwaukee WI 53217
FP
Moody, TimothyJ S
3830 W Rawson Ave
Franklin WI 53132
Moscosojr, Walter E
11121 W Meinecke Ave, #8
Wauwatosa WI 53226
IM
Nagelhout, David A
1264 Kavanaugh PI
Wauwatosa WI 53213
N IM PN*
Nausieda, Paul A
2025 East Newport Ave
Milwaukee WI 532 1 1
ORS GS
Nord, Stephen L
6141 N Santa Monica
Whitefish Bay WI 53217
Otterson, Mary F
1930 West Birch Ct
Milwaukee WI 53209
Prein, Thomas E
1128 Kavanough PI
Wauwatosa WI 53213
CD IM
Puchner, Thomas C
2300 N Mayfair Rd, #830
Wauwatosa WI 53226
Puig, Xiomara
9122 West Dixon St, #204
Milwaukee WI 53214
Purvis, KathyJ
1314 South 97th St
West Allis WI 53214
PM*
Reddy, Nanjappareddy M
1000 N 92nd St
Milwaukee WI 53226
FP
Redlin, Kenneth C
2319 East Euclid Ave
Milwaukee WI 53207
EM
Robinson, Jonathan
201 North Westfield
Madison WI 53717
DR R*
Rose, Quentin F
3481 North Lake Dr
Milwaukee WI 53211
Sandberg, James W
9131 West Dixon St, #7
Milwaukee WI 53214
continued
30
WISCONSIN MEDICAL JOURNAL, MAY 1985:VOL. 84
ORGANIZATIONAL
MILWAUKEE continued
IM* CD
Schuchard, Gregory H
2014 Forest St
Wauwatosa WI 53213
AN
Sheth, Pravin C
961 1 W Meadow Park Dr
Hales Corners WI 53130
PM
Siliunas, Mindas V
8330 North 46th St, #101
Milwaukee WI 53233
FP
Small, Maureen D
2665 N Pierce St
Milwaukee WI 53212
Sullivan, Lawrence
2919 North 50th St
Milwaukee WI 53210
EM
Sutphen, Sussan K
2528 W Highland Blvd
Milwaukee WI 53233
Tomlinson, Craig P
8325 Portland Ave
Milwaukee WI 53226
FP
Trevino, Maria T
1834 West Wisconsin
Milwaukee WI 53233
FP
Trevino, Rodolfo N
1834 West Wisconsin
Milwaukee WI 53233
Twelmeyer, John M
1174 Pilgrim Parkway
Elm Grove WI 53122
FP
Velazquez, Arturo
5408 North 56th St
Milwaukee WI 53218
IM GS
Wartgow, Rick R
3939 N Murray Ave, #104
Milwaukee WI 53211
EM*
Waters, Victor O
1234 N 122nd St
Wauwatosa WI 53226
EM IM*
Whitcomb, John E
2900 W Oklahoma Ave
Milwaukee WI 53215
TR PD*
Wolfson, Sorrell L
2323 North Lake Dr
Milwaukee WI 53211
N
Wooten, Marvin R
2015 E Newport Ave
Milwaukee WI 532 1 1
ONEIDA VILAS
FP*
Robins, E Lanny
Eagle River WI 54521
OUTAGAMIE
FP
Quayle, James M
2917 North Drew St
Appleton WI 54911
PIERCE ST CROIX
IM
Osterbauer, Joseph J
POB 68
New Richmond WI 54017
RACINE
OBG PD
Campbell, Mary I
5625 Washington Ave
Racine WI 53406
ROCK
IM*
Austin, John A
1200 Home Park Ave
Janesville WI 53545
IM
Baker, Charles S
202 Jefferson Ave
Janesville WI 53545
N PN*
Berentsen, Thomas R
580 N Washington St
Janesville WI 53545
D*
Boardman, Charles R
1905 Huebbe Parkway
Beloit WI 53511
PD*
Bostian, K Eugene
580 N Washington St
Janesville WI 53545
N PN*
Brugger, Andrew M
580 N Washington St
Janesville WI 53545
IM*
Deeds, Ernest C
580 N Washington St
Janesville WI 53545
OTO GS
Ellison, Warren R
580 N Washington St
Janesville WI 53545
PD*
Possum, Jane E
1905 Huebbe Parkway
Beloit WI 53511
IM*
Gruhn, Stanley W
580 N Washington St
Janesville WI 53545
IM* RHU
Maciolck, Steven P
580 N Washington St
Janesville WI 53545
OTO* HNS
Mundy, John C
580 N Washington St
Janesville WI 53545
IM
Odette, William G
5 West Rollin
Edgerton WI 53534
D*
Pearson, Bruce R
580 N Washington St
Janesville WI 53545
OBG*
Vogel, James G
580 N Washington St
Janesville WI 53545
WAUKESHA
PS*
Feinberg, Lilia Breyer
1053 Lake Waterville
Oconomowoc WI 53066
IM
Gundersen II, Gunnar
2612 N Maryland, #107
Milwaukee WI 53211
IM*
Hennessyjr, Donald J
W180 N7950 Town Hall Rd
Menomonee Falls WI 53051
FP*
Koewler, ThomasJ
225 Eagle Lake Ave
Mukwonago WI 53149
EM IM*
Saperstein, Henry I
7370 North Seneca Rd
Fox Point WI 53217
AN
Woo, Sung-Kyun
1840 W Woodbury Lane
Glendale WI 53209
WOOD
Allen, Jon W'
1700 N Apple Ave, #1N
Marshfield WI 54449
Elmecr, David C
422 Bluebird Ln
Marshfield WI 54449
FP*
Fontannini, Steven M (DO)
510 Marathon
Marshfield WI 54449
PS*
Hacker, Louis C
1000 North Oak Ave
Marshfield WI 54449
DR R*
Herbert, Timothy G
2300 Mann St
Marshfield WI 54449
ORS
Johnson, James A
420 Dewey St
POB 1265
Wisconsin Rapids WI 54494
N* EM
Karanjia, Percy N
1000 North Oak Ave
Marshfield WI 54449
P CHP
Kumaraperu, Indrani L
1126 Onstad
Marshfield WI 54449
DR IM*
Manor, William F
1000 North Oak Ave
Marshfield WI 54449
OPH
Miller, Kevin B
500 Dewey St
POB 309
Wisconsin Rapids WI 54494
continued
WISCONSIN MEDICAL JOURNAL, MAY l985:VOL. 84
31
ORGANIZATIONAL
County society transfers
DANE
(from Marathon)
Jarzemsky, Daniel R
100 E North St
De Forest WI 53532
MARATHON
(from Price-Taylor)
Cameron, Vinoo
101 W Gibson Ave
Medford WI 54451
MILWAUKEE
(from Dane)
Kieser, Randall J
1614 E Newton Ave
Shorewood WI 53211
RACINE
(from Ozaukee)
Paquette, Camille A
1 120 Main St
Union Grove WI 53182
WAUKESHA
(from Milwaukee)
Cooper-Young, Helen M
515 W Moreland Blvd
Waukesha WI 53186
WOOD
(from Oneida-Vilas)
Wood, Michael T
1000 North Oak Ave
Marshfield WI 54449B
Members! Are your Membership Records current?
The 1985 Membership Directory will contain a list of all members of record at May 31 as compiled by the
Membership Department. The following information will be included:
County Medical Society
Up to 3 specialties
recognized by the AMA,
by code (see opposite page)
Up to three Board certified
specialties or subspecialties,
by code (see opposite page)
1
PRIMARY
4
PRIMARY
2
SECONDARY
5
SECONDARY
3
SECONDARY
6
SECONDARY
Phone number (if desired) L
Name
Address.
City State Zip
Members are encouraged to review the information
here and on the opposite page in preparation of com-
pleting the Membership Records Verification Form
which will be sent to all members of record at May
3 1 . Watch your mail for this Verification Form; it will
be the only one sent.
Type of practice
D Resident — First Year
□ Medical Research
n Resident — All Other Years
□ Other Patient Care
□ Direct Patient Care
□ Other Non-Patient Care
□ Administration
D Inactive
□ Medical Teaching
D No Classification
□ Student
□ Retired
n Temporarily not in practice
□ Semi-Retired
□ Not active for other reasons
□ Disabled
32
WISCONSIN .MEDICAL JOCRNAL, MAY I985:VOL. 84
ORGANIZATIONAL
Identification of specialties, secondary or subspecialties,
and Board certification, as recognized by the AM A
Primary and secondary specialties recognized by the AMA appear below in the column of boxes numbered 1,23 (limited
to no more than three specialties): Board certifications recognized by the AMA* appear below in the column of boxes
numbered 4, 5, 6 (limited to no more than three certifications). Note that only Board certifications will be permitted from
the boards of the American Board of Medical Specialists* which are recognized by the AMA. See sample form on opposite
page for information to be included in the 1985 Membership Directory to be published in the July issue of the Wisconsin
Medical Journal.
AMA recognized
specialties
1
4 Board certified
2
5 specialties and
3
6 subspecialties*
T
▼
□ A Allergy
□ ABS Abdominal Surgery
□ ADL Adolescent Medicine
□ □ Al Allergy and
Immunology
□ □ AM Aerospace Medicine
□ □ AN Anesthesiology
□ AP Anatomic Pathology
□ BE Broncho-esopha-
gology
□ □ BLB Bloodbanking
□ CCM Critical Care
Medicine
□ □ CD Cardiovascular
Diseases
□ CDS Cardiovascular
Surgery
□ □ CHN Child Neurology
□ □ CLP Clinical Pathology
□ CP Chemical Pathology
□ □ CRS Colon and Rectal
Surgery
□ □ D Dermatology
□ Dl Dermatological
Immunology
□ DIA Diabetes
□ DU Diagnostic Lab-
oratory Immunology
□ □ DMP Dermatopathology
□ □ DR Diagnostic Radiology
□ D EM Emergency Medicine
□ END Endocrinology
□ END Endocrinology
and Metabolism
□ □ FOP Forensic Pathology
□ □ FP Family Practice
□ □ GE Gastroenterology
□ GER Geriatrics
□ GON Gynecologic
Oncology
□ GP General Practice
D GPM General Preventive
Medicine
□ GPM Public Health and
General Preventive
Medicine
□ □ GS General Surgery
□ GVS General Vascular
Surgery
□ GYN Gynecology
n D HEM Hematology
□
HNS
Head and Neck
Surgery
□
HS
Hand Surgery
□
□
HYP
Hypnosis
□
ID
Infectious Diseases
□
IG
Immunology
□
□
IM
Internal Medicine
□
□
IP
Immunopathology
LAR
Laryngology
□
LM
Legal Medicine
□
MFM
Maternal and Fetal
Medicine
□
MFS
Maxillofacial Surgery
□
MMB
Medical Microbiology
□
MON
Medical Oncology
□
□
N
Neurology
□
□
NA
Neuropathology
□
ND
Neoplastic Diseases
□
□
NEP
Nephrology
□
□
NM
Nuclear Medicine
□
□
NPM
Neonatal-perinatal
Medicine
□
□
NR
Nuclear Radiology
□
□
NRP
Radioisotopic Path-
ology and Nuclear
Radiology
□
NS
Neurological Surgery
□
NTR
Nutrition
□
□
OBG
Obstetrics and
Gynecology
□
OBS
Obstetrics
□
□
OM
Occupational
Medicine
□
□
ON
Oncology
□
OPH
Ophthalmology
□
□
ORS
Orthopedic Surgery
□
OS
Other; ie, physician
designated a specialty
other than appearing
here
□
□
OT
Otology
□
OTO
Otorhinolaryngology
□
□
P
Psychiatry
□
PA
Clinical Pharma-
cology
□
□
PD
Pediatrics
□
□
PDA
Pediatric Allergy
□
PDC
Pediatric Cardiology
□
□
PDE
Pediatric Endo-
crinology
□
PDR
Pediatric Radiology
□
□
PDS
Pediatric Surgery
□
PH
Public Health
□
□
PHO
Pediatric Hema-
tology-Oncology
□
□
PM
Physical Medicine
and Rehabilitation
□
□
PNP
Pediatric Nephrology
□
□
PS
Plastic Surgery
□
PTH
Pathology
□
PTH
Anatomic and Clinical
Pathology
□
□
PUD
Pulmonary Diseases
□
PYA
Psychoanalysis
□
PYM
Psychosomatic
Medicine
□
R
Radiology
□
RE
Reproductive Endo-
crinology
□
RHI
Rhinology
□
□
RHU
Rheumatology
□
RIP
Radioisotopic
Radiology
□
RP
Radioisotopic
Pathology
□
□
TR
Therapeutic
Radiology
□
TRS
Traumatic Surgery
□
□
TS
Thoracic Surgery
□
U
Urology
□
U
Urological Surgery
* American Board of . . .
D Allergy and Immunology
□ Anesthesiology
□ Colon and Rectal Surgery
□ Dermatology
n Emergency Medicine
n Family Practice
D Internal Medicine
□ Neurological Surgery
n Nuclear Medicine
D Obstetrics and Gynecology
□ Ophthalmology
□ Orthopedic Surgery
□ Otolaryngology
□ Pathology
□ Pediatrics
□ Physical Medicine and
Rehabilitation
□ Plastic Surgery
□ Preventive Medicine
D Psychiatry and Neurology
□ Radiology
□ Surgery
n Thoracic Surgery
□ Urology
WISCONSIN MEDICAL JOURNAL, MAY 1985: VOL. 84
33
500-mg Pulvules®
250-mg Pulvules
Oral
Suspension
250 mg/5 ml
Oral
Suspension
125 mg/5 ml
Keflex
cephalexin
Additional information
available to the profession
on request.
IDISTA
Dista Products Company
Division of Eli Lilly and Company
Indianapolis, Indiana 46285
Mfd. by Eli Lilly industries, Inc.
Carolina, Puerto Rico 00630
420113
*Physician members of State Medical Society of W/scoms/m
John Kraft, MD, recently started
his medical practice with the
Grafton Clinic. A graduate of the
Medical College of Wisconsin,
Doctor Kraft previously had been
associated with the Elmbrook
Hospital in the Department of
Emergency Medicine and had
a general medical practice in the
Milwaukee area.
Howard Dubner, MD, Shore-
wood, has been appointed the
first medical director of St Jo-
seph's Hospital Oncology Center,
Milwaukee. Doctor Dubner
joined the St Joseph's Hospital
medical staff in 1974. He is a
1969 graduate of the University
of Illinois Medical School and
served his internship and resi-
dency at the University of Cin-
cinnati from 1969 to 1972 and a
fellowship from the University
of Wisconsin, Madison, from
1972 to 1974.
M Scott Harris, MD, Mequon, has
been appointed assistant profes-
sor of medicine at the Medical
College of Wisconsin, Milwaukee.
He is based at the Veterans Ad-
ministration Medical Center,
Wood, and the Milwaukee
Regional Medical Center. Doctor
Harris graduated from Harvard
Medical School and served his
internship and residency at the
Johns Hopkins Hospital and at
the Hospital of the University of
Pennsylvania in Philadelphia,
PA.
Terry L Hankey, MD,* Wausau,
recently was appointed to the
Committee on Research of the
American Academy of Family
Physicians. The Committee
oversees and coordinates the
Academy research programs.
John R Kludt, MD, * Eau Claire,
is the new program director of
the Eau Claire Family Practice
Residency Program. He suc-
ceeds Patrick W Connerly, MD. *
He graduated from the Univer-
r
V
sity of Washington School of
Medicine and completed his
family practice residency at the
Weld County General Hospital
in Greeley, CO. He previously
was assistant director at the Fam-
ily Practice Residency Training
Program for North Colorado
Medical Center in Greeley.
Philip J Taugher, MD, * Frank-
hn, has been named to the Board
of Directors of West Allis Mem-
orial Hospital. A member of the
West Allis Memorial Hospital
medical staff since 1971, Doctor
Taugher served as chief-of-staff
from 1983 through 1984 and also
was head of the Section of Oph-
thalmology from 1978 through
1980. He is a graduate of Mar-
quette University School of Medi-
cine.
Susan F Behrens, MD, * Beloit,
recently became a fellow of the
American College of Surgeons.
Doctor Behrens graduated from
the University of Wisconsin
Medical School, Madison, and is
currently a member of the
medical staff at Beloit Memorial
Hospital. In 1984 she was elected
chairman of the Wisconsin
Medical Examining Board. In
March 1983, Doctor Behrens was
the first woman to become a
member of the Wisconsin Surgi-
cal Society.
Parnell Donahue, MD, is the
new medical director of the Graf-
ton Clinic. Doctor Donahue, a
graduate from Marquette Uni-
versity School of Medicine, also
is associated with the Sports
Medicine and Knee Surgery
Center and the Good Samaritan
Sports Medicine Institute in Mil-
waukee. Doctor Donahue in
addition to his duties as the medi-
cal director of the Clinic, also will
practice adolescent medicine and
sports medicine. He previously
was in medical practice in Hart-
ford.
PHYSICIAN briefs]
Martin Vick, MD, Ashland, re-
cently joined the Carol A Blum,
MD,* SC, anesthesiology prac-
tice. Originally from Minneapo-
lis, Doctor Vick graduated from
the University of Minnesota
Medical School and completed
his residency at Abbott-North-
western Hospital and at the Uni-
versity of Minnesota Hospitals
in Minneapolis.
Doctor Goldberg Doctor Rice
Burton Goldberg, MD, Madison,
who joined the University of Wis-
consin faculty in January, has
been named chairman of the UW
Medical School's department of
pathology and laboratory medi-
cine. Doctor Goldberg previously
served as professor of pathology
at the New York University
School of Medicine, New York
City. A 1950 graduate of North-
western University Medical
School, Chicago, Doctor Gold-
berg served his internship at
Cincinnati General Hospital,
Ohio, and completed his resi-
dency at Boston City Hospital's
Mallory Institute.
Richard Rice, MD, recently be-
came associated with the medical
staff of the Middleton Clinic.
Doctor Rice graduated from the
Iowa Medical School, Iowa City,
and served his internship in Des
Moines before entering the
United States Air Force. His resi-
dency training was completed at
the UW Medical School, Madi-
son. Prior to joining the Middle-
ton Clinic, he had been in pri-
vate practice in Freeport, 111.
WISCONSIN MEDICAL JOURNAL, MAY 1985: VOL. 84
35
PHYSICIAN BRIEFS
VOLUNTARY
DONATIONS
Charles Alexander, MD
Alan W Babcock
Durward A Baker, MD
Frank H Belfus, MD
Gordon W Brewer, MD
Brown County
Medical Auxiliary
Carl SL Eisenberg, MD
Peter A Fergus, MD
Fond du Lac County
Medical Auxiliary
Robert A Frisch, MD
Francis E Gehin, MD
Irwin Harris, MD
William C Janssen, MD
Marshall R Jennison, MD
John M Johnson, MD
David M Kashnig, MD
Theodore J Kern, MD
Josef A Kindwall, MD
John R Larsen, MD
Marc A Letellier, MD
William G Longe, MD
Dean D Miller, MD
David H McKenna, MD
Walter D Moritz, MD
Geetha Murthy, MD
Ligaya Ml Newman, MD
Guenther P Pohimann, MD
Michael D O'Reilly, MD
Leon J Radant, MD
Arthur L Reinardy, MD
David B Rich, MD
Douglas D Salmon, MD
Irving E Schiek, MD
C E S
Foundation
of the State Medical
Society of Wisconsin
The Charitable, Educational and
Scientific Foundation of the
State Medical Society of Wis-
consin recognizes the generosity
of the following individuals and
organizations who have made
contributions during the month
of March 1985.
Gary A Schmidt, MD
Robert T Schmidt, Jr, MD
Philip M Schultz, MD
John L Sims, MD
Catherine M Slota, MD
Glenn A Smiley, MD
Moon-Won Song, MD
Arthur C Taylor, MD
Hart E Van Riper, MD
Frank A Walker, MD
Hong Chu Wang, MD
Waukesha County
Medical Auxiliary
William W Wendle
Maurice L Whalen, MD
James P Wise, MD
Wood County
Medical Auxiliary
HARRINGTON-
WRIGHT
SCHOLARSHIP
FUND
Brown County
Medical Auxiliary
Dodge County
Medical Auxiliary
Fond du Lac County
Medical Auxiliary
AESCULAPIAN
SOCIETY
REGULAR
Jacqueline P Dungar
SUSTAINING
Joan Janssen
BEAUMONT 500
Mace Garrison Zinggeler
IN MEMORIAM
Ruth May
Paul Mason, MD
Jerry McRoberts, MD
Mr Wendell Utrie
MEMORIAL
CONTRIBUTORS
David E Beale Family
Herman J Dick, MD
Marcella Herfel
Doug and Dee Miller
Mavis and Reese Minor
Joan Pyre
Herbert Sandmire, MD
James L Sebastian, MD, Wauwa-
tosa, recently was appointed as-
sistant professor of medicine at
the Medical College of Wiscon-
sin. Doctor Sebastian graduated
from Indiana University School
of Medicine and served his resi-
dency at the Medical College of
Wisconsin. He is on the medical
staff at the Veterans Adminis-
tration Medical Center.
Paul R Meier, MD, Marshfield,
has joined the medical staff of the
Marshfield Clinic. Doctor Meier
graduated from Loma Linda Uni-
versity School of Medicine and
completed his residency at the
University of California-San
Diego. He also completed his
fellowship at the University of
Colorado Health Sciences Center
in Denver. Doctor Meier was a
member of the perinatal staff of
the Kaiser Permanente Hospital,
San Diego, and also was an as-
sistant professor of obstetrics and
gynecology at the University of
Colorado School of Medicine.
James F Guhl, MD,* Elm Grove,
recently was elected secretary
of the International Arthroscopy
Association. He is immediate past
president of the Arthroscopy As-
sociation of North America.
R Arthur Gindin, MD, Monroe,
has joined the medical staff of the
Monroe Clinic. Doctor Gindin
was in private practice in Ports-
mouth, Ohio, before coming to
the Clinic. He graduated from the
Medical College of Virginia and
served his internship at the Uni-
versity of Oklahoma Hospital,
Oklahoma City. His residency
was completed at USPHS Hos-
pital, Staten Island, NY, fol-
lowed by a fellowship at the
Montreal Neurosurgical Institute,
Montreal, Canada. He was on the
faculty at the Medical College of
Georgia in Augusta and had been
chief of neurosurgery at the Vet-
eran's Administration Hospital in
Augusta. ■
36
WISCONSIN MEDICAI JOIIRNAL, MAY 1985:VOL. 84
'Physician members of State Medical Society of WjscoNsm
Midelfort Clinic, Eau Claire,
recently appointed Robert L
Downs as executive director. Mr
Downs succeeds James R Jepson,
administrator since 1979, who
has accepted a position in Florida.
Mr Downs is a graduate of Notre
Dame University and also has a
master's degree in Health Care
Administration from the Univer-
sity of Minnesota. For the past six
years, he has been administrator
of The Medical Associates Clinic
in Dubuque, Iowa. Mr Downs is
a member of the Medical Group
Management Association and a
fellow in the American College of
Medical Group Administrators.
Group Health Cooperative, a
Dane County health maintenance
organization, has selected John P
Hansen, MD* as its new medical
director effective in July 1985.
Doctor Hansen currently is as-
sociate professor, Department of
Family Medicine and Practice,
c
and director, Madison Residency
Department of Family Medicine
and Practice at the University of
Wisconsin. He graduated from
the University of Wisconsin
Medical School, Madison, and
also received a Master of Science
degree from the School of Public
Health, University of North
Carolina.
Marshfield Clinic has named
Robert J De Vita associate di-
rector of its prepaid plans. Mr
DeVita was executive director of
Southern Health Plan, the Blue
Cross and Blue Shield health
maintenance organization in
Memphis, Tenn, before joining
the Clinic. Previously he was
medical practice administrator
for the University of Tennessee
College of Medicine, Memphis;
medical services administrator
for Eastern Virginia Medical
Authority in Norfolk, Va, and
NEWS highlights]
business manager for the depart-
ment of anesthesiology at the
Medical College of Wisconsin in
Milwaukee.
Neillsville Clinic recently an-
nounced the following physicians
to head its medical staff for 1985.
They are MDs N Neelagaru,*
president; Bahri Gungor,* sec-
retary; and Vangala Reddy* as
treasurer. Other members of the
medical staff are MDs N R Ca-
pati,* R V Reddy,* Ana Capati,
and Rupa Chinnamaneni.
Calumet Memorial Hospital,
Chilton, has announced the fol-
lowing physicians to head its
medical staff. They are Alvin C
Theiler, MD*, president; Gene A
Tipler, MD*, vice-president;
William E Hannon, MD,* sec-
retary-treasurer; and Randy T
Theiler, MD, immediate past
president.*
Clues!
As important to a diagnosing physician as they
were to Sherlock Holmes. Without clues, in
the diagnosis of thoracic complications, the
physician may face unnecessary delays and the
patient unnecessary hospitalization and surgery.
One of the most useful diagnostic clues is
Histolyn-CYL,® a specific, inexpensive, easy-to-
use skin test for histoplasmosis. Histolyn-CYL
can give you results in forty-eight hours—
without CF antibody titer changes. You can
use this clue right in your office with the same
confidence and ease as other skin test products.
Histolyn-CYE
Clinically proven.
For more information and clinical facts call,
or write to:
Berkeley Biologicals
1831 Second St.
Berkeley, CA 94710 (415)843-6846
€>1985 Berkeley Biologicals
WISCONSIN MEDICAL JOURNAL, MAY 1985: VOL. 84
37
COUNTY SOCIETIES
^
* Physician members of State Medical Society of Wisconsin
CLARK: At the March meeting of
the Clark County Medical So-
ciety, Vangala J Reddy, MD,*
Neillsville, was elected presi-
dent for a two-year term. Rupa
Chennamaneni, MD* was
chosen secretary. Guest speaker
at the meeting was Michael E
Ryan, MD* from the Marshfield
Clinic.
MONROE: The January meeting
of the Monroe County Medical
Society was held in Tomah. Guest
speaker Thomas N Roberts, MD,
La Crosse, spoke on "Reyes Syn-
drome." MDs Janet S Chestnut*
and Michael J Saunders* were
elected to membership.
SAUK: At the February meeting of
the Sauk County Medical Society,
ten members were present.
Robert James Koontz, MD,*
Reedsburg, was the guest speaker.
SAUK: The March meeting of the
Sauk County Medical Society was
held in Spring Green. Ron Hen-
richs. Director of Membership
and Communications of SMS, dis-
cussed the recent survey of phy-
sicians in the State of Wisconsin.
WINNEBAGO: Twenty-four
members and one guest were
present at the April meeting of
the Winnebago County Medical
Society. Guest speaker for the
meeting was Robert A Bone-
brake, MD* of Madison. Doctor
Bonebrake spoke on "Diagnosis
and Treatment of Osteoarthritis."
WINNEBAGO: Thirty-eight
members and two guests were
present at the March meeting of
the Winnebago County Medical
Society. Merton D Finkler, Pro-
fessor of Economics at Law-
rence University, Appleton,
spoke on "Regulation and
Competition in Health Care."
New physicians admitted to
Society membership are Gizell
M Rosetti,* Neenah; and Curtis
D Radford,* Winneconne. ■
State Division of Health
Statewide pneumoconosis radiologic
consultation program begins June 1
Occupational disease reporting has been part of Wisconsin
statutes for many years. Under-reporting of disease is widespread,
due to the difficulty of diagnosis and physician unfamiliarity with
occupational disease. Much of the difficulty in diagnosis of
pneumoconosis arises from the unfamiliarity of physicians (other
than specialty-trained x-ray interpreters) with the international
pneumoconosis classification which allows a consistent and
schematic interpretation to classify radiologic evidence of pneu-
moconosis. The State, in recognition of these difficulties and the
paucity of NIOSH-trained physicians in the state, is implementing
a radiologic consultation program. An NIOSH-trained B-reader
will provide an ILO pneumoconosis interpretation and classifica-
tion of submitted x-rays, in accordance with NIOSH standards.
In June the State Division of Health will begin accepting sub-
mitted x-ray films. Physicians who have patients with an unusual
pleural or parenchymal radiograph and a history of dust exposure
are encouraged to participate.
To participate a physician need only send the patient's chest
radiograph, accompanied by a Physician's X-ray Submission
Sheet (a short dust exposure history form provided by the State)
to the Division of Health.
The x-ray will be classified and returned to the sender with a
full written report of the findings. This program will not replace
or function as an employee periodic examination program, nor is it
a replacement for final physician diagnosis.
All information will remain confidential as part of the patient's
medical records. Only information in tabular aggregate form will
be released as part of periodic project summaries. Physicians who
wish to participate in the pilot program or wish more informa-
tion may contact either Henry A Anderson, MD (a member of the
State Medical Society's Committee on Environmental and Occu-
pational Health and Chief, Section of Environmental and Chronic
Disease Epidemiology, State Division of Health) or Barbara
Pennington, Project Coordinator in the State Division of Health
at (608) 266-7338. ■
SMS Toll-free
number in Wisconsin
1-800-362-9080
38
WISCONSIN MEDICAL JOURNAL, MAY 1985: VOL. 84
Motrin
6CX> mg Tablets
Upjohn
j-4044 January 1984
The Upjohn Company
The Upjohn Company • Kalamazoo, Michigan 49001 USA
^Once-daily INDERAL LA
(propranolol HCI) for
smooth blood pressure
control without the
potassium problems
of diuretics
Once-daily INDERAL LA (propranolol HCI)
avoids the risk of diuretic-induced ECG ab-
normalities due to hypokalemia.' - In addi-
tion, INDERAL LA preserves potassium
balance without additive agents or supple-
ments while providing simple, well-tolerated
therapy with broad cardiovascular benefits.
Once-daily INDERAL LA
for the cardiovascular
benefits of the world's
leading beta blocker
Simply start with 80 mg once daily. Dosage
may be increased to 1 20 mg to 1 60 mg once
daily as needed to achieve additional control
Like conventional INDERAL tablets,
INDERAL LA should not be used in the
presence of congestive heart failure, sinus
bradycardia, heart block greater than first
degree, and bronchial asthma.
The appearance of these capsules
is a registered trademark
of Ayerst Laboratories
80 mg 120 mg 160 mg
Please see brief summary of prescribing information
on the next page for further details.
Once-daily
LA
(PROPRANOLOL HCI) ‘~^^SULES^
BRIEF SUMMARY (FOR FULL PRESCRIBING INFORMATION, SEE PACKAGE CIRCULAR )
INDERAL* LA brand of propranolol hydrochloride (Long Acting Capsules)
DESCRIPTION. Inderal LA is formulated to provide a sustained release of propranolol
hydrochloride inderal LA is available as 80 mg, 120 mg, and 160 mg capsules
CLINICAL PHARMACOLOGY. INDERAL is a nonselective beta-adrenergic receptor
blocking agent possessing no other autonomic nervous system activity It specifically com-
petes with beta-adrenergic receptor stimulating agents lor available receptor sites When
access to beta-receptor sites is blocked by INDERAL, the chronotropic, inotropic, and
vasodilator responses to beta-adrenergic stimulation are decreased proportionately
INDERAL LA Capsules (80. 120, and 160 mg) release propranolol HCI at a controlled and
predictable rate Peak blood levels following dosing with INDERAL LA occur at about 6 hours
ahd the apparent plasma hall-lile is about 1 0 hours When measured at steady state over a 24-
hour period the areas under the propranolol plasma concentration-time curve (AUCs) for the
capsules are approximately 60% to 65% of the AUCs lor a comparable divided daily dose of
INDERAL tablets The lower AUCs lor the capsules are due to greater hepatic metabolism of
propranolol, resulting from the slower rate of absorption of propranolol Over a twenty-tour (24)
hour period, blood levels are fairly constant for about twelve (12) hours then decline
exponentially
INDERAL LA should not be considered a simple mg for mg substitute tor conventional
propranolol and the blood levels achieved do not match (are lower than) those of two to lour
times daily dosing with the same dose Wheh changing to INDERAL LA from conventional
propranolol, a possible need for retitration upwards should be considered especially to
maintain effectiveness at the end ot the dosing inten/al In most clinical settings, however,
such as hypertension or angina where there is little correlation between plasma levels and
clinical effect, INDERAL LA has been therapeutically equivalent to the same mg dose ol
conventiohal INDERAL as assessed by 24-hour effects on blood pressure and on 24-hour
exercise responses of heart rate, systolic pressure and rale pressure product INDERAL LA
can provide effective beta blockade for a 24-hour period
The mechanism ot the antihypertensive effeot of INDERAL has hot been established
Among the factors that may be involved in contributing to the antihypertehsive action are (1)
decreased cardiac output, (2) inhibition ot renin release by the kidneys, and (3) diminution of
tonic sympathetic nerve outflow from vasomotor centers in the brain Although total peripheral
resistance may increase initially, it read|usts to or below the pretrealment level with chronic
use Effects on plasma volume appear to be minor and somewhat variable INDERAL has
been shown to cause a small increase in serum potassium concentration when used in the
treatment of hypertensive patients
In angina pectoris, propranolol generally reduces the oxygen requirement of the heart at
any given level ot effort by blocking the catecholamine-induced increases in the heart rate,
systolic blood pressure, and the velocity and extent of myocardial contraction Propranolol
may increase oxygen requirements by increasing left ventricular fiber length, end diastolic
pressure and systolic election period The net physiologic effect of beta-adrenergic blockade
IS usually advantageous and is manifested during exercise by delayed onset of pain and
increased work capacity
In dosages greater than required lor beta blockade, INDERAL also exerts a quinidine-like
or anesthetic-like membrane action which affects the cardiac action potential The signifi-
cance of the membrane action in the treatment ot arrhythmias is uncertain
The mechanism of the antimigralne effect of propranolol has not been established Beta-
adrenergic receptors have been demonstrated in the pial vessels of the brain
Beta receptor blockade can be useful in conditions in which, because of pathologic or
funotional changes, sympathetic activity is detrimental to the patient But there are also
situations in which sympathetic stimulation is vital For example, in patients with severely
damaged hearts, adequate ventricular function is maintained by virtue of sympathetic drive
which should be preserved In the presence of AV block, greater than first degree, beta
blockade may prevent the necessary facilitating effect of sympathetic activity on conduction
Beta blockade results in bronchial constriction by interfering with adrenergic bronchodilator
activity which should be preserved in patients subject to bronchospasm
Propranolol is not significantly dialyzable
INDICATIONS AND USAGE. Hypertension: INDERAL LA is indicated in the manage-
ment of hypertension, it may be used alone or used in combination with other antihypertensive
agents, particularly a thiazide diuretic INDERAL LA is not indicated in the management of
hypertensive emergencies
Angina Pectoris Due to Coronary Atherosclerosis: INDERAL LA is indicated
for the long-term management of patients with angina pectoris
Migraine: INDERAL LA is indicated for the prophylaxis of common migraine headache
The efficacy of propranolol in the treatment of a migraine attack that has started has not been
established and propranolol is not indicated for such use
Hypertrophic Subaortic Stenosis: INDERAL LA is useful in the management of
hypertrophic subaortic stenosis, especially for treatment of exertional or other stress-induced
angina, palpitations, and syncope INDERAL LA also improves exercise performance The
effectiveness of propranolol hydrochloride in this disease appears to be due to a reduction of
the elevated outflow pressure gradient which is exacerbated by beta-receptor stimulation
Clinical improvement may be temporary
CONTRAINDICATIONS. INDERAL is contraindicated in 1) cardiogenic shock, 2) sinus
bradycardia and greater than first degree block, 3) bronchial asthma, 4) congestive heart
failure (see WARNINGS) unless the failure is secondary to a tachyarrhythmia treatable with
INDERAL
WARNINGS. CARDIAC FAILURE Sympathetic stimulation may be a vital component sup-
porting circulatory function in patients with congestive heart failure, and its inhibition by beta
blockade may precipitate more severe failure Although beta blockers should be avoided in
overt congestive heart failure, if necessary, they can be used with close follow-up in patients
with a history of failure who are well compensated and are receiving digitalis and diuretics
Beta-adrenergic blocking agents do not abolish the inotropic action of digitalis on heart
muscle
IN PATIENTS WITHOUT A HISTORY OF HEART FAILURE, continued use of beta blockers
can. in some cases, lead to cardiac failure Therefore, at the first sign or symptom of heart
failure, the patient should be digitalized and/or treated with diuretics, and the response
observed closely, or INDERAL should be discontinued (gradually, if possible)
IN PATIENTS WITH ANGINA PECTORIS, there have been reports of exacerbation of
angina and. in some cases, myocardial infarction, following abrupt discontinuance of
INDERAL therapy Therefore, when discontinuance ol INDERAL is planned the dosage
should be gradually reduced over at least a few weeks, and the patient should be
cautioned against interruption or cessation ot therapy without the physician's advice If
INDERAL therapy is interrupted and exacerbation of angina occurs, it usually is advis-
able to reinstitute INDERAL therapy and take other measures appropriate for the man-
agement of unstable angina pectoris Since coronary artery disease may be
unrecognized, it may be prudent to follow the above advice in patients considered at risk
of having ocoult atherosclerotic heart disease who are given propranolol for other
indications
Nonailergic Bronchospasm (e.g., chronic bronchitis, emphysema) —
PATIENTS WITH BRONCHOSPASTIC DISEASES SHOULD IN GENERAL NOT RECEIVE BETA
BLOCKERS INDERAL should be administered with caution since it may block bronchodila-
tion produced by endogenous and exogenous catecholamine stimulation of beta receptors
MAJOR SURGERY The necessity or desirability of withdrawal of beta-blocking therapy
prior to major surgery is controversial It should be noted, however, that the impaired ability of
the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthe-
sia and surgical procedures
The appearance of these capsules
IS a registered trademark
of Ayerst Laboratories
INDERAL (propranolol HCI), like other beta blockers, is a competitive inhibitor ot beta-
receptor agonists and its effects can be reversed by administration of such agents, e g .
dobutamine or isoproterenol However, such patients may be subject to protracted severe
hypotension Difficulty in starting and maintaining ihe heartbeat has also been reported with
beta blockers
DIABETES AND HYPOGLYCEMIA Beta-adrenergic blockade may prevent the ap-
pearance of certain premonitory signs and symptoms (pulse rate and pressure changes) of
acute hypoglycemia in labile insulin-dependent diabetes In these patients, it may be more
difficult to adjust the dosage of insulin
THYROTOXICOSIS Beta blockade may mask certain clinical signs ot hyperthyroidism
Therefore, abrupt withdrawal of propranolol may be followed by an exacerbation ot symptoms
of hyperthyroidism, including thyroid storm Propranolol does not distort thyroid function tests
IN PATIENTS WITH WOLFF-PARKINSON-VVHITE SYNDROME, several cases have been
reported in which, after propranolol, Ihe tachycardia was replaced by a severe bradycardia
requiring a demand pacemaker In one case this resulted after an initial dose of 5 mg
propranolol
PRECAUTIONS. General Propranolol should be used with caution in patients with impaired
hepatic or renal function INDERAL (propranolol HCI) is not indicated for the treatmeht of
hypertensive emergencies
Beta adrenoreceptor blockade can cause reduction of intraocular pressure Patients
should be told that INDERAL may interfere with the glaucoma screening test Withdrawal may
lead to a return of increased intraocular pressure
Clinical Laboratory Tests Elevated blood urea levels in patients with severe heart disease,
elevated serum transaminase, alkaline phosphatase, lactate dehydrogenase
DRUG INTERACTIONS Patients receiving catecholamine-depleting drugs such as reser-
pine should be closely observed if INDERAL is administered The added catecholamine-
blocking action may produce an excessive reduction of resting sympathetic nervous activity
which may result in hypotension, marked bradycardia, vertigo, syncopal attacks, or orthostatic
hypotension
Carcinogenesis. Mutagenesis. Impairment of Fertility Long-term studies in animals have
been conducted to evaluate toxic effects and carcinogenic potential In 18-month studies in
both rats and mice, employing doses up to 150 mg/kg/day, there was no evidence of significant
drug-induced toxicity There were no drug-related tumorigenic effects at any of Ihe dosage
levels Reproductive studies in animals did not show any impairment of fertility that was
attributable to the drug
Pregnancy Pregnancy Category C INDERAL has been shown to be embryotoxic in
animal studies at doses about 10 times greater than the maximum recommended human dose
There are no adequate and well-controlled studies in pregnant women. INDERAL should
be used during pregnancy only if the potential benefit justifies the potential risk to Ihe fetus
Nursing Mothers INDERAL is excreted in human milk Caution should be exercised wheh
INDERAL IS administered to a nursing woman
Pediatric Use Safety and effectiveness in children have not been established
ADVERSE REACTIONS. Most adverse effects have been mild and transient and have
rarely required the withdrawal of therapy
Cardiovascular bradycardia, congestive heart failure, intensification of AV block, hypo-
tension, paresthesia of hands, thrombocytopenic purpura, arterial insufficiency, usually of the
Raynaud type
Central Nervous System lightheadedness, mental depression manifested by insomnia,
lassitude, weakness, fatigue, reversible mental depression progressing to catatonia, visual
disturbances, hallucinations, an acute reversible syndrome characterized by disorientation for
time and place, short-term memory loss, emotional lability, slightly clouded sensorium, and
decreased performance on neuropsychometrics
Gastrointestinal nausea, vomiting, epigastric distress, abdominal cramping, diarrhea,
constipation, mesenteric arterial thrombosis, ischemic colitis
Allergic pharyngitis and agranulocytosis, erythematous rash, fever combined with aching
and sore throat, laryngospasm and respiratory distress
Respiratory bronchospasm
Hematologic agranulocytosis, nonthrombocytopenic purpura, thrombocytopenic
purpura
Auto-Immune In extremely rare instances, systemic lupus erythematosus has been
reported
Miscellaneous, alopecia. LE-like reactions, psoriasiform rashes, dry eyes, male impo-
tence, and Peyronie's disease have been reported rarely Oculomucocutaneous reactions
involving the skin, serous membranes and conjunctivae reported for a beta blocker (practolol)
have not been associated with propranolol
DOSAGE AND ADMINISTRATION. INDERAL LA provides propranolol hydrochloride in a
sustained-release capsule for administration once daily If patients are switched from INDERAL
tablets to INDERAL LA capsules, care should be taken to assure that the desired therapeutic
effect IS maintained INDERAL LA should not be considered a simple mg for mg substitute for
INDERAL INDERAL LA has different kinetics and produces lower blood levels Retitration may
be necessary especially to maintain effectiveness at the end of the 24-hour dosing interval
HYPERTENSION — Dosage must be individualized The usual initial dosage is 80 mg
INDERAL LA once daily, whether used alone or added to a diuretic The dosage may be
increased to 120 mg once daily or higher until adequate blood pressure control is achieved
The usual maintenance dosage is 120 to 160 mg once daily In some instances a dosage ol640
mg may be required The time needed for full hypertensive response to a given dosage is
variable and may range from a lew days to several weeks
ANGINA PECTORIS — Dosage must be individualized Starting with 80 mg INDERAL LA
once daily, dosage should be gradually increased at three to seven day intervals until optimum
response is obtained Although individual patients may respond at any dosage level, the
average optimum dosage appears to be 160 mg onoe daily In angina pectoris, the value and
safety ot dosage exceeding 320 mg per day have not been established
If treatment is to be discontinued, reduce dosage gradually over a period of a few weeks
(see WARNINGS)
MIGRAINE — Dosage must be individualized The initial oral dose is 80 mg INDERAL LA
once daily The usual effective dose range is 160-240 mg once daily The dosage may be
increased gradually to achieve optimum migraine prophylaxis If a satisfactory response is not
obtained within four to six weeks after reaching the maximum dose. INDERAL LA therapy
should be discontinued It may be advisable to withdraw the drug gradually over a period ot
HYPERTROPHIC SUBAORTIC STENOSIS— 80-160 mg INDERAL LA once daily
PEDIATRIC DOSAGE— At this time the data on the use of the drug in this age group are too
limited to permit adequate directions lor use
REFERENCES
1. Holland OB, Nixon JV. Kuhnert L: Diuretic-induced ventricular ectopic
activity Am J Med ^98^ :70:762-768 2. Holme I, Helgeland A, Hiermann
I, et ai: Treatment of mild hypertension with diuretics. The importance of ECG
abnormalities in the Oslo study and in MRFIT JAMA 1984,251.1298-1299,
AYERST LABORATORIES 9411/1184
New York, N Y 10017
Ayersfe
Copyright © 1984 AYERST LABORATORIES
Division of AMERICAN HOME PRODUCTS CORPORATION
SOCIOECONOMICS
Some basic rules to follow
when writing to your legislator
Legislators do indeed listen to
the sentiments expressed by their
constituents. But, in order for
them to listen, the constituent
must speak— and speak to the
issue. While the letter you write to
your legislator may not change the
course of history, it can have an
impact, particularly if you observe
some fundamental guidelines.
Identify yourself
Your letter will be given more
serious consideration if it is type-
written on your personal or pro-
fessional letterhead. Your name
and address, clearly indicated,
will invite a response.
Identify your reason for writing
Specify the issue which has
prompted your letter in your
opening sentence. If you are writ-
For fast delivery to state legislators
in Madison:
State Senators:
PO Box 7882
Madison, W1 53707
Representatives:
Last Names A-L
PO Box 8952
Madison, WI 53708
Last Names M-Z
PO Box 8953
Madison, Wl 53708
Governor:
PO Box 7863
Madison, WI 53707
ing with regard to a particular
piece of legislation, refer to the bill
by title and number, if possible.
State your case
Your own personal experience
is your best supporting evidence.
Explain how the issue would af-
fect you, your profession, or what
effect it could have on your com-
munity. Try to be specific and
brief. Back your position with
reliable facts and figures, and
clearly state whether you are for
or against the bill. You may think
that the facts speak for them-
selves, but the legislator may be
less familiar with the subject.
Timing is essential
The best time to let your legis-
lator know your views is generally
while a bill is still in committee. If
he or she has not already taken a
position, constituent sentiments
will be of concern and may serve
to influence an ultimate decision.
If, on the other hand, your repre-
sentative has already formed an
opinion, your letter will let him or
her know that you support or op-
pose that stand.
Concentrate your efforts
In addition to your own legisla-
tors, you may wish to write the
chairperson or members of a com-
mittee holding hearings on legis-
lation in which you are interested.
However, remember that you
have more influence with your
own legislators, and efforts to con-
tact others can prove time-con-
suming and are not likely to net
much result.
Don't write a form letter
Phrasing which makes your let-
ter read as though it is part of an
organized pressure effort should
be avoided. Form letters generally
produce little or no impact.
Request a reply
Ask that your legislator respond
to your letter with a statement of
his or her position on the issue or
legislation. As a constituent, it is
your right to request such infor-
mation.
Remember your manners
Do not underestimate the
power of a simple 'thank you!' If
your legislator casts a vote of
which you approve, write a fol-
lowup letter in support of the ac-
tion. If, on the other hand, you
disapprove of the vote, don't
hesitate to let them know that too.
Don't demand the impossible
In fact don't demand anything!
Don't issue threats or ultimatums.
Taking any stance which makes
you sound unreasonable will not
further your case. ■
WISCONSIN MEDICAL JOURNAL, MAY 1985: VOL. 84
43
OBITUARIES
Joseph D Bonan, MD, 70,
Wauwatosa, died Feb 12, 1985 in
Wauwatosa. Born Jan 16, 1915 in
Rochester, New York, Doctor
Bonan graduated from Mar-
quette University School of Medi-
cine in 1942 and served his in-
ternship at Misericordia Hospital.
Doctor Bonan was a member of
the medical staff of Elmbrook
Memorial and St Anthony's hos-
pitals and served as chief-of-staff
at St Anthony's Hospital in 1973.
He retired from medical practice
in 1982. He was a member of The
Medical Society of Milwaukee
County, the State Medical Society
of Wisconsin, and the American
Medical Association. Surviving
are two sons, J Daniel and Robert
J; and one daughter, Jean.
Gerard J Biedlingmaier, MD,
56, Wauwatosa, died Feb 15,
1985 in Wauwatosa. Born July
10, 1929 in Scranton, Pa, Doctor
Biedlingmaier graduated from
Jefferson Medical College of Phil-
adelphia in 1954 and served his
internship at Scranton State Gen-
eral Hospital. His residency was
completed at Temple University
Medical Center, Philadelphia,
Pa. Doctor Biedlingmaier was on
the medical staff of Trinity Mem-
orial Hospital, Cudahy. He
served in the United States Navy
from 1955-57. He was a member
of The Medical Society of Mil-
waukee County, the State Medi-
cal Society of Wisconsin, and the
American Medical Association.
Surviving are his widow, Mary,
and five children.
Radio
dispatched
truck fleet
for
INDUSTRY, INSTITUTIONS,
SCHOOLS, ETC.
AUTHORIZED PARTS
AND SERVICE FOR
CLEAVER-BROOKS
Throughout Wisconsin
and Upper Michigan
SALES
Boiler room accessories
O2 trims
Cleveland controls
and Car automatic bottom
blowdown systems
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Complete Mobile Boiler Room
Rentals
Stevens Point— 715/344-7310
Green Bay— 414/494-3675
Madison-608 / 249-6604
PBBS EQUIPMENT CORP.
5401 N Park Dr
PO Box 365
Butler, WI 53007
Phone: 414/781-9620
Edwin P Bickler, MD, 87, Wau-
watosa, died Mar 2, 1985 in Mil-
waukee. Born June 15, 1897 in
Belgium, Wis, Doctor Bickler
graduated from Marquette Uni-
versity School of Medicine, Mil-
waukee, and served his intern-
ship at St Mary's Hospital in
Milwaukee. He also did post-
graduate studies at the University
of Pennsylvania. Doctor Bickler
practiced in Milwaukee from
1925 until 1975. He also was a
consulting physician for Briggs &
house of
BIDWELL, inc.
7954 West Harwood
and Watertown Plank Road
Milwaukee, Wisconsin 53213
ORTHOTIC
AND
PROSTHETIC
SERVICES
1-414 744-6250
Stratton Corp. He was a member
of The Medical Society of Mil-
waukee County, the State
Medical Society of Wisconsin,
and the American Medical Asso-
ciation. Surviving are three
brothers, Emil, Belgium; Wil-
liam, Milwaukee; and Joseph of
San Diego, Calif.
Stella I Burdette, MD, 86, Amery,
died Mar 8, 1985 in Amery.
Born Sept 10, 1898 in Ruskin,
TN, Doctor Burdette graduated
from the University of Wisconsin
Medical School, Madison, in
1934. Her internship was served
at Wisconsin General Hospital
(now UW Hospital and Clinics),
Madison, and she completed her
residency at Pine Breese Sani-
torium in Chattanooga, TN.
Doctor Burdette practiced medi-
cine in Elroy until 1950 when she
moved to Balsam Lake. She re-
tired in 1971. Surviving is her
husband, Leo.
Richard W Farnsworth, MD,
82, Janesville died March 10,
1985 in Janesville. Born June
14, 1902 in Janesville, Doctor
Earnsworth graduated from
Harvard University Medical
School and served his internship
at Peter Bent Brigham Hospital
in Massachusetts. Doctor Farns-
worth served in the United States
Army Medical Corps from 1942-
1947 during World War II. He
practiced in Janesville for 38
years until his retirement in 1978.
He was a member of the Rock
County Medical Society, the State
Medical Society of Wisconsin,
and the American Medical As-
sociation. Surviving are his
widow, Ella; a daughter, Susan
Heusler, St Charles, Mo; a son,
George, Milwaukee; two step-
sons, Samuel Richards, Janes-
ville, and Raymond Richards,
Kimberly; and a stepdaughter,
Linda Bellman of Madison. ■
44
WISCONSIN MEDICAL JOURNAL, MAY 1985:VOL. 84
American Physicians Life’s comprehensive and competi'
tively priced line of insurance products is now being
offered exclusively through SMS Services Inc., to State
Medical Society members.
APL is a wholly'Owned subsidiary of Physicians Insure
ance Company of Ohio (PICO) and a sister company of
The Professionals Insurance Company, the carrier of the
SMS^endorsed Professional Liability Insurance Plan.
APL coverages available to you through SMS Services
Inc., and its authorizied insurance representatives include;
• Innovative Universal Life coverages
• Low Cost Graded Premium Whole Life plan
• Yearly Renewable and Convertible Term Life protection
• Non-cancellable Disability Income programs
• Single and Flexible Premium Annuities
• Comprehensive Office Overhead Expense protection
Why not contact SMS Services Inc., today to find out
how American Physicians Life can solve all your life
insurance needs.
CONTACT:
SMS SERVICES INC.
330 EAST LAKESIDE STREET
P.O. BOX 1109
MADISON, WISCONSIN 53701
(608) 257-6781 OR TOLL FREE
1-800-362-9080
For professional liability insurance, the stakes are too
high to depend on anyone else.
That's why the State Pledical Society has endorsed a
professional liability plan which has been developed
especially for Wisconsin physicians.
Available only to members of the SP1S— and offered
through SPIS Services, Inc.— this medical malpractice policy
has superior features including:
• Consent of the physician is required before settlement of
any claim.
• Availability of legal counsel, experienced in defendant
medical liability.
• All members of claims and underwriting committees are
Wisconsin physicians.
• Occurrence coverage provided for claims arising during
the policy period, even if claim is reported at a later
time.
For the best in professional liability coverage, contact
SMS Services, Inc. at (608) 257-6781 or toll-free 1-800-362-9080
know how vital it is to safeguard the present...
and to protect the future.
Endorsed by the
State Medical Society
of Wisconsin
A respected leader in coverage for preferred markets.
who is number 1
in medical
office computer
systems in
Wisconsin?
NDX Clinical Hanagenent Systen
1) Financial Accounting
Z) Insurance Clain Tracking
6) Appointnent Scheduling
7) Hedical History
Not IBM nor Apple nor any other nationally-known
computer name. The answer is Advanced Technology
Associates. Number 1 means the most complete systems; the
most logical match of hardware, software and services. ATA is
the source for total packages — computers, terminals, printers,
special medical programs, careful installation, training for
your people and after-sale support.
Considering the scope of our Wisconsin experience, it
should not surprise you that ATA is endorsed by the State
Medical Society.
May we send you information listing your benefits from
a strictly medical office computer system? Call or write.
Advanced Technology Associates
4710 W, North Avenue, Milwaukee, Wl 53208
(414) 445-4280
In Wisconsin call toll free 1-800-242-4280.
Endorsed by SMS Services, Inc For members of the State Medical Society of Wisconsin.
PSYCHIATRIST
psy>chi'a*trist
(si-ki-0-trist, si)
ST
mRV'5
4IILL
W05PITAL
2350 NORTH lAKE DRIVE
MILWAUKEE, WISCONSIN 53211
414/271-5555
Sponsored by the
School Sisters of St Francis
Since 1912
Active Medical Staff — Psychiatry
John T Andersen, M.D.
Bruce H Axelrod, M.D
John T Bond, M D.
George E. Currier, M.D.
Dinshah D Gagrat, M.D
Jack E. Geisl, M.D.
Donald P. Hay. M D.
Robert E Holt. M.D,
Charles W Landis, M.D.
Anthony T. Machi, M.D,
Gilbert J, Nock, M.D
Mun> H Patel, M.D
Ezzeldin M, Salama, M.D.
K. Kv\/ang Soo, M.D.
Frederic A Steiger. M.D.
Brian T. Stemhaus, M.D,
Wess R. Vogt, M.D.
David H. Zarwell. M.D
Psychiatrist. Look it up in a dictionary and you will likely find definitions
that speak of a doctor whose practice pertains to working with patients
afflicted with mental, emotional, and behavioral disorders. And that’s
true ... as far as it goes.
At Milwaukee’s St. Mary’s Hill Hospital, we believe some elaboration
is necessary . . .
“PSYCHIATRIST: 1) a fully trained and experienced physician engaged
in the practice of psychiatry; 2) one who understands that when you
make a referral for psychiatric treatment, you should be kept informed
of and involved in your patient’s care; 3) the medical professional who has
the primary responsibility for treating patients at St. Mary’s Hill Hospital.”
Whether your patient is an adult, young adult, adolescent or child,
when professional psychiatric care is required — it makes good sense
to talk with an expert.
CLASSICAL ITALIAN
RESTAURANT
5518 UNIVERSITY AVENUE
MADISON (608) 233-2200
ELEGANT DINING • FINE WINES • INTIMATE
COCKTAIL LOUNGE • OPEN DAILY AT 5:00 PM
“For an elegant night of Italian dining. ” —Prof Herbert Kubly, Milwaukee Journal writer
Acme
Laboratories, Inc
Qualified, competent professionals are the
trademark of Acme Laboratories. For 35
years, our certified orthotists and prosthetists
have earned a reputation for excellence,
helping people improve their lives.
Acme Laboratories serves Wisconsin from
offices in Milwaukee, Green Bay. Fond du
Lae and Woodruff. We're pleased to be a
designated HMO facility for .southeastern
Wisconsin. Acme Laboratories accepts all
insurance, including Medicare and Medicaid.
10702 W. Burleigh St., Milwaukee, Wl 53222
414-259-1090
GREEN BAY ORTHOPEDIC
Division of Acme Laboratories, Inc.
428 S. Adams St., Green Bay, Wl 54301
414-435-1461
525 E. Division St., Fond du Lac, Wl 54935
414-923-6676
Affiliated with Northwoods Rehabilitation
Box LOA, Woodruff, Wl 54568
715-356-8000 Ext. 8872
Acme Laboratories — where quality of
life is our main concern JtSJSIVion
YOU CAN HELP
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For a large majority of
your Enuretic patients
• Ethical — prescription only
• Professional — you supervise
treatment
• Approximately 90 percent effective
• Proven reliable and dependable
bell, pad, and light system
• Low cost rental service — $14.00
per week (avg. 6-week treatment)
• Convenient mall order service
to the 48 states
For more information, caii or write;
S. & L. SIGNAL COMPANY
Helping Enuretic Clients
Since 1950
1142 Fleetwood A ve. Madison, W 1 53716
Phone: 608-222-7939
Accepted for advertising In the AMA Journal
MEDICAL
COLLEGE OF
WISCONSIN
Microcomputers
in Medicine
June 88, 1988 • 8 am - 5 pm
Milwaukee
WHAT: A one-day computer seminar and ex-
position for health care professionals featur-
ing health science Information specialists
and computer hardware/ software exhibitors.
Topics include choosing a system; office prac-
tice management; computer-aided diagnosis.
AMONG rSATURED SPEAKERS: Peter W.
Xolos, PhD, Stanford Medical School and
Howard L. Bleich, MD, Harvard Medical
School.
REQISTRAIION: $60 fee before May 16 In-
cludes admission, lunch and reception.
CONTACT: Micros In Medicine, MOW
Libraries, 8701 Watertown Plank Rd,
Milwaukee, Wl 63226 (414) 267-8323.
Sponsored by MOW Libraries.
CARE FOR YOUR
COUNTRt:
As an Army Reserve physician, you can serve
your country and community with just a small invest-
ment of your time. You will broaden your professional
experience by working on ,
interesting medical projects'
in your community. Army
Reserve service is flexible, so it
won't interfere with your practice.
You'll work and consult with top
physicians during monthly Reserve
meetings. You'll also attend funded
continuing medical education pro-
grams. You will all share the bond of
being civic-minded physicians who are also commis-
sioned officers. One important benefit ot being an officer
is the non-contributory retirement annuity you will get
when you retire from the Army Reserve. To find out
more, simply call the number below.
ARMY RESERVE.
BEAUYOUCANBE.
MAJOR DAVIDS BARRIE
COLLECT: (31 2) 926-3161
Experience Air Force Medicine. It can be just
what you’d like your rnedical practice to be.
More time to practice medicine. More time
with your family. Even more time for your
hobbies. It’s all part of Air Force EXPERIENCE.
Talk to a member of our medical placement
team today. Find out how you can experience
the perfect medical practice as an AIR FORCE
PHYSICIAN.
FOR INFORMATION CALL:
414-258-2430
Outside area call collect
On the leading edge of technology
■ ^ 'a 1 i I f
r. gj
a
\ i " '
V
^ ^ ^
n ^ j ^ 5 -1 u i ^ ^
‘ i s I =■
^ i 1 ^ ■
Centralized
BiW
^sterns
^ INCORPORATED
SEGMENTATION
Your solution to profitable patient and insurance
billing management.
Centralized Billing Systems can provide the
complete picture, or just the part that your
practice is missing . . . from efficient and
professional billing management systems to
complete PC software or hardware.
• Stand Alone (PC)
Systems & Software
• Statement Processing
• Insurance Processing
• On-Line Inquiry
• Patient Recall
• Appointment Scheduling
• Batch (mail-in) Systems
For further information or no-obligotion
consultation please call
3636 North 124th St. 3916 67th Street
Milwaukee, Wl 53222 Kenosha, Wl 53142
(414) 535-0100 (414) 658-8603
Ask about CyCare’s ClOO
APPOINTMENT SCHEDULING. The
physician time management system
for small and medium size practices.
□ Rush free details to me about
CyCare.
□ Have a representative contact me.
My business card/letterhead is
attached.
No. of Phys
Mail to: CyCare, 520 Dubuque
Building Dubuque. Iowa 52001
Sales and Service Offices:
Atlanta. GA; Cherry Hill, NJ; Chicago, IL; Dallas,
TX; Denver, CO; Miami, FL; Minneapolis, MN;
New York. NY; Portland, OR; San Diego. CA;
Spokane, WA; Canada: Toronto, Ont.
Authorized National ISO
Over 17 years and untold
manhours. That’s what CyCare has
invested in the study of health care.
We've long since earned our
diploma. While many aspiring com-
petitors failed to make the grade;
We chose one specialty. The
delivery of health care is a specializ-
ed business. Your data processing
company should understand it
thoroughly. That’s tough to do if
they're also marketing to banks, fac-
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From the beginning. CyCare
decided to commit only to the
medical industry. Our staff of over
600 has been living and breathing it
ever since.
Experience only CyCare can
claim. CyCare has studied with
thousands of physicians, ad-
ministrators, and nurses. We’ve
worked with nearly 850 clients of all
specialties and size. In 17 years,
we’ve treated data processing
challenges of every kind.
You know experience is the best
teacher. So choose a company that’s
been around long enough to learn.
Our knowledge benefits you. Our
experience taught us that each client
is different. We designed systems
that easily accomodate any type of
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useless “bells and whistles’’, so we
developed practical software that
enhances the delivery of patient
care. We discovered the fear of
system obsolescence. So we created
modular systems that can be expand-
ed at any time.
Learning never stops. Like you,
we never stop learning. We invest
more in research each year than
most of our competitors gross in
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Compare our credentials. Ex-
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leading supplier to medical group
practices, HMDs and ambulatory
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Put us to the test. We’re prepared.
MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
Internal Medicine. Partner sought for
established Board certified internist in
Moorhead, Minnesota. Primary care,
consultations, critical care, optional
research. Income guarantee, productivity
plus benefits, partnership one year.
Charles Nelson, Fox Hill Associates,
250 Regency Court, Waukesha, Wis
53186; ph 414/785-6500 collect. p5/85
Medical Director. New position in 50-
physician multispecialty clinic. To work
with administrative team and profes-
sional staff, plus part-time medical prac-
tice. For more information contact
James R Stormont, MD, The Monroe
Clinic, Monroe, Wis 53566; ph 608/328-
7000. p5-7/85
Internist. BC/BE internist needed to
join four internists in multispecialty
group in NE Wisconsin. Competitive
salary and benefits. Both subspecialty
and general medicine inquiries welcome.
Send CV to Neil Binkley, MD, 1510 Main
St, Marinette, Wis 54143; ph 715/735-
7421. 5-7/85
The Racine Medical Clinic, a progres-
sive cluster corporation of 31 physicians
is currently seeking an Internist-Infectious
Disease physician. Full benefits, un-
limited earnings and a full and exciting
practice are offered. Please contact: Roger
D Lacock, Administrator, Racine Medical
Clinic, 5625 Washington Ave, Racine, WI
53406; ph 4 14 / 886-5000. 12tfn / 84
Family Practice physician needed
to join five family practitioners and a
general surgeon. Immediate oppor-
tunity in west central Wisconsin near
La Crosse. $45,000 first year guarantee
plus incentive. Excellent recreational
area. Community hospital. Send CV
to WiUiam L Simpson, Administrator,
PO Box 250, Sparta, WI 54656; or
phone 608 / 269 -6731. 5-6/85
RATES: 50e per word, with a minimum
charge of $20.00 per ad. BOXED AD
RATES: $25.00 per column inch.
DEADLINE: Copy must be received by the
15th of the month preceding month of issue;
e.g., copy for the August issue is due July 15.
Send copy to: Wisconsin Medical Journal,
Box 1109, Madison, Wisconsin 53701; or
phone (area code 608) 257-6781; or toll-free
in Wisconsin: 800/362-9080.
Internist with or without subspecialty
interest. Board Certified or eligible, to
join six other internists in a well-estab-
lished, 23-man expanding multispecialty
group in prosperous lakeside south-
eastern Wisconsin city of 36,000. The
Internal Medicine Department currently
has subspecialties in cardiology, pul-
monary medicine, and medical on-
cology. Liberal fringe benefits. Initial
salary plus percentage as associate.
Full status in service corporation, with
incentive-oriented formula after first
year. Contact] F Kuglitsch, MD, Fond du
Lac Clinic, SC, 80 Sheboygan St, Fond
du Lac, Wis 54935; ph 414/923-7420
collect. 5tfn/85
Family Practice opportunity to join a
four-physician family practice group in
south central Wisconsin city of 15,000.
Pleasant community atmosphere within
1-1% hours of Madison and Milwaukee.
Excellent recreational area. First year
guaranteed salary. Contact: Chad
Burchardt, Business Manager, Medical
Associates of Beaver Dam, Wis 53916; ph
414/887-7101. 5tfn/85
Wanted— Board qualified— board cer-
tified obstetrician-gynecologist as an
associate. Modern well equipped facility.
Excellent starting salary and benefits in-
cluding profit sharing plan. Please contact
Elizabeth Allen Steffen, MD, 734 Lake
Ave, Racine, Wis 54303. 9tfn/83
Second Family Practitioner needed to
staff a satellite of a 38-physician multi-
specialty group in Kiel, a beautiful small
community in East Central Wisconsin. At-
tractive income arrangements, association
membership possible after one year, pen-
sion and profit sharing, extensive fringe
benefits. Contact R B Windsor, MD, 1011
North 8 St, Sheboygan, WI 53081; ph 414/
457-4461. c2tfn/85
Family Doctor to serve Omro: 8 miles
west of Oshkosh. Modern well-equip-
ped facility available to lease or buy.
Financial assistance available. Hos-
pital 330-bed— 20 minutes. Contact
Elaine Peck, 521 East Ontario, Omro,
Wisconsin 54963. 414/685-2228 or
Mercy Medical Center, Oshkosh, Wis-
consin, Public Relations 414/236-
2101. p4-5/85
Family Practitioners needed to staff
satellite locations and Urgent Care
Centers located in Northeast Wisconsin.
Please send CV to Dept 554 in care of the
Journal. 2-5/85
Orthopedic Surgeon. An excellent op-
portunity is available for two orthopedic
surgeons to join a progressive Medical
Group in Central Minnesota. The com-
munity serves a population base of
225,000 individuals and is an excellent
base for an orthopedic surgeon. St Cloud,
Minnesota is the hub of the State and is
home to three major colleges. It is geo-
graphically located to provide quick ac-
cess to the Metropolitan-Twin Cities area.
The St Cloud community has a 500-bed
hospital with all the latest medical and
technological advancements to assist the
practicing orthopedic surgeon. If inter-
ested in this excellent opportunity, please
call collect either Dr LaRue Dahlquist,
President, and/or Daryl Mathews, Ad-
ministrator, at 612/251-8181 and/or send
curriculum vitae to St Cloud Medical
Group, 1301 West St Germain Street, St
Cloud, Minnesota 56301. 2-5/85
Internal Medicine— Board certified or
eligible, to join 17-physician multi-
specialty clinic with 7-physician internal
medicine department. Located in beauti-
ful Wisconsin lakeshore community of
35,000. Competitive salary, complete
fringe benefits, generous vacation time.
Send CV to: Administrator, Manitowoc
Clinic, SC, PO Box 3008, Manitowoc, WI
54220. 1-5/85
Madison, Wisconsin. Experienced phy-
sician for ambulatory care center. Medic-
East, first and only independent ACC in
Madison. Now well established. Located
in heart of Eastside of Madison. Appli-
cants BC/BE demonstrated experience in
primary care, well-developed com-
munication skills. Competitive salary, ex-
cellent benefits, attractive practice setting.
Contact David A Goodman, MD, Medic-
East, 2810 E Washington, Madison, WI
53704; ph 608/244-1213. ltfn/85
Wanted— Qualified physician to prac-
tice emergency medicine in southeastern
Wisconsin. Our group is small and flexi-
ble. Salary is negotiable. If interested, send
CV to Associated Emergency Room Phy-
sicians, SC, 1131 Sherwood Lane, Cale-
donia, Wis 53108; ph 414/835-4489.
4-6/85
Family Physician and Internist, Pedi-
atrician, OB/GYN, Board eligible /certi-
fied. Full or part-time, to join a busy,
established group of physicians in Mil-
waukee. Attractive income. Send cur-
riculum vitae to PO Box 17366, Milwau-
kee, WI 53217. 2-7/85
52
WISCONSIN MEDICAL JOURNAL. MAY 1985: VOL. 84
MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
continued
OB/GYN, and internist to join seven-
doctor family practice clinic in Cloquet,
Minnesota, a community of 14,000 (30,
000) service area, located 20 minutes
from Duluth-Superior. Clinic facility is
located one block from modern, well-
equipped, 77-bed hospital. Cloquet
enjoys a stable economy (forest
products). Additionally our community
is noted for its excellent school system.
First-year salary guarantee; paid mal-
practice, health, and disability insur-
ance; vacation and study time. Con-
tact John Turonie, Administrator,
Raiter Clinic Ltd, 417 Skyline Blvd, Clo-
quet, Minnesota 55720. Telephone
218/879-1271. 4-6/85
Group Health Inc of Minneapolis/
St Paul seeks associates in Allergy,
Family Practice, Internal Medicine,
Endocrinology, Obstetrics and Gyne-
cology, Child Psychiatry, General
Surgery and Urgent Care. Must be
Board certified or eligible. Excellent
facilities, comprehensive benefits,
highly competitive earnings. Send cur-
riculum vitae to: Paul] Brat, MD, Medi-
cal Director, 2829 University Avenue
South East, Minneapolis, Minnesota
55114. An equal opportunity employer.
4-5/85
Family Practitioner needed to join
established Family Practice group in East
Central Wisconsin city of 50,000 on
beautiful Lake Winnebago. Competitive
salary, fringes, excellent recreation area.
Send CV to MS Knier, MD, 555 S Wash-
burn, Oshkosh, Wis 54901; 414/426-0265.
lOtfn/84
Board Eligible Orthopedic Surgeon to
join established orthopedic practice in
East Central Wisconsin. Contact Dept 553
in care of the Journal. 2tfn/85
US Air Force Medical Corps Cur-
rently has opportunities for specialty
physicians. Excellent benefits and
attractive practice settings world-
wide, ranging from small clinics to
1,000-bed medical centers. Positions
currently available include Family
Practice, Internal Medicine, Cardiol-
ogy, Psychiatry, General and Ortho-
pedic Surgery, Otorhinolaryngology,
as well as Aerospace Medicine. For
qualifications and more information
write to 310 W Wisconsin Ave, Suite
380, Milwaukee WI 53202-2278,
Attn: Capt Sealey or call 1-800/242-
USAF. 5-7/85
Internist/Family Practice: Board
Certified or board eligible. Established
50-doctor multispecialty group practice
located in the Milwaukee, Wisconsin
metropolitan area. Expanding practice
needs 2 internists and a family prac-
titioner. Competitive salary and ex-
cellent fringe benefits. Address inquiries
and curriculum vitae to Medical Di-
rector, PO Box 427, Menomonee Falls,
Wisconsin 53051. p4-5/85
Family Practitioner needed to join two
FPs at the Ellsworth, Wisconsin office
of a progressive eleven-physician group.
Liberal fringes and financial package.
Forty miles from metropolitan Min-
neapolis/St Paul. Contact R M Hammer,
MD, River Falls, WI 54022; ph 715/425-
670 1 or 612/436-8809 . 4tfn/85
Family Practitioner. The Racine Medi-
cal Clinic, a progressive cluster corpor-
ation of 31-physicians is currently seek-
ing a family practitioner. Full benefits,
unlimited earnings, and a full and ex-
citing practice are offered. Please contact
Roger D Lacock, Administrator, Racine
Medical Clinic, 5625 Washington Ave,
Racine, WI 53406; ph 414/886-5000.
4tfn/85
PHYSICIANS WANTED
Full or part-time PHYSICIANS
WANTED for emergency room
work throughout Wisconsin.
National Emergency Services
offers excellent income, paid
malpractice insurance, and
flexible scheduling. If you're
interested in exploring opportuni-
ties with NES and you would
like additional information, call
James Lucas at 1-800/537-3355.
5-6/85
FAMILY PRACTITIONERS
INTERNISTS, OB/GYN
The U W Office of Rural Health is seek-
ing primary care specialists for more
than 50 communities throughout Wis-
consin. Opportunities are available
throughout Wisconsin for Board certi-
fied physicians trained in US medical
schools and residencies.
CONTACT:
Laurie Glowac or Fred Moskol
New Physicians for Wisconsin
University of Wisconsin
Department of Family Medicine
777 S Mills St, Madison, WI 53715
Phone: 608/263-4095 7/84;6/85
Physicians needed full or part-time to
perform light physicals. Milwaukee area.
Professional liability provided. Phone
414/344-2100, Ms Jenkins. lOtfn/84
Wanted Board Certified Otolaryngol-
ogist. Head and neck surgeon. Join active
one-man practice. General otolaryngol-
ogy, head and neck surgery, facial plastic
surgery, nasal allergy. Computerized of-
fice with x-ray, audiologist, and hearing
aid dispensing. Northern Wisconsin near
Apostle Islands National Lakeshore. Con-
tact James A Hamp, MD, ENT Profes-
sional Associates, SC, 2101 Beaser Ave,
Suite 1, Ashland, WI 54806; ph 715/ 682-
9311. 4-9/85
The Racine Medical Clinic, a progres-
sive cluster corporation of 31 physicians
is currently seeking an Obstetrician /Gyn-
ecologist physician. Full benefits, un-
limited earnings and a full and exciting
practice are offered. Please contact: Roger
D Lacock, Administrator, Racine Medical
Clinic, 5625 Washington Ave, Racine, WI
53406; ph 414/886-5000. 12tfn/84
Wisconsin-BC/BE Pediatrician to
assume an established position of a
pediatrician leaving. Join a three-man
pediatric department. Call or write:
David L Lawrence, MD, 92 E Division
St, Fond du Lac, WI 54935; ph 414/
921-0560. p3-8/85
MESA is on the MOVE
in
Northern Illinois, Wisconsin
and the Chicagoland Area
We are seeking Board Certified/
eligible and Emergency Trained
Physicians to join our growing
organization.
• Compensation/Benefit Packages
are highly competitive with adminis-
trative and educational support
services.
• Management and Staff positions
for Emergency Departments and
Ambulatory Care Centers.
• Excellent communication skills
and the desire to excel in Emergency
Medicine is a necessity.
MESA Medical Emergency Service
Associates, SC over 20 years of
excellence in Emergency Medicine.
Contact: Ms Debbie Carsky, Director
of Recruitment, 312/459-7304 (collect)
or write to 15 South McHenry Road,
Buffalo Grove, IL 60090. p5/85
WISCONSIN MEDICAL JOURNAL, MAY 1985: VOL, 84
53
MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
continued
Family Practice Physician to share fully
equipped medical office in central Wis-
consin city. Opportunity for partnership
and eventual purchase of practice. Excel-
lent recreational, educational, hospital,
and civic advantages. Send curriculum
vitae to Dept 503 in care of the Journal.
6tfn/82
Immediate opportunities for qualified
physicians who possess excellent clinical
and communication skills to join long-
standing group of Emergency Physicians.
Positions available in a popular Wiscon-
sin area bordering Illinois. If interested,
send resume to Barbara Wilczynski,
Medical Emergency, Service Associates
(MESA), SC, 15 S McHenry Road, Suite 2,
Buffalo Grove, IL 60090 or call collect
312/459-7304. 6tfn/83
Internist or Family Practitioner to join
two Internists and General Surgeon in
growing, established. Green Bay area
practice. Send CV to John Brusky, MD,
1203 South Military Ave, Green Bay, WI
53404. 7tfn/84
Family Physicians, Ophthalmologist,
Orthopedist needed to join 30 physicians
of the Olmsted Medical Group of Roches-
ter. Opportunities available in main office
and satellites. Exceptional salary and
benefit package provided in a choice pro-
fessional and cultural community. Contact
James E Hartfield, MD, Medical Director,
210 Ninth Street SE, Rochester, MN
55903: ph 507/288-3443. 5-7/85
MEDICAL FACILITIES
Family Practice for sale in Milwaukee.
Ideal starter or satellite office. Excellent
patient goodwill. Fully equipped and fur-
nished three examining rooms, waiting
room, and office. Approximately 900 sq
ft. Contact Greg Rodenbeck, DDS, 1200
E Oklahoma Ave, Milwaukee, Wis 53207;
414/481-8111. glOtfn/84
Family Practice office available in
south central Wisconsin. Contact Dept
555 in care of the Journal. 4-5/85
For Sale. Like-new medical office fur-
niture for sale— desks, chairs, examining
tables, typewriters, file cabinets, x-ray
viewers, computer (Victor 9000), and
miscellaneous items. Phone 715/369-
1261. p4-5/85
Medical equipment, examining tables,
treatment tables, instrument cabinets,
etc. Available in June at no cost. Re-
tiring. Phone 414/284-2676. 5/85
Medical practice or equipment for
sale in Milwaukee. Completely equip-
ped, modern office with a modern
x-ray machine. I am retiring. Please
call 414/272-0250 or 414/962-9382 for
an appointment. 5/85
Beaver Dam, Wisconsin. New medical
office 1250 or 2500 sq ft office space
available. Excellent opportunity for Der-
matology or Allergy practice. Call 414/
887-8887 or write PO Box 678, Beaver
Dam, WI 53916. 5-8/85
Brick medical office building in very
good condition. Seven examining rooms,
lab and x-ray. Well-equipped. Ideal for
one to four doctors. Parking. Northwest
Milwaukee. Under $80,000. Contact Pete
Picciolo. Re/Max sw inc. Ph 414/784-
9220. 5/85
This space available
BOXED: $37.50
(IV2 column inches)
MISCELLANEOUS
Enjoy a vacation, reunion, or
mini-conference at Cedarwood on
the beautiful, wooded grounds of
Green Lake Conference Center.
This newly constructed seven bed-
room lodge can also be rented by
week as separate three, four, or
five bedroom units. Tennis courts,
large indoor pool, nature trails,
challenging golf course, miles of
private roads for biking are avail-
able on the grounds. Pier and boat
launch available for Cedarwood
guests. Call 414/294-3894 for
weekly reservations or write to
Cedarwood, Green Lake Confer-
ence Center, Green Lake, WI
54941. Also available for winter
outings— over 20-miles of groomed
ski trails. 5/85
MEDICAL MEETINGS-
CONTINUING MEDICAL
EDUCATION
WISCONSIN
JUNE 3-8, 1985: 18th Annual Postgrad-
uate Course in Gynecological Pathology, En-
docrinology, and Maternal-Fetal Medicine,
presented by the Department of Gyn-
ecology and Obstetrics of the Medical Col-
lege of Wisconsin. The course will be held
at Olympia Resort, Oconomowoc. The six-
day course includes an up-to-date review
of endocrinology, maternal-fetal medi-
cine, and cytogenetics in addition to a
thorough resume of gynecologic path-
ology. Registration is limited. Course ap-
proved for 46 cognates. Formal Learning,
by the American College of Obstetricians
and Gynecologists and 46 credit hours.
Category I, PRA/AMA. Eighty selected
35-mm slides will be available for pur-
chase to all participants. Contact Richard
F Mattingly, MD, The Medical College of
Wisconsin, 8700 West Wisconsin Ave,
Milwaukee, WI 53226; tel 414/257-5560.
p3-5/85
JUNE 12-15, 1985: 37th Annual Scientific
Assembly of the Wisconsin Academy of
Family Physicians, Americana Resort
Hotel, Lake Geneva, Wisconsin. Info:
WAFP, 850 Elm Grove Road, Elm Grove,
WI 53122; ph 414/784-3656.
12/84;l-5/85
THIS LISTING is compiled by the State
Medical Society of Wisconsin in coopera-
tion with others who wish to maintain a
centralized schedule of meetings and
courses of interest to Wisconsin physicians
and to avoid scheduling programs in conflict
with others. Hospitals, Clinics, Specialty
Societies, and Medical Schools are par-
ticularly invited to utilize this listing service.
There is a nominal charge for listing of Con-
tinuing Medical Education courses at the
following rates: 50c per word, with a mini-
mum charge of $20.00 per listing.
BOXED LISTINGS: $25.00 per column
inch. Listings of other scientific meetings
will be included at the discretion of the
editors.
COPY DEADLINE tor listings is 15th of the
month preceding the month of publication;
e.g. , copy for the August issue is due by July
15. Address communications to: Wisconsin
Medical Journal, Box 1109, Madison, Wis-
consin 53701; or phone (area code 608)
257-6781; or toll-free in Wisconsin: 800/
362-9080.
FOR LISTING of other meetings see the
January 4, 1985 issue of the Journal of the
American Medical Association: Continuing
Education Opportunities for Physicians for
period January 1985 through December
1985.
54
WISCONSIN MEDICAL JOURNAL, MAY 1985: VOL. 84
MEDICAL YELLOW PAGES
MEDICAL MEETINGS-
CONTINUING MEDICAL
EDUCATION
continued
JUNE 28, 1985: Microcomputers in Medi-
cine, Milwaukee. A one-day computer
seminar and exposition for health care
professionals. Topics include choosing a
system; office practice management,
computer-aided diagnosis. Fee: $50 before
May 15 includes admission, lunch, and
reception. Info: Micros in Medicine,
MCW Libraries, 8701 Watertown Plank
Rd, Milwaukee, WI 53226; ph 414/257-
8323. g3-4/85
JULY 17-18, 1985: 5th Annual Common
Emergency Care Conference, Sheraton Inn,
Madison. AMA, AAFP, ACEP credit.
Sponsored by University of Wisconsin
Emergency Medical Services Program
and Continuing Medical Education.
Features workshops. Contact Sarah
Aslakson, UW, CME, Room 465B, 610
Walnut St, Madison, Wis 53705; ph
608/263-2856. 5/85
For physicians, hospital
administrators
Biomedical ethics conference
June 6-7, American Club, Kohler
Sponsored by State Medical Society
of Wisconsin and Wisconsin Hos-
pital Association
For further info contact SMS offices
in Madison: Michelle Scoville
Greater Milwaukee Chapter of
Ileitis and Colitis
Announces
A Seminar for
Primary Care Physicians
^^Inflammatory Boivel
Disease — An Update**
With
Richard G. Farmer,
M.D., F.A.C.P.
Dept, of Gastroenterology,
Cleveland Clinic Hospital
Thursday, June 13, 1985
1:00 - 5:00 p.m.
Medical College of Wisconsin
For Registration or More Information
call GMIC Hotline: 242-GMIC
JULY 18-20, 1985: Wisconsin Society of
Obstetrics & Gynecology, Olympia Re-
sort, Oconomowoc. g2-6/85
SEPTEMBER 6-8, 1985: Wisconsin
Society of Anesthesiologists, American
Club, Kohler. g5-8/85
SEPTEMBER 12-14, 1985: Wisconsin
Society of Internal Medicine/American
College of Physicians Annual Meeting—
30th Anniversary, the Pioneer Inn, Osh-
kosh. Info: Wisconsin Society of
Internal Medicine, 611 E Wells St, Mil-
waukee, Wis 53202; ph 414/276-6445.
Contact: Sandra M Koehler, Executive
Director. 5-8/85
SEPTEMBER 13-14, 1985: Wisconsin
Neurosurgical Society, Sheraton, Racine.
g5-8/85
SEPTEMBER 13-14, 1985: Wisconsin
Surgical Society, Paper Valley Hotel &
Conference Center, Appleton. g2-8/85
State Medical Society
of Wisconsin
Dates and locations of
ANNUAL MEETINGS
1986-1992
All meetings will be held in Milwau-
kee at the Milwaukee Exposition and
Convention Center and Arena
(MECCA) and the new Hyatt Regency
as the headquarters hotel with the ex-
ception of 1985, when the meeting will
be held at the La Crosse Convention
Center.
1986- April 17-19
1987- March 26-28
1988- April 28-30
1989- April 13-15
1990- April 26-28
1991- April 18-20
1992- April 23-25
Meeting days will be Thursday and
Friday; the first session of the House
of Delegates will convene on Thurs-
day, the second and third on Friday.
Scientific programming will be on Fri-
day and Saturday.
Further information: Commission on
Continuing Medical Education, State
Medical Society of Wisconsin, Box
1109, Madison, Wis 53701. Local tele-
phone: 257-6781; toll-free in Wiscon-
sin: 1-800/362-9080.
SEPTEMBER 27-28, 1985: Wisconsin
Neurological Society, Paper Valley
Hotel & Conference Center, Appleton.
g5-8/85
SEPTEMBER 28-29, 1985: Wisconsin
Otolaryngological Society, Head and
Neck Surgery. Heidel House, Green
Lake. g5-8/85
OCTOBER 10-11, 1985: Wisconsin
Chapter, American College of Emer-
gency Physicians, The Abbey, Lake
Geneva. g5-9/85
OTHERS
JUNE 5-8, 1985 (Alaska): Alaska State
Medical Association Annual Convention
in Haines. Info: Alaska State Medical
Association, 4107 Laurel St, Ste ii'l.
Anchorage, Alaska 99508; ph 907/
562-2662. g2-5/85
JUNE 22-23, 1985 (Minnesota): Man-
agement of Common Psychiatric Problems in
Primary Care, Breezy Point Resort, Brain-
erd. Info: St Paul-Ramsey Medical Center,
Continuing Medical Education, 640 Jack-
son St, St Paul, MN 55101; ph 612/221-
3977. g3-85
Wisconsin Specialty
Society Meetings
• Wisconsin Academy of Family
Physicians, June 12-15, 1985,
Americana Resort, Lake Geneva
• Wisconsin Society of Obstetrics &
Gynecology, July 18-20, 1985,
Olympia Resort, Oconomowoc
• Wisconsin Society of Anesthesiolo-
gists, Sept 6-8, 1985, American
Club, Kohler
• Wisconsin Society of Physical Medi-
cine & Rehabilitation, Sept 11, 1985,
Sheraton Inn, Milwaukee
• Wisconsin Society of Internal Medi-
cine/American College of Physi-
cians Annual Meeting, Sept 12-14,
1985, Pioneer Inn, Oshkosh
• Wisconsin Surgical Society, Sept
13-14, 1985, Paper Valley Hotel &
Conference Center, Appleton
• Wisconsin Neurological Society,
Sept 27-28, 1985, Paper Valley Hotel
& Conference Center, Appleton
• Wisconsin Otolaryngological So-
ciety, Head and Neck Surgery, Sept
28-29, 1985, Heidel House, Green
Lake
WISCONSIN MEDICAL JOURNAL, MAY 1985:VOL. 84
55
MEDICAL YELLOW PAGES
MEDICAL MEETINGS-
CONTINUING MEDICAL
EDUCATION
continued
AUGUST 1-4, 1985: Second Annual St
PauiRamsey Trauma Conference (Fishing
& Family Recreation), Fox Hills Resort,
Mishicot. Info: St Paul-Ramsey Medical
Center, Continuing Medical Education,
640 Jackson St, St Paul, MN 55101; ph
612/221-3977. g3/85
AUGUST 1-4, 1985 (Georgia): Inter-
national Doctors in Alcoholics Anonymous
Annual Meeting. Hyatt Regency Hotel,
Savannah. Reservations may be made at
a later date when specific details and in-
structions are published. For further infor-
mation contact: Information Secretary,
IDAA, 1950 Volney Road, Youngstown,
Ohio 445 1 1 ; ph 2 1 6 / 782-62 16. g 12tfn / 84
SEPTEMBER 5-7, 1985 (Texas): Amer
ican Cancer Society, Second National Con-
ference on Diet, Nutrition and Cancer,
Shamrock Hilton, Houston. Info:
American Cancer Society, Second Na-
tional Conference on Diet, Nutrition and
Cancer, 90 Park Ave, New York, NY
10016. g3-8/85
SEPTEMBER 17-18, 1985 (Illinois):
Medical Practice and Hospital Privileges, at
Chicago Marriott O'Hare, Chicago. Info:
American Board of Medical Specialties,
One American Plaza, Suite 805, Evanston,
IL 60201; phone 312/491-9091.
gl2/84;l-8/85
AMA
JUNE 16-20, 1985: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 8-11, 1985: Interim AMA
House of Delegates, Washington, DC.
JUNE 15-19, 1986: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 7-10, 1986: Interim AMA
House of Delegates, Las Vegas, NV.
JUNE21-25, 1987: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 6-9, 1987: Interim AMA
House of Delegates, Atlanta, GA.
JUNE 26-30, 1988: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 4-7, 1988: Interim House
of Delegates, Dallas, TX. ■
ADVERTISERS
Acme Laboratories 49
Advanced Technology Associates,
Inc 47
Medical Computer Systems
American Physicians Life 45
Arctic Lodges, Ltd 26
Ayerst Laboratories 40, 41, 42
Inderal®
Berkeley Biologicals 37
Histolyn-CYL®
Centralized Billing Systems 50
CyCare 51
Dista Products Co (Div of Eli
Lilly & Co) 34
Keflex®
House of Bidwell 44
Medical College of Wisconsin 49
Microcomputers in Medicine
Medical Protective Company 18
PBBS Equipment 44
Peppino's 48
Professionals Insurance
Company, The 46
Roche Laboratories 59, BC
Dalmane®
St Mary's Hill Hospital 48
S & L Signal Company 49
Squibb & Sons,
Inc, E R 19, 20, 21, 22
Velosef®
United States Air Force 50
United States Army Reserve 49
Upjohn Company, The 39
Motrin®
Winthrop Breon Laboratories ... 27, 28
Talwin® Nx ■
1985 Membership
Directory
Members, watch your mail for a Member-
ship Records Verification Form to update
the information to be used in the 1985
Membership Directory to be published in
the July issue of the Wisconsin Medical Jour-
nal. See pages 32 and 33 of this issue for
further details.
56
WISCONSIN MEDICAL JOURNAL. MAY 1985 : VOL. 84
NEWS YOU CAN USE
HEALTH TRENDS as reported by the National Health Lawyers Association (NHLA) in its April issue of News
Report. "The idea of buying medical care a la carte is not long for this world, " Rep Ron Wyden (D-OregonJ told
participants at NHLA's 6th Annual Institute on Medicare and Medicaid Payment Issues. "More and more citizens
and groups will insist on buying their care in packages," and as a result alternative delivery systems, such
as preferred provider organizations (PPOs), and health maintenance organizations (HMOs) will experience
substantial growth, Wyden said. Wyden predicted that the growth in alternative delivery systems will be
spurred on by big business, "the brand new player in the health-field." "The fastest rising cost to American
business today is healthcare," and many more businessmen are willing to spend an appreciable amount of
their time in order to generate savings in this area, stated Wyden. Businessmen will be attracted to providers
who are willing to put themselves at a financial risk in providing care, he said. Another trend which Wyden
forecasts will make its way into Congress is an increased emphasis on prevention. He said that cigarette taxes
would be viewed as user fees and earmarked for the Medicare program. Calling policies by which Medicare
pays $50,000-$60,000 under Part A for the treatment of illnesses which could have been prevented if they
were covered under Part B {ie, blood pressure monitoring) "absolute insanity," he said Congress will take
action in the future to bolster prevention programs. Wyden expressed concern "that cost containment not become
care containment. " One way to avoid this result is to continually push for new advances in technology, Wyden said,
and to accomplish this goal, he favors a set-aside for quality enhancement. Lastly, Wyden discussed malpractice
reform. He believes that the no-fault approach proposed by Reps Gebhardt and Moore will lead to an explo-
sion of lawsuits. In its place he offered a three-part proposal. "First," he said, "we need to do a better job
in reporting nationwide those physicians and individuals found liable for malpractice. Secondly, we ought
to concentrate on alternative systems so consumers will be given a choice, between traditional civil litigation
and other alternatives . . . Thirdly, we need to make sure that savings from malpractice reform are actually
passed on to consumers."
Rep Willis D Gradison, Jr (R-OHIOI called the proposed Medicare freeze on hospital and physician fees "a breach
of faith by the Administration, " at a National Health Council meeting April 2. He suggested the following alter-
natives to hold down healthcare costs. First, he supports the Prospective Payment Assessment Commission's
recommendations regarding the adjustment in the DRG rates. The Commission recommended that HHS up-
date the Medicare rates by the increase in the hospital market-basket, a measure of inflation, with adjustments
for productivity, technology advancements and case mix. Secondly, Gradison said that both Medicare Part
A and Part B benefits should be taxed. This would produce $500 million in fiscal 1986, and $ 1 billion for each
year thereafter. Thirdly, he said mandatory second opinions for elective surgery should be required and could
save Medicare more than $1 billion. Lastly, Medicare should move away from retrospective reimbursement
for capital to a system whereby the capital payment would be tied to the hospital's volume of business, he
said. In regard to physician reimbursement, Gradison stated "physician DRGs may not ever happen and certainly
won 't happen in 1 985, but it may be possible to experiment with DRGs for certain medical procedures; ie, surgery. "
Gradison does not believe DRGs are the ultimate solutions for financing the nation 's healthcare. As a form of rate
regulation, they go against his procompetitive beliefs, he said. He is more optimistic about the HMO voucher
program, and says that, if it is successful, he would like to see the program broadened for all beneficiaries.
"The HMO voucher program may prove more long-lasting than DRGs," he stated.
"Major problems exist in regard to the deficiencies in the original data that was used to put the Prospective Pay-
ment System jPPSj together — data used to construct DRGs, data used to calculate DRG weights and standardized
amounts, data used for construction of wage indices, and data used for adjustment within the system, " Dr Donald
Young, executive director of the Prospective Payment Assessment Commission (ProPac), told participants at NHLA 's
Medicare and Medicaid program. "This will be a continuing problem," according to Young, and "as we move
forward we will have to balance the costs of acquiring new and better data with the value of that data for
its use in maintaining and updating the system."
continued
WISCONSIN MEDICAI JOl RNAI., MAY I985:VOI.. 84
57
NEWS YOU CAN USE
A General Accounting Office (GAOJ preliminary report concluded that Medicare's new prospective payment system
has resulted in the premature discharge of hospital patients. Sen John Heinz (R-Pennsylvania), chairman of the
Select Committee on the Aging, commissioned the report, "Information Requirements for Evaluating and
Impacts of Medicare Prospective Payment on Post-Hospital Long-Term-Care Services: Preliminary Report."
He said the study showed that in many cases patients were going home to a "no-care zone" where alternative
levels of care are not available. Among the report's other conclusions were: 1) that shortages of nursing home
and home health services in many communities could result in denial of care to "heavy care" and Medicaid-
eligible patients; 2) that even in communities where nursing home and home health services do exist, they
may not be equipped and staffed properly to care for the sicker patients whom they see today; and 3) that
treating relatively ill patients outside the hospital may cost more than leaving them in the hospital, and is likely
to increase beneficiaries' out-of-pocket costs in either case. The conclusion of the GAO report was affirmed
by a survey of state nursing home ombudsmen. Completed by three-fourths of all ombudsmen, the survey
found that 77% said that patients were being discharged "sicker or much sicker" than before DRGs. More
than half of the respondents said skilled nursing care was not adequate to meet the needs of discharged patients
in rural areas and one-third said this care was inadequate in urban areas.
The Reagan Administration plans to encourage the development of private insurance for nursing home care for the
elderly, and thereby reduce Medicare and Medicaid expenditures, according to the NHLA's April NEWS REPORT.
These two programs paid about half of the $29 billion the nation spent on nursing home care in 1983. Studies
commissioned by the Department of Health and Human Services have concluded that private insurance could
produce substantial savings for the government. Long-term care is presently considered the largest gap in
Medicare. Under the present programs elderly people must virtually impoverish themselves, by spending
or giving away most of their resources to qualify for Medicaid, and the criteria for Medicare are so restrictive
that comparatively few nursing homes have participated in the program. Thus, department officials believe
that there is a large potential market for private insurance for nursing home services. Elderly people from middle
income families, as well as their children, could be expected to purchase long-term care insurance, department officials
said. According to IGF Inc, a consulting firm that investigated the "private financing of long-term care" under
a contract with the department, "premiums in the range of $400 to $700 a year for someone age 75 just start-
ing to purchase such a policy would appear to be manageable by an increasing number of elderly concerned
about exhausting their resources." Nursing home care typically costs between $60 to $150 a day. Gerald H
Britten, a Deputy Assistant Secretary of Health and Human Services, said private insurance for long-term care
would lead to "more consumer choice, more innovations" in the delivery and financing of long-term care
while alleviating some of the financial burden borne by Federal and State governments. Insurance industry
spokesmen warn, however, that private long-term insurance would create a new demand for nursing home
care, and thereby set off further inflation in medical costs. ■
PHYSICIANS MORE AWARE OF CHILD SEXUAL ABUSE. Physicians are more aware of child sexual
abuse now than they were before 1984, but some who suspect such abuse still hesitate to report it.
An opinion poll of 1000 physicians appearing in the April 12, 1985, edition of American Medical News
shows that 76 percent of 214 physicians responding reported greater awareness of the issue than in
the past. About a quarter of the physicians suspected they had seen cases of child sexual abuse in
their practices, but fewer than that said they had actually reported their suspicions. Among the
reasons physicians cited for their hesitancy in reporting child sexual abuse were inadequate training
to recognize signs of abuse and insufficient evidence to document abuse. Some physicians said they
preferred to deal directly with the child's family than to go to authorities, and other physicians said
the abuse had been reported by someone else. Only two percent of physicians who did not report
suspected abuse said that fear of legal repercussions held them back.H
58
WISCONSIN MEDICAL JOURNAL, MAY 1985: VOL. 84
COMPLETE
LABORATORY
DOCUMENTATION . . . EXTENSIVE
CLINICAL PROOF
FOP, THE PREDIQABILITY
CONFIRMED BY EXPERIENCE
D4LMAHE®
flurozepom HCIMoche
THE COMPLETE HYPNOTIC
PROVIDES ALL THESE BENEFITS:
• Rapid sleep onset' "
• More total sleep time' "
• Undiminished efficacy for at least
28 consecutive nights' ■*
• Patients usually awake rested and refreshed'*'
• Avoids causing early awakenings or rebound
insomnia after discontinuation of therapy'”""
Caution patients about driving, operating hazardous machinery or drinking
alcohol during therapy. Limit dose to 15 mg in elderly or debilitated patients.
Contraindicated during pregnancy
DALMANE^
flurozepom HCI/Poche
References: 1. Kales J et al: Clin Pharmacol Ther
72:691-697, Jul-Aug 1971. 2. Kales A et al: Clin Phar-
macol Ther 78:356-363, Sep 1975 3. Kales A et al:
Clin Pharmacol Ther 79:576-583, May 1976 4. Kales A
et al: Clin Pharmacol 7her 32:781 -788, Dec 1982
5. Frost JD Jr, DeLucchi MR: J Am Geriatr Soc
27:541-546, Dec 1979. 6. Kales A, Kales JD: J Clin
Pharmacol 3:140-150, Apr 1983 7. Greenblatl DJ,
Allen MD, Shader Rl: Clin Pharmacol Ther 27:355-361,
Mar 1977. 8. Zimmerman AM: Curr Ther Res
73:18-22, Jan 1971 9. Amrein R et al: Drugs Exp Clin
Res 9(1):85-99, 1983. 10. Monti JM: Methods Find Exp
Clin Pharmacol 3:303-326, May 1981 11. Greenblatl DJ
et al: Sleep 5(Suppl 1):S18-S27 1982 12. Kales A
et al Pharmacology 26:121-137 1983.
DALMANE*^ (S
flurazepam HCI/Roche
Before prescribing, please consult complete
product information, a summary of which follows:
Indications: Effective in all types of insomnia charac-
terized by difficulty in falling asleep, frequent nocturnal
awakenings and/or early morning awakening; in
patients with recurring insomnia or poor sleeping hab-
its; in acute or chronic medical situations requiring
restful sleep. Objective sleep laboratory data have
shown effectiveness for at least 28 consecutive nights
of administrafion. Since insomnia is often transient
and intermittent, prolonged administration is generally
not necessary or recommended. Repeated therapy
should only be undertaken with appropriate patient
evaluation.
Contraindications: Known hypersensitivity to fluraze-
pam HCI; pregnancy Benzodiazepines may cause
fetal damage when administered during pregnancy.
Several studies suggest an increased risk of congeni-
tal malformations associated with benzodiazepine use
during the first trimester. Warn patients of the potential
risks to the fetus should the possibility of becoming
pregnant exist while receiving flurazepam. Instruct
patient to discontinue drug prior to becoming preg-
nant Consider the possibility of pregnancy prior to
instituting therapy.
Warnings: Caution patients about possible combined
effects with alcohol and other CNS depressants An
additive effect may occur if alcohol is consumed the
day following use for nighttime sedation. This potential
may exist for several days following discontinuation.
Caution against hazardous occupations requiring
complete mental alertness (e.g., operating machinery,
driving). Potential impairment of performance of such
activities may occur the day following ingestion. Not
recommend^ for use in persons under 15 years of
age Though physical and psychological dependence
have not been reported on recommended doses,
abrupt discontinuation should be avoided with gradual
tapering of dosage for those patients on medication
for a prolonged period of fime. Use caufion in adminis-
tering to addiction-prone individuals or those who
might increase dosage
Precautions: In elderly and debilitated patients, it is
recommended that the dosage be limited to 15 mg to
reduce risk of oversedation, dizziness, confusion and/
or ataxia. Consider potential additive effects with other
hypnotics or CNS depressants. Employ usual precau-
tions in severely depressed patients, or in those with
latent depression or suicidal tendencies, or in those
with impaired renal or hepatic function.
Adverse Reactions: Dizziness, drowsiness, light-
headedness, staggering, ataxia and falling have
occurred, particularly in elderly or debilitated patients.
Severe sedation, lethargy, disorientation and coma,
probably indicative of drug intolerance or overdosage,
have been reported. Also reported: headache, heart-
burn, upset stomach, nausea, vomiting, diarrhea,
constipation. Gl pain, nervousness, talkativeness,
apprehension, irritability, weakness, palpitations, chest
pains, body and joint pains and GU complaints. There
have also been rare occurrences of leukopenia, gran-
ulocytopenia, sweating, flushes, difficulty in focusing,
blurred vision, burning eyes, faintness, hypotension,
shortness of breath, pruritus, skin rash, dry mouth,
bitter taste, excessive salivation, anorexia, euphoria,
depression, slurred speech, confusion, restlessness,
hallucinations, and elevated SGOT, SGPT total and
direct bilirubins, and alkaline phosphatase, and para-
doxical reactions, e g., excitement, stimulation and
hyperactivity
Dosage: Individualize for maximum beneficial effect.
Adults: 30 mg usual dosage; 15 mg may suffice in
some patients Elderly or debilitated patients: 15 mg
recommended initially until response is determined
Supplied: Capsules containing 15 mg or 30 mg
flurazepam HCI.
Roche Products Inc.
Manati, Puerto Rico 00701
PROVEN IN
THE PATIENT'S
HOME
DOCUMENTED
IN THE SLEEP
LABORATORY”.
FOR A COMPLETI
DAL
flurozepQi
STANDS
15-MG/30-M(|
See preceding page for references and summary of product information.
Copyright © 1984 by Roche Products Inc. All rights reserved.
1 sm^Mi
. WISCONSIN
I MEDICAL JOURNAL
i
Photo courtesy Fevzi Pamukcu, MD
see page 3
y i')': ^
Blue Book issue . . . A reference source on medicolegal,
socioeconomic, legislative, governmental matters of direct concern
to the physician. Also a reference source on State Medical Society
organizational structure, other related organizations, and state
governmental agencies
JUNE
1985
Special features . . . Malpractice, countersuits, fee sphtting, peer
review, summary report of House of Delegates' actions
OP-
'JULi7
t. D. S
WISCONSIN
MEDICAL JOURNAL
r T
ISSN 0043-6542 /Established 1903
Owned and published by
State Medical Society of Wisconsin
CONTENTS
June 1985
SPECIAL FEATURES
Medical Editor
Victor S Falk MD, Edgerton
Editorial Board
Victor S Falk MD, Edgerton Chairrrian
Melvin F Fliith MD. Baraboo
M C F Lindert MD. Milwaukee
Andrew B Crummy Jr MD, Madison
Richard D Sautter MD, Marshfield
Dean M Connors MD, Madison
George W Kindschi MD, Monroe
Charles H Raine MD. Racine
Darrell L Witt MD, Wausau
Garrett A Cooper MD, Madison Emeritus
Editorial Director
Wayne J Boulanger MD, Milwaukee
Editorial Associates
R Buckland Thomas MD, Monroe
Russell F Lewis MD, Marshfield
Raymond A McCormick MD, Green Bay
Victor S Falk MD. Edgerton
Medical Editor
Staff
Earl R Thayer, Madison
Secretary-General Manager
State Medical Society of Wisconsin
FI B Maroney II, Madison
Assistant Secretary -Corporate Counsel
State Medical Society of Wisconsin
Mrs Mary Angell, Madison
Managing Editor
Mrs Marjorie Stafford, Madison
Publications Assistant
Mrs Diane Upton, Madison
Editorial Assistant
NATIONAL ADVERTISING REPRESENTA-
TIVE: State Medical Journal Advertising
Bureau, Inc, 711 South Blvd, Oak Park, 111
60302. Ph 312/383-8800,
LOCAL (WISCONSINI ADVERTISING: Con-
tact: Mrs Mary Angell, Wisconsin Medical
Journal, Box 1109, Madison, Wis 53701. Ph
608/257-6781.
SUBSCRIPTION RATES: Members, $12.50
per year [included in dues): nonmembers,-
$25.00. Single copy: current year, $2.00; pre-
vious years, $3.00. SPECIAL RATES: Foreign
and Canada, $30.00. Blue Book issue, $8.00.
Membership Directory issue, $15.00.
Editorials
8 The case mix index
Wayne J Boulanger, MD
Milwaukee
Changing of the guard
Victor S Falk, MD
Edgerton
Time's-a-wastin'
Victor S Falk, MD
Edgerton
Letters
14 The public, malpractice, the
Wisconsin Patients Compen-
sation Fund, and us
Richard D Sautter, MD
Marshfield
Fee discrimination
Robert L Schwarz, MD
Menomonee Falls
Tourette Syndrome
Dr and Mrs Richard H Ward
Appleton
"BLUE BOOK " FEATURES
30 Helping the retarded,
developmentally disabled
person
31 Medical liability— A physi-
cian's rights and responsibilities
33 Medical malpractice: A
dilemma in the search for
justice
Robert J Flemma, MD
Milwaukee
41 Legal aspects of peer review
Susan M Schmidt, JD
Chicago, Illinois
43 Peer review in Wisconsin
44 How to get health-related
information in Wisconsin
45 Statewide Impaired Physician
Program
47 Mediation and peer review
services of the State Medical
Society; protocol manual
53 Wisconsin adoption agencies
53 Wisconsin Poison Control
Program Network
54 Wisconsin's fee splitting
statute
58 Recently enacted communi-
cable disease laws
59 List of communicable
diseases by category
59 AIDS
60 Legal responsibilities of the
physician-patient-hospital
relationship
23 Wisconsin Medical Journal
"Blue Book" 1985
24 State Medical Society of
Wisconsin: Officers and
Directors, Delegates and
Alternates to the AMA
25 Countersuits
SECOND CLASS POSTAGE PAID at
Madison, Wisconsin, and at additional mail-
ing offices.
PUBLISHED MONTHLY. "Acceptance for
mailing at special rate of postage provided for
in Section 1103, Act of October 3, 1917.
Authorized August 7, 1918." Address all com-
munications to THE WISCONSIN MEDICAL
JOURNAL. Street address: 330 East Lakeside
Street. Mailing address: Box 1109, Madison,
Wis 53701.
POSTMASTER: Send address changes to
Wisconsin Medical Journal, PO Box 1109,
Madison, Wis 53701.
COPYRIGHT 1985
Stale Medical Society of Wisconsin
WISCONSIN MEDICAL JOURNAL (ISSN 0043-6542) is the official publication of the State Medical
Society of Wisconsin, devoted to the interests of the medical profession and health care in Wisconsin.
Its affairs are handled by the Editorial Board, subject to policy direction of the Society's Board of
Directors. The Managing Editor is responsible for the production, business operation, and coor-
dination of contents as well as the final responsibility of the entire publication. The Editorial Director
IS responsible for Editorials. Unsigned Editorials express views consistent with the policies of the
State Medical Society of Wisconsin. Signed Editorials express personal views of the author for which
the Society takes no responsibility. Neither the Editors nor the State Medical Society will accept
responsibility for statements made or opinions expressed in the pages of the Journal. Indexed in
L'lndex Medicus," "Hospital Literature Index," and "Cambridge Scientific Abstracts."
V
Vol. 84 No. 6
CONTENTS
62 Retention and inspection of
patients' records
68 Consent to release medical
information (form)
68 Patients' right of access to
their medical records
69 "Denial of Access' forms
70 Questions about medical
records laws
72 NOTICE: Wisconsin hospital
emergency rooms and out-
patient facilities are aware of
the following federal and
state laws which prohibit . . .
1) Discrimination against
patients
2) Refusal of admission
72 Hospitals required to report
physician's loss of hospital
staff privileges to Medical
Examining Board
73 SMS members, you should
know—
• Abortion
• Abused Child Law
• Adoption process in
Wisconsin
• Adoption Records Law
• Autopsy
• Certification
• Child safety restraint
systems
• Closing a physician's office
• Communicable diseases
• Consent and related forms
for physicians
• "Denial of Access" to
healthcare records
• Determination of death
• Disability claims
• Donations of organs, body
(uniform organ donor cards
and decals; donation of
eyes; "living will" on use of
measures to sustain life)
• Drivers' licenses for
epileptics
• Drug Substitution Law
• Elderly abuse
• Employees allowed to
inspect records under law
• Good Samaritan Law
• Implied Consent Law
The Wisconsin Medical Journal
gratefully acknowledges pub-
lication support of this "Blue
Book" issue through a contribu-
tion from the Crownhart
Memorial Account of the
State Medical Society's Chari-
table, Educational and Scienti-
fic Foundation.
FRONT COVER. . .Physician-
artist Fevzi Pamukcu, MD of
Kenosha has depicted here the
tension and imbalance which
have developed between the
medical profession and legal sys-
tem. In his oil painting, the
physician is shown trying to right
the balance which has been tip-
ped in favor of huge dollar
awards for malpractice claims.
The gavel of justice is seen to be
poised in a blow struck at the
caduceus, the ancient symbol of
the medical profession.
THE STATE MEDICAL SOCIETY OF WISCONSIN, created by the Territorial Legislature in 1841,
represents over 5600 member physicians in Wisconsin, comprising 55 county medical societies
and 25 medical specialty sections. The purpose of the Society is to "bring together the physicians
of the State of Wisconsin to advance the science and art of medicine and the better health of the
people of Wisconsin, and to secure the enactment and enforcement of just medical laws." The major
activities of the Society include continuing medical education, peer review, legislation, community
health education, scientific affairs, socioeconomics, health planning, services for physicians, opera-
tion of a Charitable, Educational and Scientific Foundation, and publication of the Wisconsin Medical
Journal.
S'I'ATK IVIUDICAI,
SOCIIITY
OF WISCONSIN
President: John K Scott. MD. Madison
President-Elect: Charles W Landis,
MD. Milwaukee
Secretary-General Manager:
Earl R Thayer, Madison
Treasurer: John J Foley, MD
Menomonee Falls
Board of Directors
Chairman: Darold A Treffert, MD
Fond du Lac
Vice Chairman: Roger L
von Heimburg, MD, Green Bay
First District
Jerome W Eons Jr, MD, Cudahy
Carl S Eisenberg, MD, Milwaukee
Thomas A Hofbauer, MD,
Menomonee Falls
Wayne H Konetzki. MD, Waukesha
Fredrick Wood Jr, MD, Kenosha
William L Treacy, MD. Milwaukee
Richard D Fritz, MD, Milwaukee
William J Listwan, MD, West Bend
Glenn H Franke, MD, Milwaukee
Lucille B Glicklich, MD. Milwaukee
Second District
J D Kabler, MD. Madison
Cyril M Hetsko, MD, Madison
James J Tydrich, MD, Richland Center
Alwin E Schultz, MD, Madison
Kenneth I Gold. MD, Beloit
Third District
Pauline M Jackson, MD, La Crosse
Fourth District
John J Kief, MD, Rhinelander
Jung K Park, MD, Wisconsin Rapids
W George Looker, MD, Wausau
Fifth District
Darold A Treffert, MD. Fond du Lac
Kenneth M Viste Jr, MD. Oshkosh
C William Freeby, MD, Appleton
Sixth District
Roger L von Heimburg, MD. Green Bay
Joseph C DiRaimondo, MD, Manitowoc
Seventh District
Marwood E Wegner, MD, St Croix Falls
Philip J Happe. MD, Eau Claire
Eighth District
Joseph M Jauquet, MD, Ashland
President: Doctor Scott
President-Elect: Doctor Landis
Past President: Timothy T Flaherty,
MD. Neenah
Speaker: Duane W Taebel, MD,
La Crosse
Vice Speaker: Vernon M Griffin. MD.
Mauston
A,
J
CONTENTS
continued
• Jail health care in
Wisconsin
• Joint practice: physicians
and nurses
• Jury duty
• Licensure in Wisconsin
• Living wilts— the Natural
Death Act, Chapter 154
• Medic Alert Foundation
International
• Minor's consent
• Newborn infant eye drops
• Opening a physician's
practice
• Optometrist referral law
• Patients' records /retention
and inspection
• Patients' right of access to
their medical records
• Physical therapy relating to
practice
• Physician-patient-hospital
relationship
• Physician's Assistants (PA)
• Premarital examinations
• Standard casualty medical
report form
80 Let these guides help you
81 Physician licensure verifica-
tion procedure
81 Physician re-registration
82 Alternate modes of treatment
83 Use of consent and related
forms for physicians
90 Must a Wisconsin physician
report . . .
91 Unprofessional conduct
defined
92 Some considerations before
opening a physician's office
93 Some considerations in the
closing of a physician's
practice
94 Problems of a physician's
widow /er
96 Important notice to physi-
cians and clinics re toxic
substances and infectious
agents
97 Wisconsin Clearinghouse (for
information on alcohol and
other mood-altering drugs,
etc)
97 Narcotics
98 Attending a physician's
return-to-work recommenda-
tions record
98 Alcoholics Anonymous
100 Accreditation Program for
Continuing Medical
Education
State Medical Society
of Wisconsin
102 Charter Law of Medical
Societies
103 Constitution and Bylaws of
the State Medical Society of
Wisconsin
108 American Medical
Association— Principles of
Medical Ethics
109 Expense reimbursement
policy and procedure for
physicians on State Medical
Society business
no
111
112
113
114
115
116
118
118
119
120
120
120
120
121
122
126
The Oath of Hippocrates;
Declaration of Geneva
Medical Ethics
Charitable, Educational and
Scientific Foundation
CES Foundation: Officers,
Board of Trustees,
Nonmedical Trustees, and
Corporate Members
CES Foundation: Contribu-
tions during the month of
April 1985
Facts . . . about the CES
Foundation Student Loan
Program
"The Beaumont 500" Club
Board districts and directors:
1985-1986
SMS Placement Service aids
physicians and communities
Officers and directors:
1985-1986
Board of Directors Commit-
tees: 1985-1986
SMS Services, Inc: 1985
SMS Auxiliary: 1985-1986
Past Presidents of the State
Medical Society of Wisconsin
Officers and Directors:
1985-1986 (pictures)
Commissions and Commit-
tees: 1985-1986
1985 Physicians Alliance
Districts and Field
Consultants
4
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
CONTENTS
continued
127 Wisconsin Physicians
Political Action Committee
128 County Medical Societies;
Presidents and Secretaries,
et al
131 Special Sections of the State
Medical Society: Officers
133 Specialty Societies in Wiscon-
sin: Presidents and
Secretaries
State Government Agencies
143 Department of Health and
Social Services
• Division of Health
• Division of Community
Services
• Division of Vocational
Rehabilitation
• Division of Care and Treat-
ment Facilities
146 Department of Regulation
and Licensing
• Bureau of Health
Professions
—Medical Examining Board
—Dentistry Examining
Board
—Pharmacy Examining
Board
• Bureau of Nursing
—Board of Nursing
146 Department of Industry,
Labor and Human Relations
147 Health Policy Council
148 Wisconsin Health Systems
Agencies; Physician members
of Wisconsin Health Systems
Agency Boards
149 Wisconsin Peer Review
Organization (WiPRO)
151 Membership facts
ORGANIZATIONAL
152 Doctor Scott installed SMS
president; Top priorities:
Malpractice reform, member-
ship; Election results; New
directors
153 Doctor Charles Landis,
Milwaukee, is president-elect
154 Board of Directors April
meeting highlights; New
Editorial Board member; SMS
Secretary issues call for
tougher peer review
155 Some controls needed; House
of Delegates highlights
157 Medical Museum season
began May 1
158 Summary report of SMS
House of Delegates, April
25-26, 1985, La Crosse,
Wisconsin
166 Medical School deans
receive Directors Award
167 Outstanding medical students
receive Houghton Award
168 Corporation recognized for
support of primary care;
Interstate Teaching Award
goes to Doctor Sandmire
169 Maryland physician recipient
of Beaumont Award; Doctor
Jowsey delivers Elvehjem
Lecture
170 Society honors long-time
employee; Scientific Exhibit
Awards
171 The "Beaumont 500" Club
172 New Fifty-Year Club
members
173 SMS Task Force on Medical
Care
1 74 Report of President Scott to
House of Delegates; A full
and promising agenda already
laid out
177 Report of Outgoing President
Flaherty to House of
Delegates: Our number one
priority is malpractice reform
and that's coming!
181 Report of Secretary Thayer to
the House of Delegates: The
problem of competence or
incompetence
DEPARTMENTS
18 Principles of Advertising:
Wisconsin Medical Journal
18 Publication information
185 Medical Yellow PAGES:
Physicians exchange . . .
Medical facilities . . .
Miscellaneous . . . Medical
meetings . . . Continuing
Medical Education . . .
Advertisers*
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
5
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Laboratories, Inc.
Qualified, competent professionals are the
trademark of Acme Laboratories. For 35
years, our certified orthotists and prosthetists
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Acme Laboratories serves Wisconsin from
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Lac and Woodruff. We're pleased to be a
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Wisconsin. Acme L.aboratories accepts all
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Accepted for advertising In the AMA Journal
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When Saving Time Means Saving Lives.
MED
Your patients . they rely on you — your training and
your judgment, any day and any time. But in a critical
situation who can you rely on? Med Flight, the critical
care transport service from University of Wisconsin Hospi-
tal and Clinics.
Med Flight, an integral part of the hospital's complete
critical care system, carries a specially-trained physician
on every flight, certified and experienced in Advanced
Trauma Life Support and Advanced Cardiac Life Support,
and a registered nurse trained in critical care
Med Flight— a direct link between you and specialized
critical care. Through Med Flight's communication net-
work, you will be in constant contact with a physician
before, during and after Med Flight's arrival.
Med Flight, with full life support equipment, carries
up to three patients and three medical professionals at
one time With a 200-mile service area and a 160 mph
cruising speed, it flies quickly and directly, to you and
your patient.
MED FLIGHT. When your patient’s life depends on you, you can depend on us.
For more information about MED FLIGHT, or any of the other critical care services available at UW Hospital and Clinics,
call (608) 263-8010.
600 Highland Avenue
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Out of state
1-800-472-01 1 1
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UW Hospital & Clinics
EDITORIALS
Wayne J Boulanger, MD, Editorial Director
Unsigned editorials express views consistent with the policies of the State Medical Society of Wisconsin.
Signed editorials express personal views of the author for which the Society takes no responsibility.
The case mix index
DRG REIMBURSEMENT is based in
part on the complexity of the
problem. From the very begin-
ning even HCFA recognized that
not all cases of pneumonia or ap-
pendicitis follow a predictable
course. Taking this into account,
the case mix index was devel-
oped. The record of each hos-
pital over a three-year period
was scrutinized with the idea of
assessing the severity of ill-
ness experienced by its patients.
If a certain hospital attracted
patients with just average ail-
ments in that three-year period,
it was granted a case mix index of
one. If, on the other hand, its pa-
tients tended to be more sick than
average, the case mix index might
be 1.1 or 1.2. Then the HCFA
would multiply the DRG total
dollars by 1.1 or 1.2 to determine
the amount actually to be paid by
Medicare. My hospital's case mix
index turned out to be 1.087.
However, at the time all this
was going on, doctors were
changing their practices to ac-
commodate the new system by
admitting fewer, but sicker pa-
tients. It doesn't take Ein-
stein to figure out what that does
to the case mix index.
So far this year, my hospital's
case mix index is 1.24 and rising
while in 1984 it was 1.17. But
payment is still being made on
the basis of a severity index of
1.087. At my hospital, at least,
HCFA has made no adjustment to
compensate for the change, nor is
any in the offing. This will lead to
more personnel layoffs and fur-
ther curtailment of patient ser-
vices. Most hospitals are prob-
ably in the same fix. The hos-
pitals need our help in appli-
cation of pressure to induce
change if we are to retain rea-
sonable quality of care.
— Wayne J Boulanger, MD, Milwaukee
Changing of
the guard
The sms Board of Directors
made some changes in appoint-
ments for the Wisconsin Medical
Journal. Dr Wayne Boulanger
was not eligible for reappoint-
ment to the Editorial Board, but
the Board did reappoint him as
editorial director. Thus, we will
be able to still benefit from his
pithy comments and bursts of
poetry. Dr Andrew Crummy,
Professor of Radiology at the Uni-
versity of Wisconsin Medical
School, was appointed to replace
Doctor Boulanger. Dr George
Kindschi of Monroe was reap-
pointed to the Editorial Board. Dr
R Buckland Thomas, a psychia-
trist with the Monroe Clinic, was
appointed editorial associate.
Doctor Thomas was formerly ed-
itor of the South Carolina Medical
Journal. He replaces Dr John Mul-
looly of Milwaukee. Dr Raymond
McCormick and Dr. Russell
Lewis were reappointed editorial
associates.
The staff of the Wisconsin Med-
ical Journal thanks the former
members for their service to and
interest in the Medical Journal
and welcomes aboard the new
members.
—Victor S Falk, MD, Edgerton
Time's-a-wastin'
A MAJOR US manufacturing cor-
poration with plants in Wisconsin
has come up with a new require-
ment. Whenever an employee or
family member requires hospital-
ization, permission must be ob-
tained by calling Detroit. The
company has 100 "800" numbers
and a like number of operators.
The initial problem is to get one
of the "800" lines. For example,
my office nurse called the Detroit
number five times. After four
busy signals she was put on hold
on the fifth attempt. She then
held for 45 minutes awaiting a
response from the individual at
the other end. Judging by the re-
sponses in Detroit, it is obvious
that the operators have no med-
ical background whatsoever.
After providing the information
about the patient along with the
policy number, group number,
provider number, the hospital
location, etc, the operator deigns
to allow a certain number of hos-
pital days.
Recently I was allowed two
days for a patient with acute
appendicitis. If it becomes neces-
sary for such an individual to stay
in the hospital for a third or
fourth day, one must again call
the 800 number in Detroit and
after the usual wait, request per-
mission for the additional hos-
pital days. Then a week or two
later, one receives a computer-
type letter authorizing the hos-
8
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
TIME'-A-WASTIN'
EDITORIALS
pital stay which has long since
terminated.
One hundred hotlines and 100
operators do not come cheap. The
time of physicians or their as-
sistants apparently is regarded as
of little or no value since my col-
leagues report periods of 35 to
50 minutes on hold. This is ano-
ther strange way to cut the cost
of medical care.
—Victor S Falk, MD, Edgerton
Editorial Board comment: If only the
patient/voter really knew what ripples
(tidal waves! the strategies of the Fed-
eral Government healthcare agencies
are/will be causing to the delivery of
good medicine to the general public.
Alas, their fate will be the same as
those who live on/around the San
Andreas fault. The full impact on both
will only be apparent after the quake. . .
We are all frustrated with similar pre-
admittance requirements. I guess we
just have to hang in there!! Perhaps
"medical marketing" will streamline
some of these agonizing frustrations. ■
SMS Services
Inc.
is pleased to announce
a
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“WATS” LINE
FOR MEMBERS
As a service for its members, the
State Medical Society of Wisconsin
has a toll-free WATS line — Wide
Area Telecommunications Service)
to provide member physicians with
quick and easy access to SMS
staff. The in-WATS line can be
used to contact anyone at SMS
headquarters (330 East Lakeside
Street, Madison) from anywhere
within the State of Wisconsin be-
tween the hours of 8:00 am and
4:30 pm weekdays. The number to
dial is:
1-800-362-9080
1233 North Mayfair Road, Suite 301, Milwaukee, NAZI 53226 (414) 453-9070
The Board of PrimeCare approved at its last meeting (May 16) the return
of 100% of the 20% physician contingency reserve to all physicians from
the inception of the Health Plan to December 31, 1984.
The Board wishes to thank all primary care physicians for their support
and their adherence to the policies that have insured the continuation
and growth of the only primary care physician-run HMO in Wisconsin.
WISCONSIN MEDICAL JOURNAL, JUNE 1985 : VOL. 84
9
Turn of the century
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doctors since
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the source for total packages — computers, terminals, printers,
special medical programs, careful installation, training for
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Considering the scope of our Wisconsin experience, it
should not surprise you that ATA is endorsed by the State
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May we send you information listing your benefits from
a strictly medical office computer system? Call or write.
Advanced Technology Associates
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Consider the
causative organisms...
cefaclor
250-mg Pulvules* t.i.d.
offers effectiveness against
the major causes of bacteriai bronchitis
H. influenzae, H. influenzae, S. pneumoniae, S. pyogenes
(ampicillin-susceptible) (ampicillin-resistant)
Brief SufflmarY Consult the package literature for prescribing
inforfflallon
liMlicatloAs and Usage Ceclor* (cefaclor Lilly) is indicated in the
treatment of the following infections when caused by susceptible
strains of the designated microorganisms
Lower resDiratorv infections including pneumonia caused by
Siteptococcus pneumoniae (Diplococcus pneummaei. Haemoph
ilus influenzae and S pyogenes (group A beta-hemolyiic
streptococci)
Appropriate culture and susceptibility studies should be
performed to determine susceptibility of the causative organism
to Ceclor
Contraindication; Ceclor is contraindicated in patients with known
allergy to the cephalosporin group of antibiotics
Warnings IN PENICILLIN-SENSITIVE PATIENTS, CEPHALO-
SPOfilN ANTIBIOTICS SHOULD BE ADMINISTERED CAUTIOUSLY
THERE IS CLINICAL AND LABORATORY EVIDENCE OF PARTIAL
CROSS-ALLERGENICITY OF THE PENICILLINS AND THE
CEPHALOSPORINS, AND THERE ARE INSTANCES IN WHICH
PATIENTS HAVE HAD REACTIONS, INCLUDING ANAPHYLAXIS,
TO BOTH DRUG CLASSES
Antibiotics, including Ceclor. should be administered cautiously
to any patient who has demonstrated some form of allergy
particularly to drugs
Pseudomembranous colitis has been reported with virtually all
broad-spectrum antibiotics (including macrolides. semisynthetic
penicillins and cephalosporins), therefore, it is important to
consider its diagnosis in patients who develop diarrhea in
association with the use of antibiotics Such colitis may range in
severity from mild to life-threatening
Treatment with broad-spectrum antibiotics alters the normal
flora of the colon and may permit overgrowth ot Clostridia Studies
indicate that a toiin produced by Closinpium difficile is one
primary cause of antibiotic-associated colitis
Mild cases of pseudomembranous colitis usually respond to
drug discontinuance alone In moderate to severe cases, manage-
ment should include sigmoidoscopy, appropriate bactenologic
studies, and fluid, electrolyte, and protein supplementation
When the colitis does not improve after the drug has been
discontinued, or when it is severe, oral vancomycin is the drug
of choice tor antibiotic-associated pseudomembranous colitis
produced by C difficile Other causes of colitis should be
ruled out
Precautions: General Precautions - If an alleroic reaction to
Ceclor ’ (cetaclor. Lilly) occurs, the drug should be discontinued,
and. If necessary, the patient should be treated with appropriate
agents, e g . pressor amines, antihistamines, or corticosteroids
Prolonged use of Ceclor may result In the overgrowth of
nonsusceptible organisms Careful observation of the patient is
essential If supennfection occurs during therapy appropriate
measures should be taken
Positive direct Coombs’ tests have been reported during treat-
ment with the cephalosporin antibiotics In hematologic studies
or in transfusion cross-matching procedures when antiglobulin
tests are performed on the minor side or in Coombs' testing ot
newborns whose mothers have received cephalosporin antibiotics
before parturition, it should be recognized that a positive
Coombs' test may be due to the drug
Ceclor should be administered with caution in the presence of
markedly impaired renal function Under such conditions, careful
clinical observation and laboratory studies should be made
because sate dosage may be lower than that usually recommended
As a result ot administration of Ceclor, a false-positive reaction
lor glucose in the urine may occur This has been observed with
Benedict’s and Fehling’s solutions and also with Ctinitest''
tablets but not with Tes-Tape" (Glucose Enzymatic Test Strip.
USP. Lilly)
Broad-spectrum antibiotics should be prescribed with caution in
individuals with a history of gastrointestinal disease, particularly
colitis
Usage in Pregnancy - Pregnancy Category B - Reproduction
studies have been performed in mice and rats at doses up to 12
times the human dose and in ferrets given three times the maximum
human dose and have revealed no evidence ot impaired fertility
or harm to the fetus due to Ceclor* (cetaclor. Lilly) There are.
however, no adequate and well-controlled studies in pregnant
women Because animal reproduction studies are not always
predictive of human response, this drug should be used during
pregnancy only if clearly needed
Nursing Mothers - Small amounts ot Ceclor have been detected
in mother s milk following administration of single 500-mg doses
Average levels were 0 18. 0 20. 0.21 . and 0 16 mcg/ml at two.
three, four, and five hours respectively Trace amounts were
detected at one hour The effect on nursing infants is not known
Caution should be exercised when Ceclor is- administered to a
nursing woman
Usage in Children ~ Safety and effectiveness of this product tor
use in infants less than one month of age have not been established
Adverse Reactions Adverse effects considered related to therapy
with Ceclor are uncommon and are listed below
Gasirointesiinal symptoms occur in about 2 5 percent ot
patients and include diarrhea (1 in 70).
Symptoms of pseudomembranous colitis may appear either
during or alter antibiotic treatment Nausea and vomiting have
been reported rarely
Hypersensitivity reactions have been reported in about 1 5
percent ot patients and include morbilitorm eruptions |1 in 100)
Pruritus, urticaria, and positive Coombs’ tests each occur in less
than 1 in 200 patients (^ases ot serum-sickness-like reactions
(erythema multiforme or the above skin manifestations accompanied
by arthritis/arthralgia and. frequently, fever) have been reported
These reactions are apparently due to hypersensitivity and have
usually occurred during or following a second course of therapy
with Ceclor Such reactions have been reported more frequently
in children than in adults Signs and symptoms usually occur a tew
days after initiation of therapy and subside within a tew days
after cessation of therapy No serious sequelae have been reported
Antihistamines and corticosteroids appear to enhance resolution
of the syndrome
Cases of anaphylaxis have been reported half of which have
occurred in patients with a history of penicillin allergy
Other effects considered related to therapy included
eosinophilia (1 in 50 patients) and genital pruritus or vaginitis
(less than 1 in 100 patients)
Causal Relationship Uncertain - Transitory abnormalities in
clinical laboratory test results have been reported Although they
were of uncertain etiology, they are listed below to serve as
alerting information tor the ph^ician
Hepatic - Slight elevations in SGOT, SGPT. or alkaline
phosphatase values ]l in 40)
Hematopoietic - transient fluctuations in leukocyte count,
predominantly lymphocytosis occurring in infants and young
children (1 in 40)
Renal - Slight elevations in BUN or serum creatinine (less than
1 in 5(^1 or abnormal urinalysis (less than 1 in 200)
1061 782R)
Note Ceclor* (cetaclor. Lilly) is contraindicated in patients
with known allergy to the cephalosporins and should be given
cautiously to peniciilin-aliergic patients
Penicillin is the usual drug of choice in the treatment and
prevention ot streptococcal infections, including the prophylaxis
ot rheumatic lever See prescribing information
© 1984, ELI LILLY AND COMPANY
Additional mtormation available to
the profession on reouest Irom
£li Lilly and Company
Indianapolis. Indiana 46285
Eli Lilly Industries. Inc
Carolina Puerto Rico 00630
LETTERS
The Editors would like to encourage physicians to contribute to the LETTERS section where they can ventilate their frustrations as well as opinions. This feature
is intended to be lively and spirited as well as informative and educational. /Is with other material which is submitted for publication, all letters will be subject
to the usual editing. Address correspondence to: The Editor. Wisconsin Medical Journal. Box 1109. Madison. Wis 53701.
The public, malpractice, the Wisconsin
Patients Compensation Fund, and us
To The Editor: The public, poli-
ticians, trial lawT^ers, and phy-
sicians are all concerned about
malpractice. Some individuals in
each group accuse other groups
and individuals of bad faith, con-
niving, misrepresentation, and so
forth. Newspaper articles and
editorials pick and exploit various
points of view. There may be a
grain of truth in all the various
positions on this issue.
The State Medical Examining
Board has been criticized. Com-
parisons were made with other
boards and more activity was
suggested. One wonders of the
400 odd cases the Medical Exam-
ining Board has under advise-
ment, awaiting disposition, how
many of these physicians have
had malpractice claims against
them. There is a financial incen-
tive for the physicians in Wis-
consin to weed out the incompe-
tent practicing doctors. The Wis-
consin Patients Compensation
Fund (WPCF) needs to run "lean
and mean" rather than "thin and
grim" as it is presently. With the
possible exception of some trial
law^’^ers, the consensus is that
something really ought to be done
to correct the present situation
regarding the huge escalation in
premiums for the Wisconsin Pa-
tients Compensaton Fund.
Suggestions have been offered
as to a solution and now action
is needed. I believe an ideal solu-
tion would be to:
— protect the public from incom-
petent physicians,
—keep good physicians in prac-
tice (especially important in rural
areas) by holding down premium
payments,
— protect the Wisconsin Patients
Compensation Fund from further
dollar erosion and escalation of
premiums, and
— reduce the number of frivolous
claims.
I suggest the State Medical So-
ciety recommend the Legislature
pass enabling legislation to estab-
lish a committee or panel with
precisely this mission. Changing,
modifying, or increasing the
charge to the Medical Examining
Board would be awkward, take
too long, and probably wouldn't
work.
This committee would review
all malpractice claims, beginning
obviously with those successful
claims for the largest dollar
amounts. But ultimately this
would include even unsuccessful
claims.
This legislation should give the
committee the authority to:
— rescind, or not offer, Patients
Compensation Fund coverage to
any physician they judge to be
unfit to practice,
— rescind coverage selectively:
ie, not all thoracic surgeons
should be doing open heart sur-
gery, not all neurosurgeons
should be doing intracranial vas-
cular anastomosis, not all ortho-
pedic surgeons should be doing
spine surgery,
— add surcharges to the pre-
miums of physicians who are out-
liers in the number of mal-
practice claims. The system
needs to be fine-timed. It is not
reasonable that a neurosurgeon,
gynecologist, obstetrician, or
thoracic surgeon with no mal-
practice claims in five or ten
years should pay the same pre-
mium as one who has had a claim
per year.
It would be important for all
the players, most importantly the
Legislature, to understand our
position is that there are circum-
stances when even an excellent
physician can have a successful
malpractice claim against him or
her because we are, as phy-
sicians, also human. The question
of how many successful claims
against a single physician are evi-
dence that he is incompetent has
not been determined. What is
known is that in ten years 21
physicians have had three or
more successful malpractice
claims filed. Are these physicians
incompetent? Are they insured
by the WPCF? How many dollars
from the Fund were paid out
for these 21 physicians? Are they
included in those cases under
advisement by the Medical Ex-
amining Board? Such ques-
tions could be answered by such
a committee.
The number of physicians hav-
ing two or more claims filed
against them is not known. Per-
haps the number of unsuc-
cessful claims filed against an
individual physician are also im-
portant because they may only
reflect the quality of his/her de-
fense attorney and not the issue
of negligence.
The question of negligence
needs to be addressed by the
committee. Perhaps if gross neg-
ligence (which requires precise
definition) is proved, a single mal-
practice claim is sufficient to
withhold insuring that individual
or doubling his surcharge.
This could be left to the judg-
ment of the committee. Ob-
viously, there would need to be
peer representation to the com-
mittee in arriving at such deci-
sions.
Important to consider is that
maybe there are too many in-
competent physicians practicing
14
WISCONSIN .MEDIC.ALJOCRN.AL, JCNE 1983 :\ OL. 84
THE PUBLIC, MALPRACTICE
LETTERS
in Wisconsin. There also may be
too many trial lawyers, weak,
easily influenced juries, and so
forth. The committee could not
successfully address all of these
issues but could at least remove
the Wisconsin Patients Com-
pensation Fund from the risk of
covering incompetent physicians.
Perhaps the committee should
be authorized to take action
against attorneys who file nu-
merous frivolous claims either
through the courts or the Bar As-
sociation. Perhaps a percentage of
the Patients Compensation Fund
should be set aside for rehabili-
tation of the impaired physician.
Informing the patients of the mal-
practice problem would be
worthwhile. Perhaps a general
educational program on mal-
practice issues may be in order
for all physicians. If physicians
wished to continue receiving cov-
erage from the Wisconsin Pa-
tients Compensation Fund, at-
tendance could be made manda-
tory. Certainly the findings of the
committee should be reviewed
by the Medical Examining Board.
The composition of such a com-
mittee is critical. It is best to re-
member that large committees
have an inherent inertia. Chair-
men of such committees seldom
get the work done without a sub-
stantial time commitment. With-
out authority, necessary actions
don't take place. Without action,
committee members rapidly lose
interest. The committee must see
decisions result in action. Half-
way measures seldom get even
halfway results. Without high
quality and sufficient staff, fail-
ure could be predicted.
Our Society's immediate past
president, Timothy T Flaherty,
MD, and our current president as
well, John K Scott, MD, recog-
nize this problem; and during
Doctor Flaherty's term he recom-
mended establishment of a panel
to do much of what I have recom-
mended. Now what is needed is
action.
—Richard D Sautter, MD
1000 North Oak Ave
Marshfield, Wisconsin 54449
Fee discrimination
To THE Editor: Are you tired of
the high cost of continuing med-
ical education? Have you also
noticed that many nonphysician
health professionals are attending
medical education conferences?
Have you also noticed the other
health professionals often pay
greatly reduced fees for these
same conferences?
For example, at a recent Sports
Medicine conference at the Uni-
versity of Wisconsin-Madison,
the fee for physicians was $165.
The fee for nonphysicians was
$85. Both nonphysicians and phy-
sician attendants received the
same course booklets, heard the
same lectures, and occupied the
same amount of space in the
conference hall. Yet, the physi-
cian pays almost twice as much
money for this educational pro-
duct. Is this fee discrimination
really Justified?
Even if we assume that all phy-
sicians are rich and all nurses,
physical therapists, physician as-
sistants, etc are poor, the price
differential is unreasonable. Of-
ten, the registration fees are paid
for by employers— that is, clinics,
hospitals, and other institutions—
whose expense accounts are far
larger than the individual medi-
cal practitioner. In addition, if the
nonphysician practitioner is self-
employed and paying his or her
own fee, is it fair for the MD to
pay twice as much— in effect sub-
sidizing the education of his com-
petitors?
In any case, I resent having to
pay twice as much for my con-
tinuing medical education as
other health professionals.
Equal conference— equal fee.
—Robert L Schwarz, MD
N84 W16889 Menomonee Ave
Menomonee Falls, WI 53051
Tourette Syndrome
To THE Editor; Our daughter,
Susan, was ZYa years old when
we first sought neurological eval-
uation for "unusual eye move-
ments." When her problem was
not identified, we assumed that
we were doing things which
made her nervous. Nine years
later she was finally diagnosed
as having Tourette Syndrome.
We urge all physicians who re-
cently received the SMS mailing
on Tourette Syndrome to care-
fully read the information on this
disorder. Although many more
physicians are knowledgeable
about this not-as-rare-as-was-
thought condition, many families
are still spending thousands of
dollars and years of frustration
trying to learn why their child
makes strange movements and
sounds and has some other un-
usual behaviors, often to the
point of its preventing the living
of a normal life.
There are drug therapies which
can help control TS. The benefits
of early diagnosis and treatment
are enormous in that frustration
is more easily dealt with and the
social and emotional aspects of
the disorder can be managed
more efficiently.
We thank the CESF and SMS
for undertaking this educational
project, and we urge all phy-
sicians to learn about Tourette.
—Dr and Mrs Richard H Ward
1821 N Racine Street
Appleton, WI 54911
Editor s note: The publication
entitled "A Physician's Guide to
Diagnosis and 'Treatment of Tour-
ette Syndrome" is available by
contacting the Charitable, Educa-
tional and Scientific Foundation
(CESF), PO Box 1109, Madison,
Wisconsin 5370 1.«
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
15
It Pays
TO BE A
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PRINCIPLES OF ADVERTISING
Wisconsin Medical Journal
The acceptance of advertising in the Wisconsin MedicalJournal
is predicated on the basis that the advertised product or service
meets the ethical principles established by the Board of Direc-
tors of the State Medical Society of Wisconsin. The Journal
reserves the right to accept or reject advertising copy for any
reason.
The following general rules are applicable to advertisements
of medicinal preparations, apparatus or physical appliances
or other products for therapeutic or diagnostic purposes or for
which therapeutic, diagnostic or health claims are made:
1 . The advertiser may be required to submit evidence or data
in support of the usefulness of the product and the validity
of the claims. The appearance of one or several papers may
not necessarily be considered sufficient evidence and other
data may be required.
2. Medicinal preparations containing two or more active ingre-
dients will be considered only if in the opinion of the
Advertising Committee of the Bureau there is a logical
rationale for the inclusion of each active ingredient, and if
a statement of the active ingredients is included in each
advertisement.
3. The generic or official designation of the medicinal prepara-
tion must be adequately featured in advertising copy, in addi-
tion to the trade name.
All advertising copy is subject to the following general rules:
1 . Advertisement should not be false, deceptive or misleading
nor make use of sweeping superlatives.
2. Unfair comparisons and disparagment of a competitor’s
goods will not be allowed.
3. When excerpts from a published paper are included in
advertising copy, the Bureau may require the advertiser or
his agent to obtain written permission from the author and
from the editor or publisher of the publication in which the
paper appeared.
4. Advertising copy will not be accepted if, in the opinion of the
Bureau or the management of the medical journal, the copy
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DESCRIPTION: Velosef ‘250’ Capsules and Velosef '500' Capsules
(Cephradine Capsules USP) provide 250 mg and 500 mg cephradine,
respectively, per capsule. Velosef ‘125’ for Oral Suspension and Velosef ‘250’
for Oral Suspension (Cephradine for Oral Suspension USP) after constitution
provide 125 and 250 mg cephradine, respectively, per 5 ml teaspoonful.
INDICATIONS AND USAGE: These preparations are indicated for the
treatment of infections caused by susceptible strains of designated
microorganisms as follows: Respiratory Tract Infections (e.g„ tonsillitis,
pharyngitis, and lobar pneumonia) due to S. pneumoniae (formerly D. pneu-
moniae) and group A befa-hemolytic sfreptococci [penicillin is the usual drug
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generally effective in the eradication of streptococci from the nasopharynx:
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moniae-. Skin and Skin Structures Infections due to staphylococci and beta-
hemolytic streptococci; Urinary Tract Infections, including prostatitis, due to
£ coli, R mirabilis, Klebsiella species, and enterococci (S. laecalis).
Note: Culture and susceptibility tests should be initiated prior to and dur-
ing therapy.
CDNTRAINDICATIONS: In patients with known hypersensitivity to the
cephalosporin group of antibiotics.
WARNINGS: Use cephalosporin derivatives with great caution in penicillin-
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resins have been shown to bind the toxin in vitro. Mild cases of colitis may
respond to drug discontinuance alone. Manage moderate to severe cases
with fluid, electrolyte and protein supplementation as indicated. Oral vanco-
mycin is the treatment of choice for antibiotic-associated pseudomembra-
nous colitis produced by C. dilficile when the colitis is severe or is not
relieved by drug discontinuance; consider other causes of colitis.
PRECAUTIDNS: General: Follow patients carefully to detect any side
effects or unusual manifestations of drug idiosyncrasy. If a hypersensitivity
reaction occurs, discontinue the drug and treat the patient with the usual
agents, e.g., pressor amines, antihistamines, or corticosteroids. Administer
cephradine with caution in the presence of markedly impaired renal function.
In patients with known or suspected renal impairment, make careful clinical
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cephradine accumulates in the serum and tissues. See package insert for
information on treatment of patients with impaired renal function. Prescribe
cephradine with caution in individuals with a history of gastrointestinal dis-
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growth of nonsusceptible organisms. Take appropriate measures should
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performed in conjunction with antibiotic therapy.
Information for Patients: Caution diabetic patients that false results
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Test Interactions). Advise the patient to comply with the full course of therapy
even if he begins to feel better and to take a missed dose as soon as possible.
Tell the patient he may take this medication with food or milk since G.l. upset
may be a factor in compliance with the dosage regimen. The patient should
report current use of any medicines and should be cautioned not to take other
medications unless the physician knows and approves of their use (see
PRECAUTIONS, Drug Interactions).
Laboratory Tests: In patients with known or suspected renal impair-
ment, it is advisable to monitor renal function.
Drug Interactions: When administered concurrently, the following drugs
may interact with cephalosporins:
Other antibacterial agents — Bacteriostats may interfere with the bacterici-
dal action of cephalosporins in acute infection; other agents, e.g., amino-
glycosides, colistin, polymyxins, vancomycin, may increase the possibility of
nephrotoxicity.
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ALL ENTRIES MUST BE RECEIVED BY SEPTEMBER 9. 1985.
© 1985 E.R, Squibb & Sons, Inc , Princeton, NJ 08540 785-501A Issued: Jan. 1985 Printed in U S. A,
VELDSEFcapsules
[Cephradine Capsules USP)
BID
Diuretics (potent “loop diuretics," e.g., furosemide and ettiacrynic acid)
— Enhanced possibility for renal toxicity.
Probenecid — Increased and prolonged blood levels of cephalosporins,
resulting in increased risk of nephrotoxicity.
Orug/Laboratory Test Interactions; After treatment with cephradine, a
false-positive reaction for glucose in the urine may occur with Benedict's
solution, Fehling's solution, or with Clinitest® tablets, but not with enzyme-
based tests such as Clinistix® and Tes-Tape®. False-positive Coombs test
results may occur in newborns whose mothers received a cephalosporin prior
to delivery. Cephalosporins have been reported to cause false-positive reac-
tions in tests for urinary proteins which use sulfosalicylic acid, false
elevations of urinary 17-ketosteroid values, and prolonged prothrombin
times.
Carcinogenesis, Mutagenesis: Long-term studies in animals have not
been performed to evaluate carcinogenic potential or mutagenesis.
Pregnancy Category B: Reproduction studies have been performed in
mice and rats at doses up to 4 times the maximum indicated human dose and
have revealed no evidence of impaired fertility or harm to the fetus due to
cephradine. There are, however, no adequate and well-controlled studies in
pregnant women. Because animal reproduction studies are not always predic-
tive of human response, use this drug during pregnancy only if clearly
needed.
Nursing Mothers: Since cephradine is excreted in breast milk during
lactation, exercise caution when administering cephradine to a nursing
woman.
Pediatric Use: Adequate information is unavailable on the efficacy of
b.i.d. regimens in children under nine months of age.
ADVERSE REACTIONS: Untoward reactions are limited essentially to G.l.
disturbances and, on occasion, to hypersensitivity phenomena. The latter are
more likely to occur in persons who have previously demonstrated hypersen-
© 1985 E.R. Squibb & Sons, Inc.
sitivity and Ihose with a history of allergy, asthma, hay fever, or urticaria.
The following adverse reactions have been reported following use of
cephradine: G.l. — Symptoms of pseudomembranous colitis can appear dur-
ing antibiotic therapy; nausea and vomiting have been reported rarely. Skin
and Hypersensitivity Reactions — mild urticaria or skin rash, pruritus, joint
pains. Hematologic — mild transient eosinophilia, leukopenia and neutrope-
nia. Liver — transient mild rise of SGOT, SGPT, and total bilirubin with no
evidence of hepatocellular damage. Renal — transitory rises in BUN have
been observed in some patients treated with cephalosporins; their frequency
increases in patients over 50 years old. In adults for whom serum creatinine
determinations were performed, the rise in BUN was not accompanied by a
rise in serum creatinine. Others — dizziness, tightness in the chest, and
candidal vaginitis.
DOSAGE: Adults — For respiratory tract infections (other than lobar
pneumonia) and skin and skin structure infections: 250 mg q. 6 h or 500 mg
q. 12 h. For lobar pneumonia: 500 mg q. 6 h or 1 g q. 12 h. For uncompli-
cated urinary tract infections: 500 mg q. 12 h; for more serious UTI, including
prostatitis, 500 mg q. 6 h or 1 g q. 12 h. Severe or chronic infections may
require larger doses (up to 1 g q. 6 h). For dosage recommendations in
patients with impaired renal function, consult package insert.
Children over 9 months of age — 25 to 50 mg/kg/day in equally divided
doses q. 6 or 12 h. For otitis media due to H. influenzae: 75 to 100 mg/kg/day
in equally divided doses q. 6 or 12 h but not to exceed 4 g/day. Dosage for
children should not exceed dosage recommended for adults. There are no
adequate data available on efficacy of b i d. regimens in children under 9
months of age.
For full prescribing information, consult package insert.
HDW SUPPLIED: 250 mg and 500 mg capsules in bottles of 24 and 100
and Unimatic® unit-dose packs of 100. 125 mg and 250 mg for oral suspen-
sion in bottles of 100 ml and 200 ml.
785-501 Issued: Jan. 1985
NO POSTAGE
NECESSARY
IF MAILED
IN THE
UNITED STATES
BUSINESS REPLY MAIL
First Class Permit No. 99, Syosset, New York 11791
Postage will be paid by
“Computers in Health Care Drawing”
RO. Bqx 3036
Syosset, New York 11775
Wisconsin Medical Journal
1985
Annual edition, since 1924, devoted to
medicolegal, socioeconomic, legislative mat-
ters of direct concern to physicians in their
relationships to patients, hospitals, govern-
ment agencies, the Legislature, and others in
the medical community ... A useful reference
source throughout the year.
The Wisconsin Medical Journai gratefully acknowledges publication support
of this “Blue Book” issue through a contribution from the Crownhart Memorial
Account of the State Medical Society’s Charitable, Educational and Scientific
Foundation.
Reprints: $15.00, plus 5% sales lax in Wisconsin, unless tax-exempt status declared
COPYRIGHT, 1985, State Medical Society of Wisconsin, Madison, Wisconsin
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
23
THE STATE MEDICAL SOCIETY OF WISCONSIN
Created by the Territorial Legislature in 1841 . . . representing over 5,100 member physicians in Wisconsin, com-
prising 55 county medical societies and 25 medical specialty sections. The purpose of the Society is to “bring together
the physicians of the State of Wisconsin to advance the science and an of medicine and the better health of the people
of Wisconsin, and to secure the enactment and enforcement of just medical laws.” The major activities of the Society
include continuing medical education, peer review, legislation, community health education, scientific affairs, socio-
economics, health planning, services for physicians, operation of a Charitable, Educational and Scientific Foundation,
and publication of the Wisconsin Medical Journal.
OFFICERS OF THE SOCIETY
PRESIDENT: John K Scott, MD. Madison
PRESIDENT-ELECT: Charles W Landis, MD, Milwaukee
SECRETARY-GENERAL MANAGER: Earl R Thayer,
Madison
TREASURER: John J Foley, MD, Menomonee Falls
BOARD OF DIRECTORS
CHAIRMAN: Darold A Treffert, MD, Fond du Lac
VICE CHAIRMAN: Roger L von Heimburg, MD,
Green Bay
FIRST DISTRICT Kenosha, Milwaukee, Ozaukee, Racine,
Walworth, Washington, Waukesha counties
Glenn H Franke, MD, Milwaukee
Jerome W Fons Jr, MD, Cudahy
Carl S Eisenberg, MD, Milwaukee
Thomas A Hofbauer, MD, Menomonee Falls
Wayne H Konetzki, MD, Waukesha
Fredrick Wood Jr, MD, Kenosha
William L Treacy, MD, Milwaukee
Lucille B Gticklich, MD, Milwaukee
Richard D Fritz, MD, Milwaukee
William J Listwan, MD, West Bend
SECOND DISTRICT: Adams, Columbia, Dane, Dodge,
Grant, Green, Iowa, Jefferson, Lafayette, Marquette,
Richland, Rock, Sauk counties
J D Kabler, MD, Madison
Cyril M Hetsko, MD, Madison
James J Tydrich, MD, Richland Center
A twin E Schultz, MD, Madison
Kenneth / Gold, MD, Beloit
THIRD DISTRICT Buffalo, Crawford, Jackson, Juneau,
LaCrosse, Monroe, Trempealeau, Vernon counties
Pauline M Jackson, MD LaCrosse
FOURTH DISTRICT: Clark, Florence, Forest, Langlade,
Lincoln, Marathon, Oneida, Portage, Price, Taylor,
Vilas, Wood counties
John J Kief, MD, Rhinelander
Jung K Park, MD, Wisconsin Rapids
W George Locher, MD, Wausau
FIFTH DISTRICT: Calumet, Fond du Lac, Green Lake,
Outagamie, Waupaca, Waushara, Winnebago counties
Darold A Treffert, MD, Fond du Lac
Kenneth M Viste Jr, MD, Oshkosh
C William Freeby, MD, Appleton
SIXTH DISTRICT: Brown, Door, Kewaunee, Manitowoc,
Marinette, Menominee, Oconto, Shawano, Sheboygan
counties
Roger L von Heimburg, MD, Green Bay
Joseph C DiRaimondo, MD, Manitowoc
SEVENTH DISTRICT: Barron, Chippewa, Dunn, Eau Claire,
Pepin, Pierce, Polk, Rusk, St Croix, Burnett, Washburn
counties
Marwood E Wegner, MD, St Croix Falls
Philip J Happe, MD, Eau Claire
EIGHTH DISTRICT: Ashland, Bayfield, Douglas, Iron,
Sawyer counties
Joseph M Jauquet, MD, Ashland
PRESIDENT Scott; PRESIDENT-ELECT Landis;
PAST PRESIDENT Timothy T Flaherty, MD, Neenah
SPEAKER Duane W Taebel, MD, La Crosse; and
VICE SPEAKER Vernon M Griffin, MD, Mansion
DELEGATES TO THE AMERICAN MEDICAL
ASSOCIATION
Henry F Twelmeyer, MD, Wauwatosa
John K Scott, MD. Madison
Patricia J Stuff, MD, Bonduel
DeLore Williams, MD, West Allis
Richard W Edwards, MD, Richland Center
Cornelius A Natoli, MD, La Crosse
Timothy T Flaherty, MD, Neenah
ALTERNATES TO THE AMA
Cyril M Hetsko, MD, Madison
John D Riesch, MD, Menomonee Falls
J D Kabler, MD, Madison
Kenneth M Viste Jr, MD, Oshkosh
John P Mullooly, MD, Milwaukee
Richard H Ulmer, MD, Marshfield
Charles W Landis, MD, Milwaukee
330 East Lakeside Street (PO Box 1 1 09), Madison, Wisconsin 53701 / T elephone: (608) 257-6781
This article examines the countersuit concept as adopted by other state courts and the relative merit of the
many legal doctrines found under the broad heading '’'’countersuit. ” Finally, Wisconsin 's frivolous lawsuit
statute is examined for its potential assistance in the struggle to cope with malpractice "’mania. ”
COUNTERSUITS
It is unnecessary to introduce the idea that there
is a malpractice lawsuit problem nationwide — only
the most isolated members of society are unaware of
the popularity medical malpractice claims have en-
joyed over the past decade. Countersuits to malprac-
tice suits started to appear about the same time and
were first thought to be the meritless suit defendant’s
salvation. However, as the trial awards to counter-
suing physicians were subsequently reversed by ap-
pellate courts, it seemed that as the defendants
remedy, the case for countersuits might have been
overstated. Hope does remain in Wisconsin because
the higher courts (having precedential value and
therefore creating “case law”) have not yet addressed
countersuits to medical malpractice suits and there-
fore have not rejected their use.
What is a countersuit?
A countersuit is a lawsuit a defendant in one action
brings against the plaintiff in that original suit, the
plaintiff’s attorney or both to compensate the defen-
dant for injuries suffered as a result of the original
suit. Countersuit plaintiffs, hence referred to in this
paper as defendants, have based their right to redress
on a number of legal theories. This paper will outline
the most common legal theories and describe their
relative success in other jurisdictions.
Malicious prosecution
The most frequently used doctrine, malicious
prosecution originated in criminal law and has been
applied more recently to civil law matters. Defendants
bringing malicious prosecution suits must plead and
prove four factors:'
(1) the original (underlying) suit must have ter-
minated in the defendant’s favor;
(2) there must have been no “probable cause” for
bringing the underlying suit;
(3) plaintiff brought the original suit out of malice;
and
(4) defendant suffered special injury.
Requirement I: Favorable termination
Courts have defined “favorable termination” to
mean that the suit was terminated because the merits
were insufficient to support the malpractice claim.
Termination can mean either that the suit was dis-
missed before reaching trial or that the suit terminated
with a jury verdict for the defendant physician. Vol-
untary dismissals are not favorable terminations be-
cause, unless the claim was dismissed “with prej-
udice,” the plaintiff may bring the action again. Even
if the claim is dismissed with prejudice, the plaintiff’s
attorney might not be liable to the physician for
malicious prosecution. In Zeavin v. Lee,^ a court
found that no malicious prosecution claim arose if the
attorney filed and diligently prosecuted defendant’s
case, even though the case was dismissed due to the
plaintiff’s refusal to comply with discovery pro-
cedures. Although the requirement that the prior suit
was terminated in the physician-defendant’s favor
seems straight-forward, courts might yet qualify the
case and dismiss the countersuit action.
There is some question whether a Patient’s Com-
pensation Panel decision in the respondent physi-
cian’s favor would constitute a favorable termination
because termination means that the plaintiff must be
foreclosed from bringing the same claim again in
court. Because a plaintiff who loses at the panel level
can then appeal to the trial court for a de nuovo trial
on the facts, the claim has not been extinguished in
the same manner as a dismissal, or trial on the merits
extinguishes a claim and bars the plaintiff from bring-
ing the claim anew. Therefore, it is most likely that
unless the physician has prevailed at the trial court
level through a dismissal, favorable jury verdict or
other final decision, he or she probably cannot prove
this first element of malicious prosecution.
Requirement 2: Probable cause
Probable cause is even more troublesome for a
defendant countersuing under the malicious prosecu-
tion theory. Probable cause essentially means reason-
able cause — whether the plaintiff had reason to bring
the malpractice suit. Lack of probable cause has been
found in a malicious prosecution action against the
plaintiff’s attorney when the attorney disregarded
relevant circumstances and failed to properly inves-
tigate client’s claim before filing a malpractice suit.
In Moiel v. Sandlin,^ the Texas appellate court stated:
An attorney may generally rely in good faith upon the
facts his client relates. Unless lack of probable cause for
a claim is obvious from the facts disclosed by the client
or otherwise brought to the attorney’s attention, he may
assume the facts disclosed are substantially correct.”
(Moiel, at 570.)
Courts are more than slightly reluctant to impose
on an attorney a meaningful duty to investigate. In
Fee, Parker & Lloyd, P.A. v. Sullivan,’' the Florida
appellate court reversed a $175,000 award to a physi-
cian, stating that the attorney need only have prob-
able cause to believe the physician was guilty to file
the claim and that the trial court had evidence to that
extent. Good faith will exonerate the client as well.
WISCONSIN MEDICAL JOURNAL, JUNE 1985:VOL. 84
25
If the client relies upon the advice of his or her at-
torney in filing an action, he or she is relieved from
civil liability.’ Therefore, showing lack of probable
cause goes beyond showing that the claim filed was
not adequately supported by evidence because all that
the plaintiff and his or her attorney need to show was
that they were reasonable and acted in good faith
when they filed the action.
Requirement 3: Malice
Courts differ in their definition of malice from
state to state. Malice can be judged either by a sub-
jective (“actual malice” or “malice in fact”) or an
objective (“inference of malice”) standard. Actual
malice is defined as an evil or sinister purpose, or
wicked or malicious intent* and requires the plaintiff
to prove the defendant’s state of mind, that the defen-
dant acted maliciously and intended to harm the
plaintiff. For obvious reasons, proving malicious in-
tent is difficult, and consequently many state courts
have turned to the objective malice standard.
An example of a relaxed malice standard is Cali-
fornia’s inference of malice standard, a standard that
the defendant meets by showing that the plaintiff
lacked probable cause for filing the action.^ However,
the high threshold for establishing probable cause is
often so great a hurdle that even the inference test is
no savings to the defendant countersuing under the
malicious prosecution theory.
Requirement 4: Special injury
Finally, the defendant, now countersuit plaintiff,
must prove special injury. Although each of the four
requirements pose definitional and proof problems,
the special injury element is probably the most diffi-
cult to plead and prove in this state. Wisconsin is in
a large minority of states that follow the “English
rule” of damages.* This damages rule requires the
plaintiff to prove that damages go beyond those
ordinarily associated with defending a civil action.’
Under the strict English rule, it is necessary to
demonstrate interference with the plaintiff’s person
(arrest), property (seizure), or other special inter-
ference to prove special injury. If interference can-
not be shown, a malicious prosecution claim is ab-
solutely barred. This definition is sufficiently am-
biguous to allow a court uncomfortable with a
counterclaim to deny the suit without reaching the
suit’s merits. What this means is that a physician
might not be able to get past the complaint filing stage
of litigation because the court finds that damages as
pleaded on the complaint are not sufficient to war-
rant a malicious prosecution action. As a result, the
special damages rule has virtually eliminated the
malicious prosecution tort and its use as a counter-
suit remedy in other states, and will probably lead to
the same result in Wisconsin.
Abuse of process
Abuse of process is the intentional misuse of a
court process for some ulterior or collateral purpose
unintended by law. Unlike malicious prosecution, the
underlying case need not terminate in the plaintiff’s
favor nor must lack of probable cause for bringing
the suit be pleaded or proved. However, it is not
enough that the original suit was groundless if it was
brought in the technically correct manner. The plain-
tiff must show that the defendant had an ulterior
motive for bringing the underlying suit, i.e. to coerce
a settlement. Because it is difficult to prove this sort
of motive, abuse of process is generally unsuccessful
and infrequently used.
There has been one successful countersuit based on
abuse of process. In Bull v. McCuskey, a physician
sued an attorney for damages for abuse of process.
The physician claimed that the attorney instituted a
malpractice suit against him to coerce a nuisance
settlement although the attorney knew that there was
no basis for malpractice claim. The jury awarded the
physician $35,000 as compensatory and $50,000 as
punitive damages. Upon appeal to the Nevada
Supreme Court, the court upheld the jury verdict,
reasoning that the attorney’s offer to settle the mal-
practice case for $750, his failure to investigate the
claim before filing the suit, and his failure to present
any expert evidence at trial supported the conclusion
that the attorney abused the legal process.
Abuse of process has been used as a counterclaim
to a suit. (A counterclaim differs from a countersuit
in that it is alleged by the defendant as an answer to
the malpractice plaintiff’s complaint.) In one case, ‘ ‘
a physician sued a patient to recover an uncollectable
bill for a myelogram from the patient-defendant. The
patient in turn sued the physician for medical mal-
practice. The physician counterclaimed that the pa-
tient filed the suit solely to avoid paying his bill, and
that because of this abusive use of the legal process,
the physician sustained damage to his reputation and
expenses in defending himself in the malpractice
action. Shortly after the counterclaim was filed, the
patient dropped the malpractice suit and settled with
the physician on the claim for payment of services.
Negligence
Countersuits brought against attorneys for negli-
gence have become more popular. This form of
countersuit has two sources for negligent conduct:
(1) the attorney’s duty to third parties to exercise
reasonable care when advising clients to file a
malpractice lawsuit; and
(2) the attorney’s failure to comply with the Code
of Professional Responsibility of the American
Bar Association that prohibits instituting
frivolous litigation,'^ and potentially in Wiscon-
sin, the Wisconsin Supreme Court Rules that
prohibit the same conduct.'*
Both allegations depend on the court’s acceptance of
the notion that attorneys owe the third party, the
defendant physician, a duty to refrain from bringing
unfounded litigation. However, courts have found
that attorneys owe this duty to iheir client and the
26
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
legal system, but not to third parties so as to form the
basis for a lawsuit. In Bickel v. Mackie,'^ the court
found that an attorney’s liability to a third party is
not based on a negligence standard. The court rea-
soned that an adverse party cannot depend on the op-
posing attorney to protect him or her from harm be-
cause the adversary system did not intend this duty
to exist. Moreover, extending a duty under the at-
torney code of professional responsibilities would
raise a direct conflict of interest regarding the at-
torney’s primary duty to protect his or her client’s
interests. Therefore, there is no such thing as a
negligence countersuit according to the courts.
Even if a negligence countersuit were recognized,
it is unlikely that a court would find a lawyer negli-
gent. Part of the problem is developing a standard for
attorneys concerning their duty to investigate claims
before filing an action. Because few if any counter-
suit negligence claims have reached trial, no negli-
gence standards as yet have been established by
courts. It would be safe to say that should negligence
develop into a cause of action for physicians in the
countersuit context, the standard would most likely
be lenient.
Barratry
Few countersuits'’ have raised allegations of bar-
ratry, that is, alleging the offense of “frequently
exciting and stirring up quarrels and lawsuits.’”* Bar-
ratry is not used as a countersuit legal theory because
it is considered a public rather than private remedy,
meaning that it is used only to punish a lawyer for a
general practice behavior and not for a single merit-
less malpractice suit.
Defamation
Defamation is defined as the invasion of one’s
interest in reputation and good name in the commun-
ity through publication or communication of false
statements to a third party. Statements made in the
judicial process are privileged. What “privilege”
means is that statements made in this judicial context
do not constitute defamation. Included in the defini-
tion of judicial process is the malpractice allegation
or allegations made in the complaint filed by the
plaintiff and on record with the court. Since the media
usually have access to the court records, including the
original malpractice complaint, if the allegations are
published, the defendant has not been defamed even
if he or she wins by virtue of a jury verdict or court
dismissal. However, defamatory statements made
outside of the judicial proceedings receive no such
protection. In other words, if the attorney for the
malpractice plaintiff makes false statements to the
press outside the courtroom, the attorney could be
liable for defamation.'’
This privilege bestowed upon statements made in
the judicial process generally precludes defamation
claims in countersuits. However, one case did succeed
under the defamation theory when statements were
made out of court. In Jankelson v. Cisel,^° a dentist
recovered $12,000 in a defamation (libel and slander)
suit against a former patient who had complained to
other dentists, dental societies, and government agen-
cies about her treatment by the plaintiff. The defen-
dant’s defamatory actions took place before she
initiated two malpractice actions. The first suit was
voluntarily dismissed and the second, a counterclaim
to the defamation action, was dismissed by the court.
The court enjoined the defendant from any further
libellous activities to protect and vindicate the dentist.
Invasion of Privacy
Invasion of privacy has been used by countersuing
physicians to attempt to prove actual damages in
malicious prosecution countersuits.” However, like
defamation, invasion of privacy actions” does not
apply to injury suffered as a consequence of the
judicial process despite the fact that the suit was
groundless.”
Prima facie torts
New York state has developed its own brand of
tort — the prima facie tort, meaning “intentional
malicious injury to another by otherwise lawful
means without economic or social justification, but
solely to harm the other.”” The elements of this cause
of action as formed by courts are (1) an intent to harm
on the defendant’s part; (2) a lack of justification for
the defendant’s actions; and (3) special damages.
Prima facie tort has not been viewed favorably by
courts partly because it suggests a way to fix an other-
wise defective malicious prosecution suit, supersede
the privity (duty) requirement of negligence actions
and preempt state tort legislation to the contrary.
Moreover, prima facie tort as a countersuit claim has
not functioned well in the state that nurtured it. In
Hoppenstein v. Zemek,^^ the court held that the plain-
tiff had failed to plead special damages. Moreover,
there had been no showing of “intentional infliction
of economic damage without excuse or justifica-
tion.”” In Belsky v. Lowenthal,^^ the court refused
to accept the prima facie tort rationale in the counter-
suit context, stating that “this rationale should not
be an occasion for setting aside large bodies of case
law which have defined our limits, established our
guidelines and set forth the elements of traditional
tort.””
One case in New York gave prima facie tort theory
a short-lived success. In Drago v. Buonagurio,^^ the
appellate division court overturned the trial court’s
dismissal of a countersuit using the prima facie tort
theory. The physician defendant, now countersuit
plaintiff, sued for prima facie tort the plaintiff who
instituted a malpractice action that named the physi-
cian among those responsible for a wrongful death
although the physician was not directly or indirectly
involved. The appellate court agreed that no tradi-
tional tort theory gave a basis for the countersuit but
reasoned that “the law should never suffer an injury
and a damage without a remedy.”” However, upon
appeal to the Court of Appeals of New York, the case
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
27
was reversed, the court agreeing with the trial court
that the complaint did not state a cause of action. The
court deferred to the legislature to devise new lia-
bilities and added that the court should exercise
“judicial restraint in response to invitations to recog-
nize what is conceded to be perhaps a ‘new, novel or
nameless’ cause of action.’’^"
The “new, novel or nameless’’ cause of action has
had its day in court in other states. A prime example
of this new tort was temporarily ensconsed in Illinois
after a trial court awarded damages to a countersuing
physician in Berlin v. Nathan.^' In that famous case,
the plaintiff claimed that the state constitution which
provides that for every wrong there is a remedy^^ sup-
ported his countersuit. Upon appeal to the Illinois
Appellate Court, the physician’s claim was rejected.
The court held that so long as some remedy for
alleged wrong exists, the constitutional provision does
not mandate recognizing any new remedy. Since
then, other courts have concurred that new tort lia-
bilities do not exist simply because the state constitu-
tion allows for redress for wrongdoings.
As for tort theories upon which countersuits have
been hung, many claims have been made limited only
by the physician’s counsel’s imagination. Like the
prima facie and constitutional tort, many have been
rejected. Certainly, there must be some reason for
court reluctance to recognize countersuits in general.
The main reason is a basic policy behind the judicial
system discussed in the next section.
Public policy that counters countersuits
Why have countersuits received such a cold recep-
tion by trial and, particularly, appellate courts? The
chief reason for this judicial resistance is that the idea
that defendants should have recourse against plain-
tiffs who bring suits against them clashes with the
public policy that all persons must have free and
unfettered access to the courts “in order to settle their
grievances. This policy holds that “the courts
should be open to litigants for settlement of their
rights without fear of prosecution for calling upon the
courts to determine such rights. ’’“ For the judicial
system in this country to fulfill its constitutional man-
date, plaintiffs and their attorneys must not be fear-
ful that they will be liable to the defendant if their case
does not have the necessary merit to prevail in court.
If permitted to flourish, countersuits, it is argued, will
“chill’’ the right to free access to the courts.
Another policy that works against countersuits ac-
ceptibility concerns court economy and efficiency. If
every defendant who wins in the initial suit brings a
countersuit, litigation would increase and further clog
the already congested court dockets. If the defen-
dant-now-plaintiff then loses, the original plaintiff
then might countersue, and on and on. The result is
unending litigation with cases taking not years but
decades to reach the trial court stage.
Courts seem to recite these policies of judicial ac-
cess and efficiency without recognizing that both
policies have a flip-side. Are not defendants’ right to
redress in court for a wrong “chilled” by court reluc-
tance to recognize countersuits? Considering the great
expense involved in defending against malpractice
claims, defendant physicians to meritless suits are be-
ing denied a recovery for injury suffered at the hands
of the malpractice plaintiff when courts dismiss
countersuit claims. Plaintiffs certainly must be given
their day in court, but after plaintiffs have exercised
this right, why should the defendants then be denied
the same?
In the same manner, the judicial efficiency policy
leaves questions unanswered. Obviously, there has
been a major increase in malpractice claims filed over
the past decade. Ten years ago there was evidence that
a majority of malpractice claims were unfounded.^’
Unless the quality of medical care has plummetted to
match the increase in claims filed, it is likely that a
good share of claims filed today are meritless. Ap-
parently, judicial efficiency is not enhanced by the
current status of medical malpractice litigation in this
country.
It could be argued that the problem posed by
medical malpractice litigation’s popularity does not
lie with the judicial process so much as with state tort
law. Considering state courts’ unwillingness to create
new tort doctrines,^* perhaps the solution is best
sought in state legislatures. In Wisconsin, tort reform
is a matter of future legislation. However, Wiscon-
sin has had a statute on the rolls for nearly ten years
that was enacted to aid defendants to meritless suits —
Wisconsin Statute §814.025 (1978), the frivolous law
suit statute.
Wisconsin’s frivolous lawsuit statute
814.025 Costs upon frivolous claims and counterclaims.
(1) If an action or special proceeding commenced or con-
tinued by a plaintiff or a counterclaim, defense or cross
complaint commenced, used or continued by a defendant
is found, at any time during the proceedings or upon
judgment, to be frivolous by the court, the court shall
award to the successful party costs determined under
s. 814.04 and reasonable attorney fees.
(2) The costs and fees awarded under sub.(l) may be
assessed fully against either the party bringing the action,
special proceeding, cross complaint, defense or counter-
claim or the attorney representing the party or may be
assessed so that the party and the attorney each pay a por-
tion of the costs and fees.
(3) In order to find an action, special proceeding,
counterclaim, defense or cross complaint to be frivolous
under sub.(l), the court must find one or more of the
following;
(a) The action, special proceeding, counterclaim,
defense or cross complaint was commenced, used or con-
tinued in bad faith, solely for the purposes of harassing
or maliciously injuring another.
(b) The party or the party’s attorney knew, or should
have known, that the action, special proceeding, counter-
claim, defense or cross complaint was without any rea-
sonable basis in law or equity and could not be supported
by a good faith argument for an extension, modification
or reversal of existing law.
28
WISCONSIN MEDICAL JOURNAL, JUNE 1985; VOL. 84
By its wording, the frivolous lawsuit statute ad-
dresses meritless litigation, providing an immediate
remedy for the defendant. Unlike counterclaims such
as malicious prosecution which must be filed after \ht
original suit has been terminated, this statutory relief
is instead made by motion at any time during the
original proceedings. This requirement was probably
inserted to insure that the statute would not be used
“after the fact” — if the defendant wins, the defen-
dant decides to recover his or her costs in defending
against the suit because he or she wins. Therefore,
there is no need for the defendant to wait for the court
to decide to dismiss the suit before reaching trial or
until after successful termination of a trial on the
merits, rather, the court can decide in a summary
manner whether the suit was frivolous, and if so, if
relief is due the defendant.
In addition, the statute sets up a showing that is less
rigorous than the showing necessary for relief under
any one of the tort doctrines previously discussed.
Unlike malicious prosecution, the defendant need not
prove malice or special damages. The statute creates
a duty for the lawyer to not bring frivolous claims to
court, avoiding the privity (duty) requirement of the
negligence doctrine. This statute apparently answers
the courts’ call for legislative relief from meritless
lawsuits. The question remains, is this relief effective?
From the few cases that are precedent (and there-
fore binding on lower courts) for the application of
the frivolous lawsuit, much is left open concerning
how well the statute works. The only standard that
has so far emerged from higher courts is that when
a motion is made against an attorney, the court deter-
mines whether the action is frivolous on an objective
standard of what a reasonable attorney w'ould have
done under the same circumstances.” It is fairly cer-
tain who decides “reasonableness” in this case — not
the jury, but the judge. Depending upon the judge’s
attitudes regarding protecting the legal profession
from negligence suits in another guise, this reason-
ableness standard will probably vary greatly and give
little guidance for future decisions. Most likely, the
reasonable attorney standard will resemble “probable
cause” as required in a malicious prosecution claim
and that in itself is not encouraging. Without being
too cynical about professional protectionism, if
courts in other states were unwilling to recognize
countersuits as a legitimate exercise of legal rights,
there is reason to think that some courts in this state
will hesitate before issuing a reasonable attorney stan-
dard that penalizes attorneys. Finally, just because the
defendant wins on the merits does mean that the
judge will grant relief under the frivolous lawsuit
statute. And, as discussed above, the next considera-
tion, whether the attorney acted reasonably, is prob-
ably not going to be easy for the defendant physician
to prove.
Another question about the frivolous lawsuit
statute is its usefulness in the Patient Compensation
Panel context. Just as countersuits in general might
not be recognized by courts as favorable terminations
of judicial proceedings, a frivolous lawsuit motion
might not be sustained during a panel hearing. Al-
though the statute states that the motion can be made
during an action or special proceeding, it has yet to
be determined whether panel hearings are “special
proceedings” as the term is used in the statute. For-
mal panel hearings are statutorily required to follow
Wisconsin civil procedure, and a panel is therefore
arguably a judicial body or at least must act like one.
Moreover, the Patient’s Compensation Panel is under
the aegis of the Wisconsin Supreme Court. In this
respect, the Panel should be able to entertain
frivolous lawsuit motions. When the administrator
of the Panel system was questioned about the
statute’s applicability, she responded that she had
never encountered a frivolous lawsuit motion during
a formal panel hearing but added that she thought the
Panel would be empowered to entertain this motion
for costs. Finally, she added that the motion seems
to be most useful as a prehearing device to encourage
settlement of meritless or weak malpractice claims.
Perhaps the statute’s informal use accounts for the
lack of information about its function in a formal,
that is, trial or hearing setting.
Summary
In summary, case law in other states demonstrates
that the available tort remedies for defendants of
meritless, malicious or frivolous malpractice suits are
not generous. Although countersuit precedent in
Wisconsin is sparse, namely, no malpractice counter-
suits have reached appellate court level yet, there is
little reason to believe that Wisconsin courts will ac-
cept countersuits with any more enthusiasm than have
courts in other states. There is a potential frivolous
lawsuit remedy, Wis. Stat. §814.025, that provides
relief from meritless lawsuits in terms of awarding
statutory costs. However, in light of the limited relief
afforded by the statute and the standard set down by
the courts so far, the actual utility of the frivolous
lawsuit statute is yet to be seen. A logical, although
not necessarily comforting, conclusion could be that
the real solution to the medical malpractice litigation
situation is medical liability tort reform instituted
through the state legislature.
— Prepared by Sally L Wencel, Staff Attorney
for the State Medical Society of Wisconsin
Footnotes
1. See, e.g. Thompson v. Beecham, 72 Wis. 2d 356, 241 N.W.2d 163
(1976).
2. 186 Cal. Rptr. 545 (App. 1982).
3. 571 S.W.2d 567 (Tex. Civ. App. 1978).
4. 379 So.2d 412 (Fla. Dist. App. 1980).
5. 42 C.J.S. Malicious Prosecution §53 (1969).
6. See, e.g. Spencers. Burglass, 337 So. 2d 596, 599 (La. .App. 1976).
7. See, e.g. Weaver v. Superior Court, 95 Cal. App. 3d 166, 156 Cal.
Rptr. 745 (1975).
8. The “English Rule” is so named for Statute of Marlbridge enacted in
British Parliament in 1267 which gave the prevailing defendant his or
her costs and attorney fees in a summary proceeding at the conclusion
of the original lawsuit. The defendant could get these damages only if
he or she showed that he or she suffered some special injury apart from
costs and expenses of defending the prior suit.
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
29
9. See, e.g. Berlin v. Nathan, 381 N.E.2d 1367, at 1371 , cert denied, 444
U.S. 328 (1979).
10. 615 P.2d 957 (Nev. 1980).
1 1. See Levine, “1 Beat a Malpractice Blacltmailer,” Med. Econ., Feb.
23, 1976, at 65 where the physician involved discusses this case.
12. DR 7-102 (A)(1) states:
In his representation of a client, a lawyer shall not: (1) File a suit,
assert a position, conduct a defense, delay a trial, or take other action
on behalf of his client when he knows or where it is obvious that such
action would serve merely to harass or maliciously injure another.
EC 7-10 provides:
The duty of a lawyer to represent his client with zeal does not militate
against his concurrent obligation to treat with consideration all
persons involved in the legal process and to avoid the infliction of
needless harm.
13. SCR 20.15(1) provides that a lawyer shall not accept employment on
behalf of a person if the lawyer knows or it is obvious that the person
wishes to bring legal action for the purposes of harassing or
maliciously injuring any person. Similarly, SCR 20.15(2) forbids a
lawyer from presenting a claim or defense in litigation that is not war-
ranted under existing law, unless it can be supported by a good faith
argument for an extension, modification, or reversal of existing law.
See SCR 20,16(2), 20.36(1 )(a).
HELPING THE RETARDED,
DEVELOPMENTALLY
DISABLED PERSON
The family physician is very often the first person
a family turns to when they suspect their child may
be mentally retarded.
A resource the physician may wish to use in
counseling the family is the local Association for
Retarded Citizens. And a call to the local Unified
Board or Developmental Disabilities Board will iden-
tify the resources that are available to a family in their
county.
There should be local resources, psychological
services, OT, etc available to complement the physi-
cian’s examination. Also there are several clinics
within the state that provide specialized evaluations
for the persons who are mentally retarded and for
persons with other developmental disabilities.
• Child Development Center
Dr June Dobbs, Director, Child Development
Center, Milwaukee Children’s Hospital, 1700 West
Wisconsin Ave, Milwaukee, Wisconsin 53201;
(414) 931-4069
• University Hospitals
Dr Charles Schoenwetter, H6 4th Floor, 600
Highland Ave, Madison, Wisconsin 53792; (608)
263-6421
• Waisman Center on Mental Retardation
Pam Bright, Intake Coordinator, 1500 Highland
Ave, Madison, Wisconsin 53706; (608) 263-5815
• Comprehensive Evaluation Clinic for Multiple-
Handicapped Children
Ms Marilyn Gratto, Miller-Dwan Hospital, 502
East 2nd Street, Duluth, Minnesota 55805; (218)
727-8762
Further information may be obtained from Merlen
Kurth, Executive Director, Wisconsin Association
for Retarded Citizens, Inc, 5522 University Ave,
Madison, Wis 53705; (608) 231-3335. ■
14. See, e.g. Brody v. Ruby, 267 N.W.2d 902 (Iowa 1978), Bickel v.
Mackie, 447 F. Supp. 1376 (N.D. Iowa 1978).
15. supra.
16. Most likely the court would point out the conflict of interests posed
by the two code provisions — to represent the client zealously and to
avoid meritless litigation but nonetheless resolve the conflict in favor
of the duty to protect the client’s interests. The Wisconsin State Bar
through the Opinions of the State Bar Standing Committee on Pro-
fessional Ethics issues an opinion on this conflict in Ethics Opinion
E-83-4. In the end, this opinion suggests that where the conflict arises
(which basically concerns the lawyer’s duty to the client v. the lawyer’s
concern about liability under the frivolous lawsuit statute Wis. Stat.
§814.025), the lawyer should consider the client’s interests above his
or her own. A court would use this form of argument to demonstate
“good faith’’ or some other reason for exonerating the lawyer.
17. Berlin v. Nathan, supra; Lyddon v. Shaw, 56 111. App. 815, 372 N.E.2d
685 (1978); Motel v. Sandlin, supra.
18. Black’s Law Dictionary 137 (5th ed. 1979).
19. See, W. Prosser, ITandbook of the Law of Torts, note 29 (4th ed.
1971).
20. 3 W'ash. App. 139, 473 P.2d 202 (1970).
21. See Tappanw. Ager, 599 F,2d 376, 381-82 (10th Cir. 1979); H olfev.
Arroyo, 543 S.W.2d 11, 13 (Tex. Civ. App. 1976).
22. Invasion of privacy differs from defamation in that injury in invasion
of privacy is to peace of mind instead of reputation as in defamation.
23. Wolfe v. Arroyo, supra.
24. See Morrison v. National Broadcasting Co. , 24 Appl Div. 2d 284, 289,
266 N.Y,S.2d 406, 409, rev’don other grounds, 211 N.E.2d 572 (1967).
Also see Belsky\. Lowenthal, 405 N.Y.S.2d 62, 64 (1978). Prima facie
tort was first enunciated by Mr. Justice Holmes in Aikens v. Wis-
consin, 194 U.S. 194 (1904) in which he wrote that even lawful con-
duct can become unlawful if done maliciously.
25. 62 App. Div. 2d 979, 403 N.Y.S.2d 542 (1978).
26. supra.
21. supra, 405 N.Y.S.2d at 65.
28. 89Misc. 2d 171, 391 N.Y.S.2d6I (\911), rev'd, 61 App. Div. 2d 282,
402 N.Y.S.2d 250, rev'd, 46 N.Y.2d 778, 386 N.E,2d 821, 413
N.Y.S.2d 910 (1978).
29. supra, 402 N.Y.S.2d at 252.
30. supra, 386 N.E.2d at 822, 413 N.Y.S.2d at 911.
31. supra.
32. For example, the Illinois Constitution art. 1, §12 states:
Every person shall find a certain remedy in the laws for all injuries
and wrongs which he receives to his person, privacy, property or
reputation. He shall obtain justice by law, fully, completely, and
promptly.
33. supra, 381 N.E.2d at 1374 (1978).
34. See O'Toole, v. Franklin, 279 Or. 513 569 P.2d 561, 565 (1977).
35. Berlin v. Nathan, 381 N.E.2d 1367, 1375 (1978).
36. id, 381 N.E.2d at 1376.
37. HEW' Medical Malpractice Report of the Secretary’s Commission on
Medical Malpractice (1973), note 7, at 10.
38. See, Belsky v. Lowenthal, supra; Drago v. Buonagurio, supra and
Berlin v. Nathan, supra.
39. Hessenuis v. Schmidt, 102 Wis. 2d 697, 307 N.W.2d 232 (1981);
Sommers v. Carr, 99 Wis. 2d 789, 299 N.W.2d 858 (1981).
40. Wis. Stat. §802. 06(2)(f) (1981).
41. Wis. Stat. §802.08 (1975).
References and suggested reading
Carlova J: A Baseless Lawsuit Shattered This Doctor’s Career, Medical
Economics, April 16, 1984.
Greenbaum H: Physician Countersuits: A Cause Without Action, 12
Pacific L Journal 775 (1981).
Higgs JC: Physician Countersuits: A Solution to the Malpractice Dilemma,
2 Health Care 3 (Aug 1980).
Janzer J: Countersuits to Legal and Medical Malpractice Actions: Any
Chance for Success?, 73 Marquette L Rev 93 (1981).
McCaman B, Hirsh HL: Physician Countersuits, 85 Cased Comment 39
(Nov 1980).
Reed B: Don’t Count Out the Countersuit Movement Yet, 8 Leg Aspects
Med Prac 49 (Aug 1980),
Reuter SR: Physician Countersuits: A Catch 22. 14 U San Fran L Rev 203
(Winter 1980).
Ritter M:, Brooks S: Rx for Physicians: A Capsule on Countersuits, 7
Western State U L Rev 63 (1979). ■
30
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
Medical liability—
A physician’s rights
and responsibilities
THIS ARTICLE is intended to provide information
about medical liability insurance and outline the
rights and responsibilities of physicians and medical
liability insurance carriers in the resolution of med-
ical liability disputes.
COVERAGE AND POLICIES
Coverage
Medical liability insurance covers injuries arising
out of the rendering or failure to render professional
services. In addition to treatment rendered by the
insured physician, liability insurance policies may in-
clude coverage of such things as: the acts of employ-
ees (performed within the scope of such employment)
and service by the insured as a member of a formal
accreditation, standards review, peer review, or sim-
ilar professional board or committee of a hospital or
professional society.
SMS RECOMMENDS: Check your policy for a complete
description of coverage including what type of coverage you
have if you assume liability by signing any type of medical
care delivery contract which has a “hold harmless clause. ”
Contact your insurance agent, carrier or SMS with any
questions.
Types of policies
Two basic types of policies are available in Wis-
consin— occurrence and claims-made.
Reprints in brochure form are available upon request to the
Medical Liability Committee of the SMS Physicians Alliance
Commission, PO Box 1109, Madison, W1 53701; or phone
1-800-362-9080 or 608-257-6781.
Occurrence policies cover all claims resulting from
professional services rendered during the term of the
policy regardless of when the suit is initiated.
Claims-made policies cover claims only if: 1) the
policy was in effect at the time the services were ren-
dered, and 2) the policy was in effect at the time the
suit was initiated.
SMS RECOMMENDS: Occurrence coverage.
Limits and amounts of coverage
Wisconsin law limits a physician’s liability to
$200,000 per occurrence and $600,000 per year.
Therefore, these amounts are also the limits of liabil-
ity insurance policies. The Patients Compensation
Fund pays any portion of an award in excess of the
$200,000/600,000 limits.
SMS RECOMMENDS: That all physicians carry
$200,000/600,000 coverage so that the physician does not
become personally liable for any portion of an award.
RIGHTS AND RESPONSIBILITIES
Provided the insured physician complies with the
terms of the policy, the insurer is obligated to defend
and pay damages on behalf of the insured in the event
of a claim.
One of the most important responsibilities of the
physician is to notify the insurance carrier on a timely
basis of any claim made against the insured (or of any
incident likely to result in a claim). Some policies set
a given number of days within which the physician
must notify the carrier, while others use such terms
as: “as soon as practicable,’’ “as soon as possible,’’
“within a reasonable time,’’ etc.
In the event of a claim or incident, the following
information should be provided: name of insured,
date and place of incident, circumstances of injury,
name and address of injured party and any witnesses.
The carrier will then notify you of any additional
information which may be needed.
Physicians have both a right and responsibility to
assist in the defense of a claim. The degree of partici-
pation granted to or required of the physician will
vary from case to case and from one insurer to anoth-
er. Likewise the desire to participate will vary among
physicians.
SMS RECOMMENDS: That physicians become intimately
involved in the development of the defense.
WHAT A PHYSICIAN CAN EXPECT
Outlined below is what SMS believes a physician can
reasonably expect in his/her relationship with the
carrier.
Competent defense counsel
The Wisconsin Health Care Liability Insurance
Plan (WHCLIP) will, in most instances, honor physi-
cian requests that a particular defense attorney be ap-
pointed. While commercial carriers do not afford this
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
31
opportunity, the physician can and should request a
replacement if dissatisfied with the defense being
provided.
Inasmuch as effective communication between the
physician and attorney is essential to a successful
defense, we see merit in providing the physician input
into the selection of defense counsel. We also, how-
ever, recognize the expertise of carriers in this respect.
Regardless of how the defense attorney is selected
it is critical that the physician and attorney work to-
gether to formulate a strong defense.
Although retained by the insurance carrier, the
defense attorney owes his/her first allegiance to the
insured physician. The physician is the client.
Participation in formulating the defense
The physician is entitled to:
• An initial conference to discuss the allegations and
adjudication process;
• An explanation of the discovery process (through
which the opposing party’s case is explored) and a
tentative timetable for completion of discovery and
development of the defense;
• Review all depositions, learned treatises, etc.
obtained by counsel;
• Participate in the selection of expert witnesses and
exhibits;
• Copies of all correspondence between defense
counsel and other interested parties (carrier, claim-
ant, witnesses, etc.);
• An explanation of the technicalities of the Patients
Compensation Panel hearing process;
• Question witnesses at the Panel hearing; and
• Full disclosure of the progress of all settlement
negotiations.
We believe that most carriers and defense attorneys
will welcome this type of participation. If, however,
you feel you are not being allowed adequate input,
discuss this with your assigned defense attorney. If
your concerns are not allayed, contact your carrier.
If still dissatisfied, contact SMS and we will attempt
to resolve the problem.
OTHER CONSIDERATIONS
Physicians DO NOT have the right to “veto”
settlements agreed upon by the carrier and claimant.
Therefore, it is extremely important that you keep
abreast of the development of your defense. A strong
defense will lessen the carriers’ inclination to settle,
while a lax defense may indeed prompt a settlement
(regardless of your guilt or innocence).
Even though you have no legal right to veto actions
of the carrier, there is an ethical obligation upon the
carrier and its attorney to provide you with an ex-
planation of the carrier’s decisions regarding settle-
ments and appeals. You should request that your
defense attorney advise you on these matters prior to
their being finalized. Generally, the carrier will base
such decisions on advice from defense counsel.
You are also entitled to prompt information about
new developments in your case, final settlements or
awards, appeals, and other aspects of the defense of
your case. This again illustrates the importance of
your continuing communication with the defense
attorney and his or her regular communications with
you. You can best affect defense and/or settlement
decisions through your defense attorney.
SMS advises that you become familiar with the terms of
your medical liability insurance policy, notify your carrier
promptly in the event of a suit and assert your right to par-
ticipate fully in your defense.
For more information contact the Medical Liability Com-
mittee of the Physicians Alliance Commission at the State
Medical Society of Wisconsin, 330 East Lakeside Street,
Madison, WI 53715. 1-800-362-9080, or (608) 257-6781. ■
32
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
Medical malpractice: A dilemma
in the search for justice . .
Robert J Flemma, MD, Milwaukee
Having been invited to write an essay on medical
malpractice for the Law Review, I vowed to avoid the
opprobrious conduct currently in vogue with lawyers
and physicians. The search for justice on behalf of
injured patients deserves more than recriminations.
It demands our best introspective thoughts, examin-
ing the causes and searching for solutions that will
bring justice for patients, physicians, hospitals, attor-
neys, and society in general.
I. A BRIEF HISTORY
A. From Babylon to London
Throughout history, every civilized society has had
medical healers, under some name or other. In earliest
recorded time, these medical healers were perceived
to have a special relationship with the gods; later, they
professed to have some special knowledge which
exceeded that of the lay person. For that reason the
society would grant them special privileges in per-
forming medical or surgical treatment upon others.
Recognition of the potential for the harm or abuse
resulting from unbridled privilege led to regulation
of medicine in every society. The Code of Ham-
murabi from ancient Babylon was the first codified
principle of law. Criminal law was guided by the prin-
ciple of lex talionis — the eye for an eye, tooth for a
tooth, concept. Medical practice was included under
this principle, and carelessness and neglect were
severely punished as a clumsy surgeon might lose both
hands for a maiming operation.' The ancient Egyp-
tians had specialists for various parts of the body, and
if they wandered outside their special area of expertise
or varied from the specifically prescribed modes of
treatment, untoward results were punishable by
death.
The historians of classical Greek culture have
arrived at the conclusion that there were no legal
mechanisms whereby those injured by a physician, or
relatives of a deceased, could seek legal redress. One
historian explained that the ultimate penalty for a
physician was ill repute.^ This remedy was of little
solace to patients and their relatives and confuses to-
day’s legal scholars, because in that society even hom-
icide was the subject of private suits. There was, how-
ever, a theoretical consideration of malpractice as
arising from willfulness, negligence, or ignorance.
Reprinted from the Marquette Law Review, Winter 1985, with
permission. Doctor Flemma is Clinical Professor of Surgery, Med-
ical College of Wisconsin, Milwaukee. The author wishes to
acknowledge the assistance of Robert J Flemma Jr in the prep-
aration of this article. Bound copies of this article together with
a response by plaintiffs attorneys entitled “Medical Malpractice:
Eliminating the Myths” are available from the Marquette Law
Review. Please send 50<t for each copy desired to: Marquette Law
Review, 1103 West Wisconsin Ave, Milwaukee, WI 53233.
Plato’s thinking on the subject of ignorance as a cause
of injury by physicians is apropos even today. He
said ignorance falls into two categories: (1) simple
ignorance causing minor errors; and (2) the double
ignorance occurring when the physician is gripped not
only by ignorance but also by a conceit of wisdom for
things the physician knows nothing about. ^
The Greeks furnished the great ideas, but the
Romans translated them into practical use. The
Romans distinguished between dolus (evil intent),
culpa (including both negligence and incompetence),
and casus (accident). Dolus fell under the intentional
action of willful, intentional harm. Culpa and casus
came under unintentional action.^ The complex ambi-
guities of these concepts were a source of much legal
ink for the Romans, as it is today. The Romans did
recognize that there might be potential for harm with-
out evil intent and established specific, albeit limit-
ed, provisions for seeking redress against the negligent
or incompetent physician.
During the period 400 A.D. to 1300 A.D., the
admixture of religion and medicine created the sense
that disease was punishment for evil. Since there was
virtually no rational medical treatment in this period,
death and injury were considered the will of God and
not to be questioned. This was a poor time for physi-
cians and lawyers, as well as patients.
In fourteenth century England malpractice was
closely interwoven with the theory of contract.®
Physicians were commonly retained for set fees to
provide care to wealthy personages or monastic
groups, and suits arose when a physician would not
travel to advise and examine them* or when a patient
would stop paying the retainer fee.’
In England, the first classical malpractice case was
recorded in 1375.* Although the surgeon was acquit-
ted on a technicality, the judge stated that the surgeon
indeed would have been liable for negligent treatment
of a wound. By 1435 a second medical opinion was
compulsory in London for “critical” cases.’ Master
surgeons and physicians were appointed by the mayor
to conduct peer review of their profession and to be
available for consultation prior to the treatment of
these cases. They were also called to testify in record-
ed malpractice suits. Some surgeons began taking out
malpractice “floater” policies on individual patients
prior to treatment that might lead to death, serious
injury, or accusations of malpractice.'"
B. In the United States
The oldest recorded American medical malpractice
litigation occurred in 1794 in Connecticut.'' There
were twenty-seven malpractice suits in the United
States between 1794 and 1861 that were adjudicated
as appeals in various state supreme courts and thus
WISCONSIN MEDICAL JOURNAL, JUNE 1985:VOL. 84
33
available for review.'^ Two-thirds of these suits in-
volved injuries relating to orthopedic problems; frac-
tures, amputations, and dislocations. Five involved
obstetrics. This review is interesting because the mal-
practice suits then as now are a reflection of the pre-
dominant surgical practice of the time.
The concept of medical negligence began to evolve
from the unintentional tort of negligence in this
period. Courts upgraded physician responsibility for
the care of their patients and expected doctors to prac-
tice up-to-date medicine. Physicians were alarmed at
the increase in malpractice claims, and it is believed
that some practitioners stopped their surgical prac-
tice because of the threat of malpractice.
With the introduction of anesthesia in 1846, the
practice of surgery expanded to operations within the
abdominal cavity and was no longer primarily ortho-
pedic and superficial-infection therapy. Over the next
forty to eighty years, operations became standardized
with predictable mortality and morbidity. By the
1920s hospitals began to provide more sophisticated
laboratory equipment to analyze blood and urine, as
science crept unobtrusively into patient care. In the
latter half of the nineteenth century, malpractice
claims continued, but the numbers are difficult to
ascertain. What was evolving legally was the eleva-
tion of standards set by the courts.''’ Physicians were
originally held to the standards of their type of med-
icine, that is, homeopathy, allopathy, and the like.
But as medicine became more scientific, all practition-
ers were held to certain minimal local standards. Pike
V. Honsinger,'^ an 1898 case in the New York Court
of Appeals, stated the principles that with some mod-
ification provided standards and precedent for cases
since then. Over the years, there was a change from
local standards of care to national standards of care.
Between 1935 and 1955, there were 605 malpractice
cases in the United States, an average of thirty-one
cases per year.'* In this period, California was the
leader with almost seventeen percent of all the cases,
followed by New York, Washington, Ohio, and
North Carolina.'^ Fifty percent of cases were from
eight states.'* Between 1945 and 1949, the fewest
number of cases occurred, and the largest judgment
was $115,000.'’ This was the calm before the storm.
The advent of antibiotics in the 1940s and the scien-
tific technological revolution left no area of the body
unexplored, surgically or medically. Truly for the first
time in the history of medicine, physicians had a
greater chance of helping patients, rather than hurt-
ing them, with treatment. The science of medicine
exploded, as laboratory tests and x-rays increased
diagnostic ability and added greater accuracy and
quantification of disease states. Physicians became
more accountable for what they did, and their inter-
pretation was more easily questioned by attorneys
who could also review the same objective data and
assess the physician’s interpretation of results. The
number of claims continued to rise, and by the 1970s
physicians perceived the increase in the number and
the size of claims as a threat that instigated job
actions, strikes, and sit downs. It was called a crisis.
However, a crisis can be a truly marvelous mechanism
for the withdrawal or suspension of established rights
and the acquisition and legitimization of new priv-
ileges. Indeed, there was a problem, as hospital mal-
practice premiums by 1976 were $1 .2 billion per year,
up from $61 million in 1960.^“ Physicians’ premiums
were skyrocketing, the number of claims was contin-
ually increasing, and this environment led to a “siege
mentality.’’ By 1975, the primary concern was the
unavailability of liability insurance.
In 1973, the Department of Health, Education, and
Welfare’s Malpractice Commission strongly recom-
mended pretrial screening panels as the primary meth-
od for speeding resolution of medical liability claims
and eliminating nonmeritorious suits. Many states
reacted with legislation in about 1975. In Wisconsin,
the legislature, in an attempt to get justice for physi-
cians, patients, providers, and attorneys, set up the
Patient’s Compensation Panel and the Patient’s
Compensation Fund. The intent was to require that
allegations of medical malpractice against a Wis-
consin health care provider be heard by a panel prior
to the filing of a circuit court action. The Patient’s
Compensation Fund was created for the purpose of
paying the portion of the settlement or award against
the health care provider in excess of the insurance cov-
erage required to be procured privately by all health
care providers — $200,000 per claim and $600,000 in
aggregate claims per year.” Has the panel system
been helpful to all or has it been solely for the pro-
tection of providers — physicians and hospitals?
II. THE PROBLEM
From July 1, 1975 to June 30, 1984 a total of 2, 012
malpractice claims were filed with the compensation
panel in Wisconsin, more than fifty percent in the last
three years.” Obviously, the incidence of claims has
risen precipitously. Malpractice premiums for provid-
ers dropped initially, then rose dramatically as the fre-
quency of claims and the size of awards and settle-
ments grew.
Not only has this affected physicians, but these
costs were passed on to patients leading to higher
health care costs for every citizen of Wisconsin.” To-
day, professional liability insurance adds about $3 to
the cost of a visit to a physician, $5 per day to the
average hospital bill, and up to $300 to the cost of
some births.” In Wisconsin, medical liability prem-
iums totaled $27.9 million, and it is estimated that the
accompanying defensive medicine — ordering all pos-
sible laboratory and x-ray tests in fear of reprisal —
adds approximately $240 million to the Wisconsin
health care bill.”
In this climate, malpractice attorneys are crying for
the abolition of the compensation panel citing four
main reasons.” They claim that the panel system; (1)
causes unnecessary delay in final disposition of a
claim; (2) is biased because there are two physicians,
one attorney, and two lay persons on a formal panel;
34
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
(3) produces findings which have a “chilling effect”
on any circuit court trial; and (4) protects repeat of-
fender physicians about whom nothing is done. Let
us now examine these arguments carefully.
Does the panel system cause unnecessary delays?
The facts say no. Panel cases disposed of before a
hearing have a median age of 362 days, while similar
cases in circuit court require 532 days.” The median
age of panel cases resolved through the hearing pro-
cess is 391 days, while circuit court trials last 655
days.^° Once opened, a case is usually resolved with-
in one year. For informal panels reviewing smaller
claims, eighty-five percent are settled in less than one
year. For formal panels reviewing larger claims, sixty-
four percent are disposed of in less than one year and
an additional twenty-two percent are disposed of in
less than one and one-half years. Before the panel sys-
tem was instituted in 1975, it took an average of two
years for a Wisconsin claim to be resolved; now it has
been cut to less than one year.^‘
Indeed, any delays are due to lawyers and Wiscon-
sin’s three year statute of limitations. Indiana and
Wisconsin have the same incidence of malpractice
claims, yet Indiana attorneys get matters on file one
year sooner because they have a two year statute of
limitations.^^ And when a one year statute of limita-
tions existed in Ohio, the claims also were filed on
time.
Thus, the lawyer’s argument does not withstand
scrutiny, as indeed the panel system has effectively de-
creased the time to resolution for patients. The system
has not been perfect, but with 1,152 claims filed in
the last three years, the panel system was physically
unable to meet its original goals. It is to the panel sys-
tem’s credit that it still resolves claims sooner than
before its existence.
Is the panel system biased? Of the 1,512 closed
claims, case disposition has been evenly divided be-
tween claimants and physicians. Fifty-six percent of
all claimants received some compensation through the
panel system, as either pre-hearing settlements or
panel awards.” In fact, claimants in Wisconsin are
more likely to be compensated than claimants in
other states.” Nationally, in the years 1975 to 1978,
claimants prevailed in jury trials fourteen percent of
the time, while in Wisconsin panel hearings, claim-
ants won thirty-one percent of the cases.” These data
hardly support the bias claim. Claimants in Wisconsin
utilizing the panel system are twice as successful as
plaintiffs in jury trials.
Does the panel system produce a “chilling effect”?
In the establishment of the panel system, the legisla-
ture allowed the findings of formal panels to be
admitted in a subsequent circuit court trial. Lawyers
feel this admission has a “chilling effect” on later
trials.
In Wisconsin between 1975 and 1981, a review of
ninety-five panel findings that were in favor of the
physician revealed that twenty-three were ultimately
settled with payment to the claimant.” Thus twenty-
five percent of physician panel victories were ulti-
mately settled with payment to the claimant when the
insurance companies ignored the panel findings.
When one remembers that Wisconsin panel verdicts
are in favor of claimants more than twice as often as
national court verdicts, providers have a greater right
to concern than plaintiffs and their lawyers. And since
less than ten percent of the panel cases were carried
to a jury trial, it is difficult to find much merit in the
“chilling effect” claim.”
Finally, are there many “repeat offenders” who
are not disciplined? The answer is of great concern
for physicians, who would be subsidizing these repeat
offenders through premium payments to insurance
companies and the panel system. There is no finan-
cial or professional incentive to protect repeat offend-
ers. Medical malpractice falls under the broad cate-
gory of unprofessional conduct. This is a problem
because while conduct may be unprofessional it does
not necessarily constitute medical malpractice. The
way the system works is that complaints to the Med-
ical Examining Board are investigated by an attorney;
the board then prioritizes the complaints and decides
the course of action. The board may receive allega-
tions from; (1) the Department of Justice (Medicare
fraud); (2) the Federal Drug Enforcement Admin-
istration (prescriptions); (3) Department of Flealth
and Social Services (nursing homes); or (4) other
physicians, pharmacies, and nurses. Only hospitals
and the Patient’s Compensation Panel are required
to report to the Medical Examining Board. The com-
pensation panel must report negligent providers to the
board. A hospital must report the name of any staff
member who loses hospital privileges for more than
30 days or resigns from the staff for 30 days or more.
However, Wisconsin does not require the reporting
of malpractice claims settled without panel awards.
For example, from 1975 to 1980, 700 cases filed with
panels were settled prior to a panel hearing;” thus no
reports were issued to the Medical Examining Board.
Further complicating the issue is the fact that insur-
ance companies may settle a claim without the pro-
vider’s approval since the settlement may be less than
the anticipated expenses of preparing for a panel
hearing. If providers and insurance companies fought
all claims, there would be legal delays, a backlog of
cases, and increased insurance premiums. These set-
tlements indeed may allow a repeat offender to ob-
fuscate the problem.
A fair solution to this has been proposed by the
Medical Society: make all claims settled over $25,000
result in a report to the examining board.” This solu-
tion would not cause great paperwork for insurance
companies. With computer technology, records could
be easily kept, and paid claims could be categorized
when reported to the board. They could distinguish
between cases in which negligence appears to have
occurred and those in which the issue of negligence
was doubtful, but it was financially expedient to
settle.
The Medical Examining Board’s division of en-
forcement has less than five full-time investigators
WISCONSIN MEDICAL JOURNAL, JUNE I985:VOL. 84
35
and only two attorneys assigned to work with them.
This staff must be increased if one expects two attor-
neys to review the over 400 claims filed each year. In
this way, repeat offenders could be better identified,
investigated, and disciplined. The board currently has
difficulty even identifying the problem, much less
dealing with it; in this area, the Medical Society and
trial lawyers are in agreement. This does not, how-
ever, detract from the panel system’s merits.
The Wisconsin Medical Society does have two rec-
ommendations that bear on this subject. First, it
advocates that the Medical Examining Board contract
with the Wisconsin Medical Society to investigate and
review data on offenders. ““ The Medical Society
already does this with Medicaid offenders, and there
is a great financial incentive for all providers to iden-
tify offenders who repeatedly increase every physi-
cian’s premiums. There would be no incentive for
physicians to cover up, ignore, or subsidize substan-
dard care of patients. And second, the Wisconsin
Medical Society has also supported an increase in
license fees if that increased revenue would be spe-
cifically allocated to pay trained board investigators.
This proposal has been offered in two budget bills
without being acted upon. The Medical Society has
recognized the problem and has proposed some solu-
tions but to little avail.
Although the panel system should not be abolished
for the reasons cited by malpractice attorneys, it may
still be improved. One improvement would be to util-
ize, on a rotating basis, retired or reserve judges and
a retired physician. They would sit on panels involv-
ing the larger claims or those of repeat offenders, and
their prestige would lend more authority to their find-
ings. And to obviate any claim of conflict of inter-
est, they should be paid by the state.
III. PATIENT CARE STANDARDS
It would be impossible to deal with all the impli-
cations of the present malpractice problem, but there
are two scenarios that adversely affect patients,
physicians, hospitals, and attorneys. Most reviews
allude to a diminution of patient care standards, but
do not demonstrate how this will occur. The follow-
ing two scenarios provide some insight into the evo-
lution of the bigger problem.
A. The Ob-Gyn Scenario
The practice of obstetrician-gynecologists (OB-
Gyn’s) is going to be the first area of patient care ad-
versely affected. Throughout the country, sixty-six
percent of Ob-Gyn’s have been sued.*" The frequency
of claims has tripled since 1976, with the rate grow-
ing ten percent per year.’’^ In Wisconsin, the current
premiums for Ob-Gyn’s are $18,600. There is in 1985
an anticipated rise of seventy-five percent on the cur-
rent basic premium of $8,600 and a two hundred and
fifty percent rise on the Patient’s Compensation Fund
premium of $10,000. If this occurs, the 1985 premium
will rise to $15,000 for primary coverage and $25,000
for the fund premium for an estimated total of
$40,000.
This malpractice insurance premium will have cer-
tain immediate effects on physician fees. Established
Ob-Gyn’s will pass these costs on to all young par-
ents and those requiring gynecologic surgery. The fear
of suits will again raise the cost of defensive medicine.
Although this fear is felt to be exaggerated by many,
one example may suffice. Neural-tube defects can be
detected intra-utero by an expensive, somewhat risky,
test that will have to be performed on all women
despite the fact that these defects occur in only one
in 1,000 newborns. Since Ob-Gyn’s are being held
liable if they do not suggest this test to an expectant
mother, despite the low incidence of this defect, and
allow her the choice of abortion, they will be forced
to perform a multitude of tests not routinely done.
The Ob-Gyn’s cannot guarantee a perfect baby for
all. This situation is unfair, impractical, and impos-
sible, but it creates a specter in the Ob-Gyn’s psyche
that is not unreasonable.
In the long-term, Ob-Gyn’s will drop out of obstet-
ric practice, leaving lesser-trained physicians and mid-
wives to perform almost all deliveries. Eighteen per-
cent of Ob-Gyn’s in Wisconsin have stopped accept-
ing high-risk patients, such as diabetics, hyperten-
sives, and women over thirty-five.'*^ It is all well and
good to say that they will be referred to high-risk units
in university centers, but babies are not predictable;
having to travel long distances will lead to more unat-
tended deliveries. This risk carries an increased mater-
nal mortality rate, and the inaccessibility of this serv-
ice is going to lead to a greater maldistribution of
medical resources. Fewer new physicians will be able
to afford the insurance to start practice, and within
ten years there will be fewer Ob-Gyn’s available
throughout the state. This will adversely affect the
children and grandchildren of every person in
Wisconsin.
B. Federal Scenario
Standards, rules, and regulations have usually been
the domain of the individual states. However, as total
health care costs have escalated, the federal govern-
ment has been seeking ways to contain costs. The
greatest concern is that looking at medical care
through a financial tunnel may lead to health care as
a commodity provided by the government at the low-
est cost and not as a commitment to excellent care for
all.
The establishment of DRG’s is the first step,
already in effect. A DRG is a form of reimbursement
to hospitals by disease related groups. Diseases are
categorized, and a prescribed number of hospital days
are reimbursed for each category. It is hoped that this
may work to eliminate inefficient practice patterns
and thus save money. Economist Patricia Danzon
feels that for DRG’s to work “they must not be held
to the customary norms of traditional fee-for-service
medicine.’’"" This willingness to subvert medical stan-
dards for economic purposes is frightening.
36
WISCONSIN MEDICAL JOURNAL. JUNE 1985: VOL. 84
Danzon and Duke Law Professor Clark Havig-
hurst raise the DRG question in relation to the stan-
dards required of health maintenance organizations
(HMO’s). An HMO contracts with a group of peo-
ple to provide for all health care needs for a set cost
per year. It theoretically provides incentives to physi-
cians to keep patients out of hospitals and thus low-
ers health care costs. They further suggest that an
HMO might contract to be bound not by a commun-
ity standard of care, but by the standard of other
HMO’s in the country. Federal programs such as
Medicare might also set up their own standards of
care that would be based on economic considerations.
Private insurers may offer a third more expensive
plan and higher standards would be expected. It is
conceivable that there could be two, three, or more
standards of medical care based on the third party
payor. Would economic restraint be translated into
a different legal and medical standard of care? Havig-
hurst casually said, “Only trial lawyers would have
reason for complaint.”''® This is not true. The patients
would have every reason to complain as would con-
cerned physicians. The obvious answer to a multi-
level standard of medical care has already been articu-
lated; everyone would be subject to the federal stan-
dard which would be predicated on economics and
politics, leading to the lowest common denominator
being the standard. The federal government would
have control of medical care and standards. How-
ever, there is little history that suggests it would func-
tion better than the post office or any other federal
agency.
IV. MEDICAL SOCIETY PROPOSALS
The most critical area of change must be the ex-
pense of malpractice insurance, since premiums have
increased the cost of health care and limited the avail-
ability of certain medical services. The Wisconsin
Medical Society has made several proposals designed
to control this expense. First, raise the threshold to
the Patient’s Compensation Fund. Increasing the
threshold (to $500,000 per claim, for example) would
reduce the fund’s liability, reduce duplication of
efforts by primary carriers and the fund, and provide
a stronger incentive for primary carriers to perform
adequate loss prevention, claims management, and
legal services. The original concept was that the fund
would function as a catastrophic loss pool. However,
from 1979 to 1983 the average dollar amount of
claims paid by the fund has substantially exceeded this
figure. In 1983, for example, 25 claims were paid at
an average of $426,672 per claim. It is obvious that
awards greater than $200,000 have become the rule
rather than the exception. The fund is threatened with
insolvency, and this proposal would be a step toward
the financial security of the fund.
Second, limit fund liability. Purchasing reinsurance
could limit the amount the fund would pay on any
given claim in a given year, and a statutory limit of
$1,000,000 per claim as a fund responsibility would
also limit liability.''* This is in no way a limit on
recovery or a cap on awards but simply a limit on the
fund’s liability. Physicians with need of more cover-
age than their primary insurance plus $1,000,000 in
fund coverage could obtain it from the private
market.
Third, structure payment of all fund awards. Cur-
rently awards in excess of $1,000,000 are paid in
installments of $50,000 per year. This concept could,
for example, be broadened so that all fund awards
could be paid at $200,000 per year. Also, periodic
payment of future damages — such as future medical
expenses, modifications to residences, and purchase
of specialized equipment — as incurred rather than as
lump-sum payments would improve the management
of fund assets.
Fourth, prohibit duplication of benefits and reduce
awards by the amount available from collateral
sources such as health and disability insurance,
worker’s compensation, and social security. The
Rand Corporation’s Institute for Civil Justice report-
ed that a mandatory collateral offset is extremely
effective in reducing the size of excessive jury verdicts
and settlements.'®*
Fifth, limit awards for non-economic damages
such as pain and suffering. Limits of $100,000,
$200,000, and $500,000 have been suggested in other
states. Data compiled from reports in the Wisconsin
Law Reporter showed that non-economic awards ex-
ceeded economic awards.®” Pain and suffering, being
subjective emotions, can lend themselves to manip-
ulation not only because of the jury’s subjective
assessment (sympathy) but also because of the attor-
ney’s skill and the claimant’s appearance and
demeanor. These factors have led to wide fluctuations
in awards for the same type of injury.
Sixth, bifurcate the trial. Separate hearings on the
liability and damage issues should be held. If liability
is determined in the first hearing stage, the parties
proceed with a hearing on damages. Plaintiffs’ attor-
ney Timothy Aiken stated that this proposal “makes
sense . . . and would cut panel time at least in half . ” ® ‘
Seventh, restrict appeals of panel decisions. Mea-
sures must be taken to dissuade claimants who lose
at the panel level from appealing cases to the circuit
courts. Requiring the posting of bonds that are suf-
ficient to cover the other party’s legal costs has been
suggested in other states. These are but a small per-
cent of cases that are heard and should not be a great
burden on over ninety percent of cases. The predom-
inant reason for panel case dismissal is absence of
merit or lack of prosecution.®^ From 1978 through
1981 , eleven percent of all cases were dismissed.®® This
increased to thirty-one percent dismissals in all cases
for 1983.®' While not resulting in payment, conges-
tion of the panel system delays resolution of meritor-
ious claims and is expensive for the panel administra-
tors and insurance carriers.
Eighth, implement loss prevention measures. State-
wide data on claims must be gathered so that abuses
of claims can be analyzed and prevention measures
WISCONSIN MEDICAL JOCRNAI, JUNE 1985:VOL. 84
37
focused appropriately. This data should be reviewed
by a physician committee for loss prevention and peer
review purposes.
Ninth, sanction “repeat” offenders. If peer review
indicated multiple cases of negligence by a particu-
lar physician, sanctions such as surcharges, restrict-
ed coverage, or referral to the Medical Examining
Board would be imposed.
Tenth, tighten the statute of limitations. Current
statutes allow three years from the incident or one
year from discovery of the injury, but never later than
five years from the incident for adults; minors are
bound by the adult statute or age ten, whichever is
later. The American Medical Association has devel-
oped a model bill which allows two years from the
incident or two years from discovery, but never more
than four years from the incident for adults and the
adult statute, or age ten, whichever is later, for
minors.
Finally, limit attorney contingency fees. Several
states have proposed sliding scales — for example,
limit attorney fees to thirty-three percent of awards
of up to $100,000, twenty-five percent of awards be-
tween $100,000 and $200,000, twenty percent of
awards between $200,000 and $300,000, and fifteen
percent of awards in excess of $300,000. This concept,
which has been adopted by several states, ideally
should be carried out by attorneys and not by state
law. A group of reasonable attorneys who are most
involved could set better guidelines. However, some
prompt considerations of this subject by attorneys
would be advisable. The federal government, as
insurer of one-third of the population through fed-
eral programs, and the state see this limitation solely
as a cost containment measure and not necessarily
from an attorney’s point of view. However, there is
recognition of the fact that limiting the contingency
fee may spur attorneys to seek higher damages than
they would under the current system, and the move
could well be counter-productive.
V. PHYSICIANS AND PATIENTS & LAWYERS
AND CLIENTS
The barely comprehensible complexities of the mal-
practice problem have perversely led to oversimpli-
fication, suggesting it is just lawyers versus physi-
cians. Unmentioned, but faintly recognized, are the
facts that the patient is the victim and that society in
general is affected through the malpractice problem’s
effect on the quality and availability of the modern
advances of medicine. Thoughtful legislators recog-
nize there is a problem, but the media’s role in pub-
licizing hostility and recriminations between physi-
cians and lawyers has made it appear that legislators
must choose sides. We all have to help solve the prob-
lem for the patient’s sake. Physicians and lawyers
have to see the relationship of their work to the whole
fabric of culture and society. In doing this, we may
elucidate rather than castigate, but it does require
more introspection on all sides.
Dr. James Todd, while President of the Physician’s
Insurance Association of America, said “efforts
directed toward tort reform and legislative relief must
be reasonable and not self-serving. Malpractice is a
medical problem not a legal one, and those injured
as a result of negligence are entitled to fair and
prompt compensation.” Agreement with that point
of view is shared by the vast preponderance of physi-
cians. However, honest and competent physicians
have the right to be free from spurious and frivolous
claims that adversely affect their ability to care for
patients. In the remainder of this essay, I would like
to share personal introspections, from a physician’s
point of view, on the relationship of the physician to
the patient, society, and attorneys as brought to light
by the medical malpractice problem.
The patient, often neglected in this controversy, de-
serves some clearer definition. Pellegrino has point-
ed out that the word “patient” is derived from the
Latin patior which means “to suffer” or “bear
something.’”^ It does not mean long-suffering. Peo-
ple become patients when they recognize that they
lack the knowledge or skill to deal with illness. Their
ability to function as “whole” persons is compro-
mised, and they seek help from one who professes
special skills and knowledge to deal with that loss of
wholeness which is a disease state. It is an unequal
relationship. Patients, by presenting themselves,
acknowledge that they need help from someone who
has more powerful tools and knowledge. This ine-
quality is indeed recognized by patients as a diminu-
tion of their person, their ego, and their self-esteem,
as well as a purely physical diminution. Patients are
confronted with their own mortality, perhaps for the
first time, and are no longer in control.
Patients present a problem because they have
sought out the physician who professes to know how
to help. Faith and confidence in that physician are an
important prerequisite for healing to occur. Patients
do not want to hear negatives or limitations. They
want to be made whole and, because it works so often
generally, expect that it will be just as easy individ-
ually. Medicine has been presented as “a miracle an
hour with a few minutes out for commercials” — the
Marcus Welby syndrome. This unequal relationship
imposes great responsibility upon the physician who
has professed to be skilled and knowledgeable with
a commitment of those skills and knowledge to the
benefit of others.
The word profession comes from the Latin verb
profitero which means to make a public avowal or
proclamation. While its earliest use was associated
with vows to join a religious order, it later became a
declaration of possession of skills and knowledge to
be placed in the service of others. It is equally applic-
able to law and ministry. It has been bastardized
today to mean a prestigious occupation; however, to
return it to the older more meaningful level we must
have “commitment,” which means one places one’s
service to others above one’s own self. This is a dif-
ficult goal to strive for. If not always attained, it
38
WISCONSIN MEDICAL JOURNAL, JUNE 1985 : VOL. 84
should be assiduously sought after as often as pos-
sible because the inequality between physician and pa-
tient is a potential source of patient resentment when
profession of skills and knowledge are not manifest,
or are performed carelessly.
In all efforts to explain the marked increase in mal-
practice claims nationally and locally, there are the
usual stock answers depending on whether one talks
with physicians, lawyers, patients, or legislators. I will
not reiterate all of the reasons, but will try to reason
from the definitions above to understand the motiva-
tion for the litigious avalanche.
1 state categorically that the increase in claims does
not represent a decrease in the quality of medicine
locally or nationally. In both Wisconsin and the
nation, medical practice is the highest quality in the
world. Why, then, the paradox of increasing claims,
and yet better medicine?
Let us reexamine malpractice under the three
groupings identified by the Romans because they are
still apropos. There is dolus, the use of medicine with
evil intent and treachery. This conduct is a rare com-
plaint and, when present, is dealt with by criminal
law. Then there is culpa, which includes negligence
and incompetence, and casus, which is accidental
conduct. These two come under unintentional action,
or now, action that results in a tort.
Definition is easy, but discerning the difference is
much more ambiguous. The ambiguities result from
the fact that medicine, despite fantastic progress, is
not an exact science. Untoward or adverse results of
medical treatment may occur without negligence or
accident. Every proposed treatment or operation has
certain negative side effects, an established incidence
of complications and failures that occur regardless of
how skillfully the treatment or operation is per-
formed. It is the physicians’ perception that lawyers
do not understand this point and feel that negligence
is behind every complication, side effect, or failure
of therapy. It is all too easy for physicians to ascribe
a lawyer’s eagerness to sue for self-serving motives
largely because of the contingency fee. While we
realize that the contingency fee is the “key to the
courthouse,’’ we resent that as a result of the contin-
gency fee the lawyer becomes a proprietor and part-
ner in the suit. Lawyers have not diminished this per-
ception by their media advertisements and portrayals
of a “million dollar club.’’ Physicians perceive this
not as a pursuit of justice for the injured patient but
as a technique that stimulates every patient to seek
fortune through the malpractice suit.
The rise in the number of malpractice claims is not
solely a creation of the lawyers’ ingenious advertis-
ing. Medicine itself has contributed to the problem:
as the scientific aspects of medicine exploded, the
physician became identified as a medical scientist.
Mastery of scientific knowledge and technology lead
to many physicians apotheosizing themselves and
their profession. This unfortunately is a double-edged
sword. Lost was the humility of imprecise knowledge,
and acquired was the hubris of technology. Physi-
cians had been seduced into thinking that mastery of
science and technology made them masters of the pa-
tient. Neo-Cartesian reductionism led medicine to be-
lieve that human beings are an electron transfer sys-
tem gone awry, that can be righted by science if only
well enough understood. Specialization and the
acquisition of highly specialized knowledge was the
logical aftermath of the scientific, technological
breakthroughs depicted as daily events to the public
by improved media communication systems. In the
course of these technological successes, personal and
hospital aggrandizement were not trivial events.
Lost in the hubris of the moment was the fact that
physicians are unable to confer immortality. The pa-
tients, who by definition are not whole, were having
expectations heightened, and specialization led to pa-
tients being treated skillfully for their individual parts.
Specialist physicians became “part” doctors, and lost
was the physician who could see patients as more
complicated than the sum of the parts. Impersonality,
inherent in specialization of medical care, while suc-
cessful for many isolated problems, does not react
well anymore to the majority of illnesses since illness
does not usually occur in a vacuum. The whole of a
person provides the setting in which illness occurs.
The complete physician has to understand as much
as possible about a whole patient to help the entire
patient be made whole. There is a dichotomy between
the true benefits of reductionist specialization and the
needs of a whole patient.
This dichotomy can only be addressed when
knowledge and skills provide physicians with an
understanding of their limitations. The patients also
must be made aware of medicine’s limitations and not
just its successes. Even the benefits of a simple aspirin
must be weighed against its potential, but significant,
harmful side effects. Surgeons must realize that the
feasibility of an operation is not necessarily an indi-
cation for its performance. Physicians must differ-
entiate between what a treatment does to a patient
and what it does for a patient.
The physician’s knowledge of beneficial and ad-
verse effects of a treatment must be presented to the
patient and be consonant with the patient’s expecta-
tions from that treatment. The definition of consent
is “to feel together” and “to feel with.” Put in the
context of physician hubris and unrealistic patient
expectations, untoward, unexpected results lead to
patient anger from unfulfilled expectations. This
leads a disappointed patient to seek an attorney, turn-
ing the patient into a client.
Patients have been converted to clients by both pro-
fessions. Physicians have been deficient in dealing
with the whole patient and not recognizing and ex-
plaining the risks and limitations of therapy. By not
understanding that medicine is not an e.xact science,
lawyers seek to redress every untoward event by a law-
suit, even when no negligence is involved. I am not
discussing motivation for claims when there has been
negligent action, but those instances in which unto-
ward results have occurred that could have been antic-
WISCONSIN .MEDICAL JOURNAL, JUNE 1985: VOL. 84
39
ipated in a certain percentage of patients. Physicians
cannot be held to be guarantors of cure, nor should
they present themselves as such.
The big problem lies not in the cost of liability in-
surance but in the consequences of the adversarial
quality that relationships between physicians and law-
yers have assumed. Society will protect itself from this
destructive attitude. If confronted with no other
choice, the federal government will intrude with cost
containment measures that will lead to a lower qual-
ity of care for everyone. Before this occurs, both pro-
fessions have to rid themselves of their entrepre-
neurial members who denigrate their respective pro-
fessions. The time for self-serving rhetoric is past. For
all parties concerned, come let us reason together for
justice.
REFERENCES
1 . See Reed, Understanding Tort Law: The Historic Basis of Med-
ical Legal Liability, J. LEGAL MED., Oct. 1977, at 51.
2. See Amundsen, The Liability of the Physician in Classical Greek
Legal Theory and Practice, J. HIST. MED., Apr. 1977, at 172, in which
the author quoted from the text in translation of an anonymous treatise
in the Hippocratic Corpus entitled Law.
3. See Amundsen, note 2, at 175. It is interesting that both Plato
and Aristotle believed that physicians’ actions could be best judged by other
physicians.
4. See id.
5. For a discussion of the relationship between the medieval medical
practitioner and early vestiges of the common law, see generally Post, Doc-
tor Versus Patient: Two Fourteenth-Century Lawsuits, MED. HIST., July
1972, at 296-300.
6. Having been paid, the physicians would not make house calls.
7. These cases presage current health maintenance organizations
(HMO) contracts by 600 years,
8. This case has been identified as Stratton v. Swanlond, Y.B. 48 Edw.
3, f. 6, pi. 1 1 (1375). See genera//v Chapman, Stratton v. Swanlond: The
Fourteenth Century Ancestor of the Law of Malpractice, PHAROS, Fall
1982, at 20-24.
9. Cosman, The Medieval Medical Third Party: Compulsory Consul-
tation and Malpractice Insurance, ANNALS OF PL.ASTIC SURGERV . Feb.
1982, at 155-58. Of particular interest is the author’s discussion of a Lon-
don ordinance in 1423 which required that a physician treating a critically
ill patient consult a “master surgeon” on the case within three days of
diagnosis. See id. at 157-58.
10. See id. at 161 .
1 1 . See Reed, supra note 1, at 53 (discussing Cross v. Guthrie, 2 Root
90 (Conn. 1794)). In Cross, a husband sued a physician for the death of
his wife who was undergoing a mastectomy. He alleged unskillful, igno-
rant, and cruel treatment.
12. See Burns, Malpractice Suits in A merican Medicine Before the Civil
War, Bull. Hist. MED., Jan. -Feb. 1969, at 42. One of the suits originated
in a Racine, Wisconsin circuit court in 1853. See id. at 43-44 (citing Rey-
nolds v. Graves, 3 Wis. 371 (1854)).
During this period, Abraham Lincoln had been a defendant’s attorney
in a malpractice suit. See Letter from Clark Heath to editor, NEW ENG.
J. MED., Sept. 23, 1976, at 735-36. The letter refers to a quote attributed
to Lincoln in defense of the accused surgeons: “Mr. Eleming, instead of
bringing suit against these surgeons for not giving your bone proper atten-
tion, you should go on your knees and thank God and them that you have
your leg.” Id. at 736.
13. See generally J. ELWELL, A MEDICO-LEGAL TREATISE ON
Malpractice and medical evidence, comprising the ele-
ments OF MEDICAL JURISPRUDENCE (1860). Elwell published the first
sytematic review of American malpractice claims and recognized that they
had become a part of American medicine.
14. See generally Weigel, Medical Malpractice in America’s Middle
Years, TEX. REP. BIOLOGY MED,, Spring 1974, at 191-205.
15. 155 N.Y. 201, 49 N.E. 760 (1898).
16. See Stetler, The History of Reported Medical Professional Liability
Cases, 30 TEMP. L.Q, 366, 367 (1957).
17. See id. at 368.
18. See id. at 369.
19. See id. at 381 .
20. See T. LOMBARDI. MEDICAL MALPRACTICE INSURANCE: A
LEGISLATOR'S VIEW (1978). The author relied upon data presented in an
interview of James L. Groves of the American Hospital Association before
the New York State Senate Health Committee Staff on May 9, 1977.
21. See SECRETARY’S Commission, u.s. dep’tof Health, educa-
tion, AND WELFARE REPORT ON MEDICAL MALPRACTICE, DHEW
Pub. No. (05), at 73-78 (1973).
22. See DIRECTOR OF STATE Courts Office, a status reporton
THE PATIENT’S COMPENSATION PANEL SYSTEM IN WISCONSIN:
1976-1981, June 1982, at 1,
23. This fund is paid for by the providers’ contributions.
24. See WISCONSIN LEGISLATIVE COUNCIL STAFF, DATA RELATING
TO MEDICAL Malpractice, Informational Memorandum 84-25, Aug.
7, 1984, at 3 [hereinafter cited as LEGISLATIVE COUNCIL].
Wisconsin Compensation Panel Experience
Claims Filed
Claims Paid
Average Paid/Claim
1978
145
4
$138,064
1980
262
10
$203,353
1982
413
18
$238,022
1983
376
25
$426,672
1984
451 (projected)
—
—
State medical Society of Wisconsin, report to the legis-
lative Council Special committee on medical Malpractice,
Sept. 4, 1984, at 3 [hereinafter cited as SMS REPORT). SMS information
was obtained from the Patient’s Compensation Fund.
25. Certain groups, such as obstetricians, have even changed or ceased
their practice. See infra text accompanying note 43.
26. See STATE MEDICAL Society of Wisconsin, Statement to
Legislative Council Special Committee on medical Malprac-
tice, Sept. 4, 1984, at I.
27. See id. at 2.
28. See, e.g.. The Medical Malpractice War, NAT’L L.J., Aug. 27,
1984, at 1.
29. See SMS REPORT, supra note 24, at 21 (figures exclude Milwaukee
County).
30. See id. (figures exclude Milwaukee County).
31. See Medical protective Company, professional Liabili-
ty IN Wisconsin, Sept. 4, 1984, at 4 (presented to the Wisconsin Legis-
lative Council).
32. See id. at 4-5.
33. See PHYSICIAN’S ALLIANCE, STATE MEDICAL SOCIETY OF
Wisconsin, 1985-1986 Legislative issues 10 (1984).
34. See SMS REPORT, supra note 24, at 22 (citing study by the National
Association of Insurance Commissioners).
35. See id. at 23,
36. See id.
hi . See id. at 22.
38. See LEGISLATIVE COUNCIL, supra note 24, at 3.
39. See SMS REPORT, supra note 24, at 9.
40. See id. at 8-9.
41. Address by Elvoy Raines, Management of Liability — Attracting
Incidents, to the Seminar on Gynecologic Surgery, St, Thomas, V.I., Feb.
16-19, 1984, at I.
42. Id.
43. See SMS REPORT, supra note 24, at 6.
44. See The Medical Malpractice War, Nat’L L.J., Aug. 27, 1984, at
12 (testimony before Congress in July 1984).
45 . See id.
46. See supra notes 24-27 and accompanying text.
47. See SMS REPORT, supra note 24, at 3.
48. St. Paul Fire & Marine Company stated that seventy-five percent
of its insured physicians have policies with a limit of one million dollars.
See id. at 12.
49. American Medical association special Task force on
PROFESSIONAL LIABII.ITY AND INSURANCE, PROFESSIONAL LIABILITY
IN THE 80’s, NOV. 1984, at 15.
50. See SMS REPORT, supra note 24, at 1 1 . Information compiled from
the Wisconsin Law Reporterhawem iemuetTy 1, 1982 and June 23, 1984
indicated non-economic awards of $6,357,490 and economic awards of
$5,143,110.
51. See WISCONSIN LEGISLATIVE COUNCIL, SPECIAL COMMITTEE
ON MEDICAL MALPRACTICE: SUMMARY OF PROCEEDINGS, Sept. 4,
1984, at 11.
52. See SMS REPORT, supra note 24, at 21.
53. See id.
54. See id.
55. E. PELLEGRINO, HUMANISM AND THE Physician 225 (1979). ■
40
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
Legal aspects of peer review
Susan M Schmidt, JD, Chicago, Illinois
Medical peer review is an indispensable part of
modern medical practice. Peer review may be man-
dated or it may be voluntarily undertaken. It may be
required by state licensure laws, federal laws, ac-
creditation standards, or by individuals seeking to im-
prove the quality of medical care in an institution.
The review may be conducted within a particular
institution, by an independent organization, by a
medical society, or a variety of other individuals or
groups. The review may focus on the appropriate
utilization of services or facilities, analyze medical
practices, recommend credentials decisions, or affect
other aspects of patient care or medical services.
Courts have recognized the necessity of peer review
activities. In Bredice v. Doctors Hospital, the court
noted that the purpose of the meetings “. . . is the
improvement, through self-analysis, of the efficiency
of medical procedures and techniques. They are not
a part of current patient care but are in the nature of
retrospective review of the effectiveness of certain
medical procedures. The value of these discussions
and reviews in the education of doctors who par-
ticipate, and the medical students who sit in, is un-
deniable . . . There is an overwhelming public interest
in having those staff meetings held on a confidential
basis so that the flow of ideas and advice continue
unimpeded.”'
For the physician involved in peer review activities,
various questions arise: what is the legal liability ex-
posure, will the proceedings and reports be accessi-
ble to medical negligence plaintiffs or others, and can
members of a review committee be subpoenaed or
deposed? No single answer applies to all of these
questions in every state. The legal issues that arise in-
volve both the common law and state statutes.
This article will discuss the most common theories
of legal liability that arise and the various protections
afforded to physicians involved in peer review activi-
ties.'^ The peer review protections applicable under
Connecticut law will be discussed. [This section has
been deleted and Wisconsin’s peer review law has
been added at the end of this article.]
Potential legal liability
Defamation
One of the most frequent allegations that arises
from peer review activities involves defamation.
Defamation is injury to a person’s “reputation.” One
authority defines defamation as a communication
that tends “to diminish the esteem, respect, goodwill,
or confidence in which the plaintiff is held or to excite
Reprinted with permission from Conneciicui Medicine (Oct
1984;48:677-680) and from the author who is staff attorney Health
Law Division, Office of the General Counsel of the American
Medical Association. Copyright 1984, Connecticut Medicine.
adverse, derogatory or unpleasant feelings against
him.”^ To establish the legal cause of action for
defamation, the plaintiff must establish that a writ-
ten or oral communication was published to a third
person by the defendant and that the third person
became aware of its derogatory meaning.
Various defenses exist to a defamation allegation.
Truth is an absolute defense. A conditional, or quali-
fied, privilege exists with regard to communications
made in good faith, without actual malice, when
reasonable or probable grounds exist for believing the
statements are true. Further, the communication
must be one in which the author has an interest, or
a public duty of a legal, judicial, political, moral, or
social nature, and the communication must be made
to a person with a corresponding duty.
The scope of this cause of action as applied to peer
review activities is evident. The communications
should be made in good faith and reasonable care
should be taken to insure their truth. The informa-
tion should be conveyed only to those persons who
have an interest in receiving them, that is, persons
who have the authority or responsibility to act on
them. Peer review proceedings and opinions should
not be repeated to persons not involved in the peer
review process.
Courts have recognized the applicability of the
qualified privilege doctrine to members of hospital
medical staff and medical society committees respon-
sible for evaluating the professional competence of
colleagues. The courts tend to balance the obligation
of the medical profession to assure the public of com-
petent practitioners and the right of the physicians to
maintain their reputations in the community. The
court, in Kinney v. Daniels,* applied these principles.
The Chief of the Medical Service reviewed the prac-
tice of a physician who had placed several patients on
dialysis. During this review, the physician requested
review reports from several members of the Internal
Medicine department. The letter sent to the physician
that questioned the propriety of the physician’s activi-
ties was also sent to three other physicians who, in
some manner, were responsible for privilege review
and peer review in the hospital. The court found that
the publication of the letter to these three physicians
was within the common law, qualified privilege to
defamation actions. The court stated that given the
letter’s substantial truth and limited publication in the
context of health care peer review, the privilege
applied.
Antitrust liability
To maintain an antitrust action, the plaintiff must
satisfy a threshold requirement that the activities of
the peer review committee affect interstate commerce
WISCONSIN MEDICAL JOL'RNAL, JUNE 1985: VOL. 84
4
within the meaning of the Sherman Act. In addition,
the plaintiff would have to show that the physicians
involved with the peer review combined or conspired
to restrain trade or monopolized or attempted to
monopolize within the meaning of the Sherman Act.’
These requirements often are difficult to establish.
So long as the activities are within the legitimate
scope of the peer review process and do not have an
improper anticompetitive effect, antitrust liability
should not exist. A recognized impermissible anti-
competitive purpose is if a member of a peer review
committee has an independent stake, usually eco-
nomic, in achieving the object of a conspiracy.
Sokol V. University Hospital, Inc.,^ discusses these
antitrust arguments. In that case, the district court
discussed whether the denial of staff privileges con-
stituted an antitrust violation. The court said that the
denial was “. . .an isolated instance of the restric-
tion on one doctor’s privileges, which may be ana-
logized to a refusal to deal in commercial situations.
This has not been held to violate the Sherman Act in
the absence of an agreement, combination, or con-
spiracy. Whether the act complained of is an act of
the corporation, the fact that the concurrence of a
number of the personnel of a corporation is required
to generate the corporate act does not satisfy the Sher-
man Act’s requirement of an agreement, combina-
tion, or conspiracy.”’ Therefore, if the peer review
activities are conducted properly, a court would have
difficulty in establishing that a conspiracy existed.
Breach of a confidential communication
The relationship between physician and patient is
extremely confidential. A physician who reveals a pa-
tient’s confidential communications violates ethical
principles unless the patient has authorized the release
or it is required by law.®
The likelihood of a suit being brought because of
a breach of confidentiality is remote. The review can
be made by using a coding system to ensure anony-
mity of the patient, and the review is performed by
physicians who are aware of the need for confiden-
tiality. So long as the information is used for legiti-
mate purposes no breach of confidentiality should
arise.
The issue of whether an internal hospital commit-
tee may examine patient records was raised in Kluge
V. Lutheran Medical Center of St. Louis.^ The court
recognized the hospital committee’s right to review
patient records and noted that the confidentiality of
the patient’s name can be assured in these pro-
ceedings.
Statutory privilege
All fifty states and the District of Columbia have
enacted laws that restrict, to some degree, the civil
liability of persons involved in medical peer review
and the discovery and admissibility of peer review
proceedings.'® Some statutes provide complete pro-
tection of all activities and documents while others are
not so comprehensive. At a minimum these statutes
usually codify the conditional privilege that applies
to defamation actions. The statutes vary in the scope
of persons they cover. Some laws only cover physi-
cian members of the committees while others extend
to agents and consultants of the committee and per-
sons who provide information to or testify before the
committee. Almost every statute provides immunity
only to those persons who act without malice and in
good faith. Some statutes require, in addition, that
a reasonable effort must be made to ascertain the
facts.
The discovery of peer review activities addresses
conflicting goals of opening up the litigation process
and insuring confidentiality. Without confidentiality,
physicians would be more reluctant to serve on these
committees and necessary professional self-evaluation
would not occur. The value of self-evaluation has
been recognized by courts and legislatures. Others
argue that airing the truth about an incident is more
valuable.
When evaluating whether certain communications
are protected the wording of the statute is very impor-
tant. For example, although the medical peer review
proceedings are protected from discovery, the fact
that they occurred may not be. Further, the statute,
by its terms, may not prevent members of the medical
review process from testifying if they have indepen-
dent knowledge as to a particular physician’s quality
of practice that was not obtained through the peer
review proceedings. Not all review documents may
be protected. Incident reports that are not specifically
mentioned in the statute probably are discoverable.
Further, the laws generally cover only the medical
review proceedings, not discussions about those pro-
ceedings after or outside of the meeting.
[The section on Connecticut statute has been deleted,
and sections of the Wisconsin peer review law appear
at the end of this article.]
Conclusion
General agreement exists that only the medical pro-
fession is qualified to evaluate the professional com-
petence of physicians and the quality of medical care
that they provide. Public policy favors protecting
those activities of the profession designed to improve
standards of professional competence and evaluate
the quality of care available to the public. In every
state, laws codify the protection, although no uni-
formity exists. Courts, in reaching their decisions,
recognize these public policies and legislative goals.
For these reasons, conducting objective peer review
of the professional competence of colleagues does not
appear to increase the liability exposure of physicians.
However, the limits of these protections are defined
by law and the physician who participates in peer
review activities is advised to be aware of the scope
of the applicable state law.
42
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL, 84
References
1. 50 FRD 249 (DDC 1970).
2. A comprehensive di.scus,sion can be found in Peer Review: A Legal Up-
date. American Medical Association, 1981.
3. W Prosser, Handbook of Tort Law, §111 (4th Ed 1971).
4. 574 F Supp 542 (SD W Va 1983).
5. 15 use §§l, 2.
6. 402 F Supp 1029 (D Mass 1975).
7. Id. at 1030. See Smith v Northern Michigan Hospitals, 703 F 2d 942
(6th Cir 1983) and Pontius v Children’s Hospital, 552 F Supp I352(WD
Pa 1982) (in which the courts found that no independent stake or intra-
corporate conspiracy existed.)
8. Opinion 5.05, Confidentiality, Current Opinions of the .ludicial Coun-
cil of the American Medical Association, 1984. Some states have
codified the confidentiality principles. Legal and ethical exceptions to
confidentiality requirements are recognized.
9. 518 SW 2d 157 (Mo 1974).
10. See Peer Review: A Legal Update, supra, note 2. ■
Peer review in Wisconsin
WISCONSIN’S PEER REVIEW LAW is set forth in the
two statutes reproduced below. The first statute,
§146.37, does two things. First, it defines peer review
programs for the purposes of the state law. Second,
§146.37 grants civil immunity to those participating
in good faith in peer review.
As a companion to §146.37 is §146.38 (see below),
which was created by the same legislation. Chapter
187, Laws of 1975. This statute grants qualified con-
fidentiality to information acquired in connection
with peer review activities. Subsection (2) specifically
states that records of peer review investigations, in-
quiries, proceedings and conclusions are not to be
used in any civil action for personal injuries against
the healthcare provider of facility under review.
However, information, documents, or records used
during review do not become immune from disclosure
and discovery by virtue of their use during the peer
review process. In other words, records created for
and by the peer review committee receive immunity
while other records, testimony, and documents other-
wise accessible to the injured party remain so despite
their use by the peer review committee.
The Wisconsin peer review law has been success-
fully defended from those trying to gain access to peer
review information through claims that the laws are
unconstitutional and therefore should be removed
from the rolls. In one circuit court case, the judge
upheld peer review’s constitutionality, finding that
the privileged status of peer review information
rationally related to improving healthcare and
minimizing healthcare costs. Until a higher court; ie.
Appellate or Supreme Court, rules to the contrary,
peer review’s confidentiality provisions remain in
good legal health.
1 46.37 Health care services review; civil immunity.
(1) No person acting in good faith who participates
in the review or evaluation of the services of health-
care providers or facilities or the charges for such
services conducted in connection with any program
organized and operated to help improve the quality
of healthcare, to avoid improper utilization of the
services of healthcare providers or facilities or to
determine the reasonable charges for such services,
or who participates in the hospital rate-setting activi-
ties under ch. 54 or s. 146.60, is liable for any civil
damages as a result of any act or omission by such
person in the course of such review or evaluation.
(2) In determining whether a member of the review-
ing or evaluating organization has acted in good faith
under sub. (1), the court shall consider whether such
member has sought to prevent the healthcare provider
or facility and its counsel from examining the docu-
ments and records used in the review or evaluation,
from presenting witnesses, establishing pertinent facts
and circumstances, questioning or refuting testimony
and evidence, confronting and cross-examining
adverse witnesses or from receiving a copy of the final
report or recommendation of the reviewing organiza-
tion.
(3) This section applies to any person acting in good
faith who participates in the review or evaluation of
the services of a psychiatrist, or facilities or charges
for services of a psychiatrist, conducted in connec-
tion with any organization, association or program
organized or operated to help improve the quality of
psychiatric services, avoid improper utilization of
psychiatric services or determine reasonable charges
for psychiatric services. This immunity includes, but
is not limited to, acts such as censuring, reprimand-
ing or taking other disciplinary action against a
psychiatrist for unethical or improper conduct.
History: 1975 c. 187; 1979 c. 221; 1981 c. 323; 1983 a. 27.
Person reviewing peer can be found to have acted in bad faith even if
procedural rights under (2) w'ere not denied, but whether procedural rights
were denied is factor which must be considered in determination of “good
faith.” Qasem v. Kozarek, 716 F (2d) 1 172 (1983).
146.38 Healthcare services review; confidentiality
of information. (1) No person who participates in the
review or evaluation of the services of healthcare pro-
viders or facilities or charges for such services may
disclose any information acquired in connection with
such review or evaluation except as provided in
sub. (3).
(2) All organizations reviewing or evaluating the
services of healthcare providers shall keep a record
of their investigations, inquiries, proceedings and
conclusions. No such record may be released to any
person under s. 804. 10(4) or otherwise except as pro-
vided in sub. (3). No such record may be used in any
civil action for personal injuries against the health-
care provider or facility; however, information, docu-
ments or records presented during the review or eval-
uation may not be construed as immune from dis-
WISCONSIN MEDICAL JOURNAL, JUNE 1985:VOL. 84
43
covery under s. 804.10(4) or use in any civil action
merely because they were so presented. Any person
who testifies during or participates in the review or
evaluation may testify in any civil action as to mat-
ters within his or her knowledge, but may not testify
as to information obtained through his or her par-
ticipation in the review or evaluation, nor as to any
conclusion of such review or evaluation.
(3) Information acquired in connection with the
review and evaluation of healthcare services shall be
disclosed and records of such review and evaluation
shall be released, with the identity of any patient
whose treatment is reviewed being withheld unless the
patient has granted permission to disclose identity, in
the following circumstances:
(a) To the healthcare provider or facility whose
services are being reviewed or evaluated, upon the re-
quest of such provider or facility;
(b) To any person with the consent of the health-
care provider or facility whose services are being
reviewed or evaluated;
(c) To the person requesting the review or evalua-
tion, for use solely for the purpose of improving the
quality of healthcare, avoiding the improper utiliza-
tion of the services of healthcare providers and
facilities, and determining the reasonable charges for
such services;
(d) In a report in statistical form. The report may
identify any provider or facility to which the statistics
relate;
(e) With regard to any criminal matter, to a court
of record, in accordance with chs. 885 to 895 and after
issuance of a subpoena; and
(1) To the appropriate examining or licensing board
or agency, when the organization conducting the
review or evaluation determines that such action is
advisable.
(4) Any person who discloses information or
releases a record in violation of this section, other
than through a good faith mistake, is civilly liable
therefor to any person harmed by the disclosure or
release.
Hi^lor>: 1975 c. 187; 1979 c. 89; 1983 a. 27. ■
“WATS” LINE FOR MEMBERS
As a service for its members, the State
Medical Society of Wisconsin has a
toll-free WATS line (Wide Area Telecom-
munications Service) to provide member
physicians with quick and easy access to
SMS staff. The in-WATS line can be used
to contact anyone at SMS headquarters
(330 East Lakeside Street, Madison) from
anywhere within the State of Wisconsin
between the hours of 8:00 am and 4:30
pm weekdays. The number to dial is:
1-800-362-9080
How to get health-related
information in Wisconsin
The Wisconsin Health Sciences Library Network, a
network of libraries that blanket the state, stands ready to
put Wisconsin health-care practitioners in touch with in-
formation in libraries throughout the country.
Any practitioner needing such information should first
contact the library in his or her institution. If the person is
an independent practitioner or the institution has no
library, another local hospital or clinic should be con-
tacted. Many such libraries will now serve people who are
not among their primary clientele. A great number of
these libraries are now organized into resource-sharing
consortia and can get a needed item quickly even if they
do not have it in their own collection. The libraries are
also eligible to forward requests to the two Wisconsin
resource libraries — in Madison (the UW Middleton
Health Sciences Library) and in Milwaukee the Todd
Wehr Library (Medical College of Wisconsin). The local
libraries are likely to have the tools to identify which other
library has the needed information.
If no local library can be found to provide these ser-
vices, inquiries can be sent directly to the resource
libraries at the addresses given below. Any requests that
can’t be filled at the state level are eligible for referral to
resource libraries in the Greater Midwest Regional Medical
Library Network, which encompasses a six-state area and to
the National Library of Medicine.
In addition to providing lending and photocopying ser-
vices, the two resource libraries and many of the local
libraries provide reference service. Computer searches, in-
cluding MEDLINE, can now be done at the resource
libraries and at Columbia, St Joseph’s, St Luke’s St
Mary’s, St Michael’s, Mt Sinai, St Francis hospitals and
Good Samaritan Medical Center, Lutheran Campus in
Milwaukee; Milwaukee County Medical Complex; Trinity
Memorial Hospital, Cudahy; VA Hospital, Wood; St
Elizabeth’s Hospital, Appleton; Luther Hospital, Eau
Claire; La Crosse Lutheran Hospital, La Crosse; Marsh-
field Clinic, Marshfield; Beilin Memorial Hospital, Green
Bay; Waukesha Memorial Hospital, Waukesha; the
Howard Young Medical Center, Woodruff; Holy Family
Hospital, Manitowoc; Theda Clark Regional Medical
Center, Neenah; Mercy Medical Center, Oshkosh; St Vin-
cent’s Hospital, Green Bay; Community Memorial
Hospital, Menomonee Falls; Memorial Hospital at Ocono-
mowoc, Oconomowoc; St Luke’s Hospital, Racine; VA
Hospital, Tomah; Wausau Hospital Center, Wausau; West
Allis Memorial Hospital, West Allis; and Methodist and
Madison General hospitals, St Mary’s Hospital Medical
Center, VA Hospital, and UW Clinical Sciences Center in
Madison. If your local library cannot provide computer
searches, it can forward any request to the most appropriate
library in the network.
In most cases, the only charges will be for computer
searches and for photocopies.
University of Wisconsin
Middleton Health
Sciences Library
1305 Linden Drive
Madison, Wis 53706
800-362-3020
ext 2-2376
Medical College of Wisconsin
Todd Wehr Library
Box 26509
Milwaukee, Wis 53226
414/257-8326 ■
44
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
statewide Impaired Physician Program
The Statewide Impaired Physician Program
functions under the purview of the Commission on
Mediation and Peer Review although its activities are
managed by a six-member Managing Committee.
The program follows an established protocol which
guides the general handling of inquiries or concerns
regarding identified impaired physicians. Available
to members and nonmembers alike, the program
continues to be one of education, identification, as-
sessment, and compassionate intervention. The pro-
gram refers patients to acceptable treatment facili-
ties and monitors a two-year followup after initial
therapy has been completed.
The Impaired Physician Program has achieved
some success. A number of physicians have been en-
couraged by compassionate colleagues to enter struc-
tured rehabilitation programs. However, these few
successes do not represent satisfaction of the needs
of many other physicians continuing losing battles
against alcohol or other chemical substances, or who
suffer from emotional illness or senility.
Experience to date in Wisconsin and elsewhere
provides convincing evidence that physician impair-
ment is substantial, but its degree is unknown be-
yond what is identified and intervened. Most of the
literature on the subject contends that from ten to
fourteen percent of practicing physicians have dif-
ficulty with alcohol and drugs. Some research sug-
gests that one out of every ten physicians during a
lifetime will abuse alcohol in professional circum-
stances so as to be identified as “impaired.”
Unfortunately, many people in a position to ob-
serve and identify impaired physicians do not know
what to do when they perceive a specific problem,
nor do they realize that help is available from organ-
ized programs. Furthermore, individuals such as
medical staff members, hospital administrators, and
others are reluctant to report a physician to an or-
ganized program. Their initial reaction is not to get
involved, or to conclude that the problem can be
handled by someone else in some other manner.
This attitude often results in delayed intervention
and treatment or in passive action which ultimately
fails. Another concern is that those who might other-
wise report an impaired physician may seek legal
advice, only to be told by their lawyers to be non-
committal and to respond only to a subpoena. Such
advice could be a deterrent to early intervention.
Current techniques of identification, intervention,
assessment, treatment, and followup of impaired
physicians are not well known in the medical com-
munity. Physicians are not generally adequately
trained or skilled in identification, diagnosis, and
treatment of patients with chemical dependency. The
result is that few are able to respond adequately
when they accept an impaired physician as a patient.
Since the beginning of the Impaired Physician
Program, the State Medical Society has recognized
the need to identify and publicize resources for treat-
ment and appropriate followup of impaired physi-
cians in Wisconsin. It learned that a more adequate
system of outreach, treatment, and re-entry to med-
ical practice needed to be designed, made available,
and publicized. It noted that a physician recovering
from impairment may very well bear associated
financial stress and may be unable to sustain himself
or his family without insurance, grants, loans, or
other benevolent assistance. Techniques had to be
improved for monitoring the degree to which im-
paired physicians respond to treatment and rehabili-
tation and return to medical practice.
The Society viewed the impaired physician as a
medical family concern requiring close cooperation
with the Society’s Auxiliary which assists in identi-
fying impairment and providing support for spouses
and families. It also recognized that efforts should
be made within premedical, medical, and residency
training programs to provide resources for students
and residents to deal with impairment.
In 1982, the State Medical Society Board of Direc-
tors approved development of an expanded state-
wide program for impaired physicians in recognition
of these stated needs. The expanded program con-
tains the following elements presently being imple-
mented:
PHASE I: Education and Prevention
Target individuals and groups are being educated
to an understanding of impairment among physi-
cians as a result of chemical dependency. They are
being informed of symptoms of impairment; the
need for, and techniques of, early identification and
prevention; the process of, and resources available
for, identification, assessment, intervention, and
treatment; and social, financial, legal, and other
problems associated with impairment.
Persons interested in the Impaired Physician Program may call 608/257-6781 or toll-free in Wis-
consin: 1-800-362-9080 and explain their concern to Mr John LaBissoniere or Mr H B Maroney of
the State Medical Society staff. The caller’s identity will be kept in complete confidence.
WISCONSIN MEDICAL JOCRNAL, JUNE 1985: VOL. 84
45
A. Primary Target Groups being reached in ed-
ucation and prevention efforts are:
1. Physicians: Meetings of hospital medical
staffs, county medical societies, regional or
statewide continuing medical education,
and accredited seminars, eg, at the SMS
Annual Meeting or specialty societies.
2. Hospital Personnel: Hospital administrators
and medical directors, chiefs of medical
staffs, hospital boards of trustees, directors
of nursing and pharmacy and others, eg,
anesthetists and technicians.
3. Pharmacists, Nurses, and Nursing Home
Administrators: Lectures given through as-
sociation meetings or in combination with
physician and hospital personnel meetings.
4. Spouses and Families of Physicians: Educa-
tional material available at state and county
medical society and auxiliary meetings.
5. Legal Profession: Efforts to convince law-
yers, whose state association has its own
impaired lawyers program, to encourage
their physician clients to utilize organized
medicine’s voluntary impaired physician
programs when perceived needs arise.
B. Teaching Staff for Educational and Preven-
tion Phase
Teaching staff has presented educational
and prevention programs to the various target
groups. The team approach is employed and
involves at least a physician and a physician
recovering from alcohol or other chemical
dependency.
C Literature is being developed to assist in an
understanding of the disease of chemical de-
pendency and to explain resources for inter-
vention, treatment, and followup.
PHASE II: Intervention and Treatment
To be successful, any impaired physician pro-
gram structure must include the availability state-
wide of “physician interveners” who will be able to
perform compassionate colleague-to-colleague con-
tact with physicians who have been identified as
impaired.
Approximately 25 physicians from throughout
Wisconsin have been trained and are available to
meet with and urge their impaired colleagues to leave
medical practice and to enter suitable programs for
evaluation and treatment. Interveners, sometimes
known as confronters, act as teams. At least one
intervener is either expert in, or has personal exper-
ience with, the impairment of concern. The initial
approach of interveners with an impaired physician
is always a compassionate encounter. The statewide
program in Wisconsin has no interest in the punitive
or coercive approach until all benevolent measures
have been exhausted. An intervener’s sole interest
is the personal wellbeing of a colleague.
The Impaired Physician Program consistently has
adhered to the policy that satisfactory recovery from
chemical dependency can only be realized through a
monitored two-year recovery period for each im-
paired physician. It considers the two-year “after
hospitalization” to be a critical component in assur-
ing continued recovery.
PHASE III: Benevolent Assistance
AvS it gains experience, the Statewide Impaired
Physician Program finds that in addition to the
burden of impairment, a number of physicians are
unable financially to pay the cost of inpatient care.
It is estimated that at least ten percent of Wisconsin
impaired physicians either have no health insurance
coverage or have coverage which is inadequate for
the costs of inpatient care. Some have been ill for so
long a period that their financial resources essentially
have been depleted. About ten percent of the charges
for rehabilitation of such physicians go unpaid. For
twenty percent of impaired physicians, residence and
treatment in “recovery homes” for an average of
three months at a cost of $1,500 per month is essen-
tial for completion of the two-year recovery pro-
gram. Furthermore, although adequately funded to
date, no long-term provision has been established to
allow realization of the program commitment to a
two-year recovery program.
With the approval of the State Medical Society
Board of Directors and the Board of Directors of
the CES Foundation, the Impaired Physician Pro-
gram established a Physicians Benevolent Assistance
Fund. The Fund’s $175,000 goal is to be accom-
plished through pledges to the CES Foundation ear-
marked for the Benevolent Assistance Fund and pay-
able over a two-year period. The fund appeal among
members of the State Medical Society and Wisconsin
hospitals is designed to develop a fund of $150,000
for low-interest loans for physicians who potentially
can repay them after completing the inpatient phase
and returning to medical practice. A general purpose
fund of $25,000 is intended to cover the costs of
coordinating long-term support and monitoring phy-
sicians after the inpatient phase and on to comple-
tion of the two-year treatment program. The appeal
program continues.
* *
The State Medical Society program maintains
formal linkage with the Wisconsin Medical Exam-
ining Board through the Coordinating Council on
Physician Impairment. The Council consists of three
physicians representing the State Medical Society
and three members of the Medical Examining
Board. The Council establishes guidelines for the
Statewide Program and coordinates activities so that
appropriate information is shared and Council
action can be taken in the event a physician fails to
respond to treatment or refuses to enter rehabili-
tation. The Council may refer a physician to the
MEB in an instance where the health of the public
may be jeopardized. The Council presents a desir-
46
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
able balance of concerns and interests between the
voluntary assistance program of organized medicine
and the state’s statutory licensing and disciplinary
body. Thus the Council is an appropriate step in the
reporting process if necessary during attempts at
physician rehabilitation where difficulty may be en-
countered.
Any responsible person concerned that a physi-
cian may suffer from an impairment may write to
the Society or call 608/257-6781 in Madison or
1-800-362-9080 in Wisconsin. Strict confidentiality
of all information is assured. Staff assigned to re-
ceive information will consult with the Managing
Committee chairman for guidance and early action,
but not before the information is evaluated for ac-
curacy. When it is determined that a potential prob-
lem exists, an intervener team is recruited to meet
with the involved physician. From that point the
process evolves which should assist the physician to
recognize the impairment and to accept a treatment
plan leading to recovery and a return to a successful
practice. ■
STATE MEDICAL SOCIETY
Mediation and Peer Review Services
Physicians are quite aware that medical care is
a very personal matter between them and their pa-
tients. Medicine is not an exact science, and since
each patient is different from all others and treat-
ment approaches vary greatly from patient to pa-
tient, it is understandable that physicians and pa-
tients sometimes may not agree on what is proper
care. At times misunderstandings arise about what
the physician hopes to accomplish and what the pa-
tient expects. When this occurs, it is important that
the patient first discuss any questions and concerns
regarding medical treatment with his or her physi-
cian. In the event that such differences are not
resolved at the doctor-patient level, the State Medical
Society provides a means for resolving these differ-
ences.
The State Medical Society Commission on Media-
tion and Peer Review has the responsibility to re-
ceive, investigate, and resolve differences between
physicians and patients or other complainants, and
if necessary to take disciplinary action. The prime
standard of judgment used by the Commission is
what is good medical care. Many complaints and
questions are accepted by State Medical Society
staff and resolved by telephone. However, only a
written complaint will be considered by the Commis-
sion through its protocol. If all affected parties re-
side within the boundaries of a single county medical
society, that society will be asked whether it wishes
to assume jurisdiction of the complaint. If it does,
the complaint will be transferred to the county medi-
cal society for investigation and resolution.
A Protocol Manual was developed by the Commis-
sion on Mediation and Peer Review and approved
by the Society’s Board of Directors for conducting
resolution of patient complaints, employing peer
review mechanisms to test practice patterns of physi-
cians, and responding to impaired physician inquir-
ies or requests for action. It is reproduced below.
While reviewing this Protocol Manual, consider
that it was designed to accomodate informal dispo-
sition of minor and uncomplicated complaints as
well as complex and serious matters which raise
questions including due process, patient or physician
appeals, proposed disciplinary actions, and Board of
Directors consideration of continuation of a physi-
cian’s State Medical Society membership. Certain
complaints received by the Commission on Media-
tion and Peer Review are resolved through case eval-
uation by a subcommittee of the Commission whose
members provide reports and recommendations to
the Chairman regarding the complaints. Frequently
this subgroup reaches conclusions which are im-
parted in writing to both the subject physician and,
as appropriate, to the complainant. In any event,
all cases are reported to the Commission. Matters
of more serious nature require application of the
Protocol Manual as necessary.
* * *
COMMISSION ON MEDIATION AND PEER REVIEW
Protocol Manual
I. INTRODUCTION
Purpose
This Manual has been developed to guide and regu-
late the disciplinary activities of the State Medical Society
of Wisconsin. It is designed to assure that these activities
will be conducted fairly for all parties involved and will
meet relevant legal standards of due process. In conduct-
ing its activities under this Manual the Commission is
organized and shall be operated for the purpose of im-
proving the quality of health care.
Factual Background
The Commission on Mediation and Peer Review is
assigned the function of investigation, evaluation and
decision of disciplinary matters for the State Medical
Society of Wisconsin, subject to its Constitution and
Bylaws and the policy control of its House of Delegates
and Board of Directors. The procedures for conducting
this disciplinary activity have been delegated to the Com-
mission. In developing these protocols the Commission
has considered Society discipline in relation to its other
activities including mediation, peer review, and assis-
tance to impaired physicians.
WISCONSIN MEDICAL JOURNAL, JUNE 1985:VOL. 84
47
Jurisdiction
A. The Commission has jurisdiction over all complaints
from whatever source on the basis of which any form
of discipline may be imposed by the Society.
1. If the substance of a complaint under the jurisdic-
tion of the Commission is also pending before any
court, the Medical Examining Board or any other
governmental agency, the Commission will suspend
its disciplinary proceedings until the matter is re-
solved in the other form.
2. The Chairman of the Commission may, in his
discretion and with the concurrence of the county
medical society involved, cede jurisdiction over any
disciplinary matter to a county medical society.
3. The Chairman of the Commission may, in his
discretion, accept jurisdiction over any disciplinary
matter initiated before a county medical society if
requested to do so by any party to the proceeding
and if the county medical society involved concurs.
4. The Society, through the Commission, may exer-
cise original jurisdiction over complaints made to
the Society.
B. The Commission has jurisdiction over all requests
for peer evaluation of physicians and their services.
C. The Commission has jurisdiction over Society efforts
to assist and rehabilitate impaired physicians.
D. In exercising its jurisdiction under these protocols the
Commission shall follow, interpret and implement
the policies of the State Medical Society of Wisconsin.
Commission Organization
A. For purposes of conducting its activities under this
Manual, the Commission shall be organized to per-
form the following functions: (1) receipt and screening
of complaints and requests, (2) mediation/investiga-
tion, (3) confrontation of impaired physicians, (4)
case coordination, and (5) fair hearing.
B. The Chairman of the Commission may assign mem-
bers of the Commission to the various functions,
which assignments may be made on a term or case-
by-case basis.
C. The Assignment of members of the Commission shall
be made in a manner to assure that: (1) physicians who
are subject to actions under the Commission’s juris-
diction are treated fairly and decisions affecting them
are made in an unbiased manner; (2) the Commission
operates efficiently for the purposes for which it was
created; and (3) the abilities and interests of Commis-
sion members are used effectively.
II. MEDIATION PROCEDURES
Complaints
A. All complaints on the basis of which discipline may
be imposed by the Society shall be directed to the
Chairman of the Commission or his designee for
initial screening and acknowledgement.
1 . Initial screening involves determination whether the
complaint is one upon which disciplinary action
may be taken and whether it is in a form to be
acted upon by the Commission. At this stage com-
plaints and inquiries which may lead to complaints
may be informally handled and, if possible, re-
solved without further proceedings.
2. All complaints shall, if possible, be acknowledged
indicating (a) whether the complaint is one upon
which disciplinary action may be taken, (b),
whether it is in form to be acted upon by the Com-
mission, and (c) if not, what the complainant must
do to put it in proper form. If the complaint is one
upon which disciplinary action may be taken, a
copy or abridgement of the relevant portions of the
Society’s Constitution, Bylaws and these protocols
shall accompany the acknowledgement.
B. To be in form to be acted upon by the Commission, a
complaint must:
1. Be in writing;
2. Be signed by the complainant;
3. Identify the complainant and the physician com-
plained against by name and address;
4. State the nature and reasonable details of the com-
plaint and identify, to the extent complainant is
able to do so, other sources of information bear-
ing on the complaint.
5. Include an authorization permitting the Commis-
sion or its designee to inspect and copy all medical
and hospital records of complainant related to
the subject of the complaint and waiving all priv-
ilege and confidentiality relating to such records
and to any testimony or other statements related to
the subject of the complaint.
C. After screening of a complaint, if it is one upon which
disciplinary action may be taken and it is submitted
in proper form to be acted upon, it shall be referred
by the Chairman or his designee to one or more mem-
bers of the Commission for mediation and investiga-
tion.
Mediation/Investigation
A. Those members of the Commission to whom the com-
plaint is referred for mediation and investigation
(the reviewers) shall review the complaint and any
other Commission records related to the subject phy-
sician.
B. The reviewers or their agents shall contact the subject
physician, notifying the subject physician of the fact
that a complaint has been filed and providing such
detail of the complaint as they deem appropriate.
They shall also provide the subject physician with a
copy of these protocols.
C. The reviewers shall arrange one or more meetings,
as they deem necessary or advisable, with the subject
physician.
1. The reviewers shall look into the details of the
incidents upon which the complaint is based and
determine the subject physician’s position on these
incidents.
2. The reviewers may expand their fact finding
into other parts of the subject physician’s practice
than those related to the complaint. The subject
physician shall be responsible to obtain all neces-
sary authorizations for the reviewers to review such
records as they may request and all necessary waiv-
ers for their use of the information obtained for
the functions of the Commission.
3. As a condition to the mediation efforts of the
reviewers and as an aspect of full cooperation by
the subject physician, the subject physician shall
48
WISCONSIN MEDICALJOL RNAI., JUNE 1985: VOL. 84
execute a written consent to mediation acknow-
ledging that the reviewers are acting in good faith
to help improve the quality of health care and
waiving any right of action existing or later arising
against the Society or anyone acting through it or
on its behalf for good faith efforts to pursue the
procedures established under these protocols.
4. In conducting their mediation efforts the reviewers
may use or cooperate with other commissions or
committees of the Society, county medical socie-
ties, the American Medical Association or any
other public or private organization with the pur-
pose of improving the quality of health care.
D. If it appears possible to resolve the issues of the com-
plaint amicably between the complainant and the
subject physician and this appears to be in the best
interests of the public and the quality of health care,
the reviewers may serve as mediators to effect such
resolution.
1. In the event a complaint is resolved by mediation,
the reviewers will submit a mediation report of
their findings and the resolution of the matter to the
Chairman of the Commission or his designee and
action on the complaint shall be terminated.
2. The mediation report shall be maintained on a con-
fidential basis in the records of the Commis-
sion.
E. If the complaint is not resolved by mediation, the
reviewers shall submit an investigation report and
recommendation for action to the Chairman or his
designee.
1. The investigation report shall contain: (a) a synop-
sis of the complaint, (b) a summary of the review-
ers’ actions to investigate the complaint, (c) a state-
ment of any investigation by reviewers beyond the
scope of the complaint, (d) the reviewers’ findings
on the quality of health care provided by the sub-
ject physician in regard to the matter complained
of and other aspects of the practice of the subject
physician together with excerpts or copies of rec-
ords or other matters discovered during the investi-
gation which affect their findings, and (e) the
reviewers’ recommendations.
2. The reviewers may recommend: (a) dismissal of the
complaint, (b) additional mediation to resolve the
complaint or to correct deficiencies in the subject
physician’s practice, (c) proceeding with the Com-
plaint before the Commission, or (d) such other
action as the reviewers deem appropriate.
3. The Chairman or his designee, after consideration
of the report and, if he deems it advisable, meeting
with the reviewers, shall accept the reviewers’
recommendations and proceed on the basis of them
or pursue a different course of action, in which
event he shall prepare and append to the investiga-
tion report a statement of his reasons for not ac-
cepting the recommendations. A copy of this state-
ment shall be given to the reviewers.
4. The investigation report and any statements ap-
pended to it shall be maintained on a confidential
basis in the records of the Commission.
5. Further action of the Commission on the matter
shall be as determined by the Chairman or his
designee. If further mediation is ordered, those
members assigned to conduct it shall serve and
report as reviewers under these protocols.
F. Failure of the subject physician to cooperate fully
with the work of the reviewers may be considered
cause for the imposition of discipline under these
protocols.
Hearing
A. For each complaint with which the Commission pro-
ceeds, the Chairman or his designee shall name one
member of the Commission as the Commission case
coordinator.
1. The Commission case coordinator shall review
the investigation report and recommendation and
all other matters related to the complaint and inves-
tigation and may contact the complainant, the
reviewers, the subject physician or such other
persons as he deems necessary to prepare and
present a case to a hearing panel. The Commission
case coordinator may request from the Chairman
such assistance as he may require for this purpose.
2. The Commission case coordinator shall prepare
charges and specifications against the subject phy-
sician. These charges and specifications shall state
the basis upon which discipline is sought and the
alleged actions of the subject physician which may
justify disciplinary action.
3. The Commission case coordinator shall be respon-
sible for the preparation and presentation to the
hearing panel of evidence, including witnesses,
documents and physical evidence, relating to the
imposition of discipline against the subject phy-
sician.
B. Within 15 days after advancement of a complaint
for hearing, the Chairman or his designee shall ap-
point a hearing panel of not less than three members
to hear the complaint.
1. None of the members appointed to the hearing
panel shall have been involved in any way in the
receipt, screening, reference, mediation or investi-
gation of the particular complaint at any prior time
nor shall any member be appointed to a hearing
panel if there is any reason he would be unable
to evaluate the matter fairly and objectively.
2. One of the members of the hearing panel shall
be designated presiding officer of the panel by the
Chairman or his designee.
3. The hearing panel shall be responsible for receipt
and evaluation of evidence on the charges and
specifications in each matter heard by it and for
determination on the basis of the evidence received
what discipline, if any, should be imposed by the
Society against the subject physician.
C. The Commission case coordinator shall notify the sub-
ject physician by registered or certified mail with
return receipt of the charges and specifications against
him. This notice shall also include the time, date and
place of the hearing on these charges and specifica-
tions as set by the presiding officer of the hearing
panel. The hearing shall be set not less than 10 days
nor more than 30 days after mailing of the notice,
subject to rescheduling by agreement of the presiding
officer, the Commission case coordinator and the
subject physician.
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
49
D. The rules of procedure for a hearing under these pro-
tocols shall be:
1. The complainant and the subject physician shall
have the right to be present at all times when the
hearing panel is hearing testimony or receiving
other evidence.
2. The complainant and the subject physician shall
have the right to be represented at the hearing by
a person of his choice, who may be an attorney.
3. The complainant and the subject physician shall
have the right to present witnesses, documents
and physical evidence relevant to the charges and
specifications before the hearing panel.
4. The presiding officer may appoint a hearing officer
to conduct the hearing procedure. If a hearing
officer is appointed, he shall exercise the proce-
dural discretions of the presiding officer under these
protocols.
5. The hearing panel shall not be bound by rules of
evidence applicable in courts of law but the presi-
ding officer may limit evidence presented to that
which is relevant and not unreasonably cumulative
and may set time limits for the presentations of
the Commission prosecutor and the subject phy-
sician so long as the limits set do not deprive the
subject physician of a fair hearing of his case.
6. The order of hearing shall be: (a) the Commission
case coordinator presenting evidence relating to the
imposition of disciplinary actions; (b) the subject
physician; (c) rebuttal by the Commission case
coordinator. During rebuttal no new matters may
be raised. Evidence may be presented by question
and answer, in narrative form, or whatever manner
the party chooses. There shall be no cross-examina-
tion but the hearing panel and hearing officer,
if any, may ask questions of any witness. If the
subject physician fails to appear at the hearing the
Commission case coordinator shall present the evi-
dence relating to the imposition of diseiplinary
action and this shall form the record upon which
the hearing panel acts.
7. Parties may file written summaries or briefs within
time limits set by the presiding officer.
8. All hearings may be recorded stenographically or
electronically.
9. As to all other procedural matters the presiding
officer shall establish such rules as will insure a
fair and impartial hearing.
E. In those situations in which discipline is imposed for
failure of the subject physician to pay dues or as a
result of the subject physician’s loss of his license
to practice medicine, no mediation or investigation is
necessary before prosecution. The Commission case
coordinator shall have made a prima facie case by
presenting a signed statement from the treasurer of the
Society that the subject physician’s dues are unpaid, or
from a member or staff person of the Medical Examin-
ing Board that the subject physician is no longer
licensed to practice medicine in Wisconsin, as appro-
priate.
F. The hearing panel shall meet in executive session to
determine what discipline, if any, shall be imposed.
1. Discipline may include private or public reprimand,
limitation, suspension or revocation of the subject
physician’s membership in the Society. The hearing
panel may also recommend to the Society’s Board
of Directors that the matter be referred to the
proper governmental agency for further action.
This referral may be made only by act of the Board
of Directors.
2. The hearing panel shall reduce its decision to
writing stating: (a) the facts found by it, (b) that
these facts do or do not support the imposition of
disciplinary action, and (c) the discipline imposed
or that no discipline is imposed. The decision shall
be signed by a majority of the hearing panel and
if any member of the hearing panel disagrees with
the decision that member may present separate
views which shall be appended to the decision.
3. A copy of the decision and separate views, if any,
shall be sent registered or certified mail with return
receipt to the complainant and the subject phy-
sician.
G. Within 15 days after the date of mailing of the deci-
sion, either the complainant or the subject physician
may request in writing addressed to the Chairman
that the matter be reheard.
1. Rehearing may be granted by the Chairman only on
the grounds of material error by the hearing panel
or new evidence which could not reasonably have
been presented at the hearing. The request must be
specific in stating and supporting the grounds
asserted.
2. The rehearing, if granted, shall be held on 15 days’
written notice to all parties who appeared at the
hearing. It shall be limited to those matters stated
as grounds for seeking rehearing.
3. A matter returned for rehearing shall be decided
considering the additional evidence presented to-
gether with that originally presented. A decision as
outlined in paragraph E., above, shall be issued
and served.
H. The decision of the hearing panel shall stand as the
act of the Society and shall be accepted and ratified by
the Board of Directors unless it is appealed as provid-
ed in these protocols or the Board of Directors on its
own motion determines the return of the matter to the
Commission for further proceedings.
Appeal
A. A decision of a hearing panel may be appealed to the
Board of Directors by either the complainant or the
subject physician.
1 . A notice of appeal shall be filed with the Secretary
of the Society in writing within 15 days after (a)
the final decision or (b) notice of denial of a re-
quest for rehearing is mailed to the party taking
the appeal.
2. The notice of appeal must state: (a) the basis upon
which it is taken, (b) that part or parts of the deci-
sion with which the appealing party disagrees,
and (c) the appealing party’s proposed modifica-
tion of the decision.
B. An appeal under these protocols shall be set as a
special order of business on the agenda of the Board
of Directors not sooner than 15 days nor later than
90 days after the notice of appeal is filed with the
Secretary unless all parties agree otherwise.
1 . A summary of the matter shall be prepared by the
presiding officer of the hearing panel for distribu-
50
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
tion as a confidential enclosure to the agenda. In the
case of appeal from a county medical society decision,
the summary shall be prepared by an officer of that
society.
2. If the Secretary deems it necessary, all or part of the
record of the hearing panel, including exhibits,
documents and physical evidence, shall be made
available to the directors in advance of or at the
hearing of the appeal.
C. The appeal shall be heard before the Board of Direc-
tors in closed session.
1 . The case for complainant shall be presented by the
Commission case coordinator or his representative.
The case for the subject physician shall be present-
ed by the subject physician or his representative.
2. No new evidence may be presented on appeal nor
will witnesses be heard. Presentations will be
limited to argument of the issues as stated in the
notice of appeal. Reference to evidence presented
to the hearing panel may be made during such
argument. The appealing party shall speak first
and be given time for rebuttal. Written summaries
or briefs may be submitted within time limits set
by the Board of Directors.
3. The Chairman of the Board of Directors may set
other rules of procedure, including reasonable time
limitations, as he deems appropriate.
D. The Board of Directors may affirm, modify or reverse
the decision appealed from or may refer the matter for
further hearing and decision to a hearing panel with
whatever instructions it deems appropriate.
E. The Board of Directors or Society committee so
designated by the Board shall hear and decide appeals
from disciplinary decisions of county medical societies
using the same procedures as those set forth herein for
decision of appeals from a hearing panel.
III. PEER REVIEW PROCEDURES
Requests
A. All requests for peer evaluation of physicians and their
services shall be directed to the Chairman of the Com-
mission or his designee for initial screening and
acknowledgement.
1. Initial screening involves determination whether
the evaluation procedure is one which the Com-
mission is empowered to undertake and capable
of undertaking and whether the requesting party
is one for which the Commission may legally
undertake the requested evaluation.
2. Compensation to the Society for the Commission’s
peer review activities shall be set by the Board
of Directors.
3. The request shall contain such authorizations for
the inspection, copying and use of records as the
requesting party has relating to the subject matter
of the request.
4. In acknowledging the request a copy of these pro-
tocols shall be supplied to the third party unless
this has been done previously.
B. After screening of a request, if it is one which the
Commission is empowered to undertake and capable
of undertaking and the requesting party is one for
which the Commission may legally undertake the
requested evaluation, it shall be referred to one or
more members of the Commission for evaluation.
Evaluation
A. Those members of the Commission to whom the
request is referred for evaluation (the evaluators)
shall review the request and any materials sent with
it.
B. The evaluators or their agents shall contact the subject
physician, notifying the subject physician of the
fact a request has been received and providing such
detail of the request as they deem appropriate. They
shall also provide the subject physician a copy of these
protocols.
C. The evaluators shall make as thorough an investiga-
tion as possible of the matters relating to the request
so as to be able to report responsively to the request-
ing party.
1. The investigation may include meeting with the
subject physician if the evaluators deem this neces-
sary or advisable.
2. The evaluators shall seek to obtain, from the sub-
ject physician or otherwise, all authorizations
for the inspection, copying and use of records
necessary for them to investigate the matters
thoroughly.
3. The subject physician shall be asked to execute a
written consent to review acknowledging that
the evaluators are acting in good faith to help
improve the quality of health care and waiving
any right of action existing or later arising against
the Society or anyone acting on its behalf for good
faith efforts to pursue the procedures established
under these protocols. Refusal to execute this con-
sent and waiver may be considered cause for the
imposition of disciplinary action against the subject
physician.
4. In conducting their review the evaluators may use
or cooperate with other commissions or commit-
tees of the Society, county medical societies, the
American Medical Association or any other public
or private organization with the purpose of improv-
ing the quality of health care.
Report
A. Following their investigation the evaluators shall pre-
pare a review report and submit this to the Chairman
or his designee.
1. The review report shall be responsive only to the
specific request of the third party and summarize
the findings of the evaluators’ investigation.
2. In addition, the evaluators may submit a supple-
mental report to the Chairman or his designee
covering matters found in their investigation not
bearing on a responsive reply to the request. The
Chairman or his designee may, on the basis of the
supplemental report, initiate mediation proce-
dures or recommend that the Board of Directors
refer the matter to an appropriate public or private
organization.
3. Except as otherwise provided herein, the review
report and any supplemental report shall be main-
tained on a confidential basis in the records of the
Commission.
WISCONSIN MEDICAL JOCRNAI,, JL'NE 1985:VOL. 84
51
B. The Chairman or his designee shall read the review
report and may, upon consultation with the evaluators
or others, make modifications in it.
C. Once the review report is in final form, a copy shall
be sent on a confidential basis to the third party who
requested the peer evaluation and a copy shall be sent
to the subject physician informing him that he may
submit a statement objecting to or clarifying the
review report. If any such statement is received a copy
shall be promptly sent to the third party.
IV. IMPAIRED PHYSICIAN PROCEDURES
Requests
A. All requests for assistance to an impaired physician
or notification of need for such assistance shall be
directed to the Chairman of the Commission or his
designee for initial screening and acknowledgement,
if appropriate.
1. The term “impaired physician” includes physicians
whose professional or personal well being or
performance is adversely affected or threatened
by abuse of alcohol or other chemical substances,
or by reason of physical or mental illness or
senility.
2. Initial screening involves verification of the facts
underlying the request for assistance or notifica-
tion.
B. After screening, if the situation involves an impaired
physician, the Chairman shall designate a member
of the Commission (the confronter) to “confront”
the impaired physician in the company of a consult-
ant. The consultant should be chosen on the basis
of experience in the field of the subject physician’s
impairment, if possible.
Confrontation
A. The impaired physician shall be confronted compas-
sionately by the confronter and the consultant with
respect to the impairment and advised of the concerns
of colleagues, family and others.
B. The confronter shall discuss the impairment with
the subject physician and urge acceptance of appro-
priate recommendations of assistance. The con-
fronters shall not provide any form of therapy, but
rather recommend available types of therapy and
identify and suggest rehabilitation facilities through
which therapy is available.
C. Confrontation on more than one occasion by different
teams of confronters and consultant may be neces-
sary.
D. Assuming the subject physician accepts and enters
a course of rehabilitation or therapy, liaison shall
be maintained with the impaired physician and seek
to obtain reports concerning his progress rather than
the details of therapy.
E. All records, notes and reports related to the con-
frontation of impaired physicians shall be maintained
on a confidential basis in the records of the Commis-
sion.
Referral
A. In the event the subject physician refuses to accept
confrontation, declines to enter or continue a recom-
mended course of treatment, or abandons treatment
prematurely, the Chairman of the Commission or his
designee shall on consultation with the chairman of
the Board of Directors refer the matter to the
Medical Examining Board or other appropriate agen-
cy if the subject physician poses a potential health
hazard to the public.
B. If no such potential health hazard exists, the Chair-
man of the Commission may recommend that the
Board of Directors refer the matter. The Board of
Directors shall not refer the subject physician to the
Medical Examining Board until it has advised the
subject physician in writing of its intent to refer, the
reason for referral, and has allowed 15 days for an
appeal of the proposed action. ■
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52
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
WISCONSIN ADOPTION
AGENCIES
Licensed Voluntary Agencies
Bethany Christian Services, W255 N499 Grand-
view, Waukesha 53187
Catholic Social Services— Diocese of Green Bay,
1825 Riverside Dr, PO Box 38, Green Bay 54305
Catholic Charities, Inc,— Diocese of LaCrosse,
128 South 6th St, PO Box 266, LaCrosse 54601
Catholic Social Services— Diocese of Madison,
2702 International Lane, Madison 53704
Catholic Social Services of the Archdiocese of
Milwaukee, Inc, 2021 N 60th St, Milwaukee 53208
Children’s Service Society of Wisconsin, 610
North Jackson St, Milwaukee 53202
Lutheran Children’s Friend Society, 8138 Har-
wood Ave, PO Box 13367, Wauwatosa 53213
Lutheran Social Services of Wisconsin and Up-
per Michigan, 3200 West Highland Blvd, Mil-
waukee 53208
Pauquette Children’s Service, 304 West Cook St,
53901
Seven Sorrows of Our Sorrowful Mother Infants’
Home, Rt #1, Box 905, Necedah 54646
Wisconsin Lutheran Child and Family Service,
6800 North 76th St, Milwaukee 53223
Public Agencies
Division of Community Services (Regional Offices)
(See page 152 for list of Regional Offices.)
Milwaukee County Department of Social Ser-
vices, Child Welfare Division, 1220 West Vliet St,
Milwaukee 53205
Maternity Homes
Lutheran Maternity Home, 1910 South Avenue,
LaCrosse 54601
Rosalie Manor, 19305 West North Ave, Brookfield
53005
♦ * ♦
Agencies licensed to make adoptive home studies
and to contract with other agencies to make place-
ments but not licensed to accept guardianship.
The Human Element, Inc, 2701 North 56th St,
Milwaukee 53210
Hope International Family Services, Inc, 421 S Main
St, Stillwater, MN 55082
WISCONSIN POISON CONTROL
PROGRAM NETWORK
It is a health service that provides standardized
poison management information and treatment to
both medical professionals and the general public
through a network of regional and satellite centers.
Each center is staffed by specially trained poison
information professionals available to answer tele-
phone inquiries 24 hours a day, seven days a week.
Telecopying equipment enables the staff to make
immediate contact with national headquarters in
Pittsburgh when additional information or re-
search is needed on difficult cases of ingestion.
The centers:
• recommend treatment procedures to physicians
and to the public in poison emergencies.
• maintain a record of calls received, treatment
advised or given and disposition of the case.
• report certain poison incidents to the Division of
Health.
• conduct education and prevention activities in the
community.
The two regional centers are:
Milwaukee Poison Center
Milwaukee Children’s Hospital
1700 W Wisconsin Avenue
Milwaukee, WI 53233
Tel 414/931-41 14
Poison Center— Madison Area
University Hospitals
600 Highland Avenue
Madison, WI 53792
Tel 608/262-3702
The three satellite centers are:
Eau Claire Poison Center
Luther Hospital
310 Chestnut Street
Eau Claire, WI 54701
Tel 715/835-1515
Green Bay Poison Center
St Vincent Hospital
835 So Van Buren St
Green Bay, WI 54305
Tel 414/433-8100
In addition, other small poison control centers in
many other hospitals may have direct contact with
a regional or satellite center to receive assistance as
a “member center’’ of the network.
This information provided by the
WISCONSIN DEPARTMENT OF HEALTH
AND SOCIAL SERVICES
DIVISION OF HEALTH
PO Box 309 Madison, Wis 53701
LaCrosse Poison Center
St Francis Hospital
709 South 10th Street
LaCrosse, WI 54601
Tel 608/784-3971
WISCONSIN MEDICAl JOL RNAI., Jl NE 198.5 : VOL. H4
53
Wisconsin’s fee splitting statute
WISCONSIN’S LAW prohibiting fee splitting appears
as a part of the Medical Practices Act, Wisconsin
Statute Chapter 448. The original fee splitting law was
enacted in 1913. At the time it was passed, the law’s
objective was to prohibit physicians and surgeons in
the larger cities from paying fees or commissions to
the country physicians and surgeons for inducing or
advising patients to submit to operations or treat-
ments by the city physicians and surgeons. Despite
subsequent changes in 1959, 1973, 1975 and 1977 in
numbering, organization, and the inclusion of addi-
tional provisions, the law’s basic prohibition, to pre-
vent physicians from receiving referral fees and com-
missions from other healthcare providers, has re-
mained constant.
Another important feature of the fee splitting
statute is its definition of physician employment and
consultation contracts with hospital and medical
education and research organizations. Vital to this
definition of employment and consultation contracts
is the manner in which contracts are authorized
through both the institution and its medical staff.
In conjunction with the statutory prohibition
against fee splitting practices set out in §448.08,
Chapter 448 of the Wisconsin Statutes includes a
penalty section, §448.09. Under the penalty section,
violations as described in 448.08 are punishable by
fines not to exceed $10,000 or imprisonment not to
exceed nine months or both. Because criminal penal-
ties are imposed, section 448.08 must be strictly con-
strued, that is to say, the fee splitting definitions must
be read for what they state and not for what they
could mean. With this guideline in mind, what
follows is a provision-by-provision look at the fee
splitting statute with interpretative and explanatory
comments.
Wisconsin Statutes, section 448.08 (1977)
(1) Fee Splitting. Except as otherwise provided in this
section, no person licensed or certified under this
chapter may give or receive directly or indirectly to or
from any person, firm or corporation any fee, commis-
sion or rebate or other form of compensation or any-
thing of value for sending, referring or otherwise
inducing a person to communicate with a licensee in
a professional capacity, or for any professional services
not actually rendered personally or at his or her
direction.
The first section of the statute prohibits two things.
First, it prohibits a licensee under chapter 448 from
receiving any fee for sending, referring or otherwise
inducing a person to communicate with another
licensee. Second, the statute prohibits any licensee
under the chapter from receiving any fee “for any
professional services not actually rendered personally
or at his or her direction.” Each reference the statute
makes to “licensee” means cr// licensees under chapter
448, namely, (1) physical therapists, (2) physicians,
and (3) podiatrists.
More specifically, the statute prohibits a physician
from taking any fee or commission from another
service provider, even if the provider is not licensed
under chapter 448 for any service not actually per-
sonally rendered by the physician or at the physician’s
direction. “Service provider” refers to hospitals,
laboratories, clinics as well as allied healthcare pro-
viders whether licensed by state law or not. A phy-
sician violating this provision will be subject to the
penalties listed in section 448.09 although the service
provider, if not licensed under chapter 448, will not
be subject to these or other criminal penalties.
The statute does not prohibit a physician from par-
ticipating with or directing a licensee, such as a phy-
sical therapist, to render treatment to the physician’s
patient where both the physical therapist and physi-
cian receive compensation for service rendered. (See
Opinions of the Attorney General, vol. 71, April 15,
1982.) In this instance where the physician utilizes the
services of another licensed provider, the separate bill-
ing requirement of subsection (2) must be followed.
(2) Separate Billing Required. Any person licensed
under this chapter who renders any medical or surgical
service or assistance whatever, or gives any medical,
surgical or any similar advice or assistance whatever
to any patient, physician or corporation, or to any other
institution or organization of any kind, including a
hospital, for which a charge is made to such patient
receiving such service, advice or assistances, shall,
except as authorized by Title 18 or Title 19 of the
federal social security act, render an individual state-
ment or account of the charges therefor directly to such
patient, distinct and separate from any statement or ac-
count by any physician or other person, who has
rendered or who may render any medical, surgical or
any similar advice or assistance to such patient, physi-
cian, corporation, or to any other institution or organiza-
tion of any kind, including a hospital.
This section prohibits fee splitting by requiring that
each healthcare provider licensed under this chapter
who renders service to a patient list the charge for
service separately and distinctly on the bill. Separate
billing is also required of a licensee who renders
medical services or gives advice or assistance to a cor-
poration, or any other institution or organization of
any kind, including a hospital.
This section does not prohibit a physician from bill-
ing a patient for the services of a licensee, such as a
physical therapist, who is employed by the physician’s
service corporation organized under Wisconsin
Statute section 108.99 so long as the bill reflects the
separate charges. The reason why this situation is not
fee splitting is that the licensee’s bill alone could not
include the cost of his or her employment to the
service corporation, ie salary, fringe benefits, and
operating expenses. The physician is not receiving a
referral fee or commission from the services rendered
by the licensee in this case, rather, the service corpora-
54
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
tion is charging the patient for the overhead involved
in providing the licensee’s services.
It would be a violation of this section if the physi-
cian billed a patient for services rendered if the
physical therapist’s services are included in the total
charge rather than stated separately and distinctly as
required in the statute. Without the explicit listing of
services, the implication could be that the physician
is exacting a fee for providing the physical therapist’s
services. This rule applies whether the services were
rendered in a clinic, hospital, nursing home or other
institutional setting unless federal law provides other-
wise.
(3) Billing For Tests Performed By The State Laboratory
Of Hygiene. A person other than a state or local govern-
ment agency who charges a patient, other person or
3rd party payer for services performed by the state
laboratory of hygiene shall identify the actual amount
charged by the state laboratory of hygiene and shall
restrict charges for those services to that amount.
This section addresses a specific circumstance
under which no referral fee can be added to a bill for
services — when laboratory services are performed by
the State Laboratory of Hygiene. The licensee or his
or her service corporation should be able to charge
the patient or payer for reasonable costs of collect-
ing, preparing and transporting specimens analyzed
by the State Laboratory of Hygiene so long as this
charge is clearly identified on the bill for service.
In addition to this prohibition under state law, the
AM A Judicial Council addresses laboratory charges
in the Current Opinions. In this set of opinions, the
AM A Judicial Council states that when it is not possi-
ble for the laboratory bill to be sent directly to the pa-
tient, the referring physician’s bill to the patient
should indicate the actual charges for laboratory
services, including the name of the laboratory, as well
as any separate charges for his or her own profes-
sional services. As does subsection (3), the AMA
Judicial Council opinion underscores the principle
that any compensation paid to or presumed by law
to have been paid to the physician by a provider for
referring business to the provider is illegal and un-
ethical, whether that provider is a clinic, laboratory,
hospital, another licensed or nonlicensed provider.
One question that arises from this discussion of
laboratory referrals is what happens when a physician
has ownership interest in a laboratory through, for
example, a general corporation rather than a service
corporation, and refers patient tests to this laboratory
from which he or she receives profits? This question
was posed to the Wisconsin Attorney General’s Of-
fice which enforces this and other state statutes. The
informal answer given is that so long as the labora-
tory charges are listed separately on the patient’s bill
for medical services, the physician would not be in
violation of the fee splitting statute. In this instance,
the purpose of the fee splitting prohibition is not in-
volved although the physician does indirectly receive
compensation for referring business to this nonservice
corporation business entity. The key to determining
when the fee splitting prohibition applies goes to the
original intent of the law — preventing kickbacks and
referral fees between healthcare providers.
(4) Professional Partnerships And Corporations Per-
mitted. Notwithstanding any other provision in this sec-
tion, it is lawful for 2 or more physicians, 2 or more
podiatrists or 2 or more physical therapists, who have
entered into a bona fide partnership for the practice of
medicine, podiatry or physical therapy, to render a
single bill for such services in the name of such part-
nership; and it also is lawful for a service corporation
of physicians, podiatrists or physical therapists to
render a single bill for such services in the name of the
corporation; provided that each individual physician,
podiatrist or physical therapist rendering services so
billed for shall be individually identified as having
rendered such services.
As mentioned previously, the statute recognizes the
instance where the services provided to a patient in-
volve a service corporation duly formed under Wis-
consin Statute section 180.99. In this case, fee splitting
is not presumed when the service corporation bills the
patient for services rendered by an employe and the
employe is listed as having rendered this service on
the bill. (For information on service corporations
under Wisconsin law, see SMS brochure “Guide to
the Service Corporation Law’’.)
The statute also provides an exception for bona
fide partnerships between licensees of the same cate-
gory (“2 or more podiatrists . . .’’). This means that
there must be a genuine, provable contract between
the practitioners. A “good faith’’ partnership does
not include one created for some single occasion or
circumstance, or an artificial arrangement between
two or more practitioners set up for the primary pur-
pose of avoiding the statutory requirement of
separate billing in subsection (2). Filing partnership
income tax returns would ordinarily indicate the
organization’s good faith.
The AMA Judicial Council discusses dividing in-
come among members of a group practice in its 1984
Opinions. In this section, the AMA Judicial Coun-
cil states that the division of income among members
of a group, practicing jointly or in a partnership,
may be determined by the members of the group and
may be based on the value of the professional medical
services performed by the member and his or her
other services and contributions to the group. This
activity is apparently permissible under the statutes
if the group is a bona fide partnership or a profes-
sional service corporation and if the income received
was billed according to this subsection, that is, the bill
showed which provider supplied the service to the
patient.
(5) Contract Exceptions; Terms. Notwithstanding any
other provision in this section, when a hospital and its
medical staff or a medical education and research
organization and its medical staff consider that it is in
the public interest, a physician may contract with the
hospital or organization as an employe or to provide
consultation services for attending physicians as pro-
vided in this section.
WISCONSIN MEmCAI. JOURNAL, JUNE I985:VOL. 84
55
Subsection (5) introduces the situation in which the
next statutory exception to fee splitting may occur:
when a physician is employed by a hospital or a
medical and educational research organization. By
the statute’s language, this contract between the
physician and the institution or hospital may either
be for employment or consultation services. The
reference to “its medical staff” refers to those physi-
cians and surgeons having staff privileges in the insti-
tution, even though the medical staff might not be
formally organized as might be the case in a limited
number of institutions. Finally, the statute requires
that the institution and the medical staff find that
physician contracting is “in the public interest.” This
requirement means that there is a finding as such by
the governing body of the hospital, and by a similar
finding by the medical staff. To avoid misunderstand-
ing, this finding should be incorporated in the medical
staff and hospital records.
The purpose of this subsection is to give continuing
authority to both the medical staff and the govern-
ing body of the hospital to rescind its earlier finding,
to modify it in some respects, or to elaborate it in
other respects. In other words, the decision once
made is not irrevocable.
(a) Contracts under this subsection shall; 1. Require
the physician to be a member of or acceptable to and
subject to the approval of the medical staff of the
hospital or medical education and research organiza-
tion. 2. Permit the physician to exercise professional
judgment without supervision or interference by the
hospital or medical education and research organiza-
tion. 3. Establish the remuneration of the physician.
This provision outlines what a contract between a
physician and hospital or medical education and
research organization must establish under the fee
splitting exception. The first requirement emphasizes
the previously mentioned concept that the medical
staff must approve of the physician contracting situa-
tion as well as the physician with whom the institu-
tion contracts. It is not enough that the physician with
whom the institution wishes to contract be a member
of the medical staff, having first passed the screen-
ing involved in the application and credentialing
process required for medical staff membership. The
statute clearly states that the contracting physician
employe or consultant be a member of or acceptable
to the medical staff and subject to the approval of the
medical staff of the contracting institution. There-
fore, the statute gives the medical staff co-equal
powers with the institutional board in deciding
whether it is in the public interest at all to contract
with a physician as an employe or consultant.
Earlier provisions have been enlarged by the addi-
tion of medical education and research organizations
into its purview. The statute permits the contract to
be either for employment or consultation. Before the
1973 amendment, the statute required only that a con-
tracting staff consultant be a member of or acceptable
to the medical staff. It did not require that the con-
tracting physician be “subject to the approval of” the
medical staff. As mentioned above, the emphasis has
changed to give the physicians already involved in the
institution decision-making authority.
The second requirement states a contract issue in
a positive manner that subsection (d) states in a nega-
tive manner, that is, that no contract for medical
services between a physician and a hospital or medical
education and research organization may interfere
with the physician’s practice of medicine. This sta-
tutory requirement will be discussed in greater detail
later.
The last provision requires that hospital contracts
with an employed or consulting physician shall estab-
lish the physician’s remuneration. An earlier statute
used the same language but required that remunera-
tion be on any basis other than a salary. The current
law essentially authorizes the employment of physi-
cians.
(b) If agreeable to the contracting parties, the hospital
or medical education and research organization may
charge the patient for services rendered by the physi-
cian, but the statement to the patient shall indicate that
the services of the physician, who shall be designated
by name, are included in the departmental charges.
Under this provision, the contracting physician
may elect whether to bill through or independently
of the institution with which he or she contracts. An
example of hospital billing is the “professional
services” element seen on laboratory charges that in-
dicates the fee for the services of the employed path-
ologist. If the physician bills separately, he or she
may, but need not, use the institution as his or her
collection agency. It probably is not practical for an
employed physician to bill separately, but a consulting
physician under contract with an institution clearly
has an election in this respect.
(c) No hospital or medical education and research
organization may limit staff membership to physicians
employed under this subsection.
The above provision forbids a hospital or medical
education and research organization to close its staff
membership to nonemployed physicians. This pro-
hibition is important since it gives the individual
physician the option whether to limit his or her rela-
tionship to the hospital to that of a private practi-
tioner, whether to be a consultant to the staff under
contract with the hospital, or whether to be employed
by it.
This “closed staff” prohibition can be important
in another respect. As the organizational nature of
hospitals in particular undergoes changes in this state
as seen by the movement toward proprietary and
“MeSH” (joint venture between the hospital and
medical staff) based hospitals, this prohibition will
become more important. Under this provision, it
would be illegal for a hospital, for example, which
employs all physicians through a service corporation
model, to close its medical staff membership to new
applicants. This section does not, however, prohibit
exclusive contracts such as a contract between a
56
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
hospital and an anesthesiology group, assuming that
the hospital provides services beyond those offered
by the department of anesthesiology.
(d) The responsibility of physician to patient, particularly
with respect to professional liability, shall not be altered
by any employment contract under this subsection.
As mentioned under (a) 1 ., the fee splitting statute
is designed to authorize physician contracts with hos-
pitals and certain institutions without allowing con-
tracts to change the responsibilities of the physicians
to their patients. The previous section assures that no
contract may interfere with the physician’s practice
of medicine and this provision reinforces the concept
by not allowing responsibilities and liabilities to be
contracted away. This provision could be viewed as
enabling a contracting institution to minimize its legal
exposure and liability by keeping the contracting
physician’s liability as broad as possible. Unfor-
tunately, the wording does not refer to or settle areas
such as privilege or confidentiality, both of which are
important to the patient and traditionally honored by
physicians. It should be noted, however, that other
provisions under state law regarding physician-patient
privilege and records confidentiality are not affected
by this section.
(6) Definitions. As used in this section;
(a) “Hospital” means an institution providing 24-hour
continuous service to patients confined therein which
is primarily engaged in providing facilities for diagnos-
tic and therapeutic services for the surgical and
medical diagnosis, treatment and care, of injured or
sick persons, by or under the supervision of profes-
sional staff of physicians and surgeons, and which is
not primarily a place of rest for the aged, drug addicts
or alcoholics, or a nursing home. Such hospitals may
charge patients directly for the services of their em-
ploye nurses, nonphysician anesthetist, physical thera-
pists and medical assistants other than physicians or
dentists, and may engage on a salary basis interns and
residents who are participating in an accredited train-
ing program under the supervision of the medical staff,
and persons with a temporary educational certificate
issued under s. 448.04(1 )(c).
This definition controls what is meant by the word
“hospital” wherever it appears in the fee splitting
statute. The last sentence of the subsection contains
exceptions to the fee splitting law. The phrase “phy-
sicians or” just ahead of the word “dentists” can
probably be considered impliedly repealed by the
latter enacted provisions of the section. Otherwise,
the services of a physician employed by a hospital
could not be billed when he or she acted as a “medical
assistant.” It is believed that the Legislature intended
that an institution that employs a physician should
be able to bill for all of his or her professional services
as a medical assistant.
(b) “Medical education and research organization”
means a medical education and medical research
organization operating on a nonprofit basis.
The above definition excludes a “hospital” as
defined in (a) immediately preceding. The limits of
the definition will depend upon the facts of a par-
ticular situation.
Medical staff responsibilities
This fee splitting statute analysis and comment ad-
dresses the rights of employed and consulting physi-
cians and of the institutions that contract with either
category. It is important for the interests of the pa-
tient, public, and good medical practice standards to
also emphasize medical staffs’ responsibilities under
the fee splitting statute. Although it should not be
assumed that cases of direct or indirect exploitation
will arise, to minimize this chance and to correct any
instance of exploitation, medical staffs must he aware
of their responsibilities and that they share equal
authority with hospital governing boards under con-
tracting provisions of the fee splitting law. Section
448.08(5) of the Statutes. The authority of medical
staffs is substantial under this statute. This authority
includes and carries with it a corresponding respon-
sibility on the part of medical staffs to satisfy them-
selves that:
(a) Both the governing board andlhc medical staff
have independently determined whether it is in the
public interest for the institution either to employ or
to contract for the consulting services of a physician.
If either body decides in the negative, no valid con-
tract can be made with a particular physician as an
employe or staff consultant.
(b) Any physician proposing to contract with an in-
stitution has the professional qualifications required
for membership on the medical staff. This is the pur-
pose of the statutory provision that a contracting
physician is “subject to the approval of the medical
staff.” A contracting physician is not required to be
a member of the institutional medical staff, but he or
she must be “acceptable to” the staff. Although
medical staff membership is not required by state
statute, the hospital medical staff bylaws might pro-
vide that all physicians, including those contracting
for consulting and other services, first be admitted to
the medical staff.
(c) since the contract between an institution and the
physician is predicated upon the public interest be-
ing served, and must meet certain statutory require-
ments, it follows that the contract itself is open to in-
spection by those having a legitimate interest in it.
For the same reason that the governing board of
a contracting institution is entitled to review its agree-
ment with a physician employe or consultant, the
medical staff is similarly authorized to satisfy itself
that the contract:
( 1 ) Permits the contracting physician to exercise his
or her professional judgment without super-
vision or interference by the institution;
(2) Establishes the remuneration of the physician;
(3) Makes billing arrangements for the contracting
physician’s services as permitted by the statute;
and
WISCONSIN MEDICAL JOL RNAI., JUNE 1985: VOL. 84
57
(4) Does not alter the responsibility of physician to
patient, particularly with respect to professional
liability.
(d) Nothing in the contract supersedes the right of
the medical staff to review and evaluate the profes-
sional qualifications of a contracting or consulting
physician as often as a staff member is subject to this
review and evaluation, including the right to deter-
mine whether it continues to be in the public interest
that the contract remain in force. ■
Recently enacted communicable disease iaws
Major changes in the Wisconsin communicable
disease rule went into effect May 1, 1984. The new
rule, referred to as Chapter HSS 145, Control of
Communicable Diseases, represents the first signi-
ficant revision of this rule in over 20 years. The rule
(HSS 145) is particularly important to medical and
public health professionals because it contains disease
reporting responsibilities and a new list of reportable
diseases, adopts standards for disease prevention and
control, and updates other disease control activities.
HSS 145 replaces Chapters H 45 Communicable
Diseases, H 46 Tuberculosis, H 47 Venereal Diseases,
and H 49 General Regulations on Communicable
Diseases. It is organized into three subchapters: Sub-
chapter I, General Provisions; Subchapter II, Tuber-
culosis; and Subchapter III, Sexually Transmitted
Diseases. HSS 145 requires specific disease preven-
tion and control measures, as contained in Control
of Communicable Diseases in Man, 13th edition
(1981), published by the American Public Health
Association. This manual is a familiar resource to
most public health professionals and infectious dis-
ease specialists in the State and is updated every five
years in light of new knowledge of disease mechan-
isms and the effectiveness of specific control
measures. Physicians should use the control measures
contained in this manual in the instruction of their
patients. The State Epidemiologist may also specify
other disease control recommendations necessary for
the control of a specific disease or condition.
The reporting of communicable diseases is required
of physicians, nurses, laboratories, health care
facilities, teachers in schools and day care centers, and
any other persons knowing of the presence of a com-
municable disease. The list of communicable diseases
which are to be reported has been updated to reflect
changing disease trends and the emergence of new dis-
eases such as Acquired Immune Deficiency Syn-
drome, Legionnaires’ disease, and toxic-shock syn-
drome (see complete list).
This article was prepared by Susan J Stolz, MA and Jeffrey P Davis,
MD of Madison and originally published in the June 1984 BLUE BOOK
issue of the Wisconsin Medical Journal. It is being reprinted this year. Ms
Stolz is from the Section of Acute and Communicable Disease Epidemi-
ology (Communicable Disease Laws); and Doctor Davis is State
Epidemiologist and Chief, Section of Acute and Communicable Disease
Epidemiology.
When a diagnosis of any of the diseases listed
is suspected or confirmed, this fact must be reported
(either verbally or by completing the Acute and Com-
municable Diseases Case Report form, DOH 4151)
to the local health officer in the public health agency
serving the patient’s place of residence. The local
health officer is required to forward all reports of
communicable diseases to the State Epidemiologist
at the Wisconsin Division of Health and is also
responsible for coordinating the local epidemiologic
followup of reported diseases.
(A Directory of City and County Public Health
Agencies in Wisconsin for reporting communicable
diseases is available from the Acute and Communi-
cable Disease Epidemiology Section, Bureau of Com-
munity Health and Prevention, Division of Health,
Department of Health and Social Services, PO Box
309, Madison, Wisconsin 53701; or phone: 608/267-
9003.)
The tuberculosis control measures have been re-
vised to reflect current knowledge about treatment
and transmission of the disease. The list of sexually
transmitted diseases covered by HSS 145 has been ex-
panded to include genital herpes infection (first
clinical episode only), nongonococcal urethritis,
chlamydia trachomatis, nongonococcal cervicitis, and
sexually transmitted pelvic inflammatory disease, in
addition to syphilis, gonorrhea, chancroid, granu-
loma inguinale, and lymphogranuloma venereum.
Unnecessary restrictions of persons with sexually
transmitted diseases have been removed. In addition,
the “Sexually Transmitted Disease Treatment Guide-
lines 1982,’’ published by the US Department of
Health and Human Services, is adopted by reference
in this rule.
Additionally, HSS 145 has eliminated previous
archaic and unenforceable language, including:
references to placarding, requirements for disinfec-
tion of library books by burning, restrictions on occu-
pations of persons with venereal diseases, and regula-
tions of dairies selling nonpasteurized milk (state
statute now prohibits the sale of nonpasteurized
milk).
Copies of Chapter HSS 145 are available from the
Bureau of Community Health and Prevention, Wis-
consin Division of Health, PO Box 309, Madison,
Wisconsin 53701; or phone: 608/267 -9(X)3. Questions
regarding specific provisions of this rule may also be
addressed to the above agency. ■
58
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
Communicable diseases— Category I
The following diseases are of urgent public health
importance and shall be reported by telephone to the
local health officer immediately upon identification of
a case or suspected case.
Anthrax
Botulism
Botulism, infant
Cholera
Diphtheria
Food- or water-borne
outbreaks
Hepatitis, viral
Type A
Measles
Pertussis (whooping
cough)
Plague
Poliomyelitis
Rabies (human)
Rubella
Rubella (congenital
syndrome)
Tuberculosis
Yellow fever
AIDS — Acquired Immune Deficiency Syndrome
The following is a list of AIDS educational and in-
formational materials developed by the Wisconsin
Division of Health (DOH). These materials are
available from DOH in limited quantities upon re-
quest. All materials may be reproduced.
AIDS Update
• AIDS surveillance in Wisconsin.
• Centers for Disease Control National Statistics.
Prevention
• Infection precautions for people with AIDS and for
persons providing direct care to persons with AIDS
living in the community.
• AIDS inpatient infection recommendations and
precautions.
• US Public Health Service. AIDS: precautions for
clinical and laboratory staffs.
• Advice for AIDS patients.
Wisconsin Division of Health Advisories
• Emergency medical services guidelines for the
prevention of Acquired Immune Deficiency
Syndrome.
• Prison guidelines for the prevention of Acquired
Immune Deficiency Syndrome.
Reference Materials
• Morbidity and Mortality Weekly Report and AIDS
reference bibliography.
Social Services
• List of organizations providing services to persons
at risk for AIDS.
Additional Materials
• Applying for Social Security benefits; the
basic facts for people with AIDS.
• Questions and Answers on AIDS for healthcare
providers.
• Order forms for “Living with AIDS: a Self-care
Manual” — for persons with AIDS.
• AIDS: Do You Know the Facts? — Brochure on
AIDS for college age population.
Requests for materials should be directed to:
Holly Dowling, Wisconsin Division of Health, 1
West Wilson St, PO Box 309, Madison, W1
53701-0309; telephone: 608/ 267-3583 ■
Communicable diseases— Category II
The following diseases are of less urgent public health
importance and shall be reported to the local health
officer by individual case report form or by telephone
within 72 hours of the identification of a case or sus-
pected case.
Acquired Immune
Deficiency Syndrome
(AIDS)
Amebiasis
Blastomycosis
Brucellosis
Campylobacter
enteritis
Encephalitis, viral
(specify etiology)
Giardiasis
Hepatitis, viral
Types B, non-A
non-B, or
unspecified
Histoplasmosis
Kawasaki disease
Legionnaires’ disease
Leprosy
Leptospirosis
Lyme disease
Malaria
Meningitis, aseptic
(specify etiology)
Meningitis, bacterial
(specify etiology)
Meningococcal disease
Mumps
Nontuberculous
mycobacterial disease
(specify etiology)
Psittacosis
Q fever
Reye’s syndrome
Rheumatic fever
(newly diagnosed)
Rocky mountain
spotted fever
Salmonellosis
Sexually transmitted
diseases
Chancroid
Chlamydia
trachomatis
Genital herpes
infection (first
clinical episode
only)
Gonorrhea
Granuloma inguinale
Lymphogranuloma
venereum
Nongonococcal
cervicitis
Nongonococcal
urethritis
Sexually transmitted
pelvic inflammatory
disease
Syphilis
Shigellosis
Tetanus
Toxic-shock syndrome
Toxic substance
related disease
Infant methemo-
globinemia
Lead intoxication
(specify Pb levels)
Other metal
poisonings
Other organic
chemical poisonings
Pesticide poisoning
Toxoplasmosis
Trichinosis
Tularemia
Typhoid fever
Typhus fever
Yersiniosis
Suspected outbreaks of other acute or occupationally-
related diseases
Communicable diseases— Category III
The total number of cases or suspected cases of the
following communicable disease shall be reported on
a weekly basis to the local health officer.
Chickenpox
Unlike the previous rules which detailed control
methods for each disease, the new rules adopt by
reference the applicable methods of control con-
tained in Control of Communicable Diseases in
Man, 13th edition (1981), edited by Abram S Benen-
son, published by the American Public Health As-
sociation.
This rule became effective May 1 , 1984. ■
WISCONSIN MEDICAL JOURNAL, JUNE 198,5: VOL. 84
59
Legal responsibilities
of the
physician-patient-hospitai
reiationship
Several questions pertaining to the physician-
patient-hospital relationship were addressed by the
Society’s legal counsel. The questions and excerpts
from the opinion of legal counsel are presented below.
1. is there a special legal responsibility of a physi-
cian to his hospitalized patient?
There are no Wisconsin statutes which directly
cover or govern the question set out above. The basic
statutes on hospitals relate to construction, safety,
standards of maternity departments, and licensure.
In general terms, the courts have held that a physi-
cian has a legal responsibility to his patients, hos-
pitalized or not, to furnish that degree of professional
skill which meets the standard of professional care
and to give such professional attention to the patient
as the case requires. By statute the physician must in-
form patients of alternate viable modes of treatment.
A physician is not legally excused for inattention to
one patient on the grounds that he was occupied with
the needs of others.
A physician has a continuing responsibility to his
hospitalized patient at least to the point where the lat-
ter is well enough to be discharged, or sooner leaves
without the physician’s authorization. A physician
may be charged with abandonment for neglecting a
patient who needs his care, whether during or after
hospitalization. Once a physician has agreed to care
for a particular patient, he must continue to do so
until the patient discharges him or no longer needs his
professional services. He may be legally liable for
neglect of the patient, or for ceasing to care for him
until another physician has replaced him, unless he
has been clearly discharged by the patient before the
relieving physician actually takes over.
While a hospital nurse or technician may tech-
nically be in the employ of the hospital, a physician
may incur legal liability for permitting a nurse or tech-
nician to carry out his treatment orders or assist him
when he knows or has reasonable cause to know that
such person is unsuitable for such duties by reason of
inadequate training, experience, judgment or person-
ality defect.
The essence of negligence is the absence of the
degree of care owed by one person to another. Legal
liability results when negligence causes physical injury
or monetary damage to the object of such negligence.
The principles of law involved are few, but their appli-
cation depends upon the facts of the case, frequently
as evaluated by expert testimony, and as found by a
jury or court.
There also has been a recent trend toward the
definition and codification of social or human rights
of patients apart from their right to receive care meet-
ing the appropriate standards of professional skill. A
patients’ bill of rights for nursing home and residen-
tial care facility residents has been enacted both by
statute and administrative rule. Several hospitals have
adopted or considered such a statement of rights.
While not affecting the nature of care given, this ex-
pression of patients’ rights does affect the environ-
ment within which this care is provided.
2. What is the joint legal responsibility of the physi-
cian and hospital to a hospitalized patient?
The courts in the past tended to distinguish the
administrative negligence of a hospital from the pro-
fessional or medical negligence of a physician. The
first is concerned largely with the furnishing of safe
and adequate facilities, equipment, food and related
services and the carrying out of such routines as bath-
ing or other general care. The other is concerned with
professional treatment or care by the physician, or the
carrying out of the orders of a physician by a nursing
staff, technicians or others. A hospital was liable in
general for administrative negligence, and a physician
for professional negligence on the part of himself or
an agent, where injury results.
The distinction between the administrative and
housekeeping functions for which hospitals were tra-
ditionally responsible and professional activities for
which the physician was responsible has become
blurred. Institutional liability for the negligence of its
paraprofessional employees, frequently joint liability
with independent physicians who are their immediate
supervisors, is well settled. The 1965 Darling case in
Illinois voiced a responsibility of the hospital to review
and supervise the care given in a hospital. That case
rested in part on the failure of hospital employees in
observation and reporting but the principle estab-
lished was broader. A leading Wisconsin case held a
hospital liable for granting staff privileges to an in-
competent practitioner. Other cases found liability for
the failure of the medical staff to supervise physicians
practicing in the institution and for the failure to
establish quality review systems. While these all have
administrative aspects, they also put the hospitals into
potential jeopardy for the quality, or lack of quality,
of care provided in the institution. Thus both hospital
and physician could be liable for concurrent or related
acts of negligence which united to cause damage to a
patient, or where the negligent acts of the one aggra-
vated the injuries caused by the other party.
Where joint negligence has occurred, the patient
may elect to sue the hospital, the physician, or both. If
the patient prevails in court against the two, he may
enforce his judgment wholly against the hospital or
the physician as he may prefer. If there was in fact
joint liability of hospital and physician but the patient
enforced his judgment against the latter, the physician
may then look to the hospital for recovery for such
portion of the damages he has paid as represents the
hospital’s share of the total liability established by the
litigation.
60
WISCONSIN MEDICAL JOURNAL. JUNE 1985: VOL. 84
As a general proposition the hospital and physician
have separate legal responsibility to the patient. The
former is concerned primarily with safe and adequate
facilities and the exercise of a due standard of care in
the selection and supervision of its staff and to some
extent the care given in the institution. The physician
is concerned with the professional care which he either
renders or directs on behalf of the patient. While the
decisions of various courts furnish numerous in-
stances of suits in which hospital, physician and nurse
were jointly sued, it is not uncommon for a court or
jury to determine during the course of the trial that no
liability exits against one or more of the parties sued.
In some cases only the hospital, or the physician or
the nurse is found to have been liable in a particular
situation. In other cases two of them may be found
negligent. In still other cases the suit is dismissed as to
all three.
While the functioning of the hospital as an institu-
tion and of its nurses and technical staffs with the
medical staff call for a high degree of coordination,
teamwork and close understanding, all for the benefit
of the patient, such facts do not of themselves create a
joint legal responsibility. Perhaps the best explanation
is that while teamwork and cooperation are practical
necessities they do not automatically create a joint
legal responsibility. It is up to the patient who asserts
negligence to declare whether the hospital, as an
administrative institution or as an employer, is re-
sponsible for his injury and damage, or whether the
physician or others acting under his direction were
primarily responsible.
3. What is the extent of legally enforceable rights of
a physician against a hospital in which he has
staff privileges?
The legally enforceable rights of a physician against
a hospital growing out of his staff privileges are rela-
tively limited in character. Thus a staff physician can-
not demand that certain managerial policies be
adopted, for that is the function of the governing
board and its administrator. He cannot demand that
the hospital purchase certain equipment, but is en-
titled to observe that such equipment as it has is in-
adequate, poorly maintained or unsafe. The latter
right grows out of his concern for patient interest and
his professional competence to make the observa-
tions.
There are two areas worthy of comment in which a
staff physician has legally enforceable rights. The first
is exemplified in the so-called “inhospital staff
specialties” such as radiology, pathology and
physiatry. When the medical staff and the governing
body of a hospital consider that it is in the public
interest, it is lawful for practitioners in these special-
ties to contract with a hospital to provide consultation
services for attending physicians. Such consultants
must be members of or acceptable to the medical staff
of such hospital. So long as a contract between such a
specialist and a hospital relating to his practice is in ac-
cordance with the fee splitting statute and other appli-
cable laws, it is enforceable by him against the
hospital and by the hospital against him.
The second area of legally enforceable rights en-
joyed by staff physicians are those which relate to
staff privileges as such. The documents which govern
staff privileges are typically bylaws, rules and regula-
tions, the application of an individual physician for
staff privileges and the official action on such applica-
tion, first, by the medical staff, and then by the gov-
erning body of the hospital. A physician whose staff
appointment is regular in every respect acquires legally
enforceable rights once he becomes a member of the
medical staff. Those rights depend upon and are
limited by the provisions of the hospital bylaws, rules
and regulations, and by any particular conditions at-
tached to his appointment, such as limitations on
surgical privileges.
It is the proper business of the individual and col-
lective membership of a medical staff to see that the
granting of staff privileges, their limitation, suspen-
sion and termination are spelled out clearly, ade-
quately and fairly. This is a matter of proper concern
to patients whom the physician may hospitalize, and
of enlightened self-interest to physician and hospital
as well.
There appears to be a trend generally in the courts
of this country to recognize something akin to a prop-
erty right in hospital staff privileges once they are
granted, so long as they remain in force, and assum-
ing that the physician is not guilty of acts of profes-
sional negligence or misconduct. This means that the
trend of the courts is away from permitting summary
suspension or termination of staff privileges without a
fair hearing, except for grave cause which might en-
danger patients or create liability on the part of the
hospital.
Increasing importance should be attached to
“negotiations” between the medical staff and the
governing body or administrator of a hospital. These
can be conducted by the Chief of Staff of a very small
hospital, or by the Executive Committee of the
medical staff of a larger hospital, in areas in which
patient welfare and safety are involved, or in which
tensions or conflict may arise between hospital policy
and medical policy to the detriment of patient welfare.
The latter are not matters of contract right as such,
but are akin to “collective bargaining,” and become a
matter of understanding at the point the hospital and
the medical staff are in agreement. They might in-
clude such areas as the unwillingness of the governing
body of the hospital to follow medical staff recom-
mendations for granting or limiting staff privileges;
failure to purchase desirable or needed equipment or
to replace equipment in the interests of patient safety
or welfare; inadequate selection of the nursing, tech-
nical and other staffs of the hospital, or insufficient
supervision and continued training during the course
of employment.*
WISCONSIN MKDICAI, [OllRNAI., JUNE 198.5; VOL. 84
6
Retention and inspection of patients’ records
It is generally agreed that ownership of medical
and hospital records rests, respectively, with the
physician and the hospital. Their beneficial owner-
ship, that is the right to have them used for one’s
benefit, is in the patient although the right to pos-
session remains in the physician or hospital. The
doctor-patient-hospital relationship has been con-
sidered by the legislature and the courts. They have
declared it to be in the public interest that the patient
have access to relevant records concerning his
medical care and treatment.
Because of the long-standing uncertainty regarding
the rights of physicians, hospital personnel, patients
and others in regard to health care records, efforts
both statutory and private have been made to clarify
this situation. In 1959 the State Medical Society of
Wisconsin and the Wisconsin Hospital Association
jointly developed an Interpretation seeking to define
what is a health record and restate the respective
rights of various interested parties in them. This
Interpretation was printed in the June 1975 Blue
Book issue of the Wisconsin Medical Journal.
(74 WMJ 30)
The law under which the Interpretation was pre-
pared has been subsequently amended. To the extent
of that amendment, the Interpretation is no longer
valid. It does provide a framework from which to
view the issues involved, this framework having been
developed jointly by the health professionals most
directly involved. The new statute. Sec. 804.10(4),
Wis. Stats., is discussed in the box accompanying
this article. It deals with authorization by a patient
for the examination or inspection of that patient’s
health care records.
More recently. Secs. 146.81-.83, Wis. Stats., were
enacted effective 1980. This new law deals with the
release of health care records by consent and without
consent. Health care records are defined as “all
records related to the health of a patient prepared by
or under the supervision of a health care provider.’’
Consent may be given by the patient or one legally
permitted to act on the patient’s behalf. Consent
must contain the name of the patient, the purpose
of disclosure of the records, the type of information
to be disclosed, the person to whom disclosure may
be made, which providers are to make the disclo-
sure, and the time period during which the consent
is effective. Access without consent of the patient is
permitted for staff, accreditation or review com-
mittee use, performance of health care services or
consultation regarding them, billing, collecting and
Reprinted from the June 1980 BLUE BOOK Wisconsin Medical Journal,
with modification July 1982.
payment of claims, on court order, on written
request from an appropriate government agency,
and for research purposes subject to particular con-
ditions. The new law also covers the subject of
patient access to health care records.
Since a patient does have a general right to inspect
his medical and hospital records, the question how
long to retain records is automatically raised.
A. Retention of Records
For purposes of this article patients can be clas-
sified into three legal categories. Each category calls
for retention of records for different periods. These
are patients (1) over 18 who are mentally compe-
tent; (2) over 18 who are mentally ill; and (3) under
18.
Among others, the following reasons for retention
of patient records, whether in original or reproduced
form, must be considered:
1. To aid medical science; also to facilitate the
care of a particular patient who requires treat-
ment or hospitalization at a later time.
2. To provide a record for the assistance of the
patient in enforcing his claim for injuries
against others than the physician, hospital, or
members of their respective staffs.
3. To assist the physician, hospital, a member of
the medical or nursing staff, or other personnel
in defending against an allegation of negligence
made by or on behalf of the patient.
4. To assist the physician or hospital in collecting
an unpaid debt due from a patient.
Recommendations
The following recommendations apply to each of
the foregoing reasons for retention of records above
noted.
1. As to the length of time for retaining records
as an aid to medical science or to the patient
himself, this will depend in part upon the facili-
ties of the physician’s office or the size and
character of the hospital and will necessarily
involve the judgment of the particular phy-
sician or of the medical staff of the hospital. In
any event this is a matter of medical judgment
and not legal considerations.
2. A mentally normal patient of legal age has 3
years within which to sue for personal injuries.
If a patient elects to sue on a contract rather
than for alleged negligence, he has 6 years in
which to do so. In rare instances which would
almost never apply to a patient-physician re-
lationship, he might have up to 20 years. Such
b2
WISCONSIN MEDICAL JOURNAL, JUNE 1985:VOL. 84
unusual situations would ordinarily be known
to the physician’s attorney. To aid the patient
in enforcing his claims against others, it is
recommended that records be retained for at
least 6 years. There is no legal requirement for
accommodating a former patient longer than
the suggested 6 years, although where fraud is
alleged, the injured party has 6 years in which
to sue after discovery of the fraud. For ex-
ample, a surgeon is chargeable with “fraud”
who is aware he has left a foreign object in a
patient’s body but does not disclose that fact
to the patient, or the latter’s representative.
3. The period recommended for retention of
patient records to defend against an allegation
of negligence would depend upon the category
into which the patient falls. The principal
categories can be summarized as follows:
A. If the patient is over 18 and mentally com-
petent, the Wisconsin Statutes require that
he start an action for alleged negligence
within 3 years after the alleged act.
B. If the patient is over 18 and mentally ill
at the time of his treatment or hospitali-
zation, or becomes so within 3 years there-
after, suit must be brought on his behalf, or
by him if he recovers, within one year of his
recovery, and if he does not recover, within
a maximum of 8 years after the alleged
negligence.
C. If the patient is a mentally normal minor at
the time of treatment or hospitalization,
suit for injuries resulting from alleged mal-
practice by a health care provider must be
brought on behalf of the minor within the
later of: (i) 3 years after the injury or (ii)
one year from the date the injury was, or
should have been, discovered within a maxi-
mum of five years after the alleged injury,
or (iii) the time the minor reaches the age
of 10.
D. If the patient was a minor and mentally
ill at the time of the alleged negligence, and
becomes mentally normal by age 18, he
must sue for the alleged negligence by the
time he is 20, or within three years from the
date of the injury, whichever is later. If such
patient remains insane after reaching age
18, his guardian must start suit within two
years of his recovery, or before the patient
is 20, whichever occurs later, all within a
maximum of eight years after the alleged
negligence.
4. To the extent that patients’ records are retained
to assist in collection of accounts, such claim
must be enforced by the physician or hospital
within 6 years of the time it was incurred, un-
less such time was extended by act of the person
owing the account.
An accurate and durable reproduction of the
record on microfilm or similar process is as fully
admissible before a court as the original itself.
Therefore, the originals of your records, once they
are microfilmed, may be destroyed. However, it is
advisable to keep the original record for at least 3
years or until the patient has paid your bill. The
reasons for this recommendation are:
1. The original is in many ways more convenient
to handle and to read than microfilm;
2. The opportunity for physical examination of an
original patient record minimizes the chance
of suspicion or an assertion that something is
missing.
B. Inspection and Copying of Medicai Records:
As a general rule, the right to inspect or copy
medical records is based on the consent for such
action by the patient or one legally authorized to act
for the patient. The issue may arise in any of several
situations and in the absence of a statutory exception
covering the particular situation the physician should
permit inspection and copying of a patient’s medical
records only by the patient or by one who has a
written authorization from the patient (or one
legally allowed to act on behalf of the patient)
stating the extent of the authorization and describ-
ing the records covered by the authorization.
SECTION 804.10(4)
The general rule regarding inspection and copy-
ing of medical records is codified in Section 804.
10(4), Wisconsin Statutes. It is set out in the box
below.
A physician or hospital administrator, and any-
one designated by either of them is urged to read
this article before allowing the inspection or copying
of medical records and reports which are in his
custody.
STATUTE: 804.10(4)
“804.10(4). Upon receipt of written authoriza-
tion and consent signed by a person who has been
the subject of medical care or treatment, or in case
of the death of such person, signed by the per-
sonal representative or by the beneficiary of an in-
surance policy on the person’s life, the physician
or other person having custody of any medical or
hospital records or reports concerning such care
or treatment, shall forthwith permit the person
designated in such authorization to inspect and
copy such records and reports. Any person having
custody of such records and reports who un-
reasonably refuses to comply with such authoriza-
tion shall be liable to the party seeking the records
or reports for the reasonable and necessary costs
of enforcing the party’s right to discover.”
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
63
An authorization from or on behalf of a patient
allowing the designated person to inspect and copy
medical or hospital records or reports concerning the
patient’s care and treatment may not specify what
specific records are covered. The physician on the
other hand may have records that go back many
years and cover more than one treatment or series
of treatments, and more than one illness or hospital-
ization, or more than one member of a family.
Before complying with the request of a patient to
inspect and copy his records, the physician should
confer, if practical, with the patient or his repre-
sentative to ascertain what illness, what treatment,
and what period of time are intended by the auth-
orization. If by any chance the records or reports
contain material relating to conditions which would
be embarrassing to the patient or which might in-
volve other members of the immediate family, the
patient or a representative might be very grateful to
have the physician point this out and delete them
from any preparation.
If practical, the physician might also ascertain
who suggested the copying of records. It could be
important whether this was another physician, an
insurance company, an employer, or an attorney for
any such parties.
Some physicians are requesting not only that the
time periods to be copied from a medical record or
report be specified, but also that each particular
illness be specified in the authorization from the
patient.
Once the decision has been made how far back to
go and just what portions of the total medical record
are to be copied, the physician or hospital should
not let the record leave the premises. For the infor-
mation of physicians, the statute does not authorize
the removal of medical or hospital records from the
premises. Further, the physician or hospital should
not permit anyone outside the staff to copy the
record except in the presence of a staff member.
Whether by intention or not, the physician or
hospital might lose a portion of the record if they
do not observe these precautions, and such loss
could prove a serious handicap later.
Following are some major considerations and
safeguards to be observed by a custodian of medi-
cal records and reports:
/. Validity of Authorization
Upon being presented with an authorization form
for the inspection or copying of medical records and
reports, physicians or hospitals must assure them-
selves that (1) the patient in fact signed the auth-
orization, (2) was of legal age, and (3) had the men-
tal capacity to know what he was signing. A minor
or incompetent must act through his guardian.
Where there is no formal guardianship of a minor,
a parent may sign as the natural guardian except
where the minor is emancipated as by marriage or
self-support.
The physician or hospital must take such precau-
tions as are necessary to satisfy themselves that those
designated in the authorization are thereby em-
powered to inspect and copy the medical records or
reports covered by the authorization.
The physician or hospital representatives must
also be satisfied that the person presenting the auth-
orization to inspect or copy records is the identical
person named in such instrument. So long as there
is any reasonable doubt as to the identity of a person
presenting authorization to inspect or copy records,
the physician (or his representative) or the hospital
(or his representative), depending upon which place
the authorization is presented, is warranted in re-
fusing to honor such authorization. The same is true
if there is any substantial question as to the auth-
enticity of the signature or the mental capacity or
age of the patient.
The statute authorizes the personal representative,
or the beneficiary of a life insurance policy, to sign
an authorization in case of a patient’s death. If you
receive such an authorization you can ask the per-
sonal representative to provide you with a certified
copy of his authority to act. This will take the form
of “Domiciliary Letters’’ or other documentary
evidence of appointment or authorization which are
issued by the Circuit Court branch handling probate
matters.
In the case of the beneficiary of life insurance, you
can ask for a certified statement from the insurance
company that (1) a policy on the patient was in force
at the time of his death, and (2) the person signing
the authorization is the beneficiary under the policy.
The burden of proof is on the person seeking
the information and the physician has no duty to re-
lease such information until he is satisfied that the
person asking is so authorized. On being satisfied
that the authorization presented is properly signed,
as previously outlined, that the person presenting it is
the person named therein, and that no question of
mental capacity or of minority is involved, it then
becomes the duty of the physician or hospital to per-
mit such person to inspect and copy “any medical
or hospital records or reports concerning’’ the care
or treatment designated in the authorization. Exactly
what records and reports may be inspected and
copied is discussed in point 2 immediately following.
2. What Can Be Inspected And Copied
It is first necessary to determine what must be
made available for inspection and/or copying.
It is believed that under a fair interpretation of
subsection (4) the physician’s records and reports
(office or hospital), and the hospital clinical record
or chart should be made available for inspection or
copying.
In the case of x-rays there seems to be some
disagreement among legal authorities as to whether
they are part of the medical record as such, or are
technically photographs. It is advised that x-rays be
64
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
inspected only under proper supervision, in the case
of a physician’s office by the physician in charge, an
associate, or the designee of either, in the case of a
hospital or other institution by a qualified physician,
or in the event of his unavailability, by a person
designated by the administrator.
X-rays must not be taken from the office of a phy-
sician or other custodian by a patient unless required
by a court order or subpoena. When either of the
latter is served on the custodian of medical records
or reports. Section 804.10(4) is no longer applicable,
and the authorization is no longer in force.
One of the results of the increasingly comprehen-
sive services of the modern hospital, especially teach-
ing institutions, is the development and maintenance
of two types of records relating to a patient. One
relates directly to his care and treatment, and is the
direct professional responsibility of the attending
physician and of those acting under him, and may be
described as the “official records and reports.”
The other has sometimes been described as “edu-
cational records,” which are typically made by non-
medical personnel as part of their training, or at
least for purposes not directly related to the “medi-
cal care and treatment” of the particular patient.
It is believed that no record or report, other than
that made or approved by the physician in charge, or
by a consultant, or resident, or by a registered
nurse who is recording her/his acts or observations
made pursuant to special or standing orders, tech-
nically relates to the “medical care or treatment” of
the patient, as that phrase is used in the new statute.
Nothing but one of the above should be furnished
for inspection or copy.
Any other writings should be kept separately but
not as a part of the patient’s official record, for the
reason that the persons making such writings are not
professionally responsible for the patient, are not
licensed to practice medicine, and are not necessarily
recording acts or observations made pursuant to
orders of the attending physician. Such writings
are not authentic “records” relating to the care of
treatment of the patient.
3. Safeguards
The following safeguards are recommended:
(a) Section 804.10(4) does not in words or by im-
plication, give a right to remove any records from
a physician’s office, or hospital, the records being
the legal property of the physician or hospital.
As an act of prudence, the hospital or physician
should require that inspection and copying be car-
ried on in the presence of a custodian (hospital or
physician), or the representative of either. This
statute does not require a physician or hospital
to copy any records at the request of a patient
or his representative. (See below, “Patient Access”
under Section 146.83.) If a request is made by a
patient or his representative, and the request is
granted, the physician or hospital making such copy
is entitled to make a reasonable and realistic charge
for doing so.
As a precautionary measure to hospital adminis-
trative personnel and to physicians, it is suggested
that under no circumstances should copies of any
medical or hospital records or reports, which are
prepared by a representative of the patient, be
signed, initialed or subscribed to in any manner that
may indicate authenticity and accuracy of such
copies.
(b) Few people, other than medically trained per-
sonnel, know what is important in a hospital or
medical record. For that reason a hospital librarian
or other authorized person, or a physician, may in
some situations be able to satisfy a request by
making inquiry as to what the patient or his rep-
resentative really wants from the records, and read-
ing the material relative to the inquiry. This may
save a great deal of examining, copying, and incon-
venience to everyone concerned.
(c) The word “forthwith” used in connection with
the right to inspect and copy records does not mean
“immediately,” but as soon as the convenience of
a physician, an administrator, or a record librarian,
reasonably permits, after taking into account the ur-
gency of prior demands on their time and personnel
and whether advance notice had been given of the
demand of the particular patient.
(d) When there is any indication that legal pro-
ceedings may ensue, the physician or hospital served
with a proper authorization to examine or copy a
patient’s records should promptly notify the insur-
ance carrier of this fact, and also the attorney of
the physician or hospital. It is recommended that, in
the interest of the patient, the hospital, and the
physician, the knowledge of any such authorization
be given by the person receiving same to the other
interested parties.
4. No Authorization Forms Suggested
Since no words appear in Section 804.10(4) pre-
scribing the form of an authorization to inspect and
copy a patient’s medical or hospital records or re-
ports concerning his care or treatment, model forms
are not suggested. (See below the elements of
“informed consent.”) The observance of the pre-
cautions and safeguards emphasized earlier in this
article should assure that the patient’s interest is
protected while at the same time protecting the pro-
fessional or institutional provider of services.
SECTIONS 146.81-.83
The most important exceptions to the general rule
of confidentiality have been collected in Sections
146.81- .83, Wis. Stats. This law, adopted in 1979,
defines the essential terms relating to “patient health
care records,” codifies the right of patients to have
access to their records, recognizes the general rule of
confidentiality of records, and enumerates the major
exceptions to the general rule. A copy of Sections
146.81 - .83 appears in boxes on following pages.
WISCONSIN MEniCAI.JOCRNAL, JCNi; 1985:VOI.. 84
65
146.81 Definitions. In ss. 146.81 to 146.83:
(1) “ Health care provider” means a nurse reg-
istered or licensed under ch. 441, a chiropractor
licensed under ch. 446, a dentist licensed under
ch. 447, a physician, podiatrist or physical thera-
pist licensed under ch. 448, an optometrist licensed
under ch. 449, a psychologist licensed under ch.
455, a partnership thereof, a corporation therof
that provides health care services, an operational
cooperative sickness care plan organized under ss.
185.981 to 185.985 that directly provides services
through salaried employes in its own facility, or an
inpatient health care facility as defined in s.
140.85(1).
(2) ‘‘ Informed consent” means written con-
sent to the disclosure of information from patient
health care records to an individual, agency or
organization containing the name of the patient
whose record is being disclosed, the purpose of
the disclosure, the type of information to be dis-
closed, the individual, agency or organization to
which disclosure may be made, the types of health
care providers making the disclosure, the signature
of the patient or the person authorized by the
patient, the date on which the consent is signed
and the time period during which the consent is
effective.
(3) ‘‘ Patient” means a person who receives
health care services from a health care provider.
(4) “ Patient health care records” means all
records related to the health of a patient prepared
by or under the supervision of a health care pro-
vider, but not those records subject to s. 5 1 .30.
(5) ” Person authorized by the patient” means
the parent, guardian or legal custodian of a minor
patient, as defined in s. 48.02(9) and (11), the
guardian of a patient adjudged incompetent, as
defined in s. 880.01(3) and (4), the personal rep-
resentative or spouse of a deceased patient or any
person authorized in writing by the patient. If no
spouse survives a deceased patient, “person auth-
orized by the patient” also means an adult member
of the deceased patient’s immediate family, as
defined in s. 632.78 (3) (d). A court may appoint
a temporary guardian for a patient believed in-
competent to consent to the release of records
under this section as the person authorized by the
patient to decide upon the release of records, if no
guardian has been appointed for the patient.
146.815 Contents of certain patient health
care records
(1) Patient health care records maintained for
hospital inpatients shall include, if obtainable, the
inpatient’s occupation and the industry in which the
inpatient is employed at the time of admission, plus
the inpatient’s usual occupation.
(2) (a) If a hospital inpatient’s health problems
may be related to the inpatient’s occupation or past
occupations, the inpatient’s physician shall ensure
that the inpatient’s health care record contains avail-
able information from the patient or family about
these occupations and any potential health hazards
related to these occupations.
(b) If a hospital inpatient’s problems may be re-
lated to the occupation or past occupations of the in-
patient’s parents, the inpatient’s physician shall en-
sure that the inpatient’s health care record contains
available information from the patient or family
about these occupations and any potential health
hazards related to these occupations.
(3) The department shall provide forms that may
be used to record information specified under sub.
(2) and shall provide guidelines for determining
whether to prepare the occupational history required
under sub. (2). Nothing in this section shall be con-
strued to require a hospital or physician to collect in-
formation required in this section from or about a
patient who chooses not to divulge such informa-
tion.
146.82 Confidentiality of patient health
care records.
(1) Confidentiality. All patient health care
records shall remain confidential. Patient health
care records may be released only to the persons
designated in this section or to other persons with
the informed consent of the patient or of a person
authorized by the patient.
(2) Access without informed consent, (a)
Notwithstanding sub. (1), patient health care
records shall be released upon request without
informed consent in the following circumstances:
1. To health care facility staff committees, or ac-
creditation or health care services review organiza-
tions for the purposes of conducting management
audits, financial audits, program monitoring and
evaluation, health care services reviews or ac-
creditation.
2. To the extent that performance of their duties
requires access to the records, to a health care
provider or any person acting under the supervision
of a health care provider or to a person licensed
under s. 146.35 or 146.50, including but not limited
to medical staff members, employes or persons
serving in training programs or participating in vol-
unteer programs and affiliated with the health care
provider, if:
a. The person is rendering assistance to the
patient;
b. The person is being consulted regarding the
health of the patient; or
c. The life or health of the patient appears to be
in danger and the information contained in the
patient health care records may aid the person in
rendering assistance.
3. To the extent that the records are needed
for billing, collection or payment of claims.
4. Under a lawful order of a court of record.
5. In response to a written request by any fed-
eral or state governmental agency to perform a
legally authorized function, including but not
limited to management audits, financial audits,
continued on next page
66
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
I. Definitions
The statutory definitions of “health care pro-
vider,” “Patient,” and “patient health care rec-
continued from preceding page
program monitoring and evaluation, facility li-
censure or certification or individual licensure or
certification. The private pay patient may deny
access granted under this subdivision by annually
submitting to the health care provider a signed,
written request on a form provided by the depart-
ment. The provider, if a hospital or nursing home,
shall submit a copy of the signed form to the
patient’s physician.
6. For purposes of research if the researcher is
affiliated with the health care provider and pro-
vides written assurances to the custodian of the
patient health care records that the information
will be used only for the purposes for which it is
provided to the researcher, the information will not
be released to a person not connected with the
study, and the final product of the research will not
reveal information that may serve to identify the
patient whose records are being released under this
paragraph without the informed consent of the
patient. The private pay patient may deny access
granted under this subdivision by annually sub-
mitting to the health care provider a signed, written
request on a form provided by the department.
(b) Unless authorized by a court of record, the
recipient of any information under par. (a) shall
keep the information confidential and may not
disclose identifying information about the patient
whose patient health care records are released.
146.83 Patient access to health care rec-
ords.
(1) Except as provided in s. 51.30 or 146.82
(2), any patient or other person may, upon sub-
mitting a statement of informed consent:
(a) Inspect the health care records of a health
care provider pertaining to that patient at any time
during regular business hours, upon reasonable
notice.
(b) Receive a copy of the patient’s health care
records upon payment of reasonable costs.
(c) Receive a copy of the health care provider’s
X-ray reports or have the X-rays referred to
another health care provider of the patient’s choice
upon payment of reasonable costs.
(2) The health care provider shall provide
each patient with a statement paraphrasing the pro-
visions of this section either upon admission to an
inpatient health care facility, as defined in s.
140.85 (1), or upon the first provision of services
by the health care provider after April 30, 1980.
(3) The health care provider shall note the time
and date of each request by a patient or person
authorized by the patient to inspect the patient’s
health care records, the name of the inspecting per-
son, the time and date of inspection and identify
the records released for inspection.
ords” are virtually all inclusive. Section 146.81, Wis.
Stats. The law is intended to cover all health records
of all patients of all providers.
In addition the law defines “informed consent.”
This is the statutory equivalent of the authorization
referred to above. It means the written consent for
disclosure of information from a patient’s health
care records and must include: the patient’s name,
the purpose for disclosure of the information, the
type of information to be disclosed, to whom disclo-
sure may be made, what providers must make the
disclosure, the date of the consent, the period during
which the disclosure consent is effective, and the
signature of the patient or the “person authorized
by the patient” (also a defined term).
As defined, “informed consent” is more specific
and detailed than general authorization for in-
spection and copying records as discussed above. Be-
cause of the inclusive wording of the definitions it
can be argued that all releases of information from
health records are subject to this part of the law,
notwithstanding the different phrasing of Section
804.10(4). For safety’s sake it would be well to insist
that any consent or authorization meet the standards
of Section 146.81.
Other inconsistencies between the definitions in
Sections 146.81 and 804.10(4) are relatively minor
but may be significant in particular situations (e.g.,
disclosure of information from the records of a
deceased patient).
2. Occupational Health
Physicians under Section 146.815 are to ensure that
a hospitalized patient’s records contain available in-
formation on the patient’s occupation and health
hazards related to it if the condition being treated may
be occupation related. Information on the occupation
of a patient’s parents must also be included if relevant
to the condition of the patient.
The responsibility under this section of the law is
imposed on physicians but this information does not
have to be obtained from any patient who refuses to
disclose it.
3. Statutory Exceptions
The general rule of confidentiality of patient
records is reiterated in Section 146.82. Following
that statement the law lists six situations in which in-
formation from a patient’s health care records may
be released without informed consent. These in-
clude: management, financial, and service audits and
accreditation; treatment or consultation regarding
treatment of the patient; billing and collection of
claims; under court order; government investiga-
tions; and research, where the product of this re-
search will not identify individual patients. As to the
last two (government investigation and research)
private pay patients may deny access to their rec-
ords by executing a form provided by the Depart-
VVISCONSIN MEniCAI.JOURNAI , JUNE 1985 :VOE, 84
67
merit of Health and Human Services. (This form was
not available for several months after the law be-
came effective.) Anyone obtaining information
under these exceptions may not, without court au-
thority, disclose the information received.
Perhaps the most critical exception deals with gov-
ernmental investigations. This includes the investi-
gation of complaints by license law agencies. This
exception exists if there is a written request by the
agency and it is to assist it in performing a legally
authorized function. The power to compel disclosure
CONSENT TO RELEASE
MEDICAL INFORMATION
I, do hereby
(name of patient)
consent to and authorize ,
(name of physician or health care institution)
to disclose to ^
(specific individual or organization)
information from my medical records relating to my
identity, diagnosis, prognosis or treatment compiled
during my medical treatment(s)/hospitalization
from to . I understand
(date) (date)
that the specific type of information to be disclosed
includes;
I understand that this consent may be revoked ex-
cept to the extent that action has already been taken
in reliance thereon, and that this authorization for
disclosure will be effective until:
(time or condition)
Signature of Patient OR
Person Authorized by the Patient* and
his/her relationship to patient
Witness
Dated this day of , 19
Note to recipient of information. This information has
been disclosed to you from confidential records, which are
protected by law. Unless you have further authorization,
laws may prohibit you from making any further disclosure
of this information without the specific written consent of
the patient or legal representative involved.
•Note: Person authorized by the patient means the parent,
guardian, or legal custodian of a minor patient or a patient
adjudged incompetent; the spouse or personal representa-
tive of a deceased patient; or any person authorized in writ-
ing by the patient which is witnessed and dated.
is conditioned upon the agency complying pre-
cisely with the law. If a physician receives such a
request, care should be exercised to determine that
it meets the requirements of the statute since this is
an exception to the general rule of confidentiality.
Where the governmental investigation is being
conducted to ascertain whether a physician has
been guilty of unprofessional conduct, an adminis-
trative rule of the Medical Examining Board, Med
12.03(1), must be considered to determine whether
the agency’s powers are being lawfully exercised.
This rule, which establishes the Examining Board’s
investigative procedures, permits such investigations
to be conducted by an agent of the Examining Board
acting under the supervision and direction of the sec-
retary or another member of the Examining Board.
There is some conflict in the law between the powers
of the Examining Board and the Department of Reg-
ulation and Licensing in investigative matters but
any investigation conducted under the authority of
the Examining Board must meet its standards.
4. Patient Access
The law also addresses patient access to health
records. Section 146.83, Wis. Stats. A patient or one
with a patient’s “informed consent’’ may inspect
that patient’s records at reasonable times, obtain
copies of these records upon payment of reason-
able costs, and receive copies of X-ray reports or
have the X-rays referred, also upon payment of
reasonable costs.
Physicians providing first services to a patient
after April 30, 1980, are to provide a statement para-
phrasing patient access rights to the patient. Phy-
sicians are to keep a log of patient access requests
by time and date, person authorized to inspect the
records, time and date of inspection, and identity
of records inspected. ■
Patients’ right of access
to their medical records
A notice, which explains to patients the law
requiring all physicians and hospitals to advise
their patients of the patient’s right of access to
their medical record, is available to Society
members for posting in their offices at a place
easily seen by all patients. Patients may receive
information from their record upon completion
of an “informed consent’’ release form (see
copy at left). Write: State Medical Society of
Wisconsin, Attn: Communications Coordina-
tor, PO Box 1109, Madison, Wisconsin 53701;
or phone (608) 257-6781 Madison area or 1-800-
362-9080 in Wisconsin. ■
68
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
“DENIAL OF ACCESS” FORMS. These forms can be
purchased from either of the following printers:
Wisconsin Printing and Bank Supply, PO Box 637,
Menomonee Falls, WI 53051 (ph 1-800-325-8094), or
HC Miller Co, 224-226 East Chicago St, Milwaukee,
Wl 53202 (ph 1-800-242-9971). They are not available
from the State Dept of Health and Social Services or
the State Medical Society. ■
Denial of Researcher Access
to Health Care Records
(Private Pay Patients Only)
state of Wisconsin, Department of Health & Social
Services, HSS-0003
Completion of this form is entirely optional. You do
not have to sign this form to receive care or services.
Please read the following points before deciding
whether you wish to sign.
1) In order to perform studies of health care,
researchers affiliated with your health care pro-
vider may wish to review your health care
records. These researchers have a legal duty to
keep your identity confidential and to make
sure that information from your health care
records is not given to anyone who is not con-
nected with the research.
2) State law says that a private pay patient may
choose to keep researchers from reviewing his
or her health care records; this may be done by
signing the Denial of Researcher Access state-
ment below. Please feel free to discuss this
matter with family, friends or an attorney.
3) If you decide to sign this form, you will need to
sign a new form each year that you wish to deny
access to your records.
4) If you sign this form and later change your mind
and decide to let researchers review your health
care records, you may cancel the Denial of
Researcher Access statement below at any
time by signing a written cancellation state-
ment and giving it to your health care provider.
DENIAL OF RESEARCHER ACCESS
TO HEALTH CARE RECORDS
(Private Pay Patients Only)
I have read the above information and understand
that I do not have to sign this form to receive health
care services. I understand that by signing this form,
I will keep researchers from reviewing my health
care records for a period of one year from the day I
sign it. I also understand that I may cancel this state-
ment at any time by signing a written cancellation
statement. (S. 146.82 (2) (a) 6., Stats.)
Signature of Patient
(or Legal Guardian) Date
Denial of Government Access
to Health Care Records
(Private Pay Patients Only)
state of Wisconsin, Department of Health & Social
Completion of this form is entirely optional. You do
not have to sign this form to receive care or services.
Please read the following points before deciding
whether you wish to sign.
1) State and federal law directs government agen-
cies to make sure that doctors, nurses,
hospitals, nursing homes and other health care
providers give health care of good quality in a
safe setting and protect patient rights.
2) To make sure that health care services meet the
basic legal requirements, state and federal
agencies may need to review patient health
care records. These records tell agencies how
patients have been treated and can be very im-
portant during any investigation of alleged poor
care, patient abuse, fraud, or patient rights
violations. These agencies have a legal duty to
keep the records they review confidential.
3) State law says that a private pay patient may
choose to keep state and federal agencies from
reviewing his or her health care records; this
may be done by signing the Denial of Govern-
ment Access statement below. Please feel free
to discuss this matter with family, friends or an
attorney.
4) If you decide to sign this form, you will need to
sign a new form each year that you wish to deny
access to your records.
5) If you sign this form and later change your mind
and decide to let state and federal agencies
review your health care records, you may cancel
the Denial of Government Access statement
below at any time by signing the Cancellation
Statement on the back of your copy of this form
or your own cancellation statement and giving
it to your health care provider.
DENIAL OF GOVERNMENT ACCESS
TO HEALTH CARE RECORDS
(Private Pay Patients Only)
I have read the above information and understand
that I do not have to sign this form to receive health
care services. I understand that by signing this form,
I will keep state and federal agencies from reviewing
my health care records for a period of one year from
the day I sign it. I also understand that I may cancel
this statement at any time by signing the statement
on the back of this copy or my own cancellation
statement. (S.146.82(2)(a)5., Stats.)
Signature of Patient
(or Legal Guardian) Date
(Note: If you are in a hospital or nursing home, a copy of
this form will be sent to your private physician once it is
signed.)
WISCONSIN MEDICAL JOCRNAl., JUNE 1985:VOL. 84
69
Questions about medical records laws
The preceding analysis of Wisconsin law regard-
ing record retention and inspection provides a good
starting point for understanding the law. However,
in day-to-day applications of the records laws, situa-
tions arise where a basic understanding does not sup-
ply a ready answer. The following questions and an-
swers are based in part on some of the inquiries for-
warded to the State Medical Society’s legal depart-
ment.
Who else besides patients are authorized to inspect
and obtain copies of medical records?
The law provides that all patient healthcare records
are confidential and may be released only to persons
designated in §146.82, persons with the patient’s in-
formed consent or others authorized by the patient.
Parents of minors are generally authorized as the legal
guardian to inspect and receive copies of their chil-
dren’s medical records with two exceptions: when the
child received treatment for venereal disease or drug
abuse. If the child’s parents are divorced, either
parent may have access to the medical records unless
the parent 's rights have been terminated or limited by
court order. Other exceptions to records confiden-
tiality and access are discussed below.
What happens when Worker’s Compensation claims
are involved or when insurance companies and attor-
neys not representing the patient ask for records?
The records release statute does not specify two
other situations in which patient records may be
released without the patient’s authorization. Under
Wisconsin Statute §102. 13(2), a patient who reports
an injury alleged to be work-related or files an appli-
cation for a Worker’s Compensation hearing waives
any physician-patient confidentiality with respect to
any condition or complaint reasonably related to the
condition for which the patient claims compensation.
In addition, §102.13(l)(c)3. states that any physician
attending a Worker’s Compensation claimant for any
condition or complaint reasonably related to the con-
dition for which the claimant claims compensation
may furnish to the employe, employer. Worker’s
Compensation insurer, or the Department of Labor
and Human Relations information and reports
relative to a compensation claim. This section holds
harmless any physician who reports on an injury or
disability to a Worker’s Compensation insurance car-
rier or employer without a release from the patient.
Another situation where the patient waives the
physician-patient confidentiality usually protecting
his or her medical records occurs when the patient
files claim in a court of law where his or her medical
condition is relevant to the claim or uses his or her
medical condition as a defense in a civil or criminal
case. In the same manner, medical information con-
cerning facts or immediate circumstances surround-
ing a homicide at trial or a proceeding to determine
a child’s paternity, or test results for intoxication or
blood alcohol concentrations are exempt under the
patient record confidentiality protection otherwise
afforded by law. In this instance and, in fact, in any
situation where someone other than the patient is
claiming access to medical records, the records cus-
todian should require proof to the claim of legal
authorization.
In addition, there are situations where state law
requires physicians and other healthcare providers to
disclose information without proper authorization
otherwise needed. If after examining a child, a phy-
sician has reason to suspect child abuse or that the
injury was not incurred by accident, the physician
must breach the physician-patient confidentiality and
report the incident to local authorities named in other
statutory provisions.
Does a patient have a right to his or her medical
records if the physician providing the medical
services does so under contract with or at the direc-
tion of an insurance company, attorney, or court
order because the patient’s medical condition is at
issue?
If a patient has been directed to submit to an
examination by a court order or under the direction
of an insurance company for the purposes of a
Worker’s Compensation claim or other injury claim,
he or she does not have the right to control record
disclosure (physician-patient confidentiality has been
waived). This idea is discussed in the previous ques-
tions with regard to who has access to medical infor-
mation. However, does the patient have a right to
copies and access to this medical information about
him or herself although he or she has not paid for the
services? The most reasonable answer is that the pa-
tient should still have access to this information
regardless of who paid for the services because of the
records law policy that patients, with some excep-
tions, should be able to find out about their health
and medical treatment.
What are some of the exceptions to the records
inspection law with respect to access?
In a few instances, federal law preempts state law
concerning access to medical records. One such
federal exemption concerns The Privacy Act which
limits access by federal agencies to certain informa-
tion about individuals, including certain health infor-
mation. Another exception to statutory access
granted to individuals and agencies under Chapter
146 is found in Chapter 51, the Mental Health Act.
This set of laws grants greater protection to records
concerning treatment for mental illness, developmen-
tal disabilities, drug dependence and alcoholism than
to general health records.
70
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
In addition to the limitations on access, there is a
good argument that those not competent because of
mental disease or defect are not entitled to the same
right to inspect their health records generally granted
under Chapter 146. In Chapter 51, several specific in-
stances are stated where patients do have a right to
their treatment records upon discharge from facilities
where they underwent treatment for alcohol or drug
addiction. However, no other guarantee to mental
healthcare records is given by state law to those under
the Mental Health Act’s coverage — those receiving
services for developmental disabilities or mental ill-
ness, and therefore, it is not clear whether those not
legally competent because of their mental or emo-
tional condition should or do have access.
Must I honor an insurance company’s or attorney’s
request for copies of all the medical records regard-
ing a patient?
All too often, a clinic or physician’s office will
receive a letter from an insurer or attorney accom-
panied by an authorization form signed by the patient
requesting copies of all the medical records of the pa-
tient. For the most part, the patient is unaware that
this request is made because they had previously
signed a blank waiver form as a requirement for re-
newing or purchasing medical insurance. In many in-
stances, the patient’s records are voluminous and
honoring this request would entail a substantial
amount of staff time and office equipment use. If the
authorization form does not state any limitation on
records requested, the records custodian is required
to supply all the information available, for a reason-
able charge. However, after receiving this blanket re-
quest, the patient may revoke the authorization by
signing another, more limited authorization for
records release form. In this way, the records cus-
todian can ask the patient, insurance company or
attorney filing the waiver to restrict the request to
those records relating to a specific medical condition
or injury rather than the entire medical record.
Must I provide copies of a patient’s records even if
they have accounts in arrears?
There is no restriction to a patient’s right to copy
and inspect his or her records with regard to owing
the physician or clinic money for the medical services
provided. In other words, records cannot be held
hostage for payment of outstanding bills. This pro-
hibition appears in the AMA Opinions of the Judicial
Council of 1984 and can be interpreted from the
absence of any condition of this sort at state law. A
physician or clinic can attempt to withhold records
for reason of nonpayment but will be exposed to the
risk of paying court costs should the patient get a
court order for the medical records under Wis. Stat.
§804.10(4).
I understand that there is another statutory provision
that limits copying charges to 1 0 cents a copy and $2
per x-ray— does this law apply to me?
In another section of the Wisconsin Statutes, there
is a provision that limits the charge a hospital can
make for reproducing records when involved in a suit
as a party, under court order for cause shown, or
upon a properly authorized request of an attorney.
This provision, §908.03(6m)(b), therefore applies
only to hospitals under the situation described and
does not affect the copying charges permitted by law
under Chapter 146. The only term used to describe
what a healthcare provider may charge for copying
records and x-rays is “reasonable.” ■
WISCONSIN MFDICAI. JOURNAL, JUNE 1985: VOL. 84
7
STATE MEDICAL EXAMINING BOARD
NOTICE
Wisconsin hospital emergency
rooms and outpatient facilities are
aware of the following federal and
state laws which prohibit . . .
I. Discrimination against patients
Alcohol abusers, alcoholics and drug abusers who
are suffering from medical conditions shall not be
discriminated against in admission or treatment,
solely because of their alcohol abuse, alcoholism
or drug abuse by any private or public general
hospital or outpatient facility [as defined in sec-
tion 1633 (6) of the Public Health Service Act]
which receives support in whole or in part by
funds appropriated to any federal department or
agency. Such regulations shall include procedures
for determining if a violation of subsection (a) has
occurred, notification of failure to comply with
such subsection, and opportunity for a violator to
comply with such subsection.
U.S.P.L. 91-616, Part C, Section 321 A & B
and subsequent amendments
U.S.P.L. 92-255, Section 407 A & B and subse-
quent amendments
II. Refusal of admission
“A private or public general hospital may not
refuse admission or treatment to a person in need
of medical services solely because that person is an
'alcoholic, ’ ‘incapacitated by alcohol, ’ ‘or is an in-
toxicated person’ as defined in subsection (2). This
paragraph does not require a hospital to admit or
treat the person if the hospital does not ordinarily
provide the services required by the person. A
private or public general hospital which violates
this paragraph shall forfeit no more than $500.”
Wis. Stats. 51.45 (15) (c)
Please note: Hospitals not equipped to admit or provide
treatment to the person must have a written plan and
agreement with the nearest hospital that provides services
required by the person.
Any violation should be reported to the Bureau of
Alcohol and Other Drug Abuse, 1 West Wilson
Street, Room 434, Madison, Wisconsin 53702.
Phone 608/266-2717.
Hospitals required to report
physician’s loss of
hospital staff privileges
A recently enacted state law requires hospitals to report
to the Medical Examining Board peer investigation in-
formation which results in a physician’s hospital staff
privileges being lost or reduced for 30 days or more, or
which results in a physician resigning from the hospital
staff for 30 days or more.
Chapter 135, Laws of 1981, which became effective
March 31, 1982, requires hospitals to notify the Medical
Examining Board within 30 days after the loss, reduction,
or resignation takes effect. Temporary suspensions due to
incomplete records need not be reported.
Within 30 days after receiving a hospital report, the
Medical Examining Board must notify the physician, in
writing, of the substance of the report. The physician and
the physician’s authorized representative may examine
the report and may place into the record a statement, of
reasonable length, of the physician’s view of the correct-
ness or relevance of any information in the report. An
action may be instituted in circuit court to amend or
expunge any part of the hospital report.
If the Medical Examining Board determines a hospital
report is without merit or that the physician has suf-
ficiently improved his conduct or competence, the Board
must remove the hospital report from the physician’s
record.
If no hospital reports are filed against a physician for
two consecutive years, the physician may petition the
Board to remove any prior reports, unless those reports
are related to a finding of unprofessional conduct against
the physician.
Hospitals may request information relating to a phy-
sician’s loss, reduction, or resignation of staff privileges
from other hospitals prior to admitting the physician to
the medical staff.
Introduced at the request of the State Medical Ex-
amining Board as Senate Bill 68, the law is intended to
prevent the migration of physicians who lose attending
privileges at one hospital and to shortly thereafter receive
approval for attending privileges at another, unsuspect-
ing hospital.
The system requires the Medical Examining Board to
act as a clearinghouse for the accumulation and dispersal
of disciplinary actions taken by hospitals against phy-
sicians.!
Watch your mail for the July issue containing the
1985 Membership Directory
including members' name, address, telephone number,
practice specialties, and Board-certified specialties.
72
WISCONSIN MEDICAL JOURNAL, JUNE 1985:VOL. 84
Members are encouraged to contact SMS headquarters for further information: Phone: 257-6781 in the Madison area
or 1-800-362-9080 toll-free in Wisconsin; or write: State Medical Society of Wisconsin, PO Box 1109, Madison, Wis
53701.
SMS members, you should know—
ABORTION. Wisconsin, like several other states, has a law denying subsidies from any public source for non-
therapeutic abortions except in cases in which conception results from sexual assault or incest. Laws of this
nature have been subject to challenge in the courts in other states. The validity of Wisconsin’s law, if chal-
lenged, cannot be predicted. In Wisconsin spousal consent for abortion is not required by law. Physicians
and hospitals are granted immunity from civil liability for refusal to perform abortions. In the case of the
physician this immunity is conditioned on the refusal having been based on religious or moral precepts. No
hospital, school, or employer may discriminate against a physician in regard to employment, tenure, or staff
privileges or status for refusal to perform abortions if this is based on religious or moral precepts.
ABUSED CHILD LAW. fVis. Stat. %48.98I. Child abuse by parents and others can be found at all economic,
educational, and social levels. The Wisconsin Abused Child Law was enacted to prohibit child abuse in
its many forms and prevent the cumulative effect of repeated beatings or other forms of severe abuse, includ-
ing sexual exploitation, physical crippling, brain damage, or even death. Intentional infliction of emotional
damage to a child is also considered child abuse under the law. The Abused Child Law makes it manda-
tory for physicians and others dealing with children to report suspected cases of child abuse and cases in
which injury is threatened and abuse likely to occur. The law further provides that the reports be made
to the city police departments, sheriffs, and county child welfare agencies. Civil as well as criminal im-
munity from suit is granted where a report is made in good faith. For further information, refer to the
special report on child abuse in the January, February, and March 1985 editions of the Wisconsin Medical
Journal.
ADOPTION PROCESS IN WISCONSIN. An Information Memorandum, published in the July 1982 Blue
Book issue of the WMJ, describes the process by which a potential adoptive parent adopts a child in Wis-
consin. A child from Wisconsin or from another state or country may be adopted in this state with or with-
out the services of an adoption agency. A list of adoption agencies appears elsewhere in this issue.
ADOPTION RECORDS LAW. Recent legislation in Wisconsin provides additional opportunities for adoptees
and certain other persons seeking identifying information about their birth parents and information about
medical and genetic history for themselves or certain other biological family. Chapter 359, Laws of Wis-
consin, 1981, became effective May 7, 1982. Provisions of the new law are described in an Information
Memorandum 82-25 prepared by the Wisconsin Legislative Council staff. That memorandum was pub-
lished in the July 1982 Blue Book issue of WMJ and is available upon request to the WMJ. The law has
been amended to provide for supplying nonidentifying social history of the child’s birth parents. Chapter
471, Laws of Wisconsin, 1983.
AUTOPSY. Whose consent is required to permit a physician to conduct an autopsy? Except for those cases in
which an autopsy is ordered in connection with a proposed coroner’s inquest permission for a physician to
conduct a postmortem examination requires the consent of the person who assumes custody of the body for
burial, providing that person is one of the following: father, mother, husband, wife, child, guardian, or next
of kin. If none of these persons is available, consent may be given by a friend or person charged by law with
the responsibility for burial. If two or more such persons assume custody of the body, the consent of either
one is sufficient. Section 979.03, Wis. Stats., requires autopsies for infant death in which “sudden infant
death syndrome’’ is suspected, unless the parents specifically object.
Sudden infant death (SID) syndrome. Section 979.03, Wis. Stats., requires autopsies for infant death
in which “sudden infant death syndrome’’ is suspected, unless the parents specifically object.
CERTIFICATION. Wisconsin physicians are reminded that it is their responsibility, as well as to their ad-
vantage, to keep WPS-Medicare informed of any change in their specialty or certification status. To allevi-
ate any confusion, each physician should be sure that the same specialty is shown with the various societies;
eg, AMA, State Medical Examining Board, and the State Medical Society. There have been some instances
where a different specialty was shown with each organization. Written documentation of such changes
should be directed to the WPS-Medicare, PO Box 1787, Madison, WI 53701, ATTENTION -CPCU
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SMS members, you should know—
continued
(Central Provider Control Unit). If you have any questions concerning the specialty WPS-Medicare currently
has on file for you, contact Mrs Johnson, CPCU, (608) 221-4711, ext 420. Physicians also are urged to pro-
vide the same information to the Medicaid administrator: EDS-Federal, Attention Provider Maintenance.
The contact person is Gary Holtzman (phone: 608/221-4746).
CHILD SAFETY RESTRAINT SYSTEMS. 347.48(4)(a) IVis. Stats. No resident may transport a child under the
age of 2 in a motor vehicle unless the child is properly restrained in a child safety restraint system approved
by the department. “Properly restrained” means fastened in a manner prescribed by the manufacturer of
the system which permits the system to act as a body restraint but does not include a system in which the only
body restraint is a safety belt of the type required under sub. (1). The department shall, by rule, establish
standards in compliance with applicable federal standards for approved types of child safety restraint sys-
tems for those child restraint systems purchased after November 1, 1982. No resident is required to have
more than 3 child safety restraint systems in a vehicle.
No resident may transport a child who is at least 2 years old but less than 4 years old in a motor vehicle
unless the child is properly restrained in a child safety restraint system approved by the department under
subd. 1. or in a safety belt approved by the department under sub. (2). “Properly restrained” means fastened
in a manner prescribed by the manufacturer of the system which permits the system to act as a body restraint.
When a parent is present in a vehicle operated by a resident other than the parent, the parent is responsible
for complying with the law.
CLOSING A PHYSICIAN’S OFFICE. Several articles in this issue contain information that may be helpful to
physicians or their spouses when closing an office: 1) “Some considerations before opening a physician’s
office,” 2) “Problems of a physician’s widow/er,” 3) “Retention and inspection of patients’ records,”
4) “The use of consent and related forms for physicians,” and 5) “Narcotics” (what to do in case of a phy-
sician’s death).
COMMUNICABLE DISEASES. The State Department of Health and Social Services recently implemented new
administrative rules regarding communicable diseases. The rules merge all communicable disease regulations
into a new chapter, HSS 145, of the Wisconsin Administrative Code. Physicians, nurses, laboratores, health-
care facilities, or any other person identifying a case or a suspected case of communicable disease must report
its existence to the local health officer. Further details, including a listing of communicable diseases, appear
elsewhere in this issue.
CONSENT AND RELATED FORMS FOR PHYSICIANS. A number of these forms which a physician may
have occasion to use in his regular everyday practice appear in an article, “The use of consent and related
forms for physicians,” elsewhere in this issue. Related information also is included, particularly reference to
Chapter 375, sec. 448.30 Wis. Stats., relating to requiring physicians to inform their patients of alternate
modes of treatment, granting rule-making authority, and creating a penalty.
“DENIAL OF ACCESS” TO HEALTHCARE RECORDS. These forms can be purchased from either of the follow-
ing printers: Wisconsin Printing and Bank Supply, PO Box 637, Menomonee Falls, W1 53051 (ph
1-800-325-8094), or HC Miller Co, 224-226 East Chicago St, Milwaukee, W1 53202 (ph 1-800-242-9971).
They are NOT available from the State Dept of Health and Social Services or the State Medical Society.
Sample copies of the forms appear elsewhere in this issue.
DETERMINATION OF DEATH. Wisconsin law (Chapter 134, Laws of 1981) provides that 146.71 of the stat-
utes is created to read: Determination of death. An individual who has sustained either irreversible cessation
of circulatory and respiratory functions or irreversible cessation of all functions of the entire brain, including
the brain stem, is dead. A determination of death shall be made in accordance with accepted medical stand-
ards.
DISABILITY CLAIMS. Under a recent court order the Social Security Administration will review certain dis-
ability claims in Illinois, Indiana, Ohio, Michigan, Minnesota, and Wisconsin, where individuals with mental
impairments were either denied disability benefits or terminated from the disability rolls. Certain individuals
who were either denied social security disability benefits were terminated on or after March 1, 1981, and
before January 4, 1983, who alleged a mental impairment (other than mental retardation) and who were be-
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SMS members, you should know—
continued
tween the ages of 18 and 49 may have their eligibility reviewed. If because of your special concerns for the
mentally impaired you know of anyone who meets these requirements, the SSA of the US Department of
Health and Human Services asks that you advise that person to either visit or telephone the local social secu-
rity office to obtain further information. If you are representing such a person, you may contact a social se-
curity office on behalf of that person.
DONATIONS OF ORGANS, BODY. Wisconsin, along with some 40 other states, has adopted the Uniform
Anatomical Gift Act, a law under which a donor may leave all or any part of his/her body for research or
transplantation. With the continuing publicity given to transplant technology, physicians are being queried
about the law and how their patients may make anatomical gifts. To assist physicians in providing the neces-
sary information to patients, the University of Wisconsin-Madison Anatomy Department and the Medical
College of Wisconsin Department of Anatomy have provided the State Medical Society with policy state-
ments in the acceptance of bodies. These statements appeared in the June 1981 Blue Book, on pages
46-47. Further information may be obtained by contacting the Medical College of Wisconsin, Department
of Anatomy, 8701 Watertown Plank Road, Wauwatosa, Wis 53226 (mailing address: PO Box 26509, Mil-
waukee, Wis 53226; or phone 414/257-8261); or University of Wisconsin-Madison, Anatomy Department,
Bardeen Medical Laboratories, 1300 University Ave, Rm 325 SMi, Madison, Wis 53706 (phone: 608/
262-2888).
Uniform Organ Donor Cards and Decals. These are available from the National Kidney Foundation of
Wisconsin, Inc, 6701 Seybold Rd, Madison, Wis 53719 (phone 608/274-0441), or 7332 West State St,
Wauwatosa, Wis 53213 (phone 414/453-2830).
Donation of eyes. Inquiries may be directed to the Milwaukee Eye Bank, 8700 West Wisconsin Ave,
Milwaukee, Wis 53226 (phone 414/257-5543), or to The Eye Bank, E5/410 Clinical Science Center,
University of Wisconsin-Madison, Center for Health Sciences, 600 Highland Ave, Madison, Wis 53792
(phone 608/263-6223).
“Living will” on use of measures to sustain life. Many people express their desire that no “heroic”
measures be used to sustain their physical functions if this would result in their being totally incapaci-
tated, comatose, or otherwise severely impaired. Various forms of a “living will,” purporting to direct
the scope of care to be given or withheld in such situations have been prepared and are in circulation.
The 1983-84 Legislature addressed itself to this issue and enacted Assembly Bill 513 which created
Chapter 154 of the statutes relating to authorizing adult patients to direct the withholding or with-
drawal of life-sustaining procedures if the patient becomes terminally ill and providing a penalty. The
new law, 1983 Wisconsin Act 202, which appeared in its entirety in the June 1984 BLUE BOOK edi-
tion of the Wisconsin Medical Journal, provides the basis for physicians in drawing up a “living will”
document.
DRIVERS’ LICENSES FOR EPILEPTICS. A person subject to epileptic seizures may be licensed to drive a
motor vehicle in Wisconsin on a temporary basis if: (1) He or she submits with his/her application a certifi-
cate from a licensed physician recommending that a temporary driver’s license be issued, and (2) He or she is
otherwise qualified to obtain a license. The certificate is a form prepared by the Department of Transporta-
tion and is designed to elicit medical information necessary to determine whether permitting the epileptic to
drive would be a hazard to public safety. For two years following the issuance of the license the epileptic is
required to present medical certificates to the Department of Transportation at six-month intervals and
yearly thereafter on the licensee’s birth date until the licensee has been free of seizures for a period of 10 years
from the date of issuance of the license, except that in no event is such license valid beyond the date of expira-
tion shown on the license. On such date, the license is subject to renewal. The issuance of a temporary license
is discretionary with the Department of Transportation. A denial may be reviewed, however, by a special
board. Prior law had required the epileptic to file yearly medical certificates following the two-year initial
period in which the epileptic was required to submit certificates at six-month intervals.
DRUG SUBSTITUTION LAW — In April 1984, Senate Bill 365 became effective. This bill eliminated the Wis-
consin Drug Quality Council and Drug Formulary, adopted the Food and Drug Administration’s “Ap-
proved Prescription Drug Products with Therapeutic Equivalent Evaluations,” prohibits preprinted state-
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SMS members, you should know—
continued
merits on prescription order blanks regarding drug substitution, and set up other measures to assure con-
sumer choice of less expensive drug equivalents. Under the law, physicians continue to have the authority
to prohibit substitutions by noting on the prescription order so long as this prohibition is not a preprinted
statement. Since the State Department of Health and Social Services will no longer publish the Wisconsin
Drug Formulary and Wisconsin Administrative Code section HSS 127 is repealed, pharmacists and others
interested can obtain the FDA list by contacting: Superintendent of Documents, Government Printing Of-
fice, Washington, DC 20402; (202) 783-3238. A more comprehensive explanation of SB 365 appeared in
the June 1984 edition of the Wisconsin Medical Journal.
ELDERLY ABUSE. Each county is now required to designate a county agency to receive reports of abuse or
neglect of elder persons. Anyone may report situations in which facts or circumstances leading to a reason-
able belief that an elder person (60 years or older or subject to the infirmities of aging) has been the victim
of physical or financial abuse, neglect or self-neglect. Reports made in good faith are immune from civil
liability. Physicians may be expected to have more opportunities than others to observe reportable facts
and circumstances. Chapter 398, Laws of Wisconsin, 1983.
EMPLOYEES ALLOWED TO INSPECT RECORDS UNDER LAW. Physicians as well as other employers
in the state should note the personnel records inspection law which became effective May 21, 1980. The
law gives the employee the right to inspect any employer-maintained personnel records used in hiring, pro-
moting, transfering, giving raises, or terminating that employee as well as certain medical records. The em-
ployer is required to grant the employee at least two requests to view records per calendar year, each within
seven days of the request, and at a location convenient to the employee during working hours, or other agree-
able arrangement. Employers may require that request in writing. An employee involved in a current griev-
ance against the employer may designate in writing a representative, such as a union agent, to inspect the
personnel records. Upon agreement of the employer and employee, any errors or differences of opinion may
be noted in the record. If an agreement cannot be reached, the employee may add a written statement, to be-
come part of the permanent file, expressing his/her opinion. The employee may also inspect any of his/her
medical records that are in the employer’s file. If the employer feels these medical records would be detri-
mental to the employee, the employer may release them to the employee’s physician or the employee’s im-
mediate family. The employer may withhold some information under the law. Among the exceptions are:
any records relating to possible criminal offenses, letters of reference, test documents (the employee may see
the test scores), information about a third person, records relating to a pending legal claim between employer
and employee, or material used by the employer for staff management planning. For complete details refer
to Section 103.13, Wisconsin Statutes.
GOOD SAMARITAN LAW. The Legislature has broadened the immunity provided by the Wisconsin Good
Samaritan Law to cover any person rendering aid at the scene of an emergency. First enacted to protect phy-
sicians, these laws are common throughout the United States. They are designed to encourage prompt care
for persons who are injured or become ill away from normal locations where treatment is given. The scene of
an emergency does not include a hospital or physician’s office. Persons employed and trained to render
emergency care, acting for compensation and within the scope of their employment are not protected under
the law.
IMPLIED CONSENT LAW. The theory of Wisconsin’s implied consent law is that every person (including
minors) using the state’s roads is presumed to have consented to testing for alcohol and controlled sub-
stances if he or she is arrested for a violation involving driving under the influence of an intoxicant. (A pre-
liminary breath test may be given before arrest, but this will not involve physician participation.) This pre-
sumption is overcome if the individual refuses to submit to the test, but refusal may result in suspension of
his driving privileges and a severe sentence if he is convicted of driving under the influence of an intoxicant.
A person who is unconscious is presumed not to have withdrawn his consent to such chemical testing. If the
driver does not refuse to take a test, one may be given upon request of a traffic officer. The test may be
blood, breath or urine, and the law enforcement agency administering the test is to designate which one shall
be used. The law says who may draw blood for testing purposes. This is a procedure which should be done
only by or at the direction of a physician. When acting upon the request of a traffic officer to draw blood,
the one drawing blood is immune from civil or criminal liability except for civil liability for negligence
(malpractice) in doing so, providing the person has been arrested under certain specified statutes. Records of
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SMS members, you should know—
continued
blood-alcohol tests conducted under the implied consent law are not “health care records” for purposes
of statutes related to the confidentiality of records and the physician-patient privilege does not apply to
the results of or circumstances surrounding such tests. Recommended physician guidelines and a sample
form for request /consent for drawing blood were published in the July 1982 Blue Book issue of WMJ.
A reprint of the article and reproducible form is available to SMS members at no charge under auspices
of the CES Foundation; available to others at a cost of $3.00 plus 5% state sales tax to: CES Foundation,
Attn: Drawing Blood Consent Form, PO Box 1109, Madison, WI 53701; phone 257-6781 in Madison
area or 1-800-362-9080 in Wisconsin.
JAIL HEALTH CARE IN WISCONSIN. Since 1976 the State Medical Society of Wisconsin has been working
with interested sheriff’s departments on a voluntary basis to develop health care systems using the AMA’s
Standards for Health Services in Jails, in Juvenile Correctional Facilities, and in Prisons. Although the AMA
does the accrediting of jails, the State Medical Society provides ongoing consultation which includes tech-
nical assistance emphasizing the use of existing community resources such as the county nursing service and
mental health and alcoholism counselors from the Unified Services Board. Interested physicians or institu-
tions desiring more information on what constitutes adequate care for incarcerated persons may contact the
State Medical Society of Wisconsin, Attn: Jail Health Care Technical Assistance Committee, PO Box 1 109,
Madison, Wisconsin 53701; or phone 257-6781 (Madison area) or 1-800-362-9080 toll-free in Wisconsin.
JOINT PRACTICE: PHYSICIANS AND NURSES. Reprints of the following items, which were published in
the June 1981 Blue Book issue of the WMJ, are available upon request to: State Medical Society of Wis-
consin, Attn: Joint Practice Committee, PO Box 1109, Madison, Wisconsin 53701; or phone 257-6781
(Madison area) or l-8(X)-362-9080 toll-free in Wisconsin: (1) Guidelines for Implementation of Joint Prac-
tice of Physicians and Nurses, (2) Statement on Joint Practice, and (3) Guidelines for Institutional Joint
Practice Privileges.
JURY DUTY. Physicians are no longer automatically exempt from serving as a juror. However, there are
some qualifying circumstances under which a physician might be excused in the discretion of a judge for
hardship or extreme inconvenience. Physicians interested in further details may contact the State Medical So-
ciety of Wisconsin, Attn: Physicians Alliance Division, PO Box 1109, Madison, Wisconsin 53701; or phone
257-6781 (Madison area) or 1-800-362-9080 toll-free in Wisconsin.
LICENSURE IN WISCONSIN. The practice of medicine and surgery within this state requires a license. Even
physicians just finishing their military service, or moving to Wisconsin from another state, must be licensed
in this state before they enter active practice. Failure to complete licensure before beginning practice may
subject the physician to disciplinary action as well as criminal penalties. Temporary licenses may be granted
under special circumstances by the State Medical Examining Board. Emergency treatment and consultation
with licensed Wisconsin practitioners may be undertaken by physicians not licensed in this state. But, the
general rule is that a physician must have a Wisconsin license to practice in this state.
LIVING WILLS— THE NATURAL DEATH ACT, Chapter 154. On October 1, 1984, Wisconsin’s Natural Death
Act became effective. This legislation authorizes physicians and healthcare institutions to honor patients’
prospective requests regarding their treatment as evidenced by documents called “living wills” when af-
flicted with a terminal condition. The law sets up specific circumstances under which living wills become
effective and where the documents must appear in the patient’s medical records. The full text of the law
appeared in the June 1984 edition of the Wisconsin Medical Journal.
MEDIC ALERT FOUNDATION INTERNATIONAL, a nonprofit, tax-exempt organization, provides life-pro-
tecting services such as bracelets designed to alert emergency personnel to hidden medical conditions. The
Medic Alert emblem is imprinted on the front side and on the back is the member’s hidden medical condi-
tion along with an ID number and 24-hour emergency telephone number which can be utilized to retrieve the
computerized emergency medical data within seconds. Information that is stored can include physician’s
telephone number, type of insurance policy, next-of-kin, blood type, medication name and dosage. Free in-
formation is available from Medic Alert, Turlock, California 95380.
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SMS members, you should know—
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MINOR’S CONSENT. A common question from physicians throughout the state is under what circumstances
may a physician provide medical services to a minor without parental consent. As a general rule, consent
for medical services to be provided to an unemancipated minor must be given by the minor’s parent, guard-
ian, or court-appointed sustaining parent. Under appropriate circumstances a court may give consent in lieu
of a parent. Emancipation occurs when a minor is no longer under parental care and custody. A common
example of emancipation is marriage by a minor. Wisconsin law also provides that a minor may receive
diagnosis of and treatment for venereal disease, Wis. Stats. §143.07, and drug abuse, Wis. Stats. §51.47,
without parental consent. Attempts to expand this law to include all medical care have failed. This area
of the law, parental rights versus minors’ right of privacy, is now quite active and physicians should be
alert to rulings which bear on this conflict.
NEWBORN INFANT EYE DROPS. The permanent administrative rule allowing the use of either silver nitrate,
tetracycline, or erythromycin for the prevention of gonococcal ophthalmia in newborn infants became ef-
fective October 1, 1980. The rule also changes the time frame in which the preventive agent must be ad-
ministered after birth from “immediately” to “as soon as possible, but not later than one hour after birth.”
Under the rule only one child shall be treated per container.
OPENING A PHYSICIAN’S PRACTICE. Some considerations for physicians to note when opening a medical
practice are outlined in an article “Some considerations before opening a physician’s office” elsewhere in
this issue. Physicians also are reminded that the annual Blue Book issues of IVMJ are excellent sources of
information whether opening a practice for the first time or moving a practice to Wisconsin. Reprints of this
year’s issue, as well as previous issues, are available upon request to the Wisconsin Medical Journal, PO Box
1109, Madison, Wis 53701, or phone 257-6781 (Madison area) or 1-800-362-9080 toll-free in Wisconsin.
Cost: $15.00 plus 5% sales tax in Wisconsin, unless tax-exempt status declared.
OPTOMETRIST REFERRAL LAW. Several publicly and privately sponsored glaucoma screening programs
have inquired of the State Medical Society as to whether it is appropriate to refer persons suspected of ele-
vated intra-ocular pressure directly to an appropriate medical specialist for further evaluation. The question
arises because one section of the Wisconsin Statutes, 449.01 (3), requires any agency of the state, county,
municipality, or school district to give the recipient of a vision screening program equal opportunity to
choose between optometric or physician services for follow-up as a consequence of vision screening activities.
At the same time, another section of the statutes, 449. 19, which was passed at a later date by the Legislature,
requires that an optometrist who determines the possibility of the existence of a pathologic condition to refer
the person examined to an “appropriate medical specialist” for further evaluation. The State Medical So-
ciety believes that the implication of these statutes, when taken in combination, is clearly a legislative intent
that whenever there is the possibility of the existence of a pathologic condition, the patient should be referred
to an appropriate medical specialist for further evaluation. The Legislature’s action was a recognition of the
seriousness of possible pathology in the eye and the urgency and importance of referral to medical care. The
Medical Society therefore feels it appropriate that a public health nurse or other person who as a result of
screening tests believes there is reason to suspect glaucoma should immediately refer directly to an ophthal-
mologist or other appropriate medical specialist. At the same time, the Medical Society wishes to emphasize
that the policy of nondiscrimination for referral to optometrists or physicians following tests for visual acuity
must be respected and is encouraged.
PATIENTS’ RECORDS/ RETENTION AND INSPECTION. Information on this subject appears in an article en-
titled, “Retention and inspection of patients’ records,” elsewhere in this issue and will not be repeated here.
However, briefly stated the statute 804.10(4) reads: “Upon receipt of written authorization and consent
signed by a person who has been the subject of medical care or treatment, or in case of the death of such
person, signed by the personal representative or by the beneficiary of an insurance policy on the person’s life,
the physician or other person having custody of any medical or hospital records or reports concerning such
care or treatment, shall forthwith permit the person designated in such authorization to inspect and copy
such records and reports. Any person having custody of such records and reports who unreasonably refuses
to comply with such authorization shall be liable to the party seeking the records or reports for the reason-
able and necessary costs of enforcing the party’s right to discover.”
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SMS members, you should know—
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PATIENTS’ RIGHT OF ACCESS TO THEIR MEDICAL RECORDS. A notice, which explains to patients the
law requiring all physicians and hospitals to advise their patients of the patient’s right of access to their med-
ical record is available to Society members for posting in their offices at a place easily seen by all patients. Pa-
tients may receive information from their record upon completion of an “informed consent’’ release form
(see copy of form in article “Retention and inspection of patients’ records’’ elsewhere in this issue). Write:
State Medical Society of Wisconsin, Attn: Communications Coordinator, PO Box 1109, Madison, Wiscon-
sin 53701; or phone 257-6781 (Madison area) or l-8(X)-362-9080 toll-free in Wisconsin.
PHYSICAL THERAPY RELATING TO PRACTICE. An Attorney General’s opinion, issued in April 1982 re-
garding two issues relating to the practice of physical therapy, fee splitting, and professional service corpora-
tion, appeared in the July 1982 Blue Book issue of IVMJ and will not be repeated here. The following is a
capsule opinion: There is no violation of the “fee splitting’’ statute, sec. 448.08(1), Wis. Stats., where a phy-
sician, through a service corporation owned by the physician, bills the patient for his own services, and that
of physical therapist employed by the corporation, provided the billing states an accurate dollar figure for the
respective services. A medical professional service corporation is not in violation of sec. 180.99(2) Wis.
Stats., when physical therapists are on the staff of the corporation.
PHYSICIAN-PATIENT-HOSPITAL RELATIONSHIP. Questions pertaining to this issue are addressed in an
article entitled, “Legal responsibilities of the physician-patient-hospital relationship,” which appears else-
where in this issue.
PHYSICIAN’S ASSISTANTS (PA). Under Wis. Stat. §§15.08(5), 227.04, 448.40, the State Medical Exam-
ining Board governs the certification and regulation of physician’s assistants. The Wisconsin Administra-
tive Code contains specific regulatory codes regarding the physician’s assistant’s scope of practice, super-
vision by physicians, and the new prescribing rules found in Med 8.08. Under the new prescribing rules,
the supervising physician may direct a PA to prepare a prescription order only if:
— a written protocol is used and reviewed annually;
— it is mutually determined that a PA is qualified through training and experience to prepare
prescription orders as specified in the protocol;
— when practicable, the PA consults directly with the supervising physician prior to preparing an order;
— the order includes the supervising physician’s telephone number, the PA’s address; and
— the physician either reviews and countersigns before, within one day of preparation, or reviews with-
in 48 hours and countersigns within one week.
PAs may not prepare a prescription order for a controlled substance, as defined in §161.01(4).
Chapter Med 8 of the Wisconsin Administrative Code, stating the rules under which the Medical
Examining Board must govern physician’s assistants, was published in toto in the July 1982 Blue Book
issue of the fVMJ. Copies are available upon request to WMJ.
PREMARITAL EXAMINATIONS. Previous statutes requiring couples to have premarital (VD screening) exam-
inations have been repealed. The physician’s practice of giving complete physical examinations or represent-
ing complete physical examinations is no longer a mandatory requirement of the statutes.
STANDARD CASUALTY MEDICAL REPORT FORM. In 1963 the State Medical Society of Wisconsin and the
Wisconsin Claims Council developed an agreement whereby a doctor who files a standard short report form
without charge receives insurance company support of his or her financial interest at the time of payment.
The casualty companies and the State Medical Society devised the form to protect the interests of doctors,
companies, and insureds. Because it is the standard report form recognized by the Society, it cannot be
changed by any insuror other than to add the logo of the insurance company requesting the information.
Physicians are cautioned that this agreement only applies to the short form. If a physician is asked to file a
lengthy narrative report by the insurance company, he or she should expect payment for this additional serv-
ice. Physicians usually get these forms from the insurance company involved. ■
WISCONSIN MEDICAL JOURNAL. JUNE 1985: VOL. 84
79
LET THESE GUIDES HELP YOU
The following guides and manuals have been prepared or obtained at the direction of the Board of Directors and/
or commissions and committees of the State Medical Society of Wisconsin to be of direct personal assistance to the
physician or his county medical society. Each is available (some without cost, others at nominal cost) upon request to
the Communications Dept., State Medical Society of Wisconsin, Box 1 109, Madison, Wis. 53701.
• Interprofessional Code (1977 Revision) — An instrument
for better understanding between attorneys and physi-
cians with reference to medictd testimony and interpro-
fessional conduct and practices.
• Communications Guide for Wisconsin Hospitals and
Physicians — Establishes a communications guide for
Wisconsin hospitals and physicians to promote coopera-
tion between the allied medical professions and those
who report medical news.
• Comments on Fee Splitting Statute, Including Chapter
82, Laws of Wisconsin, 1973 — Governing physicians and
others and authorizing employment of physicians by
hospitals and others.
• Approved Program in Continuing Medical Education —
Explains the State Medical Society of Wisconsin’s ac-
creditation program for continuing medical education in
conjunction with the American Medical Association’s
Council on Medical Education.
• Physician Guidelines: Biood-Alcohol Testing — Includes a
request/consent form for drawing blood. (Revised 1978
— Single copy 25<t with order.)
• If You Have a Complaint About Medical Care — Medical
care is a personal matter between patient and physician.
Yet, sometimes misunderstandings arise about what the
physician hopes to accomplish and what the patient ex-
pects. This brochure, aimed at patients, explains the
State Medical Society’s grievance and peer review system.
• School Health Examination — A guide for physicians and
school authorities in establishing a program of school
health examinations. (Single copy $2.00 plus 5% sales tax
with order.)
• Occupational Health Guide — For medical and nursing
personnel. A practical manual covering everything from
“abnormal injuries” to “wounds,” with every item sug-
gesting steps to be taken, and providing space for specific
instructions of the plant physician. Over 70 pages of in-
structional materiad, with all sections provided as
separate sheets, punched to fit a ring book 10"xll‘/2".
For handy reference order ring book, with full set of in-
serts, including anatomical charts. (Complete guide in-
cluding ring binder: Sll.fX); complete guide without
binder: $10.00 — to accompany order.)
• Make Yours a Smokeless Pregnancy— Points out the
dangers of smoking during pregnancy and its effects on
the fetus.
• Retention and inspection of patients’ records — Ex-
plains the right of access to physician and hospital
records concerning patient care, and includes the re-
vised form, through statute amendment, of an Inter-
pretation of Chapter 301, Laws of 1959.
• Legal Responsibilities of the Physician-Patient Relation-
ship
• Putting the UCR Fee Puzzle Together — Explains what
“usual, customary and reasonable” means, how mis-
understandings concerning it can be avoided and how
problems can be resolved when they occur. The small
size of the brochure makes it suitable for enclosure in
office statements or for placement in patient reception
areas.
• Guide to the Service Corporation Law
• Some Straight ‘Dope’ on Marijuana — Increasing evidence
appearing regularly that marijuana is hazardous to health
has led the State Medical Society of Wisconsin to declare
it to be a dangerous drug. This brochure explains what
marijuana is, who uses it, and points out some of the
psychological and physiological hazards associated with
its use.
• Rubella— Red Measles Brochure — This conveniently
sized 2 Vi "x4 " sized brochure alerts women to the neces-
sity of being immunized for Rubella before they become
pregnant. The brochure also reminds parents to have
their children immunized for the red measles. Perfect for
patient billing statements or waiting rooms.
• Getting the Most Out of Your Health Care Dollar —
Explains the reasons for rising health care costs and offers
advice on what the patient can do to control them.
• Alcohol and Your Unborn Baby . . . — Warns women of
the harmful effects alcohol can have on an unborn child.
Available in both English and Spanish versions.
• To All My Patients, Partners in Good Health — Explains
the rights and responsibilities physicians and patients
have in medical care. Available in standard brochure or
smaller “statement stuffer” form.
• I Want To Know What You Think— a questionnaire physi-
cians can use with patients to elicit their attitudes and
opinions regarding his/her medical practice.
continued next page
80
WISCONSIN MEDICAL JOURNAL, JUNE I983:VOL. 84
STATE DEPARTMENT OF REGULATION
& LICENSING
Physician licensure
verification procedure
The Department of Regulation & Licensing offers
several avenues available to verify the licensure of
medical professionals.
A. Purchase of the Department’s current master
printout of licensees (name, address, and license
number) at a cost of about $60 for all licensees of
the Medical Examining Board. Contact the De-
partment’s Renewal Section at (608) 266-0627 for
further information and ordering.
B. Purchase of the Department’s directory of Medi-
cal Board licensees which is current up to
December 1984, contains no license numbers, and
costs $6.30.
C. Checking, at the physician’s facility, the current
registration card of all Medical Board licensees.
That certificate, stamped “valid to December
1985’’ is the physician’s proof of being currently
registered with the Medical Examining Board.
D. Writing or calling the Medical Board office when
the following is true:
1 . Applicant for staff privileges is not listed in the
printout or directory.
2. Applicant for staff privileges cannot produce
a current registration card.
3. Applicant is a new licensee in Wisconsin.
4. A person has good reason to believe the Medi-
cal Examining Board has disciplined the
licensee and vertification of that fact is desired.
Physicians who have been members of a hospital
or clinic medical staff for a number of years will be
expected to show their license “renewal card’’ every
two years to the staff.
A physician experiencing no problems on a medi-
cal staff, having a current renewal card, and not listed
in the Digest of Rules and Discipline will not show
up as a problem on the Department’s records.
The Department of Regulation & Licensing and the
Medical Examining Board have told the State Medical
Society that they wish to assure effective regulation
of the profession to the citizens of Wisconsin and,
therefore, are most anxious to assist physicians in the
verification process.*
Physician re-registration
Every two years physicians are required to re-
register their license. As a part of this process phy-
sicians are required to attest to their having attained
30 hours of AMA Category 1 Continuing Medical
Education Credits.
This requirement is subject to audit by the State
Medical Examining Board. In this case physicians
would be required to prove their attendance at con-
tinuing medical education programs that would
grant them at least 30 hours of Category I Credit
Hours in the previous two-year period.
Currently physicians are licensed for 1984 and
1985 and will be next required to attest to CME with
re-registration forms mailed late in 1985 for their
1986-87 license. Physicians are reminded to let the
Medical Examining Board know of any address
change (the post office only forwards for a six-
month period). All fees associated with re-registra-
tion must be received by the Medical Examining
Board by December 31 of the year re-registration
occurs. ■
LET THESE GUIDES HELP YOU continued
• Getting the Most Out of Your Health Care Dollar — Offers
tips on how patients can spend their health care dollar
wisely and be a cost conscious patient. The brochure also
shows where the Nation’s Health Care Dollar is spent and
explains what doctors are doing to control costs.
• UPDATE— Health Maintenance Organizations: The
Wisconsin Law — Explains health maintenance organiza-
tions (HMOs) and how they are organized under Wis-
consin law. A summary of SMS concerns with the law is
included as well as the Society’s proposed alternative
legislation.
• UPDATE— Medical Liability in Wisconsin: Problems and
Recommendations for Change — Provides an overview of
the problem of medical liability in Wisconsin and offers
State Medical Society recommendations for resolving it.
• Medical Liability— A Physician’s Rights and Responsibili-
ties— Provides information about medical liability insur-
ance and outlines the rights and responsibilities of physi-
cians and medical liability insurance carriers in the resolu-
tion of medical liability disputes.
• UPDATE— Prospective Hospital Reimbursement: DRGs
— Looks at the new prospective payment system utiliz-
ing Diagnosis Related Groups (DRGs) and examines how
it will affect physicians, patients, and hospitals. ■
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
81
Wisconsin Administrative Code
MEDICAL EXAMINING BOARD
Chapter Med 18
ALTERNATE MODES OF TREATMENT
Med 18.01 Authority, purpose and scope
Med 1 8.02 Definitions
Med 18.03 Communication of alternate modes of treatment
Med 18.04 Exceptions to communication of alternate modes of treatment
Med 18.05 Recordkeeping
Med 18.01 Authority, purpose and scope. (1) Authority. The rules in this chapter are adopted pursuant
to authority in ss. 15.08 (5)(b), 227.014, and 448.40, Stats.
(2) Purpose. The purpose of the rules is to define the obligation of a physician to communicate alternate
modes of treatment to a patient.
(3) Scope. The scope of the rules pertain to medical and surgical procedures which may be prescribed and
performed only by a physician, as defined in s. 448.01 (5), Stats.
Med 18.02 Definitions. (1) “Emergency” means a circumstance in which there is an immediate risk to a
patient’s life, body part or function which demands prompt action by a physician.
(2) “Experimental treatment” means a mode of treatment which has not been generally adopted by the
medical profession.
(3) “Viable” as used in s. 448.30, Stats., to modify the term, “medical modes of treatment” means modes
of treatment generally considered by the medical profession to be within the scope of current, acceptable
standards of care.
Med 18.03 Communication of alternate modes of treatment. (1) It is the obligation of a physician to com-
municate alternate viable modes of treatment to a patient. The communication shall include the nature of the
recommended treatment, alternate viable treatments, and risks or complications of the proposed treatment,
sufficient to allow the patient to make a prudent decision. In the communication with a patient, a physician
shall take into consideration:
(a) A patient’s ability to understand the information;
(b) The emotional state of a patient; and,
(c) The physical state of a patient.
(2) Nothing in sub. (1) shall be construed as preventing or limiting a physician in recommending a mode of
treatment which is in his or her judgment the best treatment for a patient.
Med 18.04 Exceptions to communication of alternate modes of treatment. (1) A physician is not required
to explain each procedural or prescriptive alternative inherent to a particular mode of treatment.
(2) In an emergency, a physician is not required to communicate alternate modes of treatment to a patient
if failure to provide immediate treatment would be more harmful to a patient than immediate treatment.
(3) A physician is not required to communicate any mode of treatment which is not viable or which is
experimental.
(4) A physician may not be held responsible for failure to inform a patient of a possible complication or
benefit not generally known to reasonably well-qualified physicians in a similar medical classification.
(5) A physician may simplify or omit communication of viable modes of treatment if the communication
would unduly confuse or frighten a patient or if a patient refuses to receive the communication.
Med 18.05 Recordkeeping. A physician shall indicate on a patient’s medical record he or she has com-
municated to the patient alternate viable modes of treatment. ■
82
WISCONSIN MEDICAL JOURNAL, JUNE 1985 :VOL. 84
Use of consent and related forms for physicians
PREFACE. The forms referred to in this article are
those which a physician may have occasion to use in
his regular everyday practice. Since the forms were
printed in the January 1970 “Blue Book” issue of
the Wisconsin Medical Journal, they will not be
reprinted here except for a few examples. Any physi-
cian wishing “sample” copies of these forms may
obtain them upon request to the State Medical So-
ciety of Wisconsin, Box 1109, Madison, Wis 53701;
or telephone 257-6781 in the Madison area or toll-
free in Wisconsin 1-800-362-9080. These forms will
frequently need to be adapted for a particular situa-
tion. Each physician should review them carefully
before using them to make sure that they reflect
the realities of a specific situation.
The forms, as printed in the January 1970 “Blue
Book” issue and as listed in the box below, and the
text in this article have been prepared by legal coun-
sel for the State Medical Society of Wisconsin, and
reflect changes in the laws and courts in Wisconsin
since the previous publication in January 1970.
The forms listed in the box below do not cover
every possible situation where a consent should be
obtained. Additional forms are contained in a pub-
lication of the American Medical Association called
Medico-legal Forms with Legal Analysis, 1979. The
Society attorneys suggest that any forms that a
physician might wish to use outside of the forms
referred to in this article be checked with the physi-
cian’s personal attorney to determine their legal
adequacy.
CONSENT FORMS FOR PHYSICIANS
Forms which a physician may have occasion to use in his regular everyday practice were printed in the
January 1970 “Blue Book” issue of the WISCONSIN MEDICAL JOURNAL, and, therefore will not be reprinted
here. Any physician wishing “sample” copies of these forms may obtain them upon request to the Wisconsin
Medical Journal, PO Box 1109, Madison, Wisconsin 53701; or phone 608/257-6781. (Member physicians in
Wisconsin may dial toll-free number: l-8(X)-362-9080.) Form numbers and titles as they appeard in 1970 are
listed below for easy reference when requesting such forms. These forms will frequently need to be adapted for
a particular situation. Each physician should read them carefully before using them to make sure that they reflect
the realities of a specific situation.
Form 1: Letter to former patient where physician
does not wish to treat later illness.
Form 2: Authorization to disclose information to
new physician.
Form 3: Letter of withdrawal from case.
Form 4: Letter to confirm discharge by patient.
Form 5: Letter to patient who fails to follow advice.
Form 6: Letter to patient who fails to keep appoint-
ment.
Form 7: Statement of patient leaving hospital against
medical advice.
Form 8: Provision for substitute physician at delivery.
Form 9: Consent to office treatment.
Form 10: Consent to examination of physician’s
records.
Form 11: Consent to taking of photographs.
Form 12: Consent to publication of photographs.
Form 13: Authority to admit observers.
Form 14: Consent to taking of motion pictures of
operation.
Form 15: Consent to televising of operation.
Form 16: Statement of need for therapeutic abortion.
Form 17: Authorization to treat condition of recent
or partial abortion.
Form 18: Artificial insemination homologous consent.
Form 19: Aid consent.
Form 20: Aid donor consent.
Form 21: Aid donor’s wife consent.
Form 22: Consent to sterilization as a result of
operation
Form 23: Consent to therapeutic sterilization.
Form 24: Consent to non-therapeutic sterilization.
Form 25: General consent to operation.
Form 26: Consent to operation.
Form 27: Consent to operation for cosmetic
purposes.
Form 28: Consent to removal of tissue for grafting.
Form 29: Consent to operation and grafting of tissue.
Form 30: Order for taking of x-ray films.
Form 31: Consent to x-ray therapy.
Form 32: Permission to use radioisotopes.
Form 33: Consent to diagnostic procedure.
Form 34: Agreement for blood transfusion.
Form 35: Agreement for blood plasma transfusion.
Form 36: Agreement with blood donor.
Form 37: Release and receipt (blood donor).
Form 38: Agreement with blood donor.
Form 39: Release and receipt (blood donor).
Form 40: Consent to disposal of amputated part of
organ.
Form 41: Gift of part of body under Wisconsin
Uniform Anatomical Gift Act of 1969.
Form 42: Authorization for tissue donation.
Form 43: Authorization for autopsy and tissue
donation.
Form 44: Authorization for autopsy.
Form 45: Consent to disposal of dead fetus.
WISCONSIN MEDICAL JOURNAL, JUNE I985:VOL. 84
83
Finally, the forms do not cover those procedures
which are normally done in a hospital. The Wiscon-
sin Hospital Association has a publication entitled
Consent Manual, 1981. All member hospitals of that
Association have the manual. Those forms cover
hospital situations, whereas this article is concerned
primarily with the physician in his regular practice.
I. WHAT IS CONSENT
Consent, in the context that we are using it, means
permission from a patient or his legal representative,
to a physician to diagnose and treat the patient.
a. Informed consent
To be legally valid, consent must be given by the
appropriate person (see II. Who Can Consent,
below) and this consent must be given with appropri-
ate understanding of the nature of the treatment and
the risks associated with it. This has been the law of
the United States and Wisconsin for many years;
and the courts have held the physician liable for
treatment without proper consent, even when the
treatment worked and the results were good. Treat-
ment without consent is actionable and is the easiest
form of suit against a physician because no expert
testimony or evidence is needed and historically the
burden has been on the physician to prove that he
or she proceeded only with proper patient consent.
Under Wisconsin law you must disclose to the
person giving consent such information as is neces-
sary under the circumstances to enable a reasonable
person under those circumstances to intelligently
exercise his right to consent to or refuse treatment.
The disclosure must be made in terms understand-
able to the person giving consent and need not in-
clude disclosure of matters already known to the
person or risks which are extremely remote pos-
sibilities.
This rule leaves broad areas of professional judg-
ment to the physician but requires disclosure of all
matters that would be relevant to a reasonable
person to permit him to make an intelligent decision
to consent to or refuse the recommended treatment.
In addition recent Wisconsin statutes and admin-
istrative rules require that the patient be informed
about available alternate methods of treatment. The
law is as follows:
Chapter 375, Laws of 1981
An Act to amend 448.02(3) (intro.) and 448.40; and
to create 448.30 of the statutes, relating to requiring
physicians to inform their patients of alternate modes
of treatment, granting rule-making authority and
creating a penalty.
448.02(3) Investigation; hearing; action, (intro.) The
board shall investigate allegations of unprofessional
conduct by persons holding a license or certificate
granted by the board. A finding by a panel estab-
lished under s. 655.02 or by a court that a physician
has acted negligently is an allegation of unprofessional
conduct. An allegation that a physician has violated
s. 448.30 is an allegation of unprofessional conduct.
After the investigation, if the board finds that there is
probable cause to believe that the person is guilty of
unprofessional conduct, the board shall hold a hear-
ing on such conduct. The board may, when it finds
a person guilty of unprofessional conduct, warn or
reprimand that person, or limit, suspend or revoke any
license or certificate granted by the board to that
person. The board shall comply with rules of pro-
cedure for such investigation, hearing and action
promulgated under s. 440.03(1).
448.30 Information on alternate modes of treatment.
Any physician who treats a patient shall inform the
patient about the availability of all alternate, viable
medical modes of treatment and about the benefits
and risks of these treatments. The physician’s duty to
inform the patient under this section does not require
disclosure of:
(1) Information beyond what a reasonably well-
qualified physician in a similar medical classifi-
cation would know.
(2) Detailed technical information that in all prob-
ability a patient would not understand.
(3) Risks apparent or known to the patient.
(4) Extremely remote possibilities that might
falsely or detrimentally alarm the patient.
(5) Information in emergencies where failure to
provide treatment would be more harmful to
the patient than treatment.
(6) Information in cases where the patient is in-
capable of consenting.
Also see page 82 for complete rule on alternate modes
of treatment.
The forms, as printed in January 1970, and other
standard forms which you may use generally do not
provide for a full description of the disclosures
given, either as to treatment or risks involved. You
should make some provision in your patient records
to indicate specifically what disclosures were made.
Some physicians tape record their disclosures and
retain these tapes with the patient records. Some
who are involved in the same procedure frequently
use prepared statements covering the treatment and
its risks and obtain receipts for copies of this infor-
mation. Some give disclosures in front of witnesses
and have their notes on the matters disclosed ini-
tialed or countersigned by the witnesses. For your
protection you should have some record of the mat-
ters disclosed in each situation.
b. Implied consent
There are situations where the consent of the
patient does not have to be in writing or even ex-
pressed orally. This is implied consent.
A classic example of implied consent is the un-
conscious victim of an automobile accident where
immediate action needs to be taken to save the life
of the patient or at least to minimize the effect of his
injuries. In this emergency situation consent is im-
84
WISCOXSIX MEDICAL JOfRXAL.JL’XE 1985: VOL. 84
plied. The courts say that if the patient had been
conscious he would have given consent to save his
life and, therefore, the physician will not be penal-
ized for doing what he would have been allowed to
do if the patient had been conscious.
II. WHO CAN CONSENT
Persons who are adults and are competent to
understand what the physician is proposing to do,
why it is necessary or desirable, and what the risks of
doing it are going to be, can give a consent.
a. Minors
In Wisconsin, persons under the age of 18 are
minors.
The proper person to consent to surgery or other
treatment of a minor is either parent, or if neither
parent is living, the minor’s court appointed guard-
ian. A physician is not legally protected by a consent
signed by a relative of a minor, other than a parent,
unless the relative has been appointed as the minor’s
legal guardian by a court.
There are two exceptions to the above general
rule. First, in an emergency, a consent is not neces-
sary if the parents or guardian cannot be located,
and, in the judgment of the physician in charge and,
of consultants where consultation is practical, im-
mediate treatment is necessary to save life or to pre-
vent the deterioration or aggravation of the condi-
tion of the patient.
The legal reason for the above exception is that in
an emergency the law implies the consent of the pa-
tient, or in the case of a minor, of his parent or
guardian. Because the law does not imply consent
beyond the treatment actually necessary to meet an
emergency, the physician may safely treat only the
emergency condition itself, and nothing else, with-
out actual consent of a parent or guardian.
Second, an emancipated minor can give a consent
for medical treatment, including surgery. A minor
is emancipated (1) who is lawfully married, or (2)
whose parents have divested themselves of their
legal right of control over him. Typically a minor in
the latter situation is one who is self-supporting.
An unmarried minor attending school away from
his home community is not emancipated by virtue
of that fact alone.
A physician who has any doubt whether a minor is
emancipated, should require the consent of a parent
or the legal guardian before proceeding with non-
emergency treatment.
b. Incompetents
Physicians, above all others, are qualified to de-
termine whether a person is competent to sign a con-
sent. If a patient is incompetent, a consent by the
patient will not be any protection. For incompetents
other than minors, consent can only be given by the
person’s legally appointed guardian, except in emer-
gencies. Courts in Wisconsin have very limited
powers to substitute their discretion for that of a
person’s legally appointed guardian.
c. Persons under the influence
of drugs or intoxicants
Unless there is an emergency situation, the physi-
cian should either wait until the influence of the drug
or intoxicant passes, or, make appropriate contacts
for the appointment of a guardian. In the case of an
emergency, treatment necessary to save life can be
given.
III. WHY CONSENTS
In Wisconsin failure to obtain informed consent
for medical treatment is the negligent violation of a
legal duty. As a result of this, a physician may be
sued for a species of malpractice. In other states,
and under earlier case law in Wisconsin, treatment
without consent was treated as a form of assault and
subject to civil, and possibly criminal, liability on
that basis. It is possible that in an aggravated sit-
uation, where the physician has obtained no consent
or where his treatment has gone beyond the consent
given, courts would still act on the assault rather
than the negligence basis. In most cases, however, it
should be anticipated that the question will be
whether informed consent was given and failure of
the physician to obtain consent based on an ade-
quate explanation of the treatment and its possible
risks is a form of negligent malpractice.
In an action for failure of informed consent, the
patient has the responsibility for proving failure of
disclosure by the physician, lack of knowledge by the
patient of the nature of the treatment and its risks,
and the adverse effects of the treatment. The physi-
cian, by way of defense, may prove reasons why
no disclosure was given, these defenses to be based
on the “reasonable person” rule discussed above.
No expert testimony is required to assist the jury in
determining whether the failure of disclosure led to
consent to the treatment, or phrased another way,
whether adequate disclosure would have resulted in
the patient’s refusing the treatment.
A few minutes spent preparing, explaining, and
obtaining the consent signed by the patient and
making appropriate notes in the patient records
can save untold hours of time, money, and embar-
rassment for the physician.
IV. CONSENTS LIMITED
A word of caution needs to be set forth. A valid
consent must not be too broad. It cannot be a gen-
eral consent for the physician to do anything he
wants to do. It should be limited to the specific
situation presented by the diagnosis of the patient’s
illness. Finally, a consent is not effective if the treat-
ment or procedure consented to is illegal, is con-
trary to public policy or, is given by a person who
had no legal right to give it.
WISCONSIN MEDICAL JOURNAL, JUNE I983:VOL. 84
85
V. CONSENT AND RELATED FORMS
The text and suggestions that follow are related
to the numbered forms as printed in the January
1970 “Blue Book” and as listed in the box on page
83. Physicians should read the text and suggestions
prior to attempting to use or adapt a particular
form.
situation. A physician need not accept every person
who wishes services. He can accept patients as he
wishes. Further, specialists need not accept patients
who have illnesses outside their specialty.
However, once the patient-physician relationship
has been entered into the physician is under an ob-
ligation to treat the patient until the relationship is
terminated.
PHYSICIAN AND PATIENT
1. Contract for services
The physician-patient contract is established when
the physician, in response to an express or implied
request to treat the patient, undertakes to render
professional services to him. It is not necessary to
have a formal written contract. The contract be-
tween the patient and physician is implied and is
enforceable. If you wish, you may restrict your
services to one procedure, one treatment or treat-
ments at a particular time or place. This can be done
by a letter requesting the patient to sign and return
a copy to you. No form has been included for this
FORM 1
LETTER TO FORMER PATIENT WHERE PHYSICIAN
DOES NOT WISH TO TREAT LATER ILLNESS
Dear :
This letter is to confirm our conversation of
(date).
At that time 1 informed you that I could not accept
you as a patient for your present illness. I suggested to
you that you contact another physician and 1 urge you to
do so now if you have not already done so.
Since I have treated you for a previous condition, I
have records which your new physician can use. Upon
receipt of your written approval, I will make available to
your new physician your case history and complete infor-
mation regarding the diagnosis and treatment which you
have received from me.
For your convenience I enclose a form that you may
use to give me such written approval.
Very truly yours,
M.D.
(Enclose Form 2)
FORM 2
AUTHORIZATION TO DISCLOSE INFORMATION
TO NEW PHYSICIAN
1 authorize
, M.D., mv former
physician, to disclose complete information to my pre-
sent physician.
, M.D., con-
cerning medical
findings and treatment from about
19
until the date of this authorization.
Signed
Place
Date
Witness
Witness
2. Termination of contract
Care must be taken to inform the patient appro-
priately, but unmistakably when the patient-physi-
cian relationship is terminated. What should be done
depends upon how the situation arises.
a. Former patient
If you have a former patient who calls and wishes
further services, and you do not wish to further treat
that patient, you should make your decision clear.
Following such conversation you should confirm it
by a letter. Form 1, with its enclosure. Form 2, is
appropriate and gives the physician a record for his
file. (These forms appear as “examples” on this
page.)
b. Withdrawal from a case
There may be occasions where a physician does
not wish to continue on a case. Consistent with
legal as well as ethical principles he must find ap-
propriate steps to withdraw. He cannot just stay
away and not notify the patient. This would be aban-
doning the patient and could subject the physician
to a suit for damages.
He must give the patient proper notice that he is
withdrawing from the case and must give the patient
FORMS
LETTER OF WITHDRAWAL FROM CASE
Dear Mr. :
I find it necessary to inform you that 1 am withdrawing
from further professional attendance upon you for the
reason that you have persisted in refusing to follow my
medical advice and treatment.
Since your condition requires medical attention, 1 sug-
gest that you place yourself under the care of another
physician without delay. If you so desire, 1 shall be avail-
able professionally to attend you for a reasonable time
after you have received this letter, either for regular or
emergency medical treatment, but in no event for more
than days following such receipt. This should
give you ample time to select a physician of your choice
from the many competent practitioners in this area.
With your written approval, 1 will make available to
this physician your case history and complete information
regarding the diagnosis and treatment which you have
received from me.
Very truly yours.
Enclosure Form 2
M.D.
86
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
a reasonable amount of time to obtain a new physi-
cian. What is a reasonable amount of time will
depend upon the circumstances of the case and the
availability of other physicians in the area. We sug-
gest that under most circumstances that the time set
forth be not less than five (5) days. To provide a
record and protect the physician a letter should be
sent to the patient. If the letter is sent by certified
mail with a return receipt requested, the physician
will have record in his file showing not only that the
patient was notified, but also the date the patient
received the notification. Form 3 (example below) is
appropriate for this purpose. We suggest that you
may wish to enclose Form 2 with the letter for the
patient’s convenience.
c. Discharge of a physician
The patient may also terminate the contract by
discharging the physician. The physician will want to
make an immediate and adequate record that he did
not abandon the patient. The physician may do well
to try to obtain from the patient a signed statement
of the facts and discharge of the physician. Where
this is not available we suggest that the physician
send a letter to the patient such as Form 4. Again,
the enclosure of Form 2 is appropriate. We suggest
the letter be sent by certified mail, with a return
receipt requested so that your file will show receipt
of the letter by the patient.
3. Special problems during treatment
There are many problems that can arise during
the treatment of a patient. The ones covered in this
section are of particular importance to the physician
since, if no protective steps are taken and a record
made of such steps, the defense against allegations of
malpractice could be made considerably harder and
more expensive.
FORM 4
LETTER TO CONFIRM DISCHARGE BY PATIENT
Dear Mr. :
This will confirm our telephone conversation of today
in which you discharged me from attending you as your
physician in your present illness. In my opinion your
condition requires continued medical treatment by a phy-
sician. If you have not already done so, I suggest that you
employ another physician without delay. You may be as-
sured that, at your written request, I will furnish him
with complete information regarding all medical facts,
diagnosis, and treatment which you have received from
me.
Very truly yours,
, M.D.
Enclosure Form 2
a. Patient who fails to follow advice
Where a physician feels that a certain treatment
or procedure should be done and the patient refuses,
a record should be made. Form 5 may be adapted
to the situation as it occurs.
b. Patient who fails to keep appointment
If a patient fails to keep an appointment where
the patient has a condition the physician knows
needs treatment, the physician should make this fact
known to the patient. The physician, at the same
time, should see that his records reflect his profes-
sional advice to the patient. A letter such as Form 6
should be sent to the patient.
FORM 5
LETTER TO PATIENT WHO FAILS TO
FOLLOW ADVICE
Dear Mr. :
At the time that you brought your son, William, to me
for examination this afternoon, I informed you that I
was unable to determine, without X-ray pictures, whether
a fracture existed in his injured right arm. Although I
insisted and still do insist that an X-ray study should be
made of William’s arm, you have refused to follow my
advice. I strongly urge you to permit me or some other
physician of your choice to make this X-ray examination
without further delay.
Your refusal to permit a proper X-ray examination to
be made of William’s arm may result in serious con-
sequences if, in fact, a fracture does exist.
Very truly yours,
, M.D.
FORMS
LETTER TO PATIENT WHO FAILS TO
KEEP APPOINTMENT
Dear Mr. :
On , 19 , you failed to keep
your appointment at my office. In my opinion your con-
dition requires continued medical treatment. If you so
desire, you may telephone me for another appointment,
but if you prefer to have another physician attend you, I
suggest that you arrange to do so without delay. You may
be assured that, at your request, I am entirely willing to
make available my knowledge of your case.
I trust that you will understand that my purpose in
writing this letter is out of concern for your health and
well-being.
Very truly yours,
, M.D.
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
87
c. Patient who leaves hospital against medical advice
Cases arise where patients refuse to remain in a
hospital even though their physician feels that con-
tinued hospitalization is necessary. Form 7 (example
below) provides a statement that the patient may
sign which will release liability for the patient’s acts.
The physician should have two witnesses with him at
the time he informs the patient of the reasons the
physician feels indicate the need for continued hos-
pitalization. These witnesses should sign the form
whether the patient signs the form or not. If the
patient refuses to sign, that fact should be noted on
the form. The physician should have a copy of the
form for his office records. The hospital will also
want a copy for its records.
d. Substitute physician in obstetrical cases
It is not unusual for a physician to be unable
to be present at a delivery, even though the physician
would wish to be there. Another delivery might be in
progress or the speed of delivery might make it im-
possible for the physician to get to the place of de-
livery. The physician should explain this to his ob-
stetrical patient when she first comes to his offfice.
The physician should have the expectant mother sign
a form such as Form 8 as an acknowledgment of
the fact that she understands and agrees.
FORM 7
STATEMENT OF PATIENT LEAVING HOSPITAL
AGAINST MEDICAL ADVICE
This is to certify that 1 am leaving
Hospital at my own insistence and against the advice of
my attending physician and hospital authorities. I have
been informed by them of the dangers attendant on my
leaving the hospital at this time. I assume all responsibility
for any results caused by leaving the hospital prematurely,
and I hereby release my attending physician and the hos-
pitcd, its employees and officers from all liability for any
and all conditions, complications and results.
I hereby agree to hold harmless my attending phy-
sician and the Hospital, its
employees and officers, from all liability of whatsoever
nature, with reference to the discharge of the patient
named above.
(husband, wife, parent, etc.)
Date
Signed in the presence of:
Witness
Witness
NOTE: If the patient refuses to sign such a statement, he cannot be
forced to do so, legally, nor may his release be withheld until he signs.
If this occurs, the form should be filled out, witnessed by the hospital
personnel present, and the statement made on the form “signature
refused.”
e. Office treatment
Some procedures can be done either in the physi-
cian’s office or in the hospital. Where the physician
decides to do the procedure in his office he should
inform the patient of the alternatives and any special
risks involved. If the patient decides that the pro-
cedure should be done in the hospital, the physician
should not attempt to do the procedure in his office.
If the patient does agree to having the procedure in
the office, then the physician should have the patient
sign a consent such as Form 9.
4. Confidential and privileged relationship
In Wisconsin, communications between a patient
and his physician are protected both by law and
ethics.
Under Wisconsin law, certain disclosures made by
a patient to his physician in order to give the physi-
cian sufficient information to enable him to treat the
patient are “privileged.” This “privilege” means
that the statements cannot be disclosed by the physi-
cian unless the patient allows it or unless the physi-
cian is allowed or required by law to disclose them.
The “privilege” is that of the patient, and can ordi-
narily be claimed or released only by the patient.
Confidential communications involve a physi-
cian’s ethical duty to keep secret the information he
has obtained about a patient while acting in his
professional capacity. This obligation is independent
of the privilege discussed in the preceding paragraph.
It is binding on the physician at all times.
Wisconsin Statutes permit the right of an em-
ployee or the employee’s designated representative to
FORMS
PROVISION FOR SUBSTITUTE PHYSICIAN
AT DELIVERY
Date
Place
To Dr. :
In engaging you as my obstetrician, 1 understand that
if you are unavailable or unable for any reason to be
present and to deliver me, at the time of my confinement,
you will make a reasonable effort to refer me to another
duly licensed physician to render obstetrical care. I agree
to hold you free from any duty, liability or responsibil-
ity in connection with any services that may be performed
by any physician to whom you refer me or whom I may
call.
Signed
(wife)
(husband)
Signed in the presence of:
Witness
Witness
Note: If the husband is present at the time that the arrange-
ments are made, it is desirable that he should witness his wife’s
execution of this form and sign the form too.
88
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
inspect personal medical records concerning the
employee contained in the employer’s file. If the
employer believes that disclosure of an employee’s
medical records would have a detrimental effect on
the employee, the employer may release the medical
records to the employee’s physician or through a
physician designated by the employee, in which case
the physician may release the medical records to the
employee’s immediate family.
Unauthorized disclosure of confidential infor-
mation can be grounds for revocation of the physi-
cian’s license. It may also be the basis for a suit for
damages by the patient. Each physician therefore
must exercise care to protect against unauthorized
disclosure of confidential or privileged information.
a. Release of patient health care records
By earlier case law and now by statute, a patient’s
health care records (all records related to the health
of a patient prepared by or under the supervision of
a health care provider) may ordinarily only be re-
leased on the authorization of the patient or one
legally permitted to act for the patient. The law
defines “informed consent’’ with respect to the dis-
closure of information from a patient as written
consent “containing the name of the patient whose
record is being disclosed, the purpose of the dis-
closure, the type of information to be disclosed, the
individual, agency or organization to which dis-
closure may be made, the type of health care pro-
viders making the disclosure, the signature of the
patient or the person authorized by the patient, the
date on which the consent is signed and the time
period during which the consent is effective.” Wis.
Stats. §146.81 (2). In making a release of medical
records, the physician should very carefully review
the authorization to assure that the release is made
strictly in accordance with the authorization.
(1) Access without informed consent. Release of
medical records without patient authorization,
unless specifically permitted by law, is a breach of
confidentiality and may subject the physician to a
lawsuit. The law permits the release of patient health
care records upon request without informed consent
in the following circumstances:
(a) To staff, accreditation or review committees.
(b) For performance of healthcare services to per-
sons providing such services (including emergency
care) or being consulted in regard to such services.
(c) For billing, collection, and payment of claims.
(d) Under court order.
(e) On written request from an appropriate gov-
ernment agency.
(f) For research purposes under specific condi-
tions.
(2) Patient access to health care records. Any pa-
tient or other person may, upon submitting a state-
ment of informed consent, (a) inspect the patient’s
records during regular business hours upon reason-
able notice, (b) receive a copy of the patient’s rec-
ords on payment of reasonable costs, (c) receive a
copy of the patient’s x-ray reports or have the pa-
tient’s x-ray films referred to a provider of his choice
for analysis upon payment of reasonable costs. Wis.
Stats. §146.83.
b. Photographs
Physicians may wish to make a visual record of
a case for several reasons. In cosmetic surgery it may
show the result of the surgery. In other cases it may
show the result of a particular method of treatment.
It may also be used for unusual cases where doc-
umentation would be valuable for teaching pur-
poses. In any of these cases there must be a release
of the confidential or privileged relationship to
allow the taking of photographs.
a Observers, motion pictures, television
In cases similar to those where photographs may
be desirable, there are cases which should be ob-
served, televised or recorded on film. The release of
the confidential or privileged relationship must also
be obtained in these cases. Forms 13, 14 and 15 may
be used for these situations.
VI. SPECIAL SITUATIONS
There are certain procedures which the physician
should^ approach with caution and be sure to take
the necessary steps to document what has happened
and, to be sure that he proceeds only with proper
authority and consent. These include:
1. Abortions
2. Artificial insemination
a. Homologous
b. Donor
3. Sterilization
a. Sterilization as a resuit of an operation for other
purposes
b. Therapeutic sterilization
c. Nontherapeutic steriiization
VII. OTHER CONSENT FORMS
There are other forms included in the January
1970 “Blue Book” printing that may be of common
use to a physician. These forms are believed not to
require explanatory text. However, before any of
these forms are signed, the physician should review
the requirements for a valid consent given earlier in
this article. ■
WISCONSIN MEDICAL JOURNAL. JUNE 1985:VOL. 84
89
Must a Wisconsin physician report . . .
1. Deaths?
The Wisconsin Statutes requires that the following
deaths must be reported immediately to the sheriff,
police chief, or coroner of the county in which such
death occurred:
a. All deaths in which there are unexplained, unusual,
or suspicious circumstances.
b. All homicides.
c. All suicides.
d. All deaths following an abortion.
e. All deaths due to poisoning, whether homicidal,
suicidal or accidental.
f. All deaths following accidents, whether the injury
is or is not the primary cause of death.
g. When there was no physician in attendance within
30 days preceding death.
h. When a physician refuses to sign the death
certificate.
i. When a physician cannot be obtained within 24
hours of death.
Violations of the above are punishable by fine or
imprisonment.
10. Live births?
Yes, you must file with the city health officer or county
register of deeds, as appropriate, a certificate for all
births attended by you within five (5) days. Failure to
file within the time period makes fees for medical serv-
ices unlawful. Additionally, the physician must
separately report congenital defects or physical defomi-
ities of a newborn observed within 24 hours of birth.
Such cases are reportable to the Department of Health
and Social Services. Results of required metabolic
disorder tests need not be reported by physicians but
positive test results must be reported by the State Labora-
tory of Hygiene.
11. Communicable diseases?
Yes, to local health officers.
12. Sexually transmitted diseases?
Yes, to the local health officers.
13. Tuberculosis?
Yes, to local health officers.
2. Treatment of automobile accident injuries?
No. unless there is a death.
3. Drowning?
Yes.
4. Gun shot wounds?
No, except where death results.
5. Hunting accidents?
No, except where death results.
6. Industrial accidents?
No. except where death results.
7. Lead poisoning?
Yes, within 48 hours to the DHSS or local health
officer.
14. Chronic alcoholics?
No, even if you know or believe it probable that they
are driving automobiles.
15. Epileptics?
No. but see item in article “SMS members, you should
know. . ." elsewhere in this issue.
16. Drug addiction?
No.
17. Abused or neglected children?
Yes. The law requires reports of “abused” (including
sexual exploitation and “emotional damage”) or
“neglected” (those not receiving food, clothing, shelter
or care, including medical care so as to “seriously
endanger” the child’s health) children, children threat-
tened with injury, or those with exceptional educational
needs. Wilful failure to report may subject a physician
to a penalty; good faith reports provide immunity.
8. Suicide attempts?
No; only death by suicide is reportable.
9. Sending of corpses to undertaker?
Yes. Before a physician sends a corpse to a funeral direc-
tor. undertaker, mortician, orembalmer, he must notify
the next of kin or a person who may be chargeable with
the funeral expenses. There is a penalty for violation
of this requirement.
18. Cancer?
No, but hospitals are required to report to the Depart-
ment of Health and Social Services.
19. Abused elderly persons?
No, but any person with reasonable facts indicating
physical or financial abuse, neglect or self-neglect of
a person age 60 or older or who is subject to the
infirmities of aging may report this to the agency
designated by the county board to receive such re-
ports.
The foregoing list incorporates questions most commonly asked, and is by no means a complete list of all that
the statutes or department rules of the state require by way of reports from physicians.
The law prohibits a physician from disclosing, except as specifically required or authorized by law, any informa-
tion which he or she acquired in attending a patient and which is necessary for him or her to treat that patient. In-
formation provided to the Department of Health and Social Services which relates to personal facts about a patient
may be used only for statistical or summary purposes or anonymously except as its disclosure may be necessary
to provide services for the patient. Address; DHSS, 1 W Wilson St, PO Box 309, Madison, Wl 53701.
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WISCONSIN MEDICAL JOURNAL, JUNE I985:VOL. 84
Wisconsin Administrative Code
MEDICAL EXAMINING BOARD—
Chapter Med 10
UNPROFESSIONAL
CONDUCT DEFINED
Med 10.01 Authority and purpose. The definitions
of this chapter are adopted by the medical examining
board pursuant to the authority delegated by ss. 15.08
(5), 227.08, and 448.40, Stats., for the purposes of ch.
448, Stats.
Med 10.02 Definitions. (1) For the purposes of these
rules:
(a) “Board” means the medical examining board.
(b) “License” means any license, permit, certifi-
cate, or registration issued by the board.
(2) The term “unprofessional conduct” is defined
to mean and include but not be limited to the follow-
ing, or aiding or abetting the same:
(a) Violating or attempting to violate any provision
or term of chapter 448 of the statutes or of any valid
rule of the board.
(b) Violating or attempting to violate any term,
provision, or condition of any order of the board.
(c) Knowingly making or presenting or causing to
be made or presented any false, fraudulent, or forged
statement, writing, certificate, diploma, or other thing
in connection with any application for license.
(d) Practicing fraud, forgery, deception, collusion,
or conspiracy in connection with any examination for
license.
(e) Giving, selling, buying, bartering, or attempting
to give, sell, buy, or barter any license.
(0 Engaging or attempting to engage in practice
under any license under any given name or surname
other than that under which originally licensed or
registered to practice in this or any other state. This
subsection does not apply to change of name resulting
from marriage, divorce, or order by a court of record.
(g) Engaging or attempting to engage in the unlaw-
ful practice of medicine and surgery or treating the
sick.
(h) Any practice or conduct which tends to consti-
tute a danger to the health, welfare, or safety of
patient or public.
(i) Practicing or attempting to practice under any
license when unable to do so with reasonable skill and
safety to patients.
(j) Practicing or attempting to practice under any
license beyond the scope of that license.
(k) Offering, undertaking, or agreeing to treat or
cure a disease or condition by a secret means, method,
device, or instrumentality; or refusing to divulge to
the board upon demand the means, method, device,
or instrumentality used in the treatment of a disease or
condition.
(l) Representing that a manifestly incurable disease
or condition can be or will be permanently cured; or
that a curable disease or condition can be cured within
a stated time, if such is not the fact.
(m) Knowingly making any false statement, written
or oral, in practicing under any license, with fraudu-
lent intent; or obtaining or attempting to obtain any
professional fee or compensation of any form by
fraud or deceit.
(n) Wilfully divulging a privileged communication
or confidence entrusted by a patient or deficiencies in
the character of patients observed in the course of
professional attendance, unless lawfully required to
do so.
(o) Soliciting or attempting to solicit patients,
directly, indirectly, or by agents.
(p) Administering, dispensing, prescribing, supply-
ing, or obtaining controlled substances as defined in s.
161.01 (4), Stats, otherwise than in the course of
legitimate professional practice, or as otherwise pro-
hibited by law.
(q) Having a license, certificate, permit, or registra-
tion granted by another state to practice medicine and
surgery or treat the sick limited, restricted, suspended,
or revoked, or having been subject to other disciplin-
ary action by the licensing authority thereof.
(r) Conviction of any crime which may relate to
practice under any license, or of violation of any
federal or state law regulating the possession, distribu-
tion, or use of controlled substances as defined in s.
161.01 (4), Stats. A certified copy of a judgment of a
court of record showing such conviction, within this
state or without, shall be presumptive evidence
thereof.
(s) Prescribing, ordering, dispensing, administer-
ing, supplying, selling, or giving any amphetamine,
sympathomimetic amine drug or compound desig-
nated as a schedule II controlled substance pur-
suant to the provisions of ch. 161 Stats, to or for
any person except for the treatment of narcolepsy,
or for the treatment of hyper kinesis, or for the treat-
ment of drug induced brain dysfunction, or for the
treatment of epilepsy, or for the differential diag-
nostic psychiatric evaluation of depression, or
for the treatment of depression shown to be re-
fractory to other therapeutic modalities, or for the
clinical investigation of the effects of such drugs
or compounds in which case an investigative proto-
col therefore shall have been submitted to and
reviewed and approved by the board before such
investigation has been begun. ■
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91
Some considerations
before opening a
physician’s practice
When beginning a medical practice, whether start-
ing a new one or joining an existing group, there are
many matters that should be considered before see-
ing your first patient. The following check list has
been developed to itemize major tasks or decisions
a physician should consider prior to that time. De-
pending upon the type of practice, some may not
apply; however, if this list is used, the majority of
items will be covered.
□ Discuss practice location with spouse (type of
community desired, location, size, hospitals,
school system, cultural opportunities).
OOffice facilities (rent — negotiate lease; own —
negotiate and close purchase).
□ Determine office layout and size.
□ Furniture and equipment (office — chairs, desks,
calculators, computer; waiting room — chairs,
tables, lamps; examining room — desk, chairs,
exam table, medical equipment and supplies).
□ Obtain license to practice medicine.
□ Obtain federal narcotics number.
□ Develop employment contract.
□ Partnership agreement or service corporation
articles.
□ Hospital staff privileges.
□ Choose advisors (accountant, lawyer, banker,
management consultant, insurance agent, real es-
tate broker, investment counsel).
□ Obtain necessary insurance coverage (business —
professional liability. Worker’s Compensation,
general liability, umbrella [business/personal),
employee fidelity bond; personal — health, life,
disability income/income protection, home own-
ers, auto).
□ Determine office hours based on community
needs.
□ Apply for federal and state employer identifica-
tion (ID) numbers.
□ Apply for federal and state unemployment com-
pensation tax ID numbers.
□ Determine support staff needed, interview and
hire.
□ Obtain necessary financing.
□ Develop financial systems (determine fees, ac-
counting system, billing, system, statement for-
mat, collections and receivable management,
consider credit card payments by patients, in-
ternal controls).
□ Announcements to local physicians, pharmacists,
general public via newspaper, telephone direc-
tory, individually mailed announcements and
calling and appointment cards.
□ Open checking account(s).
□ Learn community resources (hospitals, schools,
pharmacies, social services, rehabilitation ser-
vices).
□ Arrange for utilities (telephone, electricity, gas/
oil, water).
□ Telephone answering service.
□ Arrange for coverage during off hours.
□ Order necessary office forms (letterhead, envel-
opes, RX forms, accounts receivable statements,
third-party claim forms or uniform claim forms).
□ Arrange for lab and x-ray services.
□ Obtain good debt collection service.
□ Repay student loans on timely basis.
[I] All employees must complete federal Form W-4
and state Form WT-4 (withholding allowance
certificates).
□ Memberships (become involved in: county and
state medical societies, AMA, specialty societies,
local service or business groups, hospital staff
activities).
The AMA has a regular schedule of “Starting
Your Own Practice” workshops which also provide
much information on this subject.
This checklist is intended to provide the most
common matters a physician should consider when
starting a practice. It is not inclusive in every instance
since individual circumstances require attention to
matters unique to that situation.
Physicians may also contact the State Medical
Society in Madison for additional information:
(608)257-6781, or toll-free in Wisconsin 1-800-362-
9080. Office location: 330 East Lakeside St, Madi-
son 53715 (Lakeside Street intersects John Nolen
Drive at the signal lights just before crossing the
“causeway” over Lake Monona to Downtown Mad-
ison, from the South Beltline near the Coliseum).
“Blue Book” good reference source
Whether opening a practice for the first time or
moving a practice to Wisconsin, physicians will find
valuable information in the annual “Blue Book”
issue of the Wisconsin Medical Journal, the official
publication of the State Medical Society of Wiscon-
sin. This is a reference source on medicolegal, socio-
economic, legislative, governmental matters of direct
concern to the physician. It ailso is a reference source
on State Medical Society organizational structure,
other related organizations, and state government
agencies.
To obtain a copy contact the Wisconsin Medical
Journal, PO Box 1109, Madison, Wis 53701, or
phone State Medical Society offices in Madison as
noted above. ■
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WISCONSIN MEDICAL JOURNAL, JUNE 1985:VOL. 84
Some considerations
in the closing
of a physician’s practice
While there are no formally slated rules for clos-
ing a medical practice, there are several important
items which should be considered and planned in ad-
vance. The list given below is not complete but the
State Medical Society of Wisconsin believes it will be
helpful.
1 . Notification of patients
Patients should be given adequate notice, a
minimum of three months is suggested, in writing that
you plan to close your office and on what date so that
they will have sufficient time to obtain another physi-
cian. It is also suggested that, in the letter of notice to
the patients, you enclose a form for the patient to sign
authorizing the release of records should they wish to
request that a copy of their records be sent to the new
physician of their choice. A list of all patients notified
should be retained in your files.
You can save postage, in the case of current patients,
by inserting the letter with a monthly statement or bill-
ing; letters to other patients will have to be mailed sep-
arately.
You also may wish to place an announcement in one
or more local newspapers.
2. Retention of medical records
(a) Medical records, including case histories, treat-
ment records, x-rays, laboratory reports, corre-
spondence with physicians and others, should not
be destroyed until the statute of limitations has ex-
pired with regard to each patient. This is because
the physician’s record and liability insurance pol-
icies could be your chief source of defense in a
future law suit.
The Statute of Limitations has been revised to
allow actions involving adults to be initiated within
three years of the occurrence or one year from dis-
covery of the injury but not later than five years
from the occurrence. Actions involving minors are
bound by this limitation, or age 10 years, which-
ever is later. Possession of the policy will be in-
valuable or you may face the defense alone at your
own expense.
(b) The patient has a general right to know what is in
his medical records and thus you should make it
known where such records can be obtained. Such
records generally should not be given to the pa-
tient, but should be forwarded to another physi-
cian of the patient’s choice with the consent and
at the request of the patient, in writing.
(c) The Wisconsin Statutes relating to the examina-
tion or inspection of medical records on patient
authorization read:
“804.10 (4). Upon receipt of written authorization and
consent signed by a person who has been the subject
of medical care or treatment, or in case of death of such
person, signed by the personal representative or by the
beneficiary of an insurance policy on the person’s life,
the physician or other person having custody of any
medical or hospital records or reports concerning such
care or treatment, shall forthwith permit the person
designated in such authorization to inspect and copy
such records and reports. Any person having custody
of such records and reports who unreasonably refuses
to comply with such authorization shall be liable to
the party seeking the records or reports for the
reasonable and necessary costs of enforcing the par-
ty’s right to discover.”
3. Disposal of drug stocks
The Regional Administrator of the Drug Enforce-
ment Administration, Chicago, Illinois, has Jurisdic-
tion over the State of Wisconsin with regard to disposal
of unused controlled substances. The following pro-
cedure has been approved as a guide to physicians:
“The physician’s DEA number (Controlled Sub-
stances Registration Certificate), unused Govern-
ment order forms and controlled drugs should be
disposed of as soon as possible. The registration
certificate and unused Government order forms
(DEA-222 c) should be returned to the Drug En-
forcement Administration, Registration Branch,
Post Office Box 28083, Central Station,
Washington, DC. 20005. The controlled drugs may
be disposed of by shipment, charges prepaid (ship-
ment by registered mail is permissible) to the
Regional Administrator, Drug Enforcement
Administration, 219 South Dearborn, Suite 1800,
Chicago, Illinois 60604, after the drugs have been
inventoried on Form DEA-41, which can be obtain-
ed from any DEA office. One copy of the Form-41
will be returned to the sender upon receipt of the
narcotic drugs. No remuneration will be made for
the narcotics surrendered to DEA.”
Forms and additional information may be obtained
from the Milwaukee District Office: Drug Enforce-
ment Administration, 517 East Wisconsin Avenue,
Room 228A, Milwaukee, Wisconsin 53202; (414)
224-3395.
Instructions on the disposal of non-narcotic drugs
in the possession of the physician may be obtained
from the Wisconsin Pharmacy Examining Board, 1400
East Washington Avenue, Madison, Wisconsin 53702.
4. Sale of medical practice
(a) If you are selling your practice, you should make
certain that the buyer is a physician licensed, or
eligible to be licensed, in Wisconsin. This
information can be obtained from the State
Medical Society or the Wisconsin Department of
Regulation and Licensing.
(b) Records relating to patients should not be sold.
However, the sale may include, as one of its terms.
WISCONSIN MEDICALJOURNAL, JUNE 1985:VOL. 84
93
unlimited access to the records of those patients
who seek the services of the purchasing physician
5. Keeping your license in force
You may wish to keep your license in force and
register each year in the event that you wish to do some
consultation work or are called upon to perform some
act of medical practice in an emergency. If you elect
to keep your license in force, you will be required to
continue to meet the continuing medical education re-
quirements. This requirement calls for 30 hours of
Category 1 credit as defined in the Physician's Recogni-
tion Award of the American Medical Association, to
be accumulated every two years. The Medical Exam-
ining Board requires this regardless of extent or nature
of practice; there are no exceptions due to age or
retirement.
6. Malpractice insurance
Your policy should be examined to determine
whether it is written on a CLAIMS INCURRED or
a CLAIMS MADE basis. Consult your insurance
agent. If the policy is written on a CLAIMS MADE
basis, only those claims made while the policy is in
force will be covered and you should either continue
your coverage or purchase coverage extension to pro-
tect you until all statutes of limitation have run.
7. Accounts receivable
Not all of your patients will have paid their bills by
the time your practice is closed. It will be necessary
to have someone available to accept, record, and
deposit payments received after the official closing of
your practice. You may wish, after a suitable waiting
period of three or four months, to turn those accounts
still unpaid over to a reputable collection agency.
8. Continuation of SMS membership
We hope that you will continue to be active in
organized medicine. The State Medical Society urges
all physicians who are retired or will be retiring to ad-
vise their county or state society of their present or
future status so that an appropriate change in classi-
fication can be arranged.
9. Income taxes
Copies of your income tax returns and all support-
ing documentation, including ledgers and accounting
records, should be preserved until the Internal Revenue
Service can no longer assess additional tax. For
Federal returns filed on time and containing all cor-
rect and pertinent data, this is usually three years; for
returns where gross income has been understated by
20 percent or more, it is six years; for fraudulent
returns or where no return has been filed there is no
time limit.
10. Payroll taxes
Final returns and payments of all Federal and state
withholding and Social Security taxes must be made
after the last employee has been terminated and the last
payroll paid.
Finally, it is recommended that you work closely
with your attorney or business manager particularly
on the tax aspects of closing your practice.*
Problems of a physician’s widow/er
Following the loss of one of its members by
death, it has long been the practice of the State
Medical Society to write the physician’s widow/er in
an effort to provide some advice during a trying
period. The Society, believing that “an ounce of pro-
tection is worth a pound of cure,” suggests that every
member give thoughtful consideration to some of the
problems which are likely to face a physician’s
widow/er. Careful preparation for such eventualities
not only protects the family, but eases its burdens at a
trying time.
Following the death of a physician, the widow/er
will be faced with many decisions involving the settle-
ment of the business affairs relating to the late hus-
band’s or wife’s practice. It is of extreme importance
that she/he act upon the advice of am attorney. When
practical it is recommended that the physician
acquaint his/her spouse with his/her legal and other
advisors and some of his/her business affairs. This
will provide an established working business relation-
ship between the spouse and the advisors for that
eventuality when she/he is called upon to act. Some
of the chief problem areas the widow/er will face are
outlined in the remainder of this article.
Former patients may seek a continuation of medi-
cation prescribed by the deceased physician. This
must never be permitted except on advice of another
physician because of the possibility of rapid change in
the condition of the patient and resulftmt possible
cause for legal action in the event unexpected results
stemmed from continued use of the medication.
The widow/er also will be presented with the prob-
lem of what to do with the physician’s narcotics. The
Regional Administrator of the Drug Enforcement
Administration, Chicago, Illinois, has jurisdiction
over the State of Wisconsin with regard to disposal of
unused controlled substances. The following pro-
cedure has been approved as a guide to physicians:
94
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
“The physician’s DEA number (Controlled Sub-
stances Registration Certificate), unused Government
order forms and controlled drugs should be disposed
of as soon as possible. The registration certificate and
unused Government order forms (DEA-222 c) should
be returned to the Drug Enforcement Administration,
Registration Branch, P.O. Box 28083, Central Sta-
tion, Washington, DC 20005. The controlled drugs
may be disposed of by shipment, charges prepaid
(shipment by registered mail is permissible) to the
Regional Administrator, Drug Enforcement Adminis-
tration, 219 South Dearborn, Suite 1800, Chicago,
Illinois 60604, after the drugs have been inventoried
on Form DEA-41, which can be obtained from any
DEA office. One copy of the Form-41 will be return-
ed to the sender upon receipt of the narcotic drugs.
No remuneration will be made for the narcotics sur-
rendered to DEA.”
Forms and additional information may be obtained
from the Milwaukee District Office: Drug Enforce-
ment Administration, 517 East Wisconsin Ave.,
Room 228A, Milwaukee, Wisconsin 53202; (414) 224-
3395.
It is important that a widow/er, other members of
the family, and the attorney see to it that there is full
and prompt compliance with the requirements of the
above communication.
Instructions on the disposal of non-narcotic drugs
in the possession of the physician at the time of
his/her death may be obtained from the Wisconsin
Pharmacy Examining Board, 1400 E Washington
Ave, Madison, Wis 53702.
Records relating to patients, including case
histories, treatment records, x-rays, laboratory
reports, correspondence with physicians and others
should not be destroyed for at least six years after the
physician’s death. Liability for malpractice and some
other claims do not cease upon the death of a physi-
cian.
The physician’s records and liability insurance
policies may be the widow/er’s chief sources of
defense. Every precaution should be taken to insure
Liability for malpractice and some other
claims do not cease upon the death of a physi-
cian. Liability suits can be quite traumatic for
the surviving spouse, especially if they should
occur shortly after the physician’s death. Some
insurance company-appointed attorneys have
been known to provide little advice or coun-
seling to surviving spouses who in a state of
bereavement may be fearful of attorneys
whom they have never known before. Should
surviving spouses have questions concerning
liability matters, they are urged to contact the
State Medical Society.
that all such basic materials are kept intact and subject
to immediate call for at least six years. The family
attorney will be able to tell when they are no longer
needed for this purpose.
The widow/er can expect that the deceased physi-
cian’s patient will seek care elsewhere unless he/she
had one or more associates. Sometimes the new physi-
cian will find it necessary for adequate treatment to
obtain a copy of the previous physician’s record of
care of his/her patient. In such event, it is wise to in-
sist upon a written request from the patient and his/
her new physician. A copy of the record, with a cover-
ing letter may then be sent. A copy of the forwarding
letter should be inserted in the original patient’s file
for future reference.
A decision may be made to sell the deceased physi-
cian’s practice. The items to be included in the sale
will vary with the nature of the practice, the amount
of equipment involved and the wishes of the buyer.
To avoid complications, the wddow/er should make
sure the buyer is a physician licensed in Wisconsin.
This information can be obtained from physician
acquaintances or the State Medical Society. Records
relating to patients should not be sold. However, the
sale may include, as one of its terms, unlimited access
to the records of those patients who seek the services
of the purchasing physician. The widow/er’s legal and
other advisors can best inform her/him how to
arrange the sale.
The collection of the deceased physician’s profes-
sional accounts is another important matter. The
widow/er should carefully follow her/his attorney’s
advice before bringing suit, since a patient can
counterclaim for mdpractice within three years. Or-
dinarily it is not desirable for a widow/er or the heirs
to enforce collection by suit within such period. She/
he should also seek legal and accounting advice on
how long to retain the financial records of her/his late
spouse. It is quite possible that his/her estate may be
subjected to audit by the state or federal income tax
authorities. The retention of complete records is
essential in anticipating such possibility,
A widow/er should consult her/his attorney as to
whether the estate needs to arrange a malpractice
policy buy-out with the deceased physician’s carrier so
as to protect the estate assets and the widow/er’s share
of such assets. Some physicians will have attempted to
do this during lifetime and if they did so this will be
evident from study of the policy, its endorsements and
correspondence. If there is uncertainty in the matter,
the attorney should contact the insurance carrier and
seek its cooperation in ascertaining the facts. The
reason for this is that a suit can be maintained against
the estate and heirs of a deceased physician who is
alleged to have committed one or more acts of profes-
sional negligence with resultant injury to a patient.
The State Medical Society office is always available
for consultation with a widow/er, the family, or the
estate attorney. ■
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
95
Important notice to physicians and ciinics
re toxic substances and infectious agents
Every employer of one or more persons in Wisconsin is required to post a notice to employees indicating that
the employer will provide upon request information about toxic substances and infectious agents which
might be found in the workplace. This law became effective December 1, 1982. SMS recommends that every
physician/clinic cut out the poster accompanying this article and make sure it is displayed where employees
can see it.
This will assure initial compliance with the law. If an employee makes a written request, the employer must
provide that individual with information about any toxic substance the employee is likely to be exposed to in
the workplace. The information which must be provided includes the name of the toxic substance or infec-
tious agent, a description of their hazardous effects, precautions for handling such substances or agents, and
procedures for emergency treatment in event of overexposure. The posted form must indicate the name of a
person who should be contacted to make such a request.
For toxic substances, the employer must provide this information within 15 working days of a written request
by an employee. For infectious agents, the information must be provided to the employee within 3 working
days. Employers who do not have the required information available for either toxic substances or infectious
agents have 30 working days to obtain such information and provide it to the employee. The information
must be requested from the manufacturer or supplier. If they refuse to provide the information, the em-
ployer is not required to provide the information for the requesting employee.
A toxic or hazardous substance is defined by law as “any substance regulated by the federal regulations part
1910, subpart z, which are introduced by an employer ... in the workplace.” The list of these substances
can be obtained from the SMS or the Department of Industry, Labor and Human Relations (DILHR) at the
address shown on the poster.
Information of the type that must be provided to the employee about toxic or hazardous substances must be
obtained from the supplier or manufacturer of the material. The physician or clinic purchase order for
materials which may contain hazardous or toxic substances should be accompanied by a “Material Safety
Data Sheet” or its equivalent. This sheet makes it a condition of the purchase order that the vendor will
supply the physician or clinic with material related to the safe use of its product and will identify all haz-
ardous components. Copies of the data sheet are available from the SMS and DILHR. Under the law a
supplier or manufacturer may refuse to provide such information on the basis of confidentiality. The em-
ployer must be sure to get such refusal in writing. Once that written statement is provided, the employer is no
longer required to make further efforts to obtain the information.
Infectious agents are defined as any bacterial, mycoplasmal, fungal, parasitic or viral agent identified by
DILHR by administrative rule which causes illness in humans, human fetuses or both, which is introduced
into the workplace by the employer. Infectious agents do not include agents on or in the body of a person
who is present in the workplace for diagnosis or treatment. Note; Until DILHR publishes rules identifying
these agents, this section of the law is not enforceable. At the time of this publication DILHR had not yet
published this rule.
The law also requires that training sessions must be held for employees exposed to such substances so as to
provide them with information about the substances or agents, symptoms and effects of overexposure, the
potential for flammability, explosion and reactivity, proper conditions for safe use of the substances or
agents, special precautions to be taken or personal protective equipment to be used when handling them,
and procedures for handling cleanups or spills. Training sessions may take almost any form, but it is impor-
tant that the employer have employees sign a statement indicating that they have received the prescribed
training. The penalties for noncompliance are a civil forfeiture of not more than $1,000 for each violation
and forfeiture of up to $10,000 per violation for those who “willfully violate or exhibit a pattern of viola-
tion.” Enforcement is through the local district attorney.
96
For additional questions /answers about this law, contact Deb Powers at SMS headquarters (telephone:
1-800-362-9080 or in Madison 257-6781), or Jack Borders at DILHR, PO Box 7969, Madison, WI 53707,
telephone: 608/ 266-773 !.■
WISCONSIN MEDICAL JOURNAL, JUNE 1985:VOL. 84
Wisconsin Clearinghouse
A state agency for information on alcohoi and
other mood-altering drugs, primary prevention,
mental health, and other health topics.
The Wisconsin Clearinghouse is a state agency
for information on alcohol and other mood-alter-
ing drugs, primary prevention, mental health, and
other health topics.
Housed by the University of Wisconsin-Madi-
son, the Clearinghouse offers many publications
which are suitable for patient information as well
as for professional reference. Dozens of these are
available at no cost to Wisconsin residents, except
for shipping and handling, and a separate catalog
lists over 30 other publications available for pur-
chase. Some of the items are produced by Clearing-
house staff, while others are provided by the Wis-
consin Office on Alcohol and Other Drug Abuse,
the National Institute on Drug Abuse, the Addic-
tion Research Foundation and other organizations.
In addition to pamphlets, books, profes-
sional manuals, public awareness kits and cur-
ricula, the Clearinghouse offers many colorful
posters aimed at people of many ages and interests.
Also available are video tapes on marijuana, caf-
feine, and the dangers of chemicals unknown to
children. The Clearinghouse staff also evaluates
films and publications from other sources. Syn-
opses, ratings, and other information on these
resources are available on request.
Wisconsin Clearinghouse office hours are 8:30
am —4:45 pm Monday-Friday, although publica-
tions may be ordered by mail or telephone. For
more information contact Wisconsin Clearing-
house, 1954 E Washington Ave, Madison, W1
53704 (608 -263 -2797). ■
NARCOTICS
Annual Registration
A physician who desires to dispense, administer, or prescribe any controlled drug substance is required to
have a Drug Enforcement Administration number (DEA no.). The initial registration application may be
obtained from the Chicago Regional Office. The Regional Office of DEA in Chicago has informed the State
Medical Society that DEA Headquarters will then annually mail a renewal application to each physician once
initially registered.
Change of Residence
If you move, or change your place or places of business, you must notify the Drug Enforcement Adminis-
tration, Registration Branch, PO Box 28083, Central Station, Washington, DC, 20005.
In Case of Death
The Regional Director, Drug Enforcement Administration, Chicago, Illinois, who has jurisdiction over
the State of Wisconsin with respect to these matters, approved the following procedure in a communication
to the State Medical Society:
“The deceased physician’s DEA number (Controlled Substances Registration Certificate), unused
Government order forms and controlled drugs should be disposed of as soon as possible. The registra-
tion certificate and unused Government order forms (DEA-222 c) should be returned to the Drug
Enforcement Administration, Registration Branch, PO Box 28083, Central Station, Washington, DC
20005. The controlled drugs may be disposed of by shipment, charges prepaid (shipment by registered
mail is permissible) to the Regional Administrator, Drug Enforcement Administration, 219 South
Dearborn, Suite 500, Chicago, Illinois 60604, after the drugs have been inventoried on Form
DEA-41 , which can be obtained from any DEA office. One copy of the Form-41 will be returned to
the sender upon receipt of the narcotic drugs. No remuneration will be made for the narcotics sur-
rendered to DEA.”
Forms and additional information may be obtained from the Milwaukee District Office:
Drug Enforcement Administration
Milwaukee District Office
517 East Wisconsin Ave, Rm 228 A
Milwaukee, Wisconsin 53202
Preprinted Prescription Blanks
The Justice Department, Drug Enforcement Administration, reports that neither Federal law nor adminis-
trative regulations prohibits the printing of the physician’s narcotic registration number on prescription
blanks. ■
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
97
Attending physician’s return-to-work recommendations record
Edward P Horvath Jr, MD, Marshfield, Wisconsin
James J Andonian, MD, Madison, Wisconsin
Donald M Rowe, MD, Kohler, Wisconsin
Periodic Meetings have been conducted between
physicians and industry representatives through the
State Medical Society’s Liaison Committee on Health
Care Costs. One of the first subjects raised by
employers was the return-to-work issue. Considering
the lost productivity and escalating costs from both
work-related and nonoccupational disorders, it is not
surprising why this was a major focus of manage-
ment. Physicians have a similar concern, albeit for
somewhat different reasons. Clinicians have long
recognized the beneficial psychologic and physical
effects which accrue to most patients by shortening
the convalescent period. Of course, any resumption
of activity must be consistent with the patient’s tem-
porary or permanent restrictions.
The Liaison Committee on Health Care Costs and
the Society’s Committee on Environmental and Oc-
cupational Health believe physicians have a respon-
Alcoholics Anonymous
The State Medical Society’s Committee on Al-
cohol and Other Drug Abuse recommends that
physicians be aware of the Central Offices of
Alcoholics Anonymous
care of their patients.
Green Bay
414-437-9971
Kenosha
414-654-8246
Madison
608-222-8989
a support group in the
Milwaukee
414-272-3081
Superior-Duluth
218-728-5572
La Crosse
608-784-7560
It should be emphasized, however, that patients
should make the call to the Central Office be-
cause Alcoholics Anonymous cannot be of as-
sistance unless the patient wants help.
Each of these Central Offices has a list of
recovering alcoholics who will call the patient
and offer help. If there is no Central Office
listed in an area, patients should check the
local phone book under Alcoholics Anonymous.
Often a local phone number will be listed where
there is no Central Office. ■
sibility to cooperate with industry in facilitating their
patients’ return to work. Employers are entitled to
counsel about medical fitness of individuals in rela-
tion to work. On occasion, more specific details of
the patient’s condition, including the diagnosis itself,
also may need to be discussed. Signed authorization
release is necessary in the latter circumstance and is
advisable in the former as well. Having been provided
with the necessary medical information by the physi-
cian, the employer can then attempt to identify a job
which matches the worker’s restrictions.
The return-to-work form, shown on opposite page,
should facilitate this process. It was independently
developed by several individuals including interested
medical and industrial groups. It has subsequently
been adopted by several county medical societies and
undergone slight modifications in content. All reports
on its use thus far have been favorable.
The Society’s Committee on Environmental and
Occupational Health and the Liaison Committee on
Health Care Costs have reviewed and endorsed this
form. While recognizing that it is not all-inclusive, it
does provide the attending physician with functional
guidelines for return-to-work recommendations. A
narrative section is available for the physician to
explain special limitations such as temperature ex-
tremes, contact with skin irritants, and visual and
hearing problems. A space for authorization release
by the patient is provided and must be signed in cir-
cumstances where specific medical information such
as the diagnosis is given.
Both Society committees recently unanimously
recommended its use by Wisconsin physicians, and
the form has been submitted for national considera-
tion through the American Medical Association and
the American Occupational Medicine Association.
The form is not copyrighted and may be reproduced
without restrictions. However, the SMS Services, Inc
has printed the form in 3-part sets, and these sets are
available to Society members upon request to:
Return-to-work Form, SMS Services, Inc, PO Box
1 109, Madison, Wisconsin 53701; or phone 257-6781
(Madison area); toll-free in Wisconsin (800)
362-9080. ■
98
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
ATTENDING PHYSICIAN’S
RETURN TO WORK RECOMMENDATIONS RECORD
Company Name
Patient’s Name (Last) (First)
(Middle Initial)
Date of Injury/ Illness
TO BE COMPLETED BY ATTENDING PHYSICIAN— PLEASE CHECK
DIAGNOSIS/CONDITION (Brief Explanation)
saw and treated this patient on
Dale
, and based on the above description of the patient’s current medical problem:
1. □ Recommend his/her return to work with no limitations on
2. □ He/She may return to work on
Date
Date
.with the following limitations:
CHECK ONLY AS RELATES TO ABOVE CONDITIONS
□ Sedentary Work. Lifting 1 0 pounds maximum and occasionally lift-
ing and / or carrying such articles as dockets, ledgers, and small tools.
Although a sedentary job is defined as one which involves sitting,
a certain amount of walking and standing is often necessary in carry-
ing out job duties. Jobs are sedentary if walking and standing are
required only occasionally and other sedentary criteria are met.
□ Light Work. Lifting 20 pounds maximum with frequent lifting and/or
carrying of objects weighing up to 1 0 pounds. Even though the weight
lifted may be only a negligible amount, a job is in this category when
it requires walking or standing to a significant degree or when it
involves sitting most of the time with a degree of pushing and pull-
ing of arm and/or leg controls.
□ Light Medium Work. Lifting 30 pounds maximum with frequent lift-
ing and/or carrying of objects weighing up to 20 pounds.
□ Medium Work. Lifting 50 pounds maximum with frequent lifting
and/or carrying of objects weighing up to 25 pounds.
□ Light Heavy Work. Lifting 75 pounds maximum with frequent lift-
ing and/or carrying of objects weighing up to 40 pounds.
□ Heavy Work. Lifting 100 pounds maximum with frequent lifting
and/or carrying of objects weighing up to 50 pounds.
1 . In an 8 hour work day patient may:
a. Stand/Walk
□ None □ 4-6 Hours
□ 1-4 Hours □ 6-8 Hours
b. Sit
□ 1-3 Hours
c. Drive
□ 1-3 Hours
□ 3-5 Hours
□ 3-5 Hours
□ 5-8 Hours
□ 5-8 Hours
□ Pushing & Pulling
2. Patient may use hand(s) for repetitive:
□ Single Grasping
□ Fine Manipulation
3. Patient may use foot/feet for repetitive movement as in
operating foot controls: □ Yes □ No
4. Patient may:
a. Bend
b. Twist
c. Squat
d. Climb
e. Reach
Not At All
□
□
□
□
□
Occasionally
□
□
□
□
□
Frequently
□
□
□
□
□
OTHER INSTRUCTIONS AND/OR LIMITATIONS INCLUDING PRESCRIBED MEDICATIONS
3. □ These restrictions are in effect until
Date
or until patient is reevaluated on
4. He/she is totally incapacitated at this time. Patient will be reevaluated on
5. Referred To: □ None □ Private physician
□ Return Here □ A Consultant
Date
Doctor
Date S Time
Doctor. Date & Time
Physician’s Signature
Date
AUTHORIZATION TO RELEASE INFORMATION
1 hereby authorize my attending physician and/or hospital to release any information or copies thereof acquired in the course of my examination or treatment for the
injury identified above to my employer or his representative.
Patient’s Signature
Date
SMSSI (6/84)
DISTRIBUTION: WHITE— Employer
CANARY— Doctor
PINK — Employee
STATE MEDICAL SOCIETY OF WISCONSIN
Accreditation Program
for Continuing Medical Education
Information is available in printed form from
either Bill Wendle, Scientific Affairs Coordinator,
or Arlene Meyer, Administrative Assistant, Con-
tinuing Medical Education, State Medical Society
of Wisconsin, PO Box 1 109, Madison, Wis 53701 ;
or telephone toll-free in Wisconsin 1-800-362-9080
(Madison area: 257-6781).
Representatives of the American Medical Asso-
ciation took the initiative to bring about the unifi-
cation of a body responsible for accreditation of
continuing medical education. This effort resulted
in the adoption by the AMA House of Delegates
at its Interim Meeting in December 1980 of the
report of the Board of Trustees recommending the
creation of the Accreditation Council for Con-
tinuing Medical Education (ACCME) and the by-
laws for this new organization (which became
operational January 1, 1981) and assumed the
responsibility for national accreditation of organ-
izations, institutions, and agencies offering con-
tinuing medical education. The state medical asso-
ciations will retain the responsibility for accredi-
tation of intrastate continuing medical education
in accordance with the agreements reached in the
creation of ACCME as stated in its bylaws.
The State Medical Society of Wisconsin’s ac-
creditation program functions under the authority
of the AMA’s newly created Accreditation Council
for Continuing Medical Education (ACCME).
Representatives from state medical societies, na-
tional medical specialty societies, AMA Section on
Medical Schools and Resident Physician’s Section,
National Medical Association, American Hospital
Association, Association for Hospital Medical
Education, Federation of State Medical Boards,
and medical specialty boards comprise the
ACCME.
CATEGORY 1 — CME activities with accredited
sponsorship . . . Education activities that are a
part of a planned program of continuing medical
education and sponsored by an accredited organ-
ization . . . (including)
• Grand rounds
• Teaching rounds
• Departmental
scientific meetings
• Seminars and
Workshops
• Clinical
Traineeships
• Mini-residencies
CAREGORY 2 — CME activities with non-
accredited sponsorship (same activities as in Cate-
gory 1, offered by a non-accredited medical
organization. No formal approval is necessary for
an organization to offer Category 2 credit).
CATEGORY 3 — Medical teaching.
CATEGORY 4 — Papers, publications, books,
presentations, and exhibits.
CATEGORY 5 — Non-supervised individual . . .
activities (includes) self-learning, consultations,
patient care review, self-assessment, specialty
board preparation.
CATEGORY 6 — Other meritorious learning
experiences. continued on opposite page
• Scientific sessions of
medical specialty societies
• Visiting lecture programs
• Continuing medical
education courses
• Audiovisual materials
(under specified
conditions).
100
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
CME Accreditation Proqxaxxx! continued
WISCONSIN INSTITUTIONS AND ORGANIZATIONS ACCREDITED by SMSW
and ACCME for continuing medicai education programming at January 1, 1985
Appleton Memorial & St Elizabeth
Hospitals, Appleton
Beilin Memorial Hospital, Green Bay
Beloit Memorial Hospital, Beloit
Berlin Memorial Hospital, Berlin
Columbia Hospital, Milwaukee
Community Memorial Hospital,
Menomonee Falls
Eagle River Memorial Hospital,
Eagle River
Family Hospital, Milwaukee
Ft Atkinson Memorial Hospital,
Ft Atkinson
Good Samaritan (Lutheran) Medical
Center, Milwaukee
Gundersen Medical Foundation Ltd and
La Crosse Lutheran Hospital, La Crosse
Hartford Memorial Hospital, Hartford
Howard Young Medical Center,
Woodruff
Kenosha Memorial Hospital, Kenosha
Lakeland Hospital, Elkhorn
Langlade County Memorial Hospital,
Antigo
Luther Hospital, Eau Claire
Madison General Hospital, Madison
Memorial Hospital of Iowa County,
Dodgeville
Memorial Hospital of Oconomowoc,
Oconomowoc
Mercy Hospital, Janesville
Mercy Medical Center, Oshkosh
Methodist Hospital, Madison
Mount Sinai Medical Center, Milwaukee
Osseo Area Municipal Hospital, Osseo
Reedsburg Memorial Hospital, Reedsburg
Riverside Community Hospital, Waupaca
Sacred Heart Hospital, Eau Claire
Sacred Heart/St Mary’s Hospitals, Inc,
Rhinelander
Sauk Prairie Memorial Hospital,
Prairie du Sac
Shawano Community Hospital, Shawano
Sheboygan Memorial & St Nicholas
Hospitals, Sheboygan
St Agnes Hospital, Fond du Lac
St Alphonsus Hospital, Port Washington
St Catherine’s Hospital, Kenosha
St Clare Hospital, Baraboo
St Clare Hospital, Monroe
St Francis Hospital, Milwaukee
St Francis Hospital, La Crosse
St Joseph’s Hospital, Chippewa Falls
St Joseph’s Hospital & Marshfield
Clinic, Marshfield
St Joseph’s Hospital. Milwaukee
St. Joseph’s Community Hospital,
West Bend
St Luke’s Hospital, Milwaukee
St Marys Hospital Medical Center,
Madison
St Mary’s Hospital, Milwaukee
St Mary’s Hospital, Rhinelander
St Michael Hospital, Milwaukee
St Michael’s Hospital, Stevens Point
St Vincent Hospital, Green Bay
Stoughton Hospital Association,
Stoughton
Theda Clark Memorial Hospital,
Neenah
Trinity Memorial Hospital, Cudahy
Veterans Administration Medical
Center, Tomah
Watertown Memorial Hospital,
Watertown
Waukesha Memorial Hospital,
Waukesha
Wausau Medical Center, Wausau
West Allis Memorial Hospital,
West Allis
Winnebago Mental Health Institute,
Winnebago
* * *
American Cancer Society, Wisconsin
Affiliate
American Heart Association,
Wisconsin Affiliate
Arthritis Foundation; Wisconsin
Chapter
Fox Valley Academy of Medicine
Madison Academy of Internal Medicine
Milwaukee Academy of Medicine
The Milwaukee Academy of Surgery
The Milwaukee Gynecological Society
Milwaukee Ophthalmological Society
Milwaukee Orthopaedic Society
The Racine Academy of Medicine
Wisconsin Academy of Family Physicians
Wisconsin Academy of Ophthalmology
Wisconsin Allergy Society
Wisconsin Association for Perinatal Care
Wisconsin Dermatological Society
Wisconsin Neurological Society
Wisconsin Orthopaedic Society
Wisconsin Psychiatric Association
Wisconsin Surgical Society
Wisconsin Urological Society
Wisconsin Society of Obstetrics and
Gynecology
Wisconsin Society of Otolaryngology
— Head and Neck Surgery
Wisconsin Society of Pathologists
Wisconsin Society of Plastic Surgeons
The Wisconsin Society of Radiation
Oncologists
* * *
Marinette-Florence County Medical
Society
* * *
ACCME Accredited
Dept CME, Medical College of
Wisconsin
Dept CME, UW Center for Health
Sciences
Interstate Postgraduate Medical
Association
State Medical Society of Wisconsin
Wisconsin Society of Anesthesiologists
WISCONSIN MEDICAL JOURNAL, JUNE 1985, VOL. 84
101
Charter Law of Medical Societies
Chapter 148
148.01 (1) State society. The state medical society of Wis-
consin is continued with the general powers of a corpora-
tion. It may from time to time adopt, alter and enforce
constitution, bylaws and regulations for admission and ex-
pulsion of members, election of officers, and management.
(2) A member expelled from a county medical society
may appeal to the state society, whose decision shall be
final.
148.02 (1) County societies. The physicians and surgeons,
not less than five in number, of the several counties, except
those wherein a county medical society exists may meet at
such time and place at the county seat as a majority agree
upon and organize a county medical society, and when so
organized it shall be a body corporate by the name of the
medical society of such county, shall have the general
powers of a corporation, and may take by purchase or gift
and hold real and personal property. County medical
societies now existing are continued with the powers and
privileges conferred by this chapter.
(2) Physicians and surgeons who, before April 20, 1897,
received a diploma from an incorporated medical college or
society of any of the United States or territories or of any
foreign country, or who shall have received a license from
the state board of medical examiners, shall be entitled to
meet for organization or become members of the county
medical society.
(3) If there be not a sufficient number of physicians and
surgeons in any county to form a medical society they may
associate with those of adjoining counties, and the physi-
cians and surgeons of not more than fifteen adjoining
counties may organize a medical society under this chapter,
meeting at such time and place as a majority agree upon.
(4) A county medical society may from time to time
adopt, alter and enforce constitution, bylaws and regula-
tions for the admission and expulsion of members, election
of officers, and management, not inconsistent with the
constitution, bylaws and regulations of the state society.
148.03 Service insurance corporations for heaith care.
The state medical society or, in a manner approved by the
state society, a county society, may establish in one or more
counties of this state a service insurance corporation for
health care under ch. 613.
NOTE ON ss. 148.03, 447.13, 449.15 and 450.13; Chapter 613
provides in general terms for the creation, governance and
regulation of service insurance corporations for any kind of
health care, as well as for other types of services. All that is
needed in each authorizing chapter for professional societies is a
brief section giving the appropriate professional society the
power to organize a ch. 613 corporation. Section 148.03 creates
that section for health care.
One basic restriction results from the repeal of the old
enabling sections: none of the professional societies will be
able to organize a service insurance plan within its own cor-
porate structure. It is a mistake to permit such a mixing of
professional and insurance activities within the same cor-
poration. The society can, of course, control the service in-
surance corporation it creates under ch. 613, but the service
insurance corporation will be legally separate. This will lead
to more effective (and appropriate) control by the insur-
ance commissioner, who should neither be empowered nor
compelled, as arguably he was under the old statutes, to
have any concern about the purely professional activities of
the societies, because of the impossibility of disentangling
the insurance and professional activities carried on by a
single corporation. ■
1841 —The Society created by territorial legislation
The first statutory recognition of the State Medical Society was by act of the Legislative Assembly of the
Territory of Wisconsin, in Act 53 of the Territorial Legislature of 1841. The organization of the Society was
authorized, with the declaration that “. . .well regulated medical societies have been found to contribute to
the advancement and diffusion of true science, and particularly of the healing art . . .”
The organization meeting was set for the second Monday in January, 1842, at Madison, for the purpose
of forming “. . .a society under the name and style of the Medical Society of the Territory of Wisconsin . .”
Drs. Bushnell B. Cary, M.C. Darling, Lucius L. Barber, Oliver E. Strong, Edward McSherry, E.W. Wolcott,
J.C. Mills, David Walker, Horace White, Jonas P. Russell, David Ward, Jesse S. Hewett, B.O. Miller, and
their associates, were authorized by statute to conduct the initial organization of the Society.
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WISCONSIN MEDICAL JOURNAL. JUNE 1985:VOL. 84
CONSTITUTION AND BYLAWS
of the State Medical Society of Wisconsin
CONSTITUTION
ARTICLE I
Name of the Association
The name and title of this organization shall be the State
Medical Society of Wisconsin.
ARTICLE II
Purpose
The purpose of the Society is to bring together the physi-
cians of the state of Wisconsin to advance the science and art
of medicine and the better health of the people of Wisconsin,
and to secure the enactment and enforcement of just medical
laws. As used in the Constitution or Bylaws, “physician”
means a doctor of medicine or a doctor of osteopathy
licensed in Wisconsin.
ARTICLE III
Component Societies
Component societies shall consist of those county medical
societies chartered by the House of Delegates of this Society.
ARTICLE IV
Composition of the Association
This Society shall consist of members who shall be the
members of and certified by the component county medical
societies; and whose dues and assessments for the current
yetu have been received by the Society secretary in accor-
dance with the schedule provided in the Bylaws.
ARTICLE V
House of Delegates
The House of Delegates shall be the legislative body of the
Society, and shall consist of;
(1) delegates elected by the component county medical
societies,
(2) one delegate representing each specialty section of
the Society organized under the Bylaws,
(3) a speaker,
(4) a vice speaker.
The officers of the Society enumerated in Article IX of
this Constitution, directors, and past presidents of the
Society shall be ex officio members, but without the right to
vote, except that if they have been duly seated as delegates,
they shall have the right to vote.
The speaker and vice speaker shall be elected by and from
the House of Delegates for two-year terms, and shall be
limited to three consecutive full terms in their respective
offices. While holding these offices, they shall be members of
the House at large and shall not represent any component
county society or specialty section.
ARTICLE VI
Board of Directors
The Board of Directors, hereinafter referred to as
“Board,” shall have full authority and power of the House
Adopted as amended by the House of Delegates March 24-25,
1983.
of Delegates between sessions of the House. It shall consist
of the directors, immediate past president, president, presi-
dent-elect, speaker and vice speaker of the House of
Delegates. The secretary and the treasurer shall be ex officio
members of the Board, but without the right to vote. A
majority of its voting members shall constitute a quorum.
Directors shall be elected from eight geographic districts
whose boundaries shall be determined by the House of
Delegates. There shall be elected one director from each dis-
trict, except that in any district with 200 or more regular and
special members, there shall be elected one additional direc-
tor for each additional 200 members or majority fraction
thereof. As nearly as possible, one-third of the members of
the Board shall be elected each year.
Each director shall be nominated and elected only by the
elected delegates of the county medical society or societies
from the district in which the director’s principal place of
practice is located. Such election shall be subject to the
approval and confirmation of the House of Delegates.
The terms of the directors shall be for three years. No in-
dividual shall be permitted to serve more than three con-
secutive three-year terms as director, and no more than a
total of six terms of service as director shall be permitted.
ARTICLE VII
Specialty Sections
The House of Delegates shall provide for a division of the
Society into specialty sections.
ARTICLE VIII
Meetings
Section 1 . The Society shall hold an Annual Meeting, at
which time the House of Delegates shall meet to conduct its
business. The Annual Meeting may also include scientific
sessions as determined by the Board.
Sec. 2. The place for holding each Annual Meeting shall
be fixed by the House of Delegates, or, by failure to act, such
authority is delegated to the Board. The time for holding
each Armual Meeting shall be approved by the Board.
Sec. 3. Special meetings of the House of Delegates shall be
called by the speaker on written request of twenty delegates
representing at least 10% of the component county medical
societies, or on request of a majority of the Board. When a
special meeting is called, the speaker shall set the time and
place. The secretary shall mail a notice to the last known
address of each member of the House of Delegates at least
twenty days before the date of the special meeting. The
notice shall specify the time and place of the meeting and the
purpose for which the meeting is called. The meeting shall
consider no business except that for which it is called.
ARTICLE IX
Officers
Officers of this Society shall be a president, a president-
elect, a secretary, and a treasurer. The president-elect and
treasurer shall be elected annually by the House of Delegates.
The secretary shall be elected annually by the Board. The
president-elect shall automatically succeed to the office of
president at the conclusion of the term as president-elect.
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
103
The treasurer shall be limited to nine consecutive terms.
No person shall hold more than one of the following
offices concurrently: president, president-elect, secretary,
treasurer, speaker, vice speaker, director. Incumbents shall
serve until their successors are elected and installed.
ARTICLE X
Funds and Expenses
Funds may be raised by annual dues or by assessment on
the members, or in any other marmer approved by the
House of Delegates. The House may establish regular and
special classifications of membership. Dues, if any, shall be
applied equitably to all members in each class.
All resolutions adopted by the House of Delegates provid-
ing for appropriations shall be referred to the Board for im-
plementation. All expenditures approved by the Board shall
be included in the annual budget.
ARTICLE XI
Referendum
The House of Delegates may, by a two-thirds vote of
those registered at that session, submit any question to the
membership of the Society for its vote, except amendments
to the Constitution. Such amendments are governed by
Article Xlll. The House shall determine prior to submission
whether a referendum shall be advisory or binding, and so
advise the membership at the time of submission. A majority
vote of all the members of the Society shall determine the
question on a binding referendum.
ARTICLE XII
Seal
The Society shall have a common seal. The power to
change or renew the seal shall rest with the House of
Delegates.
ARTICLE Xlll
Amendments
The House of Delegates may amend any article of this
Constitution by a two-thirds vote of the members of the
House present at any Annual Meeting, provided that such
amendment shall have been introduced in the form of a con-
stitutional amendment in open session at the previous
Armual Meeting, and that it shall have been published at
least once during the year in the Journal of this Society, or
sent to each member of the Society at least two months
before the meeting at which final action is to be taken.
BYLAWS
CHAPTER 1
Membership
Section 1 . The name of a physician on the official roster of
this Society, after it has been properly reported by the secre-
tary of the county society, shall be prima facie evidence of
membership and of the right to benefits.
Sec. 2. No person whose name has been dropped from the
roll of members of a component society or this Society shall
be entitled to any of the rights or benefits of this Society, ex-
cept that such rights and benefits shall continue during the
period of an appeal by such person to the Board of Direc-
tors.
Sec. 3. Every physician who holds a license to practice
medicine and surgery in Wisconsin shall be eligible to apply
for membership. Each county society shall be the judge of
the initial and continuing qualifications of its members, as
well as the appropriate membership classification, subject to
review and final decision by the Board of this Society.
Members will conduct themselves in a manner which is not in
conflict with the purposes for which the Society is organized
and is operating.
Sec. 4. By provision of its constitution or bylaws, a county
society may require that an applicant shall have practiced
within its jurisdiction for a period of one year as a condition
for election to membership; or that an applicant may first be
elected to membership for a term of one year only, then re-
submit to election by vote of the county society without
limitations as to term.
Sec. 5. A member of a component society whose license
has been revoked, suspended, nonrenewed, or voluntarily
surrendered, shall be immediately and automatically sus-
pended from membership as of the date of revocation, sus-
pension, nonrenewal, or voluntary surrender, pending
definitive action by the Board.
Sec. 6. A physician’s county society membership must be
held in that county in which the physician’s principal practice
is located. However, a physician living near a county line
may hold membership in that county most convenient for
attending meetings, with concurrence of the component
society in which the principal place of practice is maintained.
Sec. 7. A member whose principal practice is moved from
within the territorial limits of a component medical society to
the territory of another component of the State Society shall
not be eligible to continue membership in the first such
society after the expiration of the calendar year in which such
move shall have occurred. Such member shall, however, be
eligible to apply for membership anew, or by transfer to the
society into whose jurisdiction the principal practice has been
moved. The member shall be given a written certificate of
transfer for transmission to the secretary of the society in the
county to which he has moved. Pending acceptance or rejec-
tion by the society in the county to which he has moved, such
member shall be considered to be in good standing in the
first society and in the State Society until the end of the
period for which dues have been paid.
Sec. 8. When the principal practice of a member in good
standing in a component society is moved outside the
borders of this state, active membership in such component
society and in the State Society may be continued by fulfill-
ing all requirements of membership except residence pending
acceptance as a new or transfer member by the society of the
area to which the practice has been transferred. The period
of such continuing membership in this state shall cease upon
acceptance by a society in the new area of practice, and shall
in no event continue beyond two full calendar years after
that in which the practice location has been transferred.
Sec. 9. Membership Classifications. Members defined in
this section, except Affiliates, shall have all the rights and
privileges of the Society and shall pay dues and assessments,
as indicated, as a requirement of continued membership.
A. Regular. Regular members of this Society consist of all
the regular members in good standing of the component
county societies.
B. Special. Included in this classification are the following
categories of members who by virtue of their special circum-
stances are entitled to reduced dues or waiver thereof:
(1) Part-time practice. Any physician, regardless of age,
who practices 1 ,000 hours or less during a calendar
year, but does not qualify under section 9.B. (5),
may upon application, recommendation by the
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WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
county medical society, and approval by this
Society, be placed in this special category.
(2) Resident. Physicians in approved training programs
as hospital residents or as research fellows who are
licensed to practice medicine and surgery in Wiscon-
sin. Such special membership category can be main-
tained for a maximum of five (5) consecutive years.
(3) Temporary Military Service. Members who are in-
ducted into the United States Military or Public
Health Service and serve in such capacity for not
more than five (5) years.
(4) Associate. Members who suffer a disability prevent-
ing them from practicing medicine with resulting
serious financial reverses which would make the
payment of dues a matter of personal hardship.
Such membership shall be on an annual basis, upon
recommendation of the county society and approval
by the Board of this Society.
(5) Retired. Members who have retired completely from
the practice of medicine, or who practice 240 hours
or less during a calendar year, upon recommenda-
tion of the county society and approval by this
Society.
(6) Life. Those members of the State Medical Society
of Wisconsin who have been members of this or
other state medical societies for fifty (50) years, or
are past presidents of the State Medical Society of
Wisconsin. They shall receive a certificate of Life
Membership.
(7) Honorary. Members who have been elected to a
similar classification by their county society because
of outstanding contributions to the medical profes-
sion, upon approval by the Board of this Society.
(8) Over Age 70. Members who are age 70 effective
January 1 of the following year.
C. Affiliate. Persons who are not otherwise eligible for
membership may become affiliated with this Society in one
of the following categories. Their dues or assessments, as
well as rights and privileges as affiliate members, shall be
determined by the Board.
(1) Candidate. Upon application, a county medical
society or this Society may confer upon any person
then attending a medical school in Wisconsin or ful-
filling a postgraduate obligation prior to eligibility
for licensure the status of Candidate Member.
(2) Scientific Fellow. The Board may by invitation
and unanimous consent confer upon any person
engaged in teaching of or research in one or more
of the basic sciences at an accredited college or
university, and not holding the degree of Doctor
of Medicine or Osteopathy, the status of Scientific
Fellow.
(3) Emeritus. Retired members who have chosen not to
renew their license, at the discretion of the Board.
Sec. 10. Dues and Assessments. Members shall pay dues
and assessments as follows:
A. Regular members: full dues and assessments.
B. Physicians in part-time practice or over age 70: one-
half of regular member dues and assessments.
C. Physicians in residency or fellowship training: one-
tenth of regular member dues and assessments.
Dues and assessments for all other categories shall be
waived, except as may be determined by the Board for affili-
ate members.
CHAPTER II
House of Delegates
Section 1 . Each component county society shall be entitled
to send one delegate and one alternate to the House of
Delegates for each forty regular and special members or
majority fraction thereof in this Society, provided, however,
that each county society shall be entitled to at least one
delegate and one alternate from that county society.
For purposes of this section, the number of members as of
the close of the calendar year preceding the first session of
the House of Delegates at the Annual Meeting shall deter-
mine the number of delegates to which a county society shall
be entitled.
The secretary of each county society will send a list of such
delegates and alternates to the secretary of this Society by the
end of each calendar year preceding the year in which such
delegates are elected to serve.
Sec. 2. One-fourth of the members of the House of
Delegates registered, representing one-fourth of the county
medical societies in the state, shall constitute a quorum of the
House of Delegates. All meetings of the House of Delegates
shall be open to members of the Society.
Sec. 3. The speaker shall preside at the meetings of the
House of Delegates.
Sec. 4. The vice speaker shall officiate for the speaker in
the latter’s absence or at his request. In case of death,
resignation, or removal of the speaker, the vice speaker shall
officiate during the unexpired term.
Sec. 5. The speaker shall appoint members of reference
committees from among the members of the House of
Delegates. These committees shall consider and make recom-
mendations to the House relative to resolutions, reports of
officers, reports of commissions and committees, financial
and other matters germane to the business of the House. The
speaker shall also appoint a credentials committee and such
other committees as deemed necessary.
Sec. 6. The House of Delegates shall elect delegates to the
House of Delegates of the American Medical Association in
accordance with the Constitution and Bylaws of that body.
Sec. 7. The House of Delegates shall have authority to
create committees for special purposes and to appoint
members of the Society who need not be members of the
House of Delegates. Such committees shall report to the
House of Delegates, and their members may be present to
participate in the debate on their reports.
Sec. 8. It shall receive for appropriate action the annual
reports of the treasurer, secretary, and chairman of the
Board of Directors.
Sec. 9. Unanimous consent of the House of Delegates
shall be required for the introduction of any new resolution
or business not filed in proper form with the secretary’s
office of the Society two months before the first session of
the House of Delegates. This section shall not apply to new
business or resolutions presented by the Board of Directors
or any member thereof, the constitutional officers, commit-
tees of the Society or of the House of Delegates, or officers
of the House of Delegates.
Sec. 10. All questions of an ethical nature brought before
the House of Delegates shaU be referred to the Board of
Directors without discussion.
CHAPTER III
Annual Election
Section 1 . The House of Delegates, at its first session of
the Annual Meeting, shall elect a Committee on Nomina-
tions consisting of one (1) delegate for each district, except
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
105
that in any district having five hundred (500) or more regular
and special members, there shall be elected one (1) additional
delegate for each additional five hundred (500) members or
majority fraction thereof. One (1) delegate representing the
specialty sections shall also be appointed. This committee
shall become operative at the close of the final session of that
Annual Meeting and shall function until the close of the final
session of the following year’s Annual Meeting. The incom-
ing committee shall meet with the existent committee but
without vote during the overlapping days of the Annual
Meeting. Any vactmcy occurring in the Committee on Nomi-
nations between the date of its formation and the time of its
reporting shall be filled by appointment by the director or
directors of the district in which the vacancy occurs, pro-
vided that if the vacancy occurs in the representation from
the specialty sections, such vacancy shall be filled by ballot
from among the section delegates.
The Committee on Nominations shall convene at least two
(2) months prior to the Annual Meeting of the House of
Delegates to prepare a slate of candidates. This meeting, to
be held at a time, date and location published to the general
membership at least two (2) months before this meeting,
shall include an open session of not less than one (1) hour to
allow individual nomination of candidates. The Committee
shall report the result of its deliberations to the House of
Delegates in the form of a ticket containing the names of one
or more members for each of the positions to be filled.
Sec. 2. The report of the Committee on Nominations and
elections shall be the first order of business of the House of
Delegates at the third session of the Annual Meeting.
Sec. 3. The House of Delegates shall elect the president-
elect, the treasurer, the speaker and vice speaker of the
House of Delegates, and the delegates and alternates to the
American Medical Association. Where there is no contest, a
majority vote without ballot shall elect. All other elections
shall be by separate ballot for each individual position, and a
majority of the votes cast shall be necessary to elect. If no
nominee receives a majority of the votes on the first ballot,
the nominee receiving the lowest number of votes shall be
dropped, except where there is a tie, and a new ballot taken.
This procedure shall be continued until one of the nominees
receives a majority of the votes cast.
Sec. 4. Nothing in this chapter shall be construed to pre-
vent additional nominations being made from the floor by
members of the House of Delegates.
CHAPTER IV
Duties of Officers
Section 1 . The president is the chief constitutional officer
of the Society. Within the limits of the Constitution, Bylaws,
and policies of the House of Delegates and Board of Direc-
tors, the president shall have the following responsibilities
and commensurate authority:
a. Deliver an annual address to the House;
b. Serve as a member with right to vote on the Board;
c. Preside at meetings of the Executive Committee of
the Board;
d. Participate, ex officio and without the right to vote,
in sessions of the House;
e. Initiate and propose policies and programs that will
further the goals and objectives of the Society for
consideration by the House, Board, commissions
and committees;
f. Support and articulate policies and programs
adopted by the Board and the House;
g. Promote physician interest and active participation
in the Society.
Sec. 2. The president-elect shall act for the president in his
absence or disability. If the office of president should
become vacant, the president-elect shall succeed to the presi-
dency. In case of vacancy in the office of both president and
president-elect, the Board shall appoint one of its members
as acting president until the next meeting of the House of
Delegates.
Sec. 3. The treasurer shall be responsible to the Board of
Directors, and shall advise and assist it in making decisions
on investment policy and financial matters. The duties of the
treasurer shall include the following:
a. Be responsible for all funds due the Society, together
with bequests and donations;
b. Pay money out of the treasury only on written order
of the secretary;
c. Subject the treasurer’s accounts to such examination
as the House of Delegates may order;
d. Annually report on the financial standing of the
Society, including a balance sheet and income and
expense report;
e. Give bond in such amount as the Board may pro-
vide.
Sec. 4. The secretary is the chief executive officer of the
Society charged with the execution of policy as created and
defined by the House of Delegates and the Board of Direc-
tors. Duties of the secretary shall include being secretary of
and responsible to the Board; assisting the officers in making
decisions and implementing actions; sharing convictions and
arguing their merits as requested. Duties as chief executive
officer shall be:
a. Assume the general managerial duties of all Society
divisons, activities, and personnel;
b. Be custodian of all records and papers belonging to
the Society, except such as properly belong to the
treasurer;
c. Keep account of and promptly turn over to the
treasurer all funds of the Society which come into the
secretary;
d. Maintain current copies of each component county
society’s constitution and bylaws;
e. Conduct the official correspondence, notifying
members of meetings, officers of their election and
committees of their appointments and duties;
f. With the approval of the Board, employ such
assistants as are needed to effectively execute the
policies of the Society;
g. Make an annual report to the House of Delegates.
CHAPTER V
Board of Directors
Section 1 . The Board of Directors shall be the executive
body of the Society. Between meetings of the House of
Delegates it shall exercise the power conferred on the House
of Delegates by the Constitution and Bylaws.
Sec. 2. The Board shall meet during the Annual Meeting
and at such other times as necessity may require, subject to
the call of the chairman or on petition of three directors. It
shall hold an annual meeting for purposes of organization
and other business.
Sec. 3. The Board shall elect a chairman and a vice chair-
man from among its voting members. It may create such fur-
ther offices or combine or abolish them as it sees fit in the
management of its affairs and in the discharge of its respon-
sibilities. Its chairman shall submit an annual report to the
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WISCONSIN MEDICAL JOURNAL, JUNE 1985 : VOL. 84
House of Delegates including all major actions and policy
decisions of the preceding year.
Sec. 4. Each director shall be the organizer and mediator
for the district. Directors shall visit each county in their dis-
trict as needed for the purpose of organizing component
societies where none exist, for inquiring into the condition of
the profession, and to keep informed of the activities of the
component societies in the district. Each director shall
arrange for an annual conference or caucus with the societies
or their delegates within the district, at which time informa-
tion shall be disseminated concerning the activities of the
State Medical Society and component societies within the
district. Each director shall report as necessary to the Board.
The necessary traveling expenses incurred by each director in
the line of duties herein imposed may be allowed on a proper
itemized statement, but this shall not be construed to include
the expense of attending the Annual Meeting of the Society.
Sec. 5. The Board of Directors shall be the judicial body
of the Society. It may decide any questions of conduct or
discipline of members, or any questions involving the rights
and standing of members, whether in relation to other
members, to the component societies, or to this Society. It
shall develop and publish procedures for discipline, including
denial of initial or continuing membership, for those physi-
cians who fail to provide quality health care, failure to pay
dues, loss of license to practice, or other cause. Its decisions
in all cases shall be final, including the right to expel a
member should a component society fail to do so after being
so requested by the Board.
The Board’s right to original jurisdiction includes but is
not limited to the right to decide cases when:
a. the affected parties reside within the boundaries of a
single county medical society and that society does
not wish to assume jurisdiction;
b. the affected parties reside in two or more component
medical society jurisdictions.
The Board also has within its authority the right to
appoint a commission or commissions to which any or all
such matters may be referred for investigation, evaluation
and decision to acquit, admonish, or otherwise discipline as
appropriate. A member may appeal to the Board the deci-
sion of such commission or the action of a county society as
provided in Chapter X, Section 3. If the recommendation is
for suspension or expulsion of a physician from Society
membership, final action must be taken by the Board.
Sec. 6. Charters shall be issued to county societies only on
approval of the Board, with ratification by the House of
Delegates, and shall be signed by the president and secretary
of this Society. Upon the recommendation of the Board, the
House of Delegates may revoke the charter of any compo-
nent society whose actions are in conflict with the letter or
spirit of this Constitution and Bylaws.
Sec. 7. In sparsely settled sections, the Board shall have
authority to organize the physicians of two or more counties
into societies. These societies, when organized and chartered,
shall be entitled to all rights and privileges provided for com-
ponent societies until such counties shall be organized
separately.
Sec. 8. The Board shall provide for and superintend the
issuance of all publications of the Society including proceed-
ings, transactions and memoirs, and shall have the authority
to appoint an editor of the Journal and such assistants as it
deems necessary.
Sec. 9. The Board shall select a qualified independent
accounting firm and receive an annual audit of all accounts
of this Society. With the treasurer, it shall supervise the in-
vestment of funds. The Board shall adopt an armual budget
providing for the necessary expenses of the Society.
Sec. 10. The Board may, by interim appointment, fill any
vacancy in office not otherwise provided for which may
occur during the interval between Annual Meetings of the
House of Delegates. The appointee shall serve until a suc-
cessor has been elected and has qualified.
When a district initially qualifies for an additional direc-
tor, such position shall be considered new and not a vacancy
to which the Board is authorized to make an interim
appointment. Such new position shall be filled by election at
the next meeting of the House of Delegates in the maimer
provided by Article VI of the Constitution. The initial term
shall be so established as to maintain the election of sub-
stantially one-third of the directors each year.
Sec. 11. The Board may elect as secretary one who need
not be a physician or a member of the Society.
Sec. 12. The formation of salary schedules of all em-
ployees of the Society shall be the responsibility of the
Board.
Sec. 13. The Board shall provide such facilities for the
Society as may be required to properly conduct its business.
CHAPTER VI
Commissions and Committees
Section 1 . The Board shall appoint such commissions and
committees, either permanent or ad hoc, as it deems neces-
sary to properly conduct the affairs of the Society. Member-
ship on such committees and commissions shall be limited to
members of the Society and its Auxiliary. Nonmembers of
the Society or its Auxiliary may be appointed as special rep-
resentatives should their expertise and knowledge be of
benefit to the goals of such commissions or committees.
Such individuals shall not have the right to vote or hold
office.
Each commission and committee shall have the duty of
being informed on matters within the area of its special in-
terest. They shall represent the Society’s interests by con-
tinual contacts with voluntary and governmental agencies
having related concerns with the intention of coordinating
efforts to serve the health interests of the people of Wiscon-
sin. They shall develop recommendations from their studies
and activities for action by the Board or House of Delegates.
Sec. 2. Specialty sections shall be regarded as special com-
mittees of the Society from which the Board or any commis-
sion or committee may seek advice and assistance on matters
of special or general concern to the profession and the health
of the people of Wisconsin. The specialty sections will be ex-
pected to give special requests prompt consideration and
response so as to enable the Society to make maximum use
of their resources.
CHAPTER VII
Dues and Assessments
Section 1 . The annual dues and assessments of this Society
shall be determined by the House of Delegates and shall be
levied per capita on the members. Dues and assessments shall
be payable as determined by the Board of Directors. Any
member whose current year’s dues have not been received by
the secretary of this Society by May 15 shall be deemed in
arrears and his name shall be removed from the membership
rolls of his county society and this Society until such time as
full dues for the current year have been received.
Sec. 2. The record of payment of dues and assessments on
file in the offices of this Society shall be final as to the fact of
payment by a member and to the right to participate in the
business and proceedings of the Society or the House of
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
107
Delegates and to any other benefits and privileges of
membership.
CHAPTER VIII
The Board of Directors shall adopt ethical guidelines for
the members of this Society.
COMMENT: On July 18, 1981 the Board of Directors adopted the
Principles of Medical Ethics of the AMA as the ethical guidelines of the
Society.
CHAPTER IX
The current edition of Sturgis Standard Code of Par-
liamentary Procedure governs this organization in all parlia-
mentary situations that are not provided for in the law or in
its charter, constitution, bylaws, or adopted rules.
CHAPTER X
County Societies
Section 1 . All present county societies or those that may
hereafter be organized in this state shall, upon application to
the Board of Directors, receive charters from this Society,
provided that their constitutions and bylaws have been sub-
mitted to the Board and found in conformity with the Con-
stitution and Bylaws of the State Medical Society. All re-
visions shall be submitted to the Society, approved by the
Board, and filed with the secretary. Where a county society
has lost or misplaced its constitution and bylaws, the model
constitution and bylaws for county medical societies, as last
approved by the Board, shall be deemed to apply.
Sec. 2. Only one component medical society shall be
chartered in each county.
Sec. 3. Any physician who may feel aggrieved by the
action of the society of his county in suspending or expelling
him shall have the right to appeal to the Board of Directors
of the State Society. Its decision shall be final. A county
society shall at all times be permitted to appeal or refer ques-
tions involving membership to the Board of the State Society
for final determination. The mechanisms and procedures
which apply to the appeal process shall be those adopted by
the Board.
Sec. 4. Each component county society shall elect one or
more delegates and may elect an equal number of alternates
to substitute for any absent delegates from that component
society, for a term of two calendar years, to represent it in
the House of Delegates of this Society, in accordance with
Chapter II, Section 1, of these Bylaws. The term of office
shall begin on January 1 of the year succeeding the election
of such delegates and alternates.
Sec. 5. The secretary of each county society shall keep a
roster of its members.
CHAPTER XI
Specialty Sections
Section 1 . The House of Delegates shall establish specialty
sections within the Society. It shall have the power to com-
bine, enlarge, or discontinue any or all of such sections so
established.
Sec. 2. Such sections so established shall be based upon
those divisions of medicine in which the various members
possess a special interest. Qualifications for membership in
any section shall be established by the members of such sec-
tion, subject to approval of the Board of Directors. Scientific
meetings of a section shall be open to all members in good
standing of the State Medical Society.
Sec. 3. The officers of each section shall be elected by and
from its membership. The terms of such officers shall be for
one year, but any officer may be reelected.
Sec. 4. No section shall have the power to bind the State
Medical Society by any resolution or other action. No such
resolution or action shall be publicized unless it shall first
have been approved by the House of Delegates, or by a
majority of the Board when the House is not in session. No
resolution adopted by any section shall be effective until like-
wise so approved.
Sec. 5. Each section shall elect a delegate and an alternate
to the House of Delegates. The term shall be for two calen-
dar years without limitation on number of terms.
Sec. 6. The specialty sections of the Society shall be con-
sidered an integral part of the working committee structure
of the Society as outlined in Chapter VI of these Bylaws.
CHAPTER XII
Amendments
These Bylaws may be amended at any Annual Meeting by
a majority vote of the delegates present at that session, if the
proposed amendment has been properly submitted to the
House of Delegates and has laid over for one day. ■
AMERICAN MEDICAL ASSOCIATION— PRINCIPLES OF MEDICAL ETHICS
PREAMBLE: The Medical profession has long subscribed to
a body of ethical statements developed primarily for the
benefit of the patient. As a member of this profession, a
physician must recognize responsibility not only to patients,
but also to society, to other health professionals, and to self.
The following Principles adopted by the American Medical
Association are not laws, but standards of conduct which
define the essentials of honorable behavior for the physician.
I. A physician shall be dedicated to providing competent
medical service with compassion and respect for human
dignity.
II. A physician shall deal honestly with patients and col-
leagues, and strive to expose those physicians deficient in
character or competence, or who engage in fraud or decep-
tion.
III. A physician shall respect the law and also recognize a
responsibility to seek changes in those requirements which
are contrary to the best interests of the patient.
IV. A physician shall respect the rights of patients, of col-
leagues and of other health professionals, and shall safeguard
patient confidences, within the constraints of the law.
V. A physician shall continue to study, apply and advance
scientific knowledge, make relevant information available to
patients, colleagues and the public, obtain consultation, and
use the talents of other health professionals when indicated.
VI. A physician shall, in the provision of appropriate
patient care, except in emergencies, be free to choose whom
to serve, with whom to associate, and the environment in
which to provide medical services.
VII. A physician shall recognize a responsibility to partici-
pate in activities contributing to an improved community.
108
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
Expense reimbursement policy and procedure
for physicians on State Medical Society business
It is the policy of the State Medical Society of Wis-
consin to offer reimbursement of out-of-pocket ex-
pense incurred by its officers, directors, committee
chairmen and members, AMA delegates and alter-
nates and other designated physicians when such ex-
pense is incurred in the course of the conduct of
business on behalf of the Society. The Society recog-
nizes that any such leadership role requires a substan-
tial contribution in personal time on the part of the
physician. It is traditional that this be accepted as a
contribution to the profession and the health of the
public. However, out-of-pocket expenses in the dis-
charge of official functions of the Society are reim-
bursable as set forth below, except that district direc-
tors are not reimbursed for the expense of attending
the Annual Meeting of the Society (Bylaws, Chapter
V, Sec. 4).
Officers, Directors, Committee Chairmen and
Members, and Other Designated Persons
Reimbursable expenses include the cost of:
1. All meals, including normal tips, incurred while
away from the physician’s home city on SMS
business.
2. All meals in the home city of the physician when
these are in relation to an SMS business meeting.
3. Entertainment expenses where such expense is
clearly a proper and necessary adjunct to the con-
duct of the physician’s business function for the
Society.
4. Valet and laundry services when the physician is
away from the home city on SMS business con-
tinuously for four (4) days or more.
5. Lodging for those days (nights) reasonably associ-
ated with the dates of a meeting for which expenses
are claimed.
6. Transportation from home city to meeting site and
return as follows:
Air — Cost of round trip coach airfare, plus neces-
sary ground transportation.
Bus/ Train — Cost of round trip fare, plus necessary
ground transportation.
Auto — Mileage at the current Society rate (now
20C) to and from the meeting site, plus necessary
parking fees and highway tolls.
Miscellaneous Ground Transportation — Local bus
and cab fares as necessary.
Auto Rental — All or some portion of such cost
may be reimbursed as a substitute for other
ground transport when this is the most feasible
alternative following initial air, bus or train
travel. Example, remote resort meeting site.
7. Telephone and telegraph communications relative
to SMS business.
Approved by Board of Directors, July 18, 1981
Note: Use of least costly means of telephone
communication is encouraged. Examples: In
calling SMS Headquarters use toll-free number
l-8(X)-362-9080 whenever possible. Similarly, use
direct dial rather than credit card, whenever
feasible.
8. Secretarial and copying services, postage and sta-
tionery used for SMS business.
Note: SMS Headquarters is prepared to
handle most official correspondence and repro-
duction work for officers and committee mem-
bers. However, physicians may be reimbursed
for personal or office costs relating to secre-
tarial, copying, postage and stationery utilized
in conducting SMS business.
Note: Copies of all official correspondence
should be sent to the appropriate committee
staff person at SMS so as to assure proper coor-
dination and recordkeeping.
9. Expenses, as described in 1-8 above, incurred by
the physician’s spouse when accompanying him/
her in an official capacity or when the spouse is
“expected” to be in attendance are reimbursable.
Procedure for Claiming Expenses
1. To obtain reimbursement the physician must
submit a statement of expenses incurred.
2. Attach copies of bills or receipts for all lodging,
travel, and meals over $25.
3. Itemize separately costs for Item 8 above.
4. Mail to SMS, Attn: Accounting Department,
PO Box 1109, Madison, Wis 53701.
Reimbursement will be made within two weeks
following receipt and approval of the expense report.
AMA Delegates and Alternates
AMA Delegates and Alternates from Wisconsin
receive reimbursement as follows for each meeting of
the AMA House of Delegates they attend:
Round Trip Coach Airfare, or up to equivalent in
auto mileage at the current SMS mileage rate (now
204).
S6(X) cash to cover out-of-pocket expense.
When such delegates and alternates are conducting
SMS business not in conjunction with meetings of the
AMA House of Delegates, their expenses may be
reimbursed in the same manner as outlined for Of-
ficers, Directors, etc.
Out-of-State Trips
With the exception of AMA House of Delegates
meetings and travel by the President/President-Elect,
all out-of-state trips must have prior approval by the
Executive Committee to be reimbursable. Contact the
Secretary and General Manager. ■
THE HIPPOCRATIC OATH and the DECLARATION OF GENEVA are reproduced below for the
convenience of physicians and others who may have need of them from time to time.
THE OATH OF HIPPOCRATES
I SWEAR BY APOLLO, THE PHYSICIAN, AND AESCULAPIUS AND HEALTH AND
ALL-HEAL AND ALL THE GODS AND GODDESSES THAT, ACCORDING TO MY
ABILITY AND JUDGMENT, I WILL KEEP THIS OATH AND STIPULATION:
TO RECKON him who taught me this art equally dear to me as my parents, to share my substance
with him and relieve his necessities if required; to regard his offspring as on the same footing
with my own brothers, and to teach them this art if they should wish to learn it, without fee or
stipulation, and that by precept, lecture and every other mode of instruction, I will impart a
knowledge of the art to my own sons and to those of my teachers, and to disciples bound by
a stipulation and oath, according to the law of medicine, but to none others.
1 WILL FOLLOW that method of treatment which, according to my ability and judgment, I
consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous.
I will give no deadly medicine to anyone if asked, nor suggest any such counsel; furthermore,
I will not give to a woman an instrument to produce abortion.
WITH PURITY AND WITH HOLINESS I will pass my life and practice my art. I will not cut
a person who is suffering with a stone, but will leave this to be done by practitioners of this work.
Into whatever houses 1 enter I will go into them for the benefit of the sick and will abstain from
every voluntary art of mischief and corruption; and further from the seduction of females or
males, bond or free.
WHATEVER, in connection with my professional practice, or not in connection with it, I may
see or hear in the lives of men which ought not to be spoken abroad, I will not divulge, as reckoning
that all such should be kept secret.
WHILE I CONTINUE to keep this oath unviolated, may it be granted to me to enjoy life and
the practice of the art, respected by all men at all times; but should I trespass and violate this
oath, may the reverse be my lot.
DECLARATION OF GENEVA
Adopted by the General Assembly of the World Medical Association at Geneva, Switerland,
September, 1948
AT THE TIME OF BEING ADMITTED AS MEMBER OF THE MEDICAL PROFESSION:
I SOLEMNLY PLEDGE myself to consecrate my life to the service of humanity.
I WILL GIVE to my teachers the respect and gratitude which is their due.
I WILL PRACTICE my profession with conscience and dignity.
THE HEALTH OF MY PATIENT will be my first consideration.
I WILL RESPECT the secrets which are confided in me.
I WILL MAINTAIN by all means in my power, the honor and the noble traditions of the medical
profession.
MY COLLEAGUES will be my brothers.
I WILL NOT PERMIT considerations of religion, nationality, race, party politics or social
standing to intervene between my duty and my patient.
I WILL MAINTAIN the utmost respect for human life, from the time of conception; even under
threat, I will not use my medical knowledge contrary to the laws of humanity.
1 MAKE THESE PROMISES solemnly, freely, and upon my honor.
MEDICAL ETHICS
CURRENT OPINIONS OF THE JUDICIAL COUNCIL OF THE American Medical Association, 1984. This new
edition, originally compiled in 1 958 and revised annually, is intended as an adjunct to the revised Principles
of Medical Ethics that were adopted at the AMA Annual Convention in 1980. The opinions are intended as
guides to responsible professional behavior, but they are not presented as the sole or only route to medical
morality. Behavior relating to medical etiquette, custom or usage is not included.
The following topics are included in the booklet:
• Opinions on Social Policy Issues
Abortion
Abuse of Children, Elderly Perso
and Others at Risk
Allocation of Health
Resources
Artificial Insemination
Artificial Insemination by Donor
Capital Punishment
Clinical Investigation
Costs
Fetal Research Guidelines
Genetic Counseling
Genetic Engineering
In Vitro Fertilization
Organ Transplantation
Guidelines
Quality of Life
Terminal Illness
Unnecessary Services
Worthless Services
• Opinions on Confidentiality,
Advertising and Communications
Media Relations
Advertising and Publicity
Advertising and HMOs
Communications Media:
Press Relations
Communications Media:
Standards of Profes-
sional Responsibility
Confidentiality
Confidentiality: Attorney-
Physician Relation
Confidentiality:
Computers
Confidentiality: Insurance
Company Representative
• Opinions on Practice Matters
Appointment Charges
, Clinics
Consultation
Contingent Physician Fees
Contractual Relationship
Drugs and Devices:
Prescribing
Informed Consent
Laboratory Services
Lien Laws
Neglect of Patient
Patient Information
Substitution of Surgeon
Without Patient’s
Knowledge or Consent
• Opinions on Hospital Relations
Admission Fee
Assessments, Compulsory
Billing for Housestaff
Services
Health Facility Ownership
by Physician
Organized Medical Staff
Physician-Hospital
Contractual Relations
Staff Privileges
• Opinions on Physician Records
Records of Physicians:
Availability of Informa-
tion to Other Physicians
Records of Physicians:
Information and Patients
Records of Physicians
on Retirement
Sale of a Medical Practice
• Opinions on Professional Rights
and Responsibilities
Accreditation
Agreements Restricting
the Practice of Medicine
Civil Rights and Profes-
sional Responsibility
Discipline and Medicine
Due Process
Free Choice
Patent for Surgical or
Diagnostic Instrument
Peer Review
• Opinions on Interprofessional
Relations
Nonscientific Practitioners
Nurses
Optometry
Referral of Patients
Specialists
Sports Medicine
Teaching
• Opinions on Fees and Charges
Fees for Medical Services
Fees: Group Practice
Fee Splitting
Fee Splitting: Clinic or
Laboratory Referrals
Fee Splitting: Drug Pre-
scription Rebates
Insurance Form Comple-
tion Charge
Interest Charges and
Finance Charges
Laboratory Bill
Surgical Assistant’s Fee
Competition
The State Medical Society of Wisconsin Board of Directors has adopted the AMA Principles of Medical
Ethics as the ethical guidelines of the Society. The Society may refer to the Judicial Council Opinions for
further guidance.
Copies of the Opinions available by direct order to: Current Opinions (OP- 122), American Medical
Association, PO Box 10946, Chicago, IL 60610 (the distribution location of AMA publications).
The price is $6.00 each for 1-9 copies; S5.40 each for 10-49 copies; and $4.80 each for 50 copies or more.
Prices include charges for handling and shipping. Residents of Illinois and New York, please add appropriate
state sales tax to total.*
1 1 1
WISCONSIN MEOICAI. JOURNAL, JUNE I985:VOL. 84
The Charitable, Educational and Scientific Foundation was established by the State
Medical Society in 1955 to enable physicians and other friends of the profession to support,
through gifts and grants, projects vitally affecting scientific medicine and public health. The
Foundation’s scope of interest has grown with increased volume of financial contributions to
support a broad spectrum of programs affecting medical and health care needs in the State of
Wisconsin.
Student Loans. The student loan program helps students finance their preparation for careers
in medicine, nursing, dentistry, pharmacy, and allied health fields. Needy and deserving
students may apply for and obtain loans carrying no interest until graduation. Since the pro-
gram began nearly 860 students have received over one million dollars in long-term, low-interest
loans. Of these, nearly 600 students have completed their repayments.
Continuing Medicai Education. Postgraduate teaching programs are a major thrust of the
Foundation. Among these are a Speakers Service to county medical societies, the Wilson
Cunningham, MD Memorial Lecture for public health, the Elvehjem Memorial Lecture for
scientific speakers at the Annual Meeting, the Barbara Scott Maroney Memorial Fund for
papers and lectures on diabetes, and the William D Stovall MD Memorial Fund and the Beau-
mont Memorial Lecture for general education and scientific medicine. Since 1975 the Founda-
tion has been the vehicle for implementation of the accreditation of CME programming of
Wisconsin hospitals and specialty groups. To date, 57 hospitals, 25 specialty groups, and one
county society have been accredited for Category I CME.
Research and Education. The Foundation plans, administers, and funds educational and
research efforts of a scientific or medical-socioeconomic nature. One of these is the annual
Wisconsin Workshop on Health aimed at health education of high school students and teachers,
now in its 22nd year. The Foundation also supports the Wisconsin Science Congress, promotion of infant car seats, and
the Postgraduate Workshop in the Basic Sciences. In addition, its E E Bryant, Jr Memorial Fund promotes educational
activity involving law, engineering and medicine, and the C H and J G Crownhart Memorial Fund supports activities
involving medical-legal issues.
Charitable Assistance. Through the Foundation there is an opportunity for professional persons to assist their col-
leagues in need. Personal hardship strikes at physicians and their families as well as others.
Medical History. The Foundation, through a subsidiary group known as the Aesculapian Society, owns and operates the
restored Fort Crawford Military Hospital and Medical Museum at Prairie du Chien. It is one of the unique educational
and cultural institutions in the midwest — a tribute to all Wisconsin physicians and their role in securing good health for the
people of the state. This three-building medical museum complex pays special tribute to William Beaumont, MD, who
during the 1830s conducted experiments on the digestive process. More than one-half million persons have visited the
museum, which is a national historic landmark. Open from May through October, the museum depicts military and
Indian medicine, important events in the history of medicine, replicas of physician and dental offices and pharmacies,
and provides an array of health education exhibits including the transparent twins, health fads and fallacies, drug abuse,
immunization, nutrition, emergency medicine, poisons in the home, safe driving, and the birth of a baby.
Opportunities for Giving. Gifts to the Foundation may take a number of forms: cash, life insurance, securities, land,
books, instruments, stamp and coin collections, works of art, and other artifacts. Gifts may be unrestricted, restricted, or
earmarked for specific purposes of interest to the donor. In addition, service can be provided to those who wish to estab-
lish a Living Trust by naming the Foundation as trustee. Use of this mechanism can result in an immediate tax advantage
for the donor while providing a guaranteed income for life. The principal would revert to the Foundation upon death of
the donor.
Life is
short . . .
Art is
long . . .
Experience
is
difficult
All types of contributions to this Foundation are tax-deductible.
1 12
WISCONSIN MEDICALJOURNAL, JUNE 1985: VOL. 84
CHARITABLE, EDUCATIONAL AND SCIENTIFIC FOUNDATION
OF THE STATE MEDICAL SOCIETY OF WISCONSIN
THE FOUNDATION is a non-profit, non-stock corporation under Wisconsin statutes. Governing power is vested in a Board of
Trustees composed of the Board of Directors and Officers of the State Medical Society of Wisconsin and up to 10 elected nonmedical
persons. In addition each of the 55 component county societies may elect a representative who is considered a corporate member of
the Board of Trustees. Although the membership of the Board of Trustees numbers over 90, the Officers and Executive Committee
constitute an efficient working body in governing the routine affairs of the Foundation. The Officers of the State Medical Society, the
Officers of the Foundation, and certain elected trustees constitute the Executive Committee of the Board of Trustees. A meeting of
the entire Board is held at least annually. Officers are elected at that time. The Executive and other committees meet periodically
throughout the year. The Foundation’s organization insures continuing liaison at the county medical society level throughout Wisconsin
and an integration with the governing body of the State Medical Society itself. Such an arrangement assures a personal and realistic
approach to Foundation activities.
OFFICERS
PRESIDENT: R T Cooney MD, Portage— 1985 TREASURER: R W Edwards MD, Richland Center— 1985
VICE-PRESIDENT: S B Webster MD, La Crosse— 1985 SECRETARY: Mr E R Thayer, Madison— 1985
E.XECUTIVE DIRECTOR: Kristin Bjurstrom, Madison
BOARD OF TRUSTEES
OFFICERS AND DIRECTORS OF THE STATE MEDICAL SOCIETY OF WISCONSIN
J K Scott MD, Madison— 1987
C W Landis MD, Milwaukee — 1988
T T Flaherty MD, Neenah — 1986
Mr E R Thayer, Madison — 1986
J J Foley MD, Menomonee Falls — 1986
D A Treffert MD, Fond du Lac — 1988
D W Taebel MD, La Crosse— 1987
V M Griffin MD, Mauston — 1986
G H Franke MD, Milwaukee — 1988
J W Fons Jr MD, Cudahy — 1988
C S Eisenberg MD, Milwaukee — 1986
L B Glicklich MD, Milwaukee — 1987
Mrs Audrey Baird, Wauwatosa — 1985
Mrs Nancy McDowell, Milwaukee — 1985
Mrs Catherine McCormick, Shawano — 1985
T A Hofbauer MD, Menomonee Falls — 1987
W H Konetzki MD, Waukesha — 1987
Frederick Wood Jr MD, Kenosha — 1987
W L Treacy MD, Milwaukee — 1987
J D Kabler MD, Madison — 1988
C M Hetsko MD, Madison — 1988
J J Tydrich MD, Richland Center — 1988
K 1 Gold MD, Beloit— 1988
P M Jackson MD, La Crosse — 1986
J J Kief MD, Rhinelander — 1986
NONMEDICAL TRUSTEES
Mr George Kress, Green Bay — 1987
Mr Robert B Murphy, Madison— 1987
J K Park MD, Wisconsin Rapids — 1988
R L von Heimburg MD, Green Bay — 1986
J C DiRaimondo MD, Manitowoc — 1988
J M Jauquet MD, Ashland — 1987
W G Locher MD, Wausau — 1986
M E Wegner MD, St Croix Falls — 1986
K M Viste Jr MD, Oshkosh — 1986
R D Fritz MD, Milwaukee — 1987
W J Listwan MD, West Bend — 1987
A E Schultz MD, Madison — 1987
C W Freeby MD, Appleton — 1987
P J Happe MD, Eau Claire — 1988
Mr Ronald W Lewis, Madison — 1987
Mrs Mary Hoard, Fort Atkinson — 1987
Mr James Bittner, Prairie du Chien — 1987
CORPORATE MEMBERS REPRESENTING COMPONENT COUNTY MEDICAL SOCIETIES
Ashland-Bayfield-lron:
Vacancy — 1986
Barron-Washburn-Burnett:
D E Riemer MD— 1985
Brown: Robert Schmidt Sr MD — 1986
Calumet: J L Jaeck MD — 1985
Chippewa: J J Sazama MD — 1985
Clark: Vacancy — 1987
Columbia-Marquette-Adams:
R T Cooney MD— 1986
Crawford: E M Dessloch MD — 1986
Dane: R A Graf MD— 1986
Dodge: Vacancy — 1987
Door-Kewaunee: R G Evenson MD — 1986
Douglas: C J Picard MD — 1986
Eau Claire-Dunn-Pepin; G E Wahl MD — 1985
Fond du Lac: Vacancy— 1987
Forest: Vacancy— 1987
Grant: C L Steidinger MD — 1986
Green: Vacancy — 1986
Green Lake-Waushara: Vacancy — 1987
Iowa: H P Breier MD— 1986
Jefferson: J S Garman MD — 1987
Juneau: L J Radant — 1987
Kenosha: H P Rafferty MD — 1985
La Crosse: L J Logan MD — 1987
Lafayette: L L Olson MD — 1986
Langlade: E J Roth MD— 1985
Lincoln: Vacancy — 1987
Manitowoc: J R Larsen MD — 1985
Marathon: Vacancy — 1987
Marinette-Florence: C E Koepp MD — 1986
Milwaukee: J D Levin MD — 1986
Monroe: Vacancy— 1987
Oconto: J S Honish MD — 1986
Oneida-Vilas: J J Kief MD— 1985
Outagamie: Vacancy — 1986
Ozaukee: R F Henkle MD — 1985
Pierce-St Croix: D M Woeste MD— 1985
Polk: J O Simenstad MD— 1985
Portage: Vacancy — 1987
Price-Taylor: J R Keuer MD — 1985
Racine: F J Scheible MD — 1985
Richland: R W Edwards MD — 1986
Rock: Vacancy— 1986
Rusk: William Bauer MD — 1985
Sauk: H P Baker MD— 1986
Sawyer: Vacancy — 1985
Shawano: J J Albright MD — 1986
Sheboygan: J R Pawlak MD— 1985
Trempealeau- Jackson-Buffalo:
R N Yray MD— 1987
Vernon: T J Devitt MD — 1987
Walworth: Vacancy — 1985
Washington: J E Albrecht MD — 1985
Waukesha; Vacancy — 1984
Waupaca: Vacancy — 1987
Winnebago: G W Arndt MD— 1986
Wood: L C Pomainville MD — 1987H
1 13
WISCONSIN MEDICAL JOURNAL, JUNE 1985:VOL. 84
C E S
Foundation
of the State Medical
Society of Wisconsin
The Charitable, Educational and
Scientific Foundation of the
State Medical Society of W/s-
consin recognizes the generosity
of the following individuals and
organizations who have made
contributions during the month
of April 1985.
VOLUNTARY
CONTRIBUTIONS
Dennis Anderson, MD
Ashland-Bayfield-lron County
Medical Auxiliary
Felicisima B Balverde, MD
Dr and Mrs Thomas Briggs
David J Carlson, MD
Thomas J Doyle, MD
Paul R Ebling, MD
Timoteo L Galvez, MD
Grant County Medical
Auxiliary
James W Hare, MD
Heidi J Harkins, MD
Dr and Mrs Thomas Hofbauer
Jefferson County Medical
Auxiliary
Albert Kniaz, MD
Gregory J Kuhr, MD
Lawrences Larson, MD
Roland Liebenow, MD
Dr and Mrs Rolf Lulloff
John MacDougall, MD
Richard J Marchlando, MD
Dr and Mrs James R Mattson
Richard E Nells, MD
Julian J Newman, MD
LIgaya M E Newman, MD
Outagamie County Medical
Auxiliary
Raymond W Quandt, MD
Thomas R Rauschenberqer,
MD
Dr and Mrs Donald M Ruch
Sally M Schlise, MD
Dr and Mrs Daniel W Shea
Mrs K Alan Stormo
Roland G Vega, MD
Kenneth Viste, Jr, MD
Waukesha County Medical
Auxiliary
Stephen B Webster, MD
John E Whitcomb, MD
Dr and Mrs N John Yousif
SPECIAL GIFTS
Mrs Rosena Brunkow
IN MEMORIAM
Mr William E Appel
Edwin P Bickler, MD
Gerard J Biedlingmaier, MD
Joseph D Bonan, MD
Wallace Branley
Benjamin Brunkow, MD
Mrs Mary Markey Burns
Walter E Clasen, MD
Leo Donner
Richard W Farnsworth, MD
Harry Gonlag, MD
Alvin O Hendrickson, MD
Philip W Limberg, MD
Jerry W McRoberts, MD
Alphonsus Rauch, MD
William H Studley, MD
Gene A Wells
MEMORIAL
CONTRIBUTORS
Mrs J C Adams
Mr and Mrs Michael Barnard
Joan F Barry
Mr and Mrs Dudley Birder
Brown County Medical
Auxiliary
Dr and Mrs Inwin J Bruhn
Rosena E Brunkow
Agatha C Burdon
Mrs Raymond Burke
Mrs John Clancy
Miss Mary Clancy
Marie L Copps
Donna Dart
Mrs John Delaney
Delores Delwiche
Mrs Dorn Denessen
Eleanor DeWitt
Dr and Mrs Richard W
Edwards
Mr and Mrs F L Ferzacca
John R Goelz, MD
Mrand Mrs William Golueke
Dr and Mrs John Guthrie
Mr and Mrs John A Hagman
Mrand Mrs James Hogan
Mr and Mrs George Hollmiller
Dr and Mrs Robert Johnston
Mrs J E Kaufman
Mrand Mrs Thomas Kiedinger
Lorraine Martin
Mrand Mrs Robert McComb
Mrs Gerald Mortell
Mrand Mrs Spencer Mosley
Mrs E J Muench
Mrs Crane Murphy
Mrs Norris Murphy
Mrs Ellsworth Nelson
Mrs James W Nigbor
Dr and Mrs Louis Philipp
Mrand Mrs Peter M Platten,
Jr
Mrand Mrs Peter M Platten,
Sr
Dr and Mrs Herbert Sandmire
Mrand Mrs Raymond Sauvey
Dr and Mrs Daniel W Shea
Mrs. George Shinners
Mr and Mrs Bruce Somers
Marge and Dick Stafford
Mrand Mrs Michael Stern
State Medical Society
of Wisconsin
Betty Stathas
Mrand Mrs C D Swanson
Mrs Thomas G Thyes
Mrand Mrs James L
Van Egeren
Mr and Mrs Gerald P Warzella
HARRINGTONWRIGHT
SCHOLARSHIP FUND
Ashland-Bayfield-lron County
Medical Auxiliary
Barron-Washburn-Burnett
County Medical Auxiliary
Grant County Medical
Auxiliary
Waukesha County Medical
Auxiliary
WISCONSIN WORK
WEEK ON HEALTH
state Medical Society of
Wisconsin Auxiliary
IMPAIRED PHYSICIANS
PROGRAM
Wisconsin Association for
Medical Staff Sen/ice
BEAUMONT 500
Mrs Benjamin Brunkow and
the late Dr Benjamin
Brunkow
Dr Robert T Cooney
BROWN COUNTY
STUDENT LOAN FUND
Mrs J C Adams
Mrand Mrs Michael Barnard
Joan F Barry
Mrand Mrs Dudley Birder
Brown County
Medical Auxiliary
Agatha C Vurdon
Mrs Raymond Burke
Mrs John Clancy
Miss Mary Clancy
Marie L Copps
Donna Dart
Mrs John Delaney
Delores Delwiche
Mrs Dom Denessen
Eleanor DeWitt
Mrand Mrs F L Ferzacca
John R Goelz, MD
Mr and Mrs William Golueke
Dr and Mrs John Guthrie
Mr and Mrs John A Hagman
Mrand Mrs James Hogan
Mrand Mrs George Hollmiller
Dr and Mrs Robert Johnston
Mrs J E Kaufman
Mr and Mrs Thomas Kiedinger
Lorraine Martin
Mr and Mrs Robert McComb
Mrs Gerald Mortell
Mr and Mrs Spencer Mosley
Mrs E J Muench
Mrs Crane Murphy
Mrs Norris Murphy
Mrs Ellsworth Nelson
Mrs James W Nigbor
Dr and Mrs Louis Philipp
Mrand Mrs Peter M Platten, Jr
Mr and Mrs Peter M Platten, Sr
Dr and Mrs Herbert Sandmire
Mrand Mrs Raymond Sauvey
Dr and Mrs Daniel W Shea
Mrs George Shinners
Mr and Mrs Bruce Somers
Mrand Mrs Michael Stern
Betty Stathas
Mrs Thomas G Thyes
Mrand Mrs James L
Van Egeren
Mrand Mrs Gerald P
WarzellaB
14
WISCONSIN MEDICAL JOURNAL, JUNE 1983: VOL. 84
FACTS . . .
about the CES Foundation Student Loan Program
The Charitable, Educational and Scientific Foundation
of the State Medical Society of Wisconsin is a nonprofit,
nonstock Wisconsin corporation, which was chartered in
June 1955. Its purpose is to “engage in, assist, and con-
tribute to the support of charitable, educational, and scien-
tific activities and projects and to contribute to the support
of, and to create and maintain, charitable, educational,
and scientific institutions, organizations, and funds of any
and every kind.
Management: The Foundation’s governing power is vested
in a Board of Trustees composed of the Directors and Of-
ficers of the State Medical Society of Wisconsin and up to
ten elected nonmedical persons. In addition, each of the 54
component county medical societies may elect a representa-
tive who is considered a corporate member of the Board.
The Board meets at least annually. Routine affairs of the
Foundation are directed by an Executive Committee con-
sisting of the Officers of the State Medical Society, the Of-
ficers of the Foundation and certain elected Trustees.
Registration: The Foundation is registered with the
Secretary of State as a charitable organization for purposes
of contributions and fund-raising under Sec. 440.41 (2)
Wis. Stats.
Tax Information: Contributions to the CES Foundation are
deductible under both state and federal tax laws. The
Foundation is a 501 (c) (3) corporation.
THE GENERAL STUDENT LOAN FUND
One of the most important activities of the CES Founda-
tion is the Student Loan Program. Established in 1955, the
Foundation’s General Student Loan Fund is designed to
assist needy, deserving students preparing for careers in
medicine, dentistry, pharmacy, nursing, and other allied
health fields. These long-term loans are interest free until
after the student’s graduation. Personnel in the financial
aids departments of Wisconsin’s schools cooperate with the
Foundation in identifying needy and deserving students.
Only students enrolled in Wisconsin schools are eligible for
Foundation loans. The General Student Loan Fund is sup-
ported by general contributions earmarked for student
loans.
SPECIAL STUDENT LOAN AND SCHOLARSHIP FUNDS
Although the Foundation’s primary emphasis is on
loans, some outright scholarships (grants) are made to ful-
fill the wishes of some donors. These special health career
student loan and scholarship funds are administered by the
Foundation according to the wishes of the individual or
organization establishing and supporting the fund.
For example, a county medical society auxiliary may
make an original endowment to the CES Foundation to
establish a student loan or scholarship fund in the county
auxiliary’s name. The county auxiliary, as the benefactor,
may decide what restrictions, if any, it wishes to place on
the loans. Such restrictions may include:
• County residency requirements.
• Career specifications — medicine only or what other
health careers to be included.
• Schools to which loans will be granted — you may wish to
limit the fund to local university.
• Any limit or year of study — freshman only, upperclass
only.
• Restrictions on amount of each loan.
• Amount of original endowment for the Fund.
• Additional requirements.
In establishing a special student loan or scholarship fund
with the Charitable, Educational and Scientific Founda-
tion, the following points should be considered:
• The CES Foundation will furnish an accounting annually
to the benefactor or sponsoring organization.
• Brochures, folders, or other literature concerning the
Fund may be distributed by any interested organization
or person.
• Application blanks may be procured from the CES
Foundation, 330 East Lakeside Street, PO Box 1109,
Madison, Wis 53701, the benefactor, or college financial
aids office.
• Applications will be accepted and considered without
regard to race, color, creed, or national origin.
• The decision to approve individual loan applications,
amount of the loan, and terms of repayment will be
made only by the CES Foundation and will be based on
the need demonstrated and availabihty of funds.
• The Foundation may, at its discretion (a) accept addi-
tional contributions to the Fund, (b) accept accelerated
payments of obligations to the Fund, (c) waive repay-
ment in hardship cases, and (d) increase or decrease rates
of interest as the demands for loans may dictate.
• The Foundation may invest and reinvest assets of the
Fund in accordance with prudent investment policies,
and any interest or appreciation earned by such invest-
ments will accrue to the Fund.
• Direct expenses incurred by the Foundation in adminis-
tering the Fund will be charged to the Fund. (At the pres-
ent time, by action of the Board of Directors of the State
Medical Society of Wisconsin, all expenses incurred by
the student loan funds administered by the CES Founda-
tion are paid by the Society.)
• In the event it is mutually determined that the purpose
for which the Special Loan or Scholarship Fund was
established no longer exists, the remainder of the Fund
will be turned over to the Board of Trustees of the CES
Foundation to use for other charitable, educational, and
scientific purposes.
To inquire how you or your organization can establish
a Special Student Loan or Scholarship Fund, contact Kristin
Bjurstrom, Executive Director, CES Foundation, 330 East
Lakeside Street, PO Box 1 109, Madison, Wisconsin 53701;
or phone 608/257-6781; toll-free in Wisconsin
1-800-362-9080. ■
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
115
"Tfie Beaumont 500"
One of the most unique educational and cultural institutions in the midwest if not the nation ,
is the Fort Crawford Medical Museum. It is far more than a museum, it is a tribute to all Wisconsin
physicians and their role in securing the good health of the people of the State of Wisconsin.
It represents a unique concept in the public education for prevention and treatment of injury
and disease, the nature of medical care, the importance of the strong physician-patient relation-
ship, and emphasis on obtaining and keeping good health.
The restored Fort Crawford military hospital and its related museum in Prairie du Chien, is
a tribute to Dr William Beaumont: it is also a modern expression of his 1830s philosophy of
the search for truth and improvement in health. The museum has had more than 35,000 visitors
since 1979, making it one of the most popular attractions in the area. Yet the museum continues
to face financial hardships as well as some physical problems.
To this end, the MMP Endowment Fund was established in late 1981. This Fund has a goal
of raising at least $500,000, the corpus of which cannot be used for any purpose other than
to produce income earmarked for operation and maintenance of this unique National Historic
Landmark.
The first 500 physicians or others who contribute $1 ,000 or more to the Museum Endow-
ment Fund will join a select group known as the "Beaumont 500." Such contributors will receive
a specially-designed Beaumont Medallion. In addition to being a member of the prestigious
"Beaumont 500, " those who contribute $10,000 or more will receive a first edition copy or
Dr William Beaumont's famous book; Experiments and Observations on the Gastric juice and Physiology
of Digestion, written while Doctor Beaumont was stationed in Prairie du Chien, 1 829-1832, and
published in 1 833.
To date, 1 9 individuals have contributed $ 1 ,000 each to the Museum Endowment Fund and
several more have pledged support. Through the continued generosity of Wisconsin physicians
and their spouses, the Fort Crawford Medical Museum can continue to familiarize our citizens—
young and old— with the fascinating people and events that have helped shape Wisconsin
medicine.
MEDICAL MUSEUM ENDOWMENT FUND
Name
Address
City/State/Zip
□ Yes, I (we) would like to be a member of The Beaumont 500. Enclosed is my (our) contribution
of $ 1 ,000 or more.
□ Yes, I (we) would like to be a member of The Beaumont 500 and receive a first edition copy
of Dr. Beaumont's book. Enclosed is my (our) contribution of $10,000 or more.
□ Yes, I (we) would like to support medical history by contributing to the Medical Museum
Endowment Fund,
Tfie ultimate in appreciation
of medical history
"The Beaumont 500"
Donations of $ 1 ,000 or more
made payable to:
Charitable, Educational and Scientific Foundation
PO Box 1 109
Madison, Wisconsin 53701
608/257-6781
BOARD DISTRICTS AND DIRECTORS: 1985-1986
District Director
1— Glenn H Franke, MD, Milwaukee
Lucille B Glicklich, MD, Milwaukee
Carl S Eisenberg, MD, Milwaukee
Wayne H Konetzki, MD, Waukesha
Jerome W Fons Jr, MD, Cudahy
Fredrick Wood Jr, MD, Kenosha
Richard D Fritz, MD, Milwaukee
William J Listwan, MD, West Bend
Thomas A Hofbauer, MD,
Menomonee Falls
William L Treacy, MD, Milwaukee
2— J D Kabler, MD, Madison
James J Tydrich, MD, Richland Center
Alwin E Schultz, MD, Madison
Kenneth I Gold, MD, Beloit
Cyril M Hetsko, MD, Madison
3— Pauline M Jackson, MD, La Crosse
4— John J Kief, MD, Rhinelander
Jung K Park, MD, Wisconsin Rapids
W George Locher, MD, Wausau
5— Darold A Treffert, MD, Fond du Lac
Kenneth M Viste Jr, MD, Oshkosh
C William Freeby, MD, Appleton
6— Roger L von Heimburg, MD,
Green Bay
Joseph C DiRaimondo, MD,
Manitowoc
7— Marwood E Wegner, MD, St Croix Falls
Philip J Happe, MD, Eau Claire
8— Joseph M Jauquet, MD, Ashland
SMS Placement Service aids physicians and communities
One of the many functions of the State Medical
Society of Wisconsin is to assist physicians who are
seeking a location to practice in Wisconsin and to
assist communities seeking the services of physicians.
The Society’s Placement Service maintains a con-
tinuous listing of names and biographical data on
physicians who wish to locate in Wisconsin. Files are
maintained on communities desiring physicians. In-
formation is exchanged with interested physicians
and communities, with the American Medical
Association, and with the two Wisconsin medical
schools. There is no charge to either physician or
community for this service.
A list of openings is sent to physicians who con-
tact Placement Service indicating a desire to locate in
Wisconsin or to relocate within the state. A list of
physicians is sent to communities requesting assis-
tance in obtaining a physician. The physicians and
communities may then contact one another. Physi-
cians seeking associates also may request a listing of
available physicians.
Experience of Placement Service shows that
physicians seek locations on a long-range basis —
some are available at once, while others are in resi-
dency for two or three years. One word of advice:
Advise the Society’s Placement Service of your
needs as soon as possible. Overnight results occur
but more time usually means better results.
It should be noted that Placement Service is not a
recruiting effort. Its function is supported by mem-
bership in the State Medical Society of Wisconsin.
The Society does, however, cooperate with the state-
supported Office of Rural Health in its New Physi-
cians for Wisconsin Program which provides place-
ment services to communities and physicians on a
fee basis determined by budgetary funds available.
Physicians and communities also may utilize the
“Medical Yellow Pages’’ section of the Wisconsin
Medical Journal. This classified advertising section is
available to members of the State Medical Society,
other physicians, communities, clinics, hospitals,
recruitment firms, and others at reasonable rates.
Physicians using the Placement Service have
described it as one of the most effective in the United
States. Journal advertising, too, has proved highly
successful.
Inquiries should be addressed to Placement Ser-
vice, State Medical Society of Wisconsin, Box 1109,
Madison, Wis 53701; tel 608/257-6781; and/or
Wisconsin Medical Journal, Box 1109, Madison,
Wis 53701. ■
18
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
OFFICERS AND DIRECTORS: 1985-1986
Officers of the Society
President (1985-1986)
John K Scott, MD, 20 South Park St, #350, Madison 53715
President-elect (1985-1986)
Charles W Landis, MD, 2350 North Lake Dr, Milwaukee
53211
Secretary /General Manager (1985-1986)
Earl R Thayer, 330 E Lakeside St, PO Box 1 109, Madison
53701
Treasurer (1985-1986)
John J Foley, MD, PO Box 427, Menomonee Falls 53051
Board of Directors
Chairman; Darold A Treffert, MD
Vice Chairman: Roger 1. von Heimburg, MD
Directors (by districts*)
First; Kenosha, Milwaukee, Ozaukee, Racine, Walworth, Wash-
ington, Waukesha Counties
Glenn H Franke, MD (1985-1988): 324 E Wisconsin Ave,
Milwaukee 53202
Jerome W Fons Jr, MD (1985-1988): 3533 E Ramsey Ave,
Cudahy 53110
Carl S Fisenherg, MD (1983-1986): PO Box 17300, Milwaukee
53217
Thomas A Hofbauer, A/D (1984-1987): PO Box 427, Menomonee
Falls 53051
Wayne H Konetzki, MD (1984-1987): 403 N Grand Ave,
Waukesha 53186
Lucille B Glicklich, MD (1985-1987): 3431 N Lake Dr,
Milwaukee 53211
Richard D Fritz, MD (1984-1987): 788 N Jefferson St,
Milwaukee 53202
William J Listwan, MD (1984-1987): 279 S 17th Ave,
West Bend 53095
Fredrick Wood Jr, MD (1984-1987): 6530 Sheridan Rd,
Kenosha 53140
William L Treacy, MD (1984-1987): 10125 W North Ave,
Milwaukee 53226
SECOND: Adams, Columbia, Dane, Dodge, Grant, Green, Iowa,
Jefferson, Lafayette, Marquette, Richland, Rock, Sauk Counties
J DKabler, A/D (1985-1988): 1522 University Ave, Madison 53706
Cyril M Hetsko, MD (1985-1988): 1313 Fish Hatchery Rd,
Madison 53715
James J Tydrich, MD (1985-1988): 1313 W Seminary St,
Richland Center 53581
Alwin E Schultz, MD (1984-1987): 111 N Midvale Blvd,
Madison 53705
Kenneth / Gold, MD (1985-1988): 1905 Huebbe Parkway,
Beloit 5351 1
Third: Buffalo, Crawford, Jackson, Juneau, La Crosse, Monroe,
Trempealeau, Vernon Counties
Pauline M Jackson, A//>( 1983- 1986): 1836 South Ave, LaCrosse
54601
Fourth: Clark, Florence, Forest, Langlade, Lincoln, Marathon,
Oneida, Portage, Price, Taylor, Vilas, Wood Counties
John J Kief, MD (1983-1986): 1020 Kabel Ave, Rhinelander
54501
Jung K Park, A/D (1985-1988); 410 Dewey St, Wisconsin Rapids
54494
W George Locher, MD (1983-1986): 3326 N 1 1th St, Wausau
54401
"Map indicating location of districts appears on opposite page.
NOTE: Officers, directors, delegates, alternate delegates, and members
of commissions and committees are elected at the Annual Meeting (April
1985). Dates in parentheses indicate beginning and expiration of term of
office. AMA delegates and alternate delegates’ terms of office are on a
calendar basis, although elected at the Annual Meeting.
Fhth: Calumet, Fond du Lac, Green Lake, Outagamie,
Waupaca, Waushara, Winnebago Counties
Darold A Treffert, MD (1985-1988): 459 E First St,
Fond du Lac 54935
Kenneth M Piste Jr, MD (1983-1986): 100 Stoney Beach Rd,
Oshkosh 54901
C William Freeby, MD (1984-1987): 1818 N Meade St,
Appleton 5491 1
SIXTH; Brown, Door, Kewaunee, Manitowoc, Marinette,
Menominee, Oconto, Shawano, Sheboygan Counties
Roger L von Heimburg, MD (1983 - 1986): 900 S Webster,
Green Bay 54301
Joseph C DiRaimondo, MD (1985-1988): 501 N 10th St,
Manitowoc 54220
SEVENTH: Barron, Chippewa, Dunn, Eau Claire, Pepin, Pierce,
Polk, Rusk, St Croix, Burnett, Washburn Counties
Marwood F Wegner, A//J (1983-1986): 208 Adams St S, St Croix
Falls 54024
Philip J Nappe, MD (1985-1988): 733 W Clairemont Ave,
Eau Claire 54701
Eighth: Ashland, Bayfield, Douglas, Iron, Sawyer Counties
Joseph M Jauquet, A/D (1984-1987): 200 7th Ave West, Ashland
54806
* * «
PRESIDENT: /o/m K Scott, MD (1985-1986),
20 South Park St, #350, Madison 53715
PRESIDENT-ELECT: Charles W Landis, MD (1985-1986),
2350 North Lake Dr, Milwaukee 5321 1
Past president: Timothy T Flaherty, MD (1985-1986),
547 E Wisconsin Ave, Neenah 54956
SPEAKER: Duane W Taebel, MD (1985-1987), 1836 South Ave,
La Crosse 54601
Vice SPEAKER: Vernon M Griffin, A//9 (1984-1986),
767 Elm St, Mauston 53948
Ex officio, without vote
Secretary Thayer, Treasurer Foley
Delegates to the American Medical Association
Timothy T Flaherty, MD (1985), 547 E Wisconsin Ave,
Neenah 54956
DeLore Williams, MD (1985-1986), 8501 W Lincoln Ave,
West Allis 53227
Patricia J Stuff , A/D (1985-1986), PO Box 366, Bonduel 54107
John K Scott, MD (1985-1986), 20 South Park St, #350,
Madison 53715
Henry F Twelmeyer, A/D ( 1 985 / 1 986- 1 987), 2500 N Mayfair Rd,
Wauwatosa 53226
Richard W Edwards, MD (1985/ 1986-1987),
1313 W Seminary St, Richland Center 53581
Cornelius A Natoli, MD (1985/1986-1987): 2760 Hagen Rd,
La Crosse 54601
Alternate Delegates to the AMA
Charles W Landis, MD (1985), 2350 North Lake Dr,
Milwaukee 5321 1
John D Riesch, MD (1985-1986), PO Box 427,
Menomonee Falls 53051
Cyril M Hetsko, MD (1985-1986), 1313 Fish Hatchery Rd,
Madison 53715
John P Mullooly, MD (1985-1986): 8430 W Capitol Dr,
Milwaukee 53222
J D Kabler, A/D (1985 / 1986-1987), 1551 University Ave,
Madison 53706
Kenneth M Piste Jr, MD (1985 / 1986-1987), 100 Stoney Beach
Rd, Oshkosh 54901
Richard H Ulmer, MD (1985/1986-1987), 1000 N Oak Ave,
Marshfield 54449B
BOARD OF DIRECTORS COMMITTEES:
1985-86
Executive Committee of the Board
John K Scott, MD, Madison — Chairman
President of the Society
Charles W Landis, MD, Milwaukee
President-elect of the Society
Timothy T Flaherty, MD, Neenah
Immediate Past President of the Society
Darold A Treffert, MD, Fond du Lac
Chairman of the Board
Roger L von Heimburg, MD, Green Bay
Vice Chairman of the Board
Duane W Taebel, MD, La Crosse
Speaker of the House of Delegates
Cyril M Hetsko, MD, Madison
Chairman, Finance Committee
John J Kief, MD, Rhinelander
Member-at-large
Ex Officio nonvoting members
President and President-elect of SMS Auxiliary
Finance Committee of the Board
Cyril M JJetsko, MD, Madison, 1988
Chairman
Jung K Park, MD, Wisconsin Rapids, 1988
Philip J Happe, MD, Eau Claire, 1988
Jerome W Fons Jr, MD, Cudahy, 1987
Richard D Fritz, MD, Milwaukee, 1987
Joseph M Jauquet, MD, Ashland, 1987
James J Tydrich, MD, Richland Center, 1986
John J Foley, MD, Menomonee Falls
Treasurer, ex officio ■
SMS Services, Inc: 1985
BOARD OF DIRECTORS
William P Crowley Jr MD, Madison, 1986, President
John P Mullooly MD, Milwaukee, 1987, Vice President
Richard W Edwards MD, Richland Center, 1985,
Treasurer
Earl R Thayer, Madison, 1987, Secretary
Timothy T Flaherty MD, Neenah, 1985
William A Nielsen MD, West Bend, 1985
Jerome W Fons Jr MD, Cudahy, 1986
Allen O Tuftee MD, Beloit, 1986
John J Foley MD, Menomonee Falls, 1987
SPECIAL OFFICERS
H B Maroney 11, Madison, Assistant Secretary
LeRoy A Johnson, Madison, Executive Vice President^
SMS AUXILIARY: 1985-1986
ELECTED OFFICERS
President: Mrs Daniel Shea, 1336 Ridgeway Boulevard,
De Pere 54115
President-elect: Mrs Charles Dungar, 410 West Prospect Avenue,
Appleton 5491 1
Vice President: Mrs James Kuplic, 161 Valley Road,
Sheboygan Falls 53085
Secretary: Mrs Charles Hammond, 536 Reford Road,
Neenah 54956
Treasurer: Mrs W E Rosenkranz, W254 S3896 Oakdale Drive,
W'aukesha 53186
Immediate Past President: Mrs Robert Baldwin, 119 Concord
Avenue, Watertown 53094
DIRECTORS
Bay: Mrs Raymond Murphy, 356 Swiss Hill Drive, Green Bay
54301
Bluff: Mrs Patrick Connerly, 4675 Allemande Court,
Eau Claire 54701
Capital: Mrs William Funcke, Route 1, Heritage Hill Road,
Beaver Dam 53916
Fox Valiev: Mrs David Lawrence, PO Box 1514, Fond du Lac
54935
River: Mrs Stephen Webster, 2250 Wedgewood Drive, East,
La Crosse 54601
Gateway: Mrs Richard Clasen, 711 Ver Bunker Avenue,
Port Edwards 54469
Kettle Moraine: Mrs William Davies, 205 Windsor Drive,
W'aukesha 53186
Lakeshore: Mrs Donald Gore, 2528 North Third Street,
Sheboygan 53081
North Woods: Mrs Charles Longstreth, Route 1, Box 163J,
Maple Ridge Road, Ashland 54806
Rib Mountain: Mrs Thomas Starkey, 1803 Stark Street,
Wausau 54401
APPOINTED OFFICERS
Historian: Mrs Herbert Sandmire, 201 St Mary’s Boulevard,
Green Bay 54301
Parliamentarian: Mrs Robert E Johnston, 3825 W'aubenoor
Drive, Green Bay 54301
EXECUTIVE SECRETARY
Mrs La Verne Bartel, 330 East Lakeside Street, Madison 53715 ■
Charitable, Educational and Scientific
Foundation: 1985-1986
(See listing elsewhere in this issue) ■
PAST PRESIDENTS OF THE STATE MEDICAL SOCIETY OF WISCONSIN: 1961-1985
This is a partial listing. The complete listing from 1841 to 1972 appeared in the January 1973 issue.
Leif H Lokvam, MD, Kenosha 1961-1962
Nels A Hill, MD, Madison 1962-1963
tWilliam J Egan, MD, Milwaukee 1963-1964
William P Curran, MD, Antigo 1964-1%5
tJohn H Houghton, MD, Wisconsin Dells 1965-1966
tFrank E Drew, MD, Milwaukee 1966-1967
Harold J Kief, MD, Fond du Lac 1967-1968
tWilliam D James, MD, Oconomowoc 1968-1969
Robert E Callan, MD, Milwaukee 1969-1970
rJerry W McRoberts, MD, Sheboygan 1970-1971
George .A Behnke, MD, Kaukauna 1971-1972
Robert F Purtell, MD, Milwaukee 1972-1973
tDeceased
Gerald J Derus, MD, Madison 1973-1974
John E Dettmann, MD, Green Bay 1974-1975
Howard L Correll, MD, Arena 1975-1976
Charles J Picard, MD, Superior 1976-1977
Roy B Larsen, MD, Wausau 1977-1978
Jules D Levin, MD, Milwaukee 1978-1979
Darold A Treffert, MD, Fond du Lac 1979-1980
RusseU F Lewis, MD, Marshfield 1980-1981
Albert J Motzel Jr, MD, Waukesha 1981-1982
Gerald C Kempthorne, MD, Spring Green 1982-1983
Chesley P Erwin, MD, Milwaukee 1983-1984
Timothy T Flaherty, MD, Neenah 1984-1985 ■
J K Scott MD
President
E R Thayer
Secretary
C W Landis MD
President-elect
J J Foley MD
Treasurer
T T Flaherty MD
Past President
D W Taebel MD
Speaker
D A Treffert MD
Board Chairman,
Director, Dist 5
V M Griffin MD
Vice Speaker
OFFICERS AND
DIRECTORS:
1985-1986
State Medical Society
of Wisconsin
R L von Heimburg MD L B Glicklich MD
Board V-Chairman Director, Dist 1
Director, Dist 6
JWFonsJrMD
Director, Dist 1
T A Hofbauer MD
Director, Dist 1
, A
C S Eisenberg MD
Director. Dist 1
W H Konetzki MD
Director, Dist 1
F Wood Jr MD
Director, Dist 1
W L Treacy MD
Director, Dist 1
G H Franke MD
Director, Dist 1
R D Fritz MD
Director. Dist 1
W J Listwan MD
Director, Dist 1
K I Gold MD
Director, Dist 2
C M Helsko MD
Director, Dist 2
J D Kabler MD
Director. Dist 2
J J Tydrich MD
Director, Dist 2
A E Schultz MD
Director, Dist 2
P M Jackson MD
Director, Dist 3
J J Kief MD
Director, Dist 4
J K Park MD
Director, Dist 4
W G Locher MD
Director. Dist 4
COMMISSIONS AND COMMITTEES: 1985-1986
STATE MEDICAL SOCIETY OF WISCONSIN
330 East Lakeside St (PO Box 1109), Madison, Wisconsin 53701
Telephone; 608/257-6781 (toll-free in Wisconsin 1-800-362-9080)
COMMISSIONS
Continuing Medical Education
This commission shall consist of up to 20 appointed members
and the deans of the two medical schools in Wisconsin, or their
designees, with vote. It shall be responsible for all matters relating
to the whole continuum of medical education, i.e., medical school
and residency training as well as lifetime medical learning (con-
tinuing medical education). In addition, it shall be responsible
for liaison with the medical schools in Wisconsin, their students,
residents, fellows and departments of continuing medical educa-
tion; liaison with specialty societies in the achievement of these
goals; liaison with the Commissions on Peer Review and Health
Planning for purposes of implementing continuing medical educa-
tion programs related to responsibilities and activities of these two
commissions; and the scientific program of the Annual Meeting.
It shall be responsible for accreditation of continuing medical
education in hospitals and other institutions or organizations
within the state, but shall not be responsible for accreditation of
continuing medical education within the state’s medical schools.
Frank E Berridge, MD, Milwaukee, 1986
Martin Z Fruchtrnan, MD, Waukesha, 1986
J David Lewis, MD, West Bend, 1986
Joseph J Mazza, MD, Marshfield, 1986
Kathy P Belgea, MD, Wausau, 1986
James T Houlihan, MD, Woodruff, 1987
Charles L Junkerman, MD, Milwaukee, 1987
Charles E Holmhurg, MD, Waukesha, 1987
Benson I. Kichardson, Ml), Green Bay, 1987
Kay A Heggestad, MD, Madison, 1987
C William Freeby, MD, Appleton, 1988, Chairman
Bradley G Garber, MD, Osseo, 1988
Kenneth I Gold, MD, Beloit, 1988
Edwin L Overholt, MD, La Crosse, 1988, V-Chrmn
Thomas P Simerson, MD, Merrill, 1988
Bernard B Poeschel, MD, Eau Claire, 1988
Medical School Deans’ designees:
Thomas C Meyer, MD, UW-Madison
Willard Duff, PhD, Medical College of Wisconsin
CME COMMITTEE
Subcommittee on Accreditation
Bradley G Garber, MD, Osseo, Chairman
William Card, MD, Madison
John A Palese, MD, Milwaukee
Melvin F Hath, MD, Baraboo
Warren J Holtey, MD, Marshfield
Joseph J Mazza, MD, Marshfield
Jerold J Beerends, MD, West Bend
Eugene Musser, MD, Madison
Edward Zupanc, MD, Monroe
Arnold Effron, MD, Oconomowoc
Philip H Utz, MD, La Crosse
Richard D Lindgren, MD, Madison
Fevzi Pamukcu, MD, Kenosha
Edward F Banaszak, MD, Milwaukee
Expiration of term at Annual Meeting of the year designated appears
following member’s name. Chairmen and vice chairmen of commissions
and committees are elected at the first meeting following the Annual
Meeting; therefore, most of the chairmen and vice chairmen listed here are
subject to change. The BLUE BOOK is prepared prior to most of these
elections; therefore, some commissions and committees will not include
these designations.
Health Planning
This commission shall be concerned about planning for health
care, including facilities and services and their organization to
assure availability, access and quality of care; standards, guidelines
and regulations affecting health care; distribution of medical ser-
vices; relationships with allied health personnel; and matters per-
taining to the Joint Commission on Accreditation of Hospitals.
This commission also includes representatives of specialty sec-
tions / societies with voting rights when present, provided they are
SMS members, such appointments subject to approval by the
Board of Directors.
Clarence R Hart, MD, Lake Geneva, 1986
Fredric L Hildebrand, MD, Neenah, 1986, Chairman
Marvin G Parker, MD, Racine, 1986
Sigurd E Siverston, MD, Madison, 1986
Vernette M Carlson, MD, Waukesha, 1986
James G Caya, MD, Burlington, 1986
Peter L Eichman, MD, Madison, 1987
Jan E Erlandson, MD, Monroe, 1987
D Joseph Freeman, MD, Wausau, 1987
Guenther P Pohimann, MD, Milwaukee, 1987
Lee M Tyne, MD, Brookfield, 1987
Ann Bardeen, MD, Oconomowoc, 1987
Joseph B Durst, MD, La Crosse, 1988
Bradley J Sullivan, MD, Marshfield, 1988
Philip J Dougherty, MD, Menomonee Falls, 1988
Thomas F Garland, MD, Milwaukee, 1988
Kermit L Newcomer, MD, La Crosse, 1988, V-Chrmn
Michael E Tieman, MD, Berlin, 1988
Specialty Representatives
Society
Allergy: J Brent Kooistra, MD, Madison
Internal Medicine: Kenneth R Kubsch, MD, Green Bay
Neurological: Gamber E Tegtmeyer, MD, Madison
Obstetrics and Gynecology: Norman J Schroeder, MD,
Beaver Dam
Pathology: Edward A Burg Jr, MD, Milwaukee
Pediatrics (Wisconsin Chapter): Gary R Gutcher, MD, Madison
Physical Medicine and Rehabilitation; Albert M Cohen, MD,
Milwaukee
Radiological: Robert E Durnin, MD, Madison
Surgeons (Wisconsin Chapter): John T Mendenhall, MD,
Madison
Surgical: P Richard Shod, MD, Janesville
Clinic Managers: Joseph Jepsen, Eau Claire
SMS Section
Dermatology: Ha! Ridgway, MD, Madison
Emergency Medicine: Thomas A Reminga, MD, Milwaukee
Ophthalmology: James C Allen, MD, Madison
Otolaryngology; Timothy J Donovan, MD, Madison
Pathology; Charles P Nichols, MD, La Crosse
Physical Medicine and Rehabilitation: John L Melvin, MD,
Milwaukee
Mediation and Peer Review
This commission shall receive, investigate, and seek to resolve
differences between physicians and patients or other com-
plainants, or between physicians, on matters relating to quality
of care, professional ethics, and fees. When necessary, it shall
122
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
COMMISSIONS AND COMMITTEES continued
COMMITTEES
Aging, Extended Care Facilities,
and Home Health Care
This committee shall be concerned about the process of aging
and means to achieve the best possible health care for the aged,
including nursing home care and home care.
Frederick W Blanche, MD, Madison, 1986
Ricardo M Rustia, MD, Kenosha, 1986
Nunilo L Bugarin, MD, Tomahawk, 1986
Kay E Jewell, MD, Madison, 1986
Sailendra N Basu, MD, Wausau, 1986
Robert E Phillips, MD, Marshfield, 1987
Terrence N Hart, MD, Brookfield, 1987
Richard J Hendricks, MD, Madison, 1987
Wilbur E Rosenkranz, MD, Mukwonago, 1987, V-Chrmn
Edward R Winga, MD, La Crosse, 1987
Roland R Liebenow, MD, Lake Mills, 1988, Chairman
Elston L Belknap Jr, MD, Madison, 1988
Edward L Perry, MD, La Crosse, 1988
William T Russell, MD, Sun Prairie, 1988
Curt Hancock, MD, Sheboygan, 1988
Paul E Hankwitz, MD, Milwaukee, 1988
Mrs William (Joan) Janssen, Mequon, Auxiliary
Alcoholism and Other Drug Abuse
This committee shall be concerned about prevention, treatment,
and rehabilitation for persons affected by alcoholism and any
other type of drug abuse.
Pauline M Jackson, MD, La Crosse, 1986
Charles W Landis, MD, Milwaukee, 1986
David R Downs, MD, Dodgeville, 1986
Glenn H Eranke, MD, Milwaukee, 1986
Herbert White, DO, Genesee Depot, 1987
Nunilo L Bugarin, MD, Tomahawk, 1987
Fred H Koenecke, MD, Madison, 1987
Warren H Williamson, MD, Racine, 1987
Daniels Thearle, MD, Neenah, 1987
Roland E Herrington, MD, Milwaukee, 1988, Chairman
David L Nelson, MD, Stoughton, 1988
Charles Goodell, MD, Tomahawk, 1988
John T Andersen, MD, Milwaukee, 1988
David Benzer, DO, Wauwatosa, 1988
Edward J Johnson, MD, Green Bay, 1988
Mrs K Alan (Sherry) Stormo, Fond du Lac, Auxiliary
Environmental and Occupational Health
This committee shall be concerned with the health and safety
of persons in relation to their environment, including matters
relating to occupational and rural health.
Melvin S Blumenthal, MD, Monroe, 1986
Robert W Page, MD, Marshfield, 1986
Wendelin W Schaefer, MD, Sheboygan, 1986
Carl Zenz, MD, West Allis, 1986
Ruth R Schuh, MD, Watertown, 1986
Jacob Martens, MD, Wausau, 1986
John S Moore, MD, Milwaukee, 1987
Henry A Anderson HI, MD, Madison, 1987
John J Beck, MD, Sturgeon Bay, 1987
Erwin S Huston, MD, Milwaukee, 1987
John T Schmitz, MD, Milwaukee, 1987
Raymond Johnson, MD, Milwaukee, 1987
Lawrence Smith, MD, Racine, 1987
Mrs W W (Jame) Schaefer, Sheboygan, Auxiliary
Health Care Costs Liaison
This committee shall be concerned with promoting an ongoing
dialogue with business, industry, and labor. As part of this
dialogue special emphasis will be placed on issues relating to the
rapidly escalating costs of health care.
James V Seegers, MD, Elkhorn, 1986
Stephen Hathway, MD, Green Bay, 1986
Jeremy R Green, MD, Green Bay, 1986
Warren H Williamson, MD, Racine, 1 986
Russell E Lewis, MD, Marshfield, 1987, Chairman
Gerald C Kempthorne, MD, Spring Green, 1987
William C Miller, MD, Wausau, 1987
Rosanna M Ranieri, MD, Kenosha, 1987
Albert J Motzel Jr, MD, Waukesha, 1988, V-Chrmn
Raymond R Johnson, MD, Milwaukee, 1988
Ann C Beecher, MD, Mequon, 1988
Richard H Christenson, MD, Milwaukee, 1988
Carleton B Davis Jr, MD, Monroe, 1988
Joint Practice
SMS/Wisconsin Nurses Association
This committee shall be concerned with developing recommen-
dations, as appropriate, regarding education, legislation, practice
arrangements and delivery patterns; shall facilitate understanding
and acceptance by the professions and the public of changing
medical and nursing relationships, roles and practices; shall serve
as a consultation resource in matters that relate to joint practice.
James J Tydrich, MD, Richland Center, Cochairman
Use Hecht, RN, Madison, Cochairman
Robert T Cooney, MD, Portage
Marc F Hansen, MD, Madison
Judy Ellington, RN, Baraboo
Leona Eandevusse, RN, Milwaukee
Maternal and Child Health
This committee shall be concerned about all aspects of health in
pregnancy, childbirth and children, with special emphasis on the
reduction of maternal mortality and the prevention of disease or
disability in children.
Gary R Gutcher, MD, Madison, 1986
John E Inman, MD, Monroe, 1986
Joanne Selkurt, MD, Whitehall, 1986
Eerrin C Holmes, MD, Sturgeon Bay, 1986
Laura Mueller, MD, Racine, 1986
Gloria M Halverson, MD, Waukesha, 1987
Daniel F Johnson, MD, Eau Claire, 1987
Sharon L Maby, MD, Marshfield, 1987
Walter R Schwartz, MD, Wauwatosa, 1987, Chairman
Robert J Jaeger, MD, Stevens Point, 1987
Michael H Mader, MD, La Crosse, 1988, Chairman
Charles Hammond, MD, Neenah, 1988
Perry A Henderson, MD, Madison, 1988
John D Swanson, MD, Neenah, 1988
Mrs. Robert (Roberta) Baldwin, Watertown, Auxiliary
Mary-Frances Woods, MCW, Milwaukee (medical student)
Subcommittee
Study Committee on Maternal Mortality Survey
Gloria M Halverson, MD, Waukesha, Chairman
Richard C Brown, MD, Eau Claire
Perry A Henderson, MD, Madison
Frederick J Hofmeister, MD, Wauwatosa
Stanley A Korducki, MD, Milwaukee
continued next page
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
123
COMMISSIONS AND COMMITTEES continued
initiate disciplinary or other action as appropriate. It shall serve
as the Society’s advisory body to private or governmental organi-
zations on matters affecting medical peer review including utiliza-
tion review, appropriateness of care, fees, and quality assurance.
It shall advise and consult with component societies on issues of
peer review, mediation, ethics, and discipline in concert with
members of the Board of Directors. It shall serve as the initial
appellate body for peer review and mediation issues that are
appealed from local committees of component societies. It shall
coordinate the impaired physician program.
Robert E Johnston, MD, Green Bay, 1986, Chairman
D Mark Lochner, MD, Waupaca, 1986
Harry F Weisberg, MD, Milwaukee, 1986
David E Westgard, MD, La Crosse, 1986
Michael E Nesemann, MD, La Crosse, 1986
Robert T Cooney, MD, Portage, 1986
Melvin F Hath, MD, Baraboo, 1986
Lyle L Olson, MD, Darlington, 1986
Sharon L Elias, MD, Milwaukee, 1987
Joseph B Grace, MD, Green Bay, 1987
James M Huffer, MD, Madison, 1987
Thomas F Jennings, MD, West Allis, 1987
John B McAndrew, MD, Oshkosh, 1987
Robert E Phillips, MD, Marshfield, 1987
William E Raduege, MD, Woodruff, 1987
Richard C Zimmerman, MD, Waukesha, 1987
G Robert Kaftan, MD, Green Bay, 1987
Albert H Adams, MD, Milwaukee, 1988
Domenick S Bruno, MD, Milwaukee, 1988
Ronald J Darling, MD, Waukesha, 1988
John A DeGiovanni, MD, Prairie du Sac, 1988
Richard W Edwards, MD, Richland Center, 1988
Charles S Geiger Jr, MD, West Bend, 1988, V-Chrmn
Michael R McCormick, MD, Waukesha, 1988
MPR COMMITTEES
Coordinating Council on Physician Impairment
Gerald C Kempthorne, MD, Spring Green
Roland E Herrington, MD, Milwaukee
Arthur G Norris, MD, Milwaukee
(State Medical Society)
Ms Gwen Jackson, Milwaukee
George W Arndt, MD, Neenah
Patricia R Raftery, DO, Sparta
(Medical Examining Board)
Managing Committee, Statewide Impaired Physician Program
Roland E Herrington, MD, Milwaukee
Gerald C Kempthorne, MD, Spring Green
Fred H Koenecke Jr, MD, Madison
Arthur G Norris, MD, Milwaukee
A Bela Maroti, Milwaukee
John C LaBissoniere, Madison
Medicaid Medical Audit Committee
John A DeGiovanni, MD, Prairie du Sac
Richard W Edwards, MD, Richland Center
Charles S Geiger Jr, MD, West Bend
Leo R Grinney, MD, Racine
John P Hartwick, MD, Milwaukee
Gerald C Kempthorne, MD, Spring Green
John J Kief, MD, Rhinelander
D Mark Lochner, MD, Waupaca
Eirgil L Sharp, DO, Waterloo
GJohn Weir Jr, MD, Marshfield
David E Westgard, MD, LaCrosse
Alfred D Dally, MD, Madison
Physicians Alliance Commission
The Board of Directors is in the process of completing appoint-
ments to a reorganized Physicians Alliance Commission, com-
bining with it the former Governmental Affairs Commission.
It also is appointing a Task Force on Medical Liability and a
Task Force on Physician Review and Discipline.
The memberships and charges to these groups will appear in
the July issue.
Public Information
This commission shall be concerned about the members of this
Society and their image with the public. It shall plan and execute
programs of effective public information and health education,
assist component societies in the conduct of similar programs,
develop effective media relations, and recruit and retain physician
members of the Society and encourage their active participation in
the affairs of the county and state societies and the American
Medical Association.
Irwin J Bruhn, MD, Walworth, 1986, Chairman
George L Gay Jr, MD, Cambridge, 1986
Alan H Cherkasky, MD, Kaukauna, 1986, V-Chrmn
Carl R Poley, MD, Green Bay, 1987
Arthur G Barbier, MD, LaCrosse, 1987
Paul D Nelsen, MD, Ripon, 1987
William H Annesley Jr, MD, Milwaukee, 1988
Cindy L Barron, MD, Madison, 1988
Vinoo Cameron, MD, Medford, 1988
Jefferson F Ray HI, MD, Marshfield, 1988
Mrs David (Jean) Lawrence, Fond du Lac, Auxiliary
Wisconsin Medical Journal
The Wisconsin Medical Journal shall be the official journal of
the Society. An editorial board consisting of the medical editor as
chairman and six additional members shall be responsible for all
scientific, editorial, and business affairs of the Journal. An
editorial director, serving as chairman of a group of no less than
five editorial associates, shall be responsible for regularly providing
items of editorial opinion for publication in the editoriad pages of
the Journal.
Editorial Board
Victor S Falk, MD, Edgerton, 1986
Chairman and Medical Editor
Dean M Connors, MD, Madison, 1986
Melvin F Hath, MD, Baraboo, 1986
Darrell L Witt, MD, Wausau, 1986
Charles H Raine, MD, Racine, 1987
M C F Lindert, MD, Milwaukee, 1987
Richard D Sautter, MD, Marshfield, 1987
George W Kindschi, MD, Monroe, 1988
Andrew B Crummy Jr, MD, Madison, 1988
Garrett A Cooper, MD, Madison, Emeritus
Editorial Associates
(appointed annually by Board of Directors)
Wayne J Boulanger, MD, Milwaukee
Chairman and Editorial Director
Victor S Falk, MD, Edgerton, Medical Editor
Russell F Lewis, MD, Marshfield
R Buckland Thomas, MD, Monroe
Raymond A McCormick, MD, Green Bay
* * ♦
124
WISCONSIN MEDICAL JOURNAL. JUNE 1985;VOL. 84
COMMISSIONS AND COMMITTEES continued
MATERNAL MORTALITY SURVEY continued
Thomas A Leonard, (Emeritus), Middleton
Ronald W Olson, Ml), Madison
Robert P Reik, MD, Wauwatosa
Herbert F Sandmire, MD, Green Bay
Albert H Stahmer, MD, Wausau
Everett A Beguin, MD, La Crosse
John E Inman, MD, Monroe
Dan F Johnson, MD, Eau Claire
Richard F Mattingly, MD, Milwaukee
William E Martens, MD, Wauwatosa
Bernard Poeschel, MD, Eau Claire
E Howard Theis, MD, Fond du Lac
Medicine and Religion
This committee shall be concerned about the medical-spiritual
values of health care and the development of closer relationships
between physicians and clergy to permit discussion of common
problems in the total treatment and care of patients.
John W Faber, MD, Neenah, 1986
E Basil Jackson, MD, Milwaukee, 1986
G Daniel Miller, MD, Oconomowoc, 1986
John K Scott, MD, Madison, 1986
Maxwell H S Weingarten, MD, Milwaukee, 1986
Carl R Poley, MD, Green Bay, 1986
Frank J Cerny, MD, Fond du Lac, 1987
William O Myers, MD, Marshfield, 1987
Milo G Durst, MD, Milwaukee, 1987
John C Jordan, MD, Richland Center, 1987
Gilbert J Nock Jr, MD, Milwaukee, 1987
John O Simenstad, MD, Osceola, 1988, Chairman
John P Mullooly, MD, Milwaukee, 1988, V-Chrmn
James V Seegers, MD, Elkhorn, 1988
John B Weeth, MD, La Crosse, 1988
Maureen Murphy, SSM, MD, Wisconsin Dells, 1988
Mrs Glenn (Lila) Seager, La Crosse, Auxiliary
Physician-Nurse Liaison
This committee shall review shared concerns as they relate to
training, vocation, licensure, organization, structure, practice,
decision-making on hospital staffs, technology advances, recruit-
ment and retention, autonomy, patient care.
Albert J Motzel Jr, MD, Waukesha, Cochairman
Rosellen Crow, RN, Middleton, Cochairman
Carl S Eisenberg, MD, Milwaukee
Michael P Mehr, MD, Marshfield
Philip H Utz, MD, La Crosse
Norma Lang, RN, Milwaukee
Sherry Quamme, RN, Columbus
Mental Health
This committee shall be concerned with all eispects of mental
health as an equal part of the patient’s total well-being.
Gary M Herdrich, MD, West Bend, 1986
Margaret J Seay, MD, Oshkosh, 1986
Barry Blackwell, MD, Milwaukee, 1986
Peter L Eichman, MD, Madison, 1986
Rudolf W Link, MD, Madison, 1986
Erederick Eosdal, MD, Madison, 1987
Robert B Shapiro, MD, Madison, 1987
Charles W Landis, MD, Milwaukee, 1987, V-Chrmn
Clarence E Moore, MD, Fond du Lac, 1987
Mary K Kubiak, MD, Omro, 1987
Pauline M Jackson, MD, La Crosse, 1988, Chairman
William W Garitano, MD, Marshfield, 1988
Donald L Eeinsilver, MD, Milwaukee, 1988
Bruce C Rhoades, MD, Wausau, 1988
Wess R Vogt, MD, Milwaukee, 1988
Mrs C A (Marla) Natoli, La Crosse, Auxiliary
Safe Transportation
This committee shall be concerned about the health and safety
of all who may be affected by the use of vehicles of transportation
on land, water, or in the air.
James M Huffer, MD, Madison, 1986
Clarence E Moore, MD, Fond du Lac, 1986
John C Heffelfinger, MD, Watertown, 1986
Glenn C Hillery, MD, Lancaster, 1987
Kathryn P Nichol, MD, Madison, 1987
James L Weygandt, MD, Kohler, 1987, Chairman
Ralph F Hudson, MD, Eau Claire, 1988
Walter F Smejkal, MD, Manitowoc, 1988
Stephen W Hargarten, MD, Milwaukee, 1988
Susan Kinast- Porter, MD, Monroe, 1988
Mrs Donald (Audrey) Peterson, Madison, 1988
School Health
This committee shall be concerned about protecting and im-
proving the health of those attending the public or private schools
of this state, including matters related to athletics.
Lawrence K Siegel, MD, Waukesha, 1986, V-Chrmn
Roy E Buck, MD, Oshkosh, 1986
George H Handy, MD, Madison, 1987
Rolf L Simonson, MD, Sheboygan, 1987
Horace K Tenney III, MD, Madison, 1987
James C H Russell, MD, Ft Atkinson, 1988, Chairman
Conrad L Andringa, MD, Madison, 1988
James S Janowiak, MD, Merrill, 1988
Mrs Kenneth (Mary) Smigielski, Milwaukee, Auxiliary
Mrs K Alan (Sherry) Stormo, Fond du Lac, Auxiliary
Women Physicians
This committee shall serve as liaison and women’s advocate with
other commissions and committees of the State Medical Society. It
shall encourage state, county, and specialty societies to make
special efforts to recruit women physicians to membership in
organized medicine, subsequently to consider them for leadership
positions based on their professional capabilities rather than as
women physicians. It shall promote medical education that is sen-
sitive and responsive to women’s healthcare needs and enhance
educational opportunities for women. It also shall serve as a
resource to the State Medical Society, other groups, and individ-
uals on women’s health issues. It shall consist of nine members
appointed by the Board of Directors.
Carl S Eisenberg, MD, Milwaukee, 1986
Pauline M Jackson, MD, La Crosse, 1986
Janet C Lindemann, MD, Waukesha, 1986
Sandra L Osborn, MD, Madison, 1986
Hansi R Patience, MD, Sturgeon Bay, 1987
Anne M Riendl, MD, Waukesha, 1987
Jean H Schott, MD, Milwaukee, 1987
Patricia J Stuff, MD, Bonduel, 1988, Chairman
Carol Young, MD, Milwaukee, 1988
Kay E Jewell, MD, Madison, 1988
Gilbert J Nock Jr, MD, Milwaukee, 1988
Mrs Donald A (Audrey) Peterson, Madison, Auxiliary ■
HOUSE OF DELEGATES; See page 44 of March is.sue.
NOMINATING COMMITTEE: 1985, House of Dele-
gates: See page 163 of this issue.
WISCONSIN MEDICAL JOURNAL, JUNE I985:VOL. 84
125
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WAUKESHA
RAtlHE
WAAHORTH
DISTRICT 1
Lois Riley
(414/271-4328)
County medical
societies
Milwaukee
Waukesha
Ozaukee
Washington
Sheboygan
Kenosha
Racine
Walworth
DISTRICT 4
Paul Jacobson
(715/874-6125)
County medical
societies
Ashland-Bayfield-
Iron
Douglas
Barron-Washburn-
Burnett
Sawyer
Polk
Pierce-St Croix
Chippewa
La Crosse
Monroe
Eau Claire-Dunn-
Pepin
Trempealeau-
Jackson-Buffalo
Vernon
Crawford
Price-Taylor
Rusk
Clark
DISTRICT 2
Lanny Hardy
(608/257-6781)
County medical
societies
Columbia-Marquette
Adams
Green Lake-
Waushara
Lafayette
Richland
Jefferson
Green
Iowa
Grant
Rock
DISTRICT 3
Deborah Bowen Wilke
(414/964-5046)
County medical
societies
Oneida-Vilas
Lincoln
Marinette-Florence
Forest
Langlade
Shawano
Outagamie
Brown
Door-Kewaunee
Calumet
Oconto
Marathon
Wood
Portage
Waupaca
Winnebago
Fond du Lac
Manitowoc
1985
Physicians
Alliance
Districts
and
Field Consultants
Physicians Alliance is a socio-
economic-legislative-govern-
mental division of the State
Medical Society of Wisconsin
and is under the direction of the
Physicians Alliance Commis-
sion.
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126
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
WISCONSIN UNIFORM INSURANCE
CLAIM FORM can be ordered direct
from SMS Services
• Claim form approved by DHSS and EDS Federal for Wh
Medical Assistance Program (WMAP) claims.
• Accepted by all major insurance carriers.
• Form costs one third less than its national competitor.
• Available in two-part snapout and one- or two-part continuous form.
• Forms will be shipped to you wiihin 48 hours after order received.
Place your order with SMS Services, Inc, 330 East Lakeside Street, PO Box 1 1 09,
Madison, Wisconsin 53701; or phone (608) 257-6781 or toll-free in Wisconsin
(800) 362-9080.
Wisconsin Physicians Political Action Committee (WISPAC)
The Wisconsin Physicians Political Action Committee
is a voluntary, nonprofit organization whose member-
ship consists of physicians and their spouses. Restricted
from making political contributions, the State Medical
Society created and administers WISPAC to provide the
medical profession with an opportunity to assume a
more active and effective role in the political process.
WISPAC traditionally concentrates on state legislative
races and cooperates with the American Medical
Political Action Committee, AMPAC, on the national
level.
1983-85 WISPAC Board of Directors
William Treacy, MD, Chairman, Milwaukee
Michael Mehr, MD, Vice Chairman, Marshfield
John K Scott, MD, Treasurer, Madison
Sandra Osborn, MD, Assistant Treasurer, Madison
♦ ♦ *
Jay Schamberg, MD, Menomonee Falls
DeLore Williams, MD, West Allis
Thomas Dehn, MD, Bayside
Irvin Bruhn, MD, Walworth
Carl Eisenberg, MD, Milwaukee
LaVern Herman, MD, Waukesha
William Listwan, MD, West Bend
Daniel Forward, MD, Wauwatosa
Charles Pechous, MD, Kenosha
Donald Vangor, MD, Baraboo
Mel Blumenthal, MD, Monroe
Robert McDonald, MD, Madison
Glenn Seager, MD, La Crosse
Bruce Hertel, MD, Rhinelander
Kenneth Day, MD, Wausau
Henry Chessin, MD, Appleton
Michael Tieman, MD, Berlin
John Beck, MD, Sturgeon Bay
James Mattson, MD, Green Bay
Paul Haskins, MD, River Falls
Arlyn Koeller, MD, Ashland
Chesley Erwin, MD, Milwaukee
Timothy Flaherty, MD, Neenah
Kenneth Viste, MD, Oshkosh
J D Kabler, MD, Madison
Charles Picard, MD, Superior
Mrs Bea Kabler, Madison
Mrs Jeri Cushman, Racine
Mrs Roberta Baldwin, Watertown
Mrs Ann Shea, De Pere
Membership — Membership contributions may be sent
to:
WISPAC
PO Box 2595
Madison, W1 53701
(608) 257-6781
Suggested membership categories include;
$100 Sustaining Membership
S 80 Family Membership (physician /spouse)
S 40 Regular WISPAC /AMPAC
S 20 Regular WISPAC ■
WISCONSIN MEDICAL JOURNAL. JUNE 1985 r VOL. 84
127
COUNTY MEDICAL SOCIETIES
President (P) and Secretary (S); Executive Secretary (ES), Treasurer (T); Executive Vice President (EVP);
Executive Assistant (EA); Assistant Secretary (AS); and telephone numbers
ASHLAND BAYFIELD IRON
P— Mark K Belknap, MD
922 Second Avenue, West
Ashland, W1 54806
(715) 682-6651
S— David M Saarinen, MD
2101 Beaser Avenue, #2
Ashland, WI 54806
BARRON WASHBURN
BURNETT
P— Donald E Riemer, MD
PO Box 127
Cumberland, WI 54829
(715) 822-2231
S— Roger F Macy, MD
PO Box 127
Cumberland, WI 54829
(715) 822-2231
BROWN
P— James R Mattson, MD
501 S Military Avenue
Green Bay, WI 54303
S— Stephen D Hathway, MD
PO Box 1700
Green Bay, WI 54305
(414) 433-3653
T— Roger C Wargin, MD
613 Ridgeview Court
Green Bay, WI 54303
(414) 499-8859
CALUMET
P— Randy T Theiler, MD
451 East Brooklyn Street
Chilton, WI 53014
S— William E Hannan, MD
614 Memorial Drive
Chilton, WI 53014
CHIPPEWA
P— Richard C Sazama, MD
3203 Stein Blvd
Eau Claire, WI 54701
(715) 835-6548
S— Robert S Lea, MD
1 102 Dover Street
Chippewa Falls, WI 54729
CLARK
P— Vangala J Reddy, MD
216 Sunset Place
Neillsville, WI 54456
(715) 743-3101
S— Rupa Chennamaneni, MD
216 Sunset Place
Neillsville, WI 54456
(715) 743-3231
COLUMBIA MARQUETTE
ADAMS
P— Donald J Taylor, MD
1015 West Pleasant Street
PO Box 387
Portage, WI 53901
(608) 742-8389
S— Paul J Slavik, MD
916 Silver Lake Drive
Portage, WI 53901
ES— Mrs Elayne Hanson
PO Box 352
Portage, WI 53901
(608) 742-2410
CRAWFORD
P— Eli M Dessloch, MD
780 South Beaumont Road
PO Box 89
Prairie du Chien, WI 53821
(608) 326-6978
S— Michael S Garrity, MD
610 East Taylor Street
Prairie du Chien, WI 53821
(608) 326-6466
DANE
P— Sigurd E Sivertson, MD
1300 University Ave, Rm 1245A
Madison, WI 53706
S— Donald A Bukstein, MD
1313 Fish Hatchery Road
Madison, WI 53715
DODGE
P— Gerald H Klomberg, MD
130 Warren Street
Beaver Dam, WI 53916
(414) 887-1711
S— Daniel R Erickson, MD
Route 1, Highway 28
Horicon, WI 53032
(414) 485-4341
EA— Ms Shirley Dinsch
1008 West Burnett Street
Beaver Dam, WI 53916
(414) 885-4726
DOOR KEWAUNEE
P— Alfonso G Tamayo, MD
1623 Rhode Island
PO Box 107
Sturgeon Bay, WI 54235
(414) 743-3383
S— William Faller, MD
330 South 16th Place
PO Box 466
Sturgeon Bay, WI 54235
DOUGLAS
P— Robert R Mataczynski, MD
1514 Ogden Avenue
Superior, WI 54880
(715) 394-5557
S— Alfred E Lounsbury, MD
3600 Tower Avenue
Superior, WI 54880
(715) 392-8111
EAU CLAIRE DUNN PEPIN
P— Patrick W Connerly, MD
807 South Farwell Street
Eau Claire, WI 54701
(715) 839-5175
S— Stanley G Norman, MD
714 South Hamilton Avenue
Eau Claire, WI 54701
(715) 834-3448
FOND DU LAC
P— William G Sybesma, MD
80 Sheboygan Street
Fond du Lac, WI 54935
(414) 923-7400
S— Elizabeth T Sanfelippo, MD
80 Sheboygan Street
Fond du Lac, WI 54935
T— Robert H House, MD
PO Box 96
Ripon, WI 54971
(414) 748-6400
FOREST
P— Enzo F Castaldo, MD
Laona, WI 54541
(715) 674-3131
S— Burton S Rathert, MD
101 West Washington
PO Box 278
Crandon, WI 54520
(715) 478-2413
GRANT
P— John M McKichan, MD
1370 North Water Street
Platteville, WI 53818
(608) 348-2455
Robert E Stader, MD
235 North Madison Street
Lancaster, WI 53813
(608) 723-2131
GREEN
P— Carlos A Jaramillo, MD
PO Box 786
Monroe, WI 53566
(608) 328-0429
S— Jacob George, MD
1515 10th Street
Monroe, WI 53566
(608) 328-7000
GREEN LAKE WAUSHARA
P— John C Koch, MD
209 East Park Avenue
Berlin, WI 54923
(414) 361-1313
S— Michael E Tieman, MD
PO Box 266
Berlin, WI 54923
(414) 361-4306
IOWA
P— Timothy A Correll, MD
227 Commerce Street
Mineral Point, WI 53565
(608) 935-9331
S— Harold P L Breier, MD
PO Box 185
Montfort, WI 53569
(608) 943-6308
JEFFERSON
P— Alan L Detwiler, MD
500 McMillen Street
Fort Atkinson, WI 53538
(414) 563-5571
S— Edward J Hoy, MD
123 Hospital Drive, #208
Watertown, WI 53094
JUNEAU
P— D Keith Ness, MD
1040 Division Street
Mauston, WI 53948
(608) 847-5000
S— Nancy E B Ness, MD
1040 Division Street
Mauston, WI 53948
(608) 847-5000
128
WISCONSIN MEDICAL JOURNAL, JUNE I985rVOL. 84
KENOSHA
P— Andrew T Przlomski, MD
6530 Sheridan Road
Kenosha, WI 53140
(414) 658-2516
S— Aftab A Ansari, MD
3200 Sheridan Road
Kenosha, WI 53140
ES— Mr James Splitek
4109-67th Street
Kenosha, WI 53142
(414) 654-9166
LA CROSSE
P— Pauline M Jackson, MD
1836 South Avenue
La Crosse, WI 54601
(608) 782-7300
S— Thomas P Lathrop, MD
1836 South Avenue
La Crosse, WI 54601
(608) 782-7300
LAFAYETTE
P— Lyle L Olson, MD
517 Park Place
Darlington, WI 53530
(608) 776-4497
S— Richard G Roberts, MD
517 Park Place
Darlington, WI 53530
(608) 776-4497
LANGLADE
P— Theodore C Fox, MD
213 5th Avenue
Antigo, WI 54409
(715) 623-2351
S— John R Myers, MD
1 1 1 1 Langlade Road
Antigo, WI 54409
(715) 623-3761
LINCOLN
P— Muhammad Y Ahmad, MD
716 East 2nd Street
Merrill, WI 54452
(715) 536-2463
S— Gail M Amundson, MD
216 North 7th Street
Tomahawk, WI 54487
(715) 453-4700
MANITOWOC
P— John C Zeldenrust, MD
2219 Garfield Street
Two Rivers, WI 54241
(414) 293-2281
S— Henry M Katz, MD
600 York Street
Manitowoc, WI 54220
(414) 682-7124
MARATHON
P— Curt G Grauer, MD
2727 Plaza Drive
Wausau, WI 54401
(715) 847-3379
S— Leonard H Wurman, MD
425 Pine Ridge Blvd, #305
Wausau, WI 54401
(715) 845-9634
ES— Ms Lorraine W Kordas
PO Box 569
Wausau, WI 54401
(715) 845-6231
MARINETTE FLORENCE
P— James Tandias, MD
PO Box 435
Marinette, WI 54143
S— Leonard R Worden, MD
1510 Main Street
Marinette, WI 54143
(715) 735-7421
MILWAUKEE
P— Lucille B Glicklich, MD
1610 N Prospect Ave, #1202
Milwaukee, WI 53202
S— Donald P Davis, MD
2015 East Newport Avenue
Milwaukee, WI 53211
EVP— Mr William B Harlan
1020 North Broadway, #200
Milwaukee, WI 53202
MONROE
P— Jameel S Mubarak, MD
105 West Milwaukee Street
Tomah, WI 54660
(608) 372-4111
S— Jack D Brown, MD
PO Box 250
Sparta, WI 54656
(608) 269-6731
OCONTO
P— John S Honish, MD
PO Box 260
Oconto, WI 54153
S— Clyde E Siefert, MD
164 North Main Street
Oconto Falls, WI 54154
(414) 846-3671
ONEIDA VILAS
P— Stephen R Peters, MD
PO Box 549
Woodruff, WI 54568
S— Robert J Aylesworth Jr, MD
1020 Kabel Avenue
Rhinelander, WI 54501
(715) 362-5650
ES— Mrs Sally Christoffersen
1020 Kabel Avenue
Rhinelander, WI 54501
(715) 362-5650
OUTAGAMIE
P— Marvin L Hall, MD
612 East Longview Drive
Appleton, WI 54911
(414) 743-4438
S— David R Finch, MD
1611 South Madison Street
Appleton, WI 54911
(414) 739-3100
AS— Ms Dolores A Ebben
211 East Franklin Street
Appleton, WI 54911
(414) 734-5951
OZAUKEE
P— Thomas Wall, MD
326 West Pierre Lane
Port Washington, WI 53074
S— Peter W Messer, MD
3344 West Grace Avenue
Mequon, WI 53092
PIERCE ST CROIX
P— Terry G Domino, MD
280 Vine Street
Hudson, WI 54016
(715) 386-9381
S— Joseph E Powell, MD
441 East 7th Street
New Richmond, WI 54017
(715) 246-6846
POLK
P— William W Young, MD
104 Adams Street South
St Croix Falls, WI 54024
(715) 483-3221
S— Vacancy
PORTAGE
P— Joseph F Jarabek, MD
2501 Main Street
Stevens Point, WI 54481
(715) 344-4120
S — Roy J Dunlap II, MD
508 Vincent Street
Stevens Point, WI 54481
(715) 341-8001
PRICE TAYLOR
P— T Bayard Frederick, MD
789 South 7th Avenue
Park Falls, WI 54552
(715) 762-3212
S— Walther W Meyer, MD
101 North Gibson Avenue
Medford, WI 54451
(715) 748-2121
RACINE
P— Richard N Odders, MD
5625 Washington Avenue
Racine, WI 53406
(414) 886-8226
S— Dennis J Kontra, MD
5802 Washington Avenue
Racine, WI 53406
T— Kenneth J Pechman, MD
2405 Northwestern Avenue
Racine, WI 53404
ES— Mr John M Bjelajac
PO Box 592
Racine, WI 53401
(414) 634-0702
RICHLAND
P— Thomas L Richardson, MD
1313 West Seminary Street
Richland Center, WI 53581
(608) 647-6161
S— Robert P Smith, MD
1313 West Seminary Street
Richland Center, WI 53581
(608) 647-6161
ROCK
P— Jovan L Djokovic, MD
630 Wexford Drive
Janesville, WI 53545
S— Daniel T Peterson, MD
580 North Washington Street
Janesville, WI 53545
(608) 755-3500
RUSK
P— Joseph S Bachir, MD
906 College Avenue West
Ladysmith, WI 54848
(715) 532-6651
S— Ron M Charipar, MD
1216 East River
Ladysmith, WI 54848
(715) 532-5561
SAUK
P— David E Burnett, MD
1900 North Dewey Avenue
Reedsburg, WI 53959
S— James W Clay, MD
1900 North Dewey Avenue
Reedsburg, WI 53959
SAWYER
P— Lloyd M Baertsch, MD
Rte 3, Box 3998
Hayward, WI 54843
S— Paul Strapon III, MD
Rte 3, Box 3998
Hayward, WI 54843
WISCONSIN MEDICAL JOURNAL, JUNE 1985;VOL. 84
129
SHAWANO
P— William A Coan, MD
610 West Green Bay Street
Shawano, W1 54166
(715) 526-3137
S— Alois J Sebesta, MD
I26V2 South Main Street
PO Box 360
Shawano, W1 54166
(715) 526-3313
SHEBOYGAN
P— Robert A Hehniniak, MD
1011 North 8th Street
Sheboygan, WI 53081
S— Robert J Scott, MD
2809 North 7th Street
Sheboygan, Wl 53081
(414) 457-5033
TREMPEALEAU JACKSON
BUFFALO
P— John H Noble, MD
1105 Harrison Street
Black River Falls, Wl 54615
S— James J Dickman II, MD
610 West Adams Street
Black River Falls, WI 54615
(715) 284-4311
VERNON
P— David A Van Dyke, MD
PO Box 149
Viroqua, WI 54665
(608) 637-7052
VP— Thomas M Ambelang, MD
PO Box 467
Viroqua, WI 54665
S— Deverne W Vig, MD
PO Box 72
Viroqua, WI 54665
(608) 637-3195
WALWORTH
P— James L Knavel, MD
PO Box B
Ten Peller Road
Lake Geneva, WI 53147
(414) 248-4467
S— James V Seegers, MD
104 South Wisconsin Street
Elkhorn, WI 53121
(414) 723-6666
WASHINGTON
P— James D Froehlich, MD
7066 North Trenton Road
West Bend, WI 53095
(414) 673-5745
S— Emilio B Regala, MD
1004 East Sumner Street
Hartford, WI 53027
(414) 673-5745
WAUKESHA
P— Thomas J Dougherty, MD
1111 Delafield Street
Waukesha, WI 53186
(414) 542-9531
S-Robert L Warth, MD
1 1 1 1 Delafield Street
Waukesha, Wl 53186
(414) 544-4411
T— Gerald L Harned, MD
223 Wisconsin Avenue
Waukesha, WI 53186
(414) 544-5311
ES— Mr Robert Herzog
850 Elm Grove Road, #\
Elm Grove, WI 53122
(414) 784-3747
WAUPACA
P— Leslie H Gray, MD
46 North Main Street
Clintonville, WI 54929
S— Donn D Fuhrmann, MD
1420 Algoma Street
New London, WI 54961
(414) 982-3606
WINNEBAGO
P— Paul N Gohdes, MD
130 Second Street
Neenah, WI 54956
(414) 729-3005
S— Roy E Buck, MD
PO Box 165
Oshkosh, WI 54902
(414) 233-6000
WOOD
P— Richard H Ulmer, MD
1000 North Oak Avenue
Marshfield, WI 54449
S— Michael J Kryda, MD
1000 North Oak Avenue
Marshfield, Wl 54449
(715) 387-5319B
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130
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
OFFICERS OF SPECIALTY SECTIONS* OF THE STATE MEDICAL
SOCIETY as of record June 1, 1985
Section on;
ALLERGY AND CLINICAL IMMUNOLOGY
Chairman Martin Z Fruchtman, MD
217 Wisconsin Ave, Waukesha 53186
Secretary-treasurer Robert K Bush, MD
6618 Dumont Rd, Madison 53711
Delegate Martin Z Fruchtman, MD
217 Wisconsin Ave, Waukesha 53186
Alternate Delegate John Ouellette, MD
20 S Park St, Madison 53715
ANESTHESIOLOGISTS
Chairman Philip F Powondra, MD
2560 S 78th St, West Allis 53219
Secretary-treasurer W Stuart Sykes, BM
1005 Columbia Rd, Madison 53705
Delegate Warren J Holtey, MD
1000 N Oak Ave, Marshfield 54449
Alternate Delegate John F Kreul, MD
2500 Overlook Tr, Madison 53705
DERMATOLOGY
Chairman Norman F Deffner, MD
630-lst St, Wausau 54401
Secretary-treasurer James L Troy, MD
3003 W Good Flope Rd, Milwaukee 53226
Delegate Joel Taxman, MD
1622 W Wisconsin Ave, Milwaukee 53233
EMERGENCY MEDICINE
Chairman Emma K Ledbetter, MD
1836 South Ave, La Crosse 54601
Secretary-treasurer
Delegate Emma K Ledbetter, MD
1836 South Ave, La Crosse 54601
FAMILY PHYSICIANS
Chairman Francis W Schammel, MD
214 South Forrest St, Stoughton 53589
Secretary-treasurer David E Westgard, MD
815 South 10th St, La Crosse 54601
Delegate Robert S Viel, MD
18735 Pleasant St, Brookfield 53005
Alternate Delegate Thomas H Peterson, MD
995 Campus Dr, Wausau 54401-1898
HOSPITAL MEDICAL STAFF
Chairman John J Beck, MD
345 S 18th Ave, Sturgeon Bay 54235
Secretary-treasurer James L Algiers, MD
1004 E Sumner, Flartford 53027
Delegate Stephen R Peters, MD
PO Box 549, Woodruff 54568
Alternate Delegate Louis R Pfeiffer, MD
315 First St, Nekoosa 54457
•Appointments to these Sections are generally made by the Specialty
Societies. In some instances the appointees are not members of the State
Medical Society and thus cannot serve in an official capacity; these names
have been omitted.
INTERNAL MEDICINE
Chairman Philip J Dougherty, MD
W180 N7950 Town Flail Rd, Menomonee Falls 53051
Secretary-treasurer Anthony P Ziebert, MD
2400 S 90th St, #206, West Allis 53227
Delegate Philip J Dougherty, MD
W180 N7950 Town Hall Rd, Menomonee Falls 53051
Alternate Delegate Anthony P Ziebert, MD
2400 S 90th St, #206, West Allis 53227
MEDICAL FACULTIES
Delegate Mark J Ciccantelli, MD
610 N 19th St, Milwaukee 53233
Alternate Delegate Manucher J Javid, MD
600 Highland Ave, Madison 53792
MEDICAL STUDENTS
Delegate John R Meurer, UW
Alternate John A Zernia, MCW
NEUROLOGY
Chairman
Secretary-treasurer
Delegate R Clarke Danforth, MD
3070 N 51st St, #100, Milwaukee 53210
Alternate Delegate Gamber Tegtmeyer, MD
20 S Park St, Madison 53715
NEUROSURGERY
Chairman George R Bartl, MD
nil Delafield, Waukesha 53186
Secretary-treasurer S Marshall Cushman, MD
312-7th St, Racine 53403
Delegate Glenn A Meyer, MD
16475 Shore Line Dr, Brookfield 53005
Alternate Delegate S Marshall Cushman, MD
312-7th St, Racine 53403
OBSTETRICS-GYNECOLOGY
Chairman
Secretary-treasurer
Delegate Charles Hammond, MD
41 1 Lincoln St, Neenah 54956
Alternate Delegate
OPHTHALMOLOGY
Chairman John L Sella, MD
6114 W Capitol Dr, Milwaukee 53216
Secretary-treasurer Gregory P Kwasny, MD
2300 North Mayfair Rd, Milwaukee 53226
Delegate M Thomas Chemotti, MD
N94 W6539 Fieldcrest, Cedarburg 53012
Alternate Delegate
WISCONSIN MEDICAL JOURNAL, JUNE 1985 : VOL. 84
131
SPECIALTY SECTIONS continued
ORTHOPAEDICS
Chairman James M Huffer, MD
2704 Marshall Court, Madison 53705
Secretary-treasurer
Delegate Paul A Jacobs, MD
1218 W Kilbourn, Milwaukee 53233
Alternate Delegate David D Mellencamp, MD
3970 N Oakland Ave, #501, Milwaukee 5321 1
OTOLARYNGOLOGY
Chairman Mitchell F Kwaterski, MD
626 E Longview Dr, Appleton 5491 1
Secretary-treasurer Donald S Blatnik, MD
2400 S 90th St, West Allis 53227
Delegate Glenn M Seager, MD
1836 South Ave, La Crosse 54601
Alternate Delegate Thomas W Grossman, MD
11945 W Pioneer Rd, Mequon 53092
PATHOLOGY
Chairman Raymond C Zastrow, MD
400 West Villard, Milwaukee 53209
Secretary-treasurer Gerald A Hanson, MD
8700 W Wisconsin Ave, Milwaukee 53226
Delegate Edward A Burg Jr, MD
2025 E Newport Ave, Milwaukee 53211
Alternate Delegate
PEDIATRICS
Chairman Gerald E Porter, MD
1000 North Oak, Marshfield 54449
Secretary-treasurer Joanne Selkurt, MD
1897 Lincoln St, Whitehall 54773
Delegate Carl S L Eisenberg, MD
3003 W Good Hope Rd, PO Box 17300, Milwaukee 53209
Alternate Delegate Ferrin C Holmes, MD
PO Box 447, Sturgeon Bay 54235
PHYSICAL MEDICINE AND REHABILITATION
Chairman William J La Joie, MD
S32 W27641 Daleview Dr, Waukesha 53186
Secretary-treasurer Ram P Bhala, MD
2900 W Oklahoma Ave, Milwaukee 53215
Delegate William J La Joie, MD
S32 W27641 Daleview Dr, Waukesha 53186
Alternate Delegate Neal Taylor, MD
1836 South Ave, La Crosse 54601
PLASTIC SURGERY
Chairman Harold L Ripple, MD
8105 W Lisbon Ave, Milwaukee 53222
Secretary-treasurer Thomas J Schinabeck, MD
900 E Grant St, Appleton 54911
Delegate John E Hamacher, MD
20 S Park St, Madison 53715
Alternate Delegate
PREVENTIVE MEDICINE
Chairman
Henry A Anderson III, MD
PO Box 309, Madison 53701
Secretary-treasurer . . .
Constantine Panagis, MD
9609 W Hadley, Milwaukee 53222
Delegate
Paul R Ebling, MD
2500 Overlook Terr, Madison 53705
Alternate Delegate . . .
Henry A Anderson III, MD
PO Box 309, Madison 53701
PSYCHIATRY
Chairman
Robert B Shapiro, MD
5534 Medical Circle, Madison 53719
Secretary-treasurer . . .
Steven V Hansen, MD
1220 Dewey Ave, Milwaukee 53213
Treasurer
Warren Garitano, MD
1000 North Oak, Marshfield 54449
Delegate
Rudolf W Link, MD
5534 Medical Circle, Madison 5371 1
Alternate Delegate
RADIATION ONCOLOGY
Chairman Robert Edland, MD
1836 South Ave, La Crosse 54601
Secretary-Treasurer Sally M Schlise, MD
1 124 Cass St, Green Bay 54301
Delegate Robert Greenlaw, MD
1000 North Oak, Marshfield 54449
Alternate Delegate Marcia J S Richards, MD
2900 W Oklahoma Ave, Milwaukee 53215
*
RADIOLOGY
Chairman David E Enerson, MD
1200 Soo Marie Ave, Stevens Point 54481
Secretary-treasurer Eric B Wilson, MD
4397 Country Club Rd, Oshkosh 54901
Delegate Marcia Richards, MD
2315 N Lake Dr, PO Box 503, Milwaukee 53201
RESIDENT PHYSICIANS
(Appointments unknown)
THERAPEUTIC RADIOLOGY
(Appointments unknown)
SURGERY
Chairman Folkert O Belzer, MD
600 Highland Ave, Madison 53792
Secretary-treasurer George M Kroncke, MD
6006 Galley Ct, Madison 53705
Delegate P Richard Sholl, MD
580 W Washington Ave, Janesville 53545
Alternate Delegate Louis C Bernhardt, MD
501 Shearwater Rd, Madison 53715
UROLOGY
Chairman
Secretary-treasurer
Delegate Stuart W Fine, MD
2040 W Wisconsin Ave, Milwaukee 53233
Alternate Delegate Charles W Troup, MD
704 South Webster Ave, Green Bay 54301 ■
132
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
PRESIDENTS AND SECRETARIES, WISCONSIN SPECIALTY
SOCIETIES as of record June 1, 1985
WISCONSIN ALLERGY SOCIETY
President Martin Z Fruchtman, MD (Nov 1985)
217 Wisconsin Ave, Waukesha 53186
Secretary Robert K Bush, MD (Nov 1985)
6618 Dumont Rd, Madison 53711
WISCONSIN SOCIETY OF ANESTHESIOLOGISTS
President Philip F Powondra, MD (Sept 1985)
2560 South 78th St, West Allis 53219
Secretary W Stuart Sykes, BM (Sept 1985)
1005 Columbia Rd, Madison 53705
WISCONSIN DERMATOLOGICAL SOCIETY
President Norman F Deffner, MD (Oct 1985)
630-lst Street, Wausau 54401
Secretary James L Troy, MD (Oct 1986)
9200 W Wisconsin Ave, Milwaukee 53226
WISCONSIN CHAPTER, AMERICAN COLLEGE
OF EMERGENCY PHYSICIANS
President Emma K Ledbetter, MD (Nov. 1985)
1836 South Ave, La Crosse 54601
Secretary Milton R McMillen, MD (Nov 1985)
1252 Cliffwood Ln, La Crosse 54601
WISCONSIN ACADEMY OF FAMILY PHYSICIANS
President Francis W Schammel, MD (June 1985)
214 South Forrest St, Stoughton 53589
Secretary David E Westgard, MD (June 1985)
815 South 10th St, La Crosse 54601
Executive Secretary Mr Robert H Herzog
850 Elm Grove Rd, Elm Grove 53122
Tel: 414/784-3656
WISCONSIN SOCIETY OF INTERNAL MEDICINE
President Anthony P Ziebert, MD (Sept 1985)
2400 S 90th St, not,. West Allis 53227
Secretary Charles S Geiger Jr, MD (Sept 1985)
279 S 17th Ave, West Bend 53095
Executive Director Mr Don McNeil
61 1 E Wells St, Milwaukee 53202
Tel: 414/276-6445
WISCONSIN NEUROLOGICAL SOCIETY
President Herbert M Swick, MD (Oct 1985)
1700 W Wisconsin Ave, Milwaukee 53201
Secretary Ivan Stanko, MD (Oct 1985)
2727 Plaza Dr, Wausau 54401
WISCONSIN NEUROSURGICAL SOCIETY
President Teofilo O Odulio, MD (Oct 1985)
427 Pine Ridge Blvd, Wausau 54401
Secretary Marc A Letellier, MD (Oct 1985)
631 Hazel St, Oshkosh 54901
WISCONSIN SECTION, AMERICAN COLLEGE
OF OBSTETRICIANS AND GYNECOLOGISTS
Chairman Walter R Schwartz, MD (July 1986)
10425 W North Ave, Wauwatosa 53226
Vice Chairman William J Oleary, MD (July 1986)
815 S 10th St, La Crosse 54601
WISCONSIN SOCIETY OF OBSTETRICS
AND GYNECOLOGY
President John W Utrie, MD (July 1985)
1821 S Webster Ave, Green Bay 54301
Secretary William E Martens, MD (July 1985)
10425 W North Ave, Wauwatosa 53226
WISCONSIN ACADEMY OF OPHTHALMOLOGY
President John L Sella, MD (Apr 1986)
6114 W Capitol Dr, Milwaukee 53216
Secretary
Executive Secretary Mr Robert H Herzog
850 Elm Grove Rd, Elm Grove 53122
Tel: 414/784-3656
WISCONSIN ORTHOPAEDIC SOCIETY
President James M Huffer, MD (Apr 1986)
2704 Marshall Court, Madison 53705
Secretary Denis S Drummond, MD (Apr 1986)
600 Highland Ave, Madison 53792
WISCONSIN OTOLARYNGOLOGICAL SOCIETY
President Mitchell F Kwaterski, MD (Apr 1986)
626 E Longview Dr, Appleton 5491 1
Secretary Donald S Blatnik, MD (Apr 1986)
2400 S 90th St, West Allis 53227
WISCONSIN SOCIETY OF PATHOLOGISTS
President Raymond C Zastrow, MD (Oct 1985)
400 West Villard, Milwaukee 53209
Secretary Gerald A Hanson, MD (Oct 1985)
8700 W Wisconsin Ave, Milwaukee 53226
Executive Secretary Mr Robert Herzog
850 Elm Grove Rd, Elm Grove 53122
Tel: 414/784-3656
WISCONSIN CHAPTER, AMERICAN ACADEMY
OF PEDIATRICS
Chairman Gerald E Porter, MD (May 1986)
1000 N Oak Ave, Marshfield 54449
Secretary Ordean L Torstensen, MD (May 1986)
1313 Fish Hatchery Rd, Madison 53715
WISCONSIN SOCIETY OF PHYSICAL MEDICINE
AND REHABILITATION
President William J LaJoie, MD (Mar 1986)
S32 W27641 Daleview Dr, Waukesha 53186
Secretary Ram P Bhala, MD (Mar 1986)
2900 W Oklahoma Ave, Milwaukee 53215
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
133
SPECIALTY SOCIETIES continued
WISCONSIN CHAPTER, AMERICAN COLLEGE
OF PHYSICIANS
President Edwin L Overholt, MD (Apr 1986)
1836 South Ave, La Crosse 54601
Secretary Thomas Nikolai, MD (Sept 1985)
1000 N Oak Ave, Marshfield 54449
WISCONSIN SOCIETY OF PLASTIC SURGEONS
President Harold L Ripple, MD (Oct 1984)
8105 W Lisbon Ave, Milwaukee 53222
Secretary Thomas J Schinabeck, MD (Oct 1984)
900 E Grant St, Appleton 5491 1
WISCONSIN SOCIETY FOR PREVENTIVE MEDICINE
President Henry A Anderson III, MD (Mar 1986)
PO Box 309, Madison, WI 53701
Secretary Constantine Panagis, MD (Mar 1986)
9609 W Hadley, Milwaukee 53222
WISCONSIN PSYCHIATRIC ASSOCIATION
President Robert B Shapiro, MD (May 1987)
5534 Medical Circle, Madison 53719
Secretary Steven V Hansen, MD (May 1987)
1220 Dewey Ave, Milwaukee 53213
Executive Secretary Mr Howard Brower
PO Box 1 109, Madison 53701
Tel: 608/257-6781 (ext 158)
WISCONSIN SOCIETY OF RADIATION ONCOLOGISTS
President Stanton A Marks, MD (Oct 1985)
5000 West Chambers St, Milwaukee 53210
Secretary Homer H Russ, MD (Oct 1985)
1000 N Oak, Marshfield 54449
Treasurer Sally M Schlise, MD (Oct 1985)
1 124 Cass St, Green Bay 54301
WISCONSIN RADIOLOGICAL SOCIETY
President David E Enerson, MD (Oct 1985)
1200 Soo Marie Ave, Stevens Point 54481
Secretary Eric B Wilson, MD (Oct 1985)
4397 Country Club Rd, Oshkosh 54901
WISCONSIN SURGICAL SOCIETY
President Folkert O Belzer, MD (May 1986)
600 Highland Ave, Madison 53792
Secretary George M Kroncke, MD (May 1986)
6006 Galley Ct, Madison 53705
WISCONSIN CHAPTER, AMERICAN COLLEGE
OF SURGEONS
President Wayne J Boulanger, MD (Dec 1985)
2015 E Newport Ave, ^406, Milwaukee 53211
Secretary Paul S Fox, MD (Dec 1987)
1 1 1 1 Delafield, Waukesha 53186
WISCONSIN UROLOGICAL SOCIETY
President Gholam H Malek, MD (May 1986)
345 W Washington Ave, Madison 53703
Secretary Clyde Lawnicki, MD (May 1986)
1836 South Ave, La Crosse 54601 ■
SMS Members!
In late 1983 the State Medical Society launched
a publication series called Update to provide
members with issue-specific background pa-
pers that examine subjects in greater depth
than is permitted by the more traditional SMS
publications. These special publications not
only provide background information on an is-
sue but also advise all members of the plans,
strategies, and recommendations of the So-
ciety as it confronts these issues. Four editions
of Update have been published: Prospective
Hospital Reimbursement-DRGs, Health Main-
tenance Organizations: The Wisconsin Law,
Medical Liability in Wisconsin: Problems and
Recommendations for Change, and REACH —
Resource for Education and Awareness of
Community Health: A Program to Improve
Physician-Public Communications. Members
are urged to retain these Updates for future
reference. New members who would not have
received these issues are particularly urged to
contact the SMS Secretary’s Office for their
copies.
134
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
BALANCED
CALCIUM C
Low incidence of side effects
CARDIZEM® (diltiazem HCl)
produces an incidence of adverse
reactions not greater tlian that
reported with placebo therapy,
thus contributing to the patient’s
sense of well-being.
'Caxdizem is indicated in the treatment of angina pectoris due to
coronary artery spasm and in the management of chronic stable
angina (cleisslc effort-associated angina) in patients who caimot
tolerate therapy with beta-blockers and/or nitrates or who remain
symptomatic despite adequate doses of these agents.
References:
1. Strauss WE, McIntyre KM. Parisi AF, et al; Safety and efficacy
of diltiazem hydrochloride for the treatment of stable angina
pectoris: Report of a cooperative clinical trial. Am J Cardiol
49:660-566, 1982. "
2. Pool PE, Seagren SC, Bonanno JA, et al: The treatment of exercise-
inducible chronic stable angina with diltiazem: Effect on treadmill
exercise. Chest 78 (July suppl):234-238, 1980.
Beduces angina attack frequency
42% to 46% decrease reported in
multicenter study
Increases exercise tolerance*
In Bruce exercise test,^ control
patients averaged 8.0 minutes to
onset of pain; Cardizem patients
averaged 9.8 minutes (P<.005).
GAJUnZEM
Cdiltiazeni HCl)
THE BALANCED
CALCIUM CHANNEL BLOCKER
Please see full prescribing Information on following page.
PROFESSIONAL USE INFORMATION
cafdizem.
(dilhazem HCI)
AO ni}( and 60 mg tablets
DESCRIPTION
CARDIZEM’' (dlltiazem hydrochloride) is a calcium ion Inllux
inhibitor (slow channel blocker or calcium antagonist). Chemically,
dlltiazem hydrochloride is 1.5-Benzothiazepin-4(5H)ohe,3-(acetyloxy)
■5-[2-(dimethylamino)ethyl]-2,3-dihydro-2-(4-methoxyphenyl)-.
monohydrochloride,(+) -cis-. The chemical structure is
CHpCHjNICHjIj
Dlltiazem hydrochloride is a white to ofl-white crystalline powder
with a bitter taste. It is soluble in water, methanol, and chloroform
It has a molecular weight of 450.98. Each tablet of CARDIZEM
cohtaihs either 30 mg or 60 mg dlltiazem hydrochloride for oral
administration.
CLINICAL PHARMACOLOGY
The therapeutic behefits achieved with CARDIZEM are believed
to be related to its ability to inhibit the ihflux of calcium ions
during membrane depolarization of cardiac and vascular smooth
muscle
Mechanisms of Action. Although precise mechahisms of its
antianginal actions are still being delineated. CARDIZEM is believed
to act in the following ways:
1 Angina Due to Coronary Artery Spasm CARDIZEM has been
shown to be a potent dilator of coronary arteries both epicardial
and subendocardial Spontaneous and ergonovine-induced cor-
onary artery spasm are inhibited by CARDIZEM
2, Exertional Angina CARDIZEM has been shown to produce
increases in exercise tolerance, probably due to its ability to
reduce myocardial oxygen demand This is accomplished via
reductions in heart rate and systemic blood pressure at submaximal
and maximal exercise work loads.
In animal models, dlltiazem interferes with the slow inward
(depolarizing) current in excitable tissue. It causes excitation-contraction
uncoupling in various myocardial tissues without changes in the
configuration of the action potential. Dlltiazem produces relaxation
of coronary vascular smooth muscle and dilation of both large and
small coronary arteries at drug levels which cause little or no
negative Inotropic effect The resultant increases in coronary blood
flow (epicardial and subendocardial) occur in ischemic and nonischemic
models and are accompanied by dose-dependent decreases in sys-
temic blood pressure and decreases in peripheral resistahce
Hemodynamic and Electrophysiologic EHects. Like other
calcium antagonists, dlltiazem decreases sinoatrial and atrioventricu-
lar conduction in isolated tissues and has a negative inotropic effect
in isolated preparations. In the intact animal, prolongation of the AH
interval can be seen at higher doses.
In man, dlltiazem prevents spontaneous and ergonovine-provoked
coronary artery spasm It causes a decrease in peripheral vascular
resistance and a modest fall in blood pressure and, in exercise
tolerance studies in patients with ischemic heart disease, reduces
the heart rate-blood pressure product for aoy given work load
Studies to date, primarily in patients with good ventricular function,
have hot revealed evidence of a negative inotropic effect; cardiac
output, ejection fraction, and left ventricular end diastolic pressure
have not been affected. There are as yet few data on the interaction
of dlltiazem and beta-blockers. Resting heart rate is usually unchanged
or slightly reduced by dlltiazem.
Intravenous dlltiazem in doses of 20 mg prolongs AH conduction
time and AV node functional and effective refractory periods approxi-
mately 20%. In a study involving single oral doses of 300 mg of
CARDIZEM in six normal volunteers, the average maximum PR
prolongatioh was 14% with no instances of greater than first-degree
AV block. Diltiazem-associated prolongation of the AH interval Is not
mote pronounced in patients with first-degree heart block. In patients
with sick sinus syndrome, dlltiazem significantly prolongs sinus
cycle length (up to 50% in some cases).
Chronic oral administration of CARDIZEM in doses of up to 240
mg/day has resulted in small increases in PR Interval, but has hot
usually produced abnormal prolongation. There were, however, three
instances of second-degree AV block and one instance of third-
degree AV block in a group of 959 chronically treated patients.
Pharmacokinetics and Metaboiism. Dlltiazem is absorbed
from the tablet formulation to about 80% of a reference capsule and
is subiect to an extensive first-pass effect, giving an absolute
bioavailability (compared to intravenous dosing) of about 40%. CARDIZEM
undergoes extensive hepatic metabolism in which 2% to 4% of the
unchanged drug appears in the urine. In vitro binding studies show
CARDIZEM is 70% to 80% bound to plasma proteins. Competitive
ligand binding studies have also shown CARDIZEM binding Is not
altered by therapeutic concentrations of digoxin, hydrochlorothiazide,
phenylbutazohe, propranolol, salicylic acid, or warfarin. Single oral
doses of 30 to 120 mg of CARDIZEM result in detectable plasma
levels within 30 to 60 minutes and peak plasma levels two to three
hours after drug administration. The plasma eliminatioh half-life
following single or multiple drug administration is approximately 3 5
hours. Desacetyl dlltiazem is also present In the plasma at levels of
10% to 20% of the parent drug and is 25% to 50% as potent a
coronary vasodilator as dlltiazem. Therapeutic blood levels of
CARDIZEM appear to be in the range of 50 to 200 ng/ml There is a
departure from dose-linearity when single doses above 60 mg are
given; a 120-mg dose gave blood levels three times that of the 60-mg
dose. There is no information about the effect of renal or hepatic
impairment on excretion or metabolism of dlltiazem.
INDICATIONS AND USAGE
1 Angina Pectoris Due to Coronary Artery Spasm. CARDIZEM
is indicated in the treatment of angina pectoris due to coronary
artery spasm, CARDIZEM has been shown effective in the
treatmeht of spootaneous coronary artery spasm presenting as
Prinzmetal's variant angina (resting angina with ST-segment
elevation occurring during attacks)
2 Chronic Stable Angina (Classic Eltort Associated Angina).
CARDIZEM is indicated in the management of chronic stable
angina CARDIZEM has been effective in controlled trials in
reducing angina frequency and increasing exercise tolerance
There are no controlled studies of the effectiveness of the concomi-
tant use of dlltiazem and beta-blockers or of the safety of this
combinatioh in patients with impaired ventricular function or conduc-
tion abnormalities.
CONTRAINDICATIONS
CARDIZEM is contraindicated in (1) patients with sick sinus
syndrome except in the presence of a functioning ventricular pacemaker,
(2) patients with second- or third-degree AV block except in the
presence of a functioning ventricular pacemaker, and (3) patients
with hypotension (less than 90 mm Hg systolic).
WARNINGS
1 Cardiac Conduction. CARDIZEM prolongs AV node refrac-
tory periods without significantly prolonging sinus node recov-
ery time, except in patients with sick sinus syndrome. This
effect may rarely result in abnormally slow heart rates (particularly
in patients with sick sinus syndrome) or second- or third-degree
AV block (six of 1243 patients tor 0 48%) Concomitant use of
dlltiazem with beta-blockers or digitalis may result in additive
effects on cardiac conduction. A patient with Prinzmetal's
angina developed periods of asystole (2 to 5 seconds) after a
single dose of 60 mg of dlltiazem
2 Congestive Heart Failure. Although dlltiazem has a negative
inotropic effect In isolated animal tissue preparations, hemodynamic
studies in humans with normal ventricular function have not
shown a reduction in cardiac index nor consistent negative
effects on contractility (dp/dt). Experience with the use of
CARDIZEM alone or in combination with beta-blockers ih patients
with impaired ventricular function is very limited Caution should
be exercised when using the drug In such patients.
3 Hypotension. Decreases in blood pressure associated with
CARDIZEM therapy may occasiohally result in symptomatic
hypotension
4 Acute Hepatic Injury. In rare instances, patients receiving
CARDIZEM have exhibited reversible acute hepatic injury as
evidenced by moderate to extreme elevations of liver enzymes.
(See PRECAUTIONS and ADVERSE REACTIONS.)
PRECAUTIONS
General. CARDIZEM (dlltiazem hydrochloride) is extehsively metab-
olized by the liver and excreted by the kidneys and in bile. As with any
new drug given over prolonged periods, laboratory parameters should
be mohitored at regular intervals The drug should be used with
caution In patients with impaired reoal or hepatic functioh. In sub-
acute and chronic dog and rat studies designed to produce toxicity,
high doses of dlltiazem were associated with hepatic damage In
special subacute hepatic studies, oral doses of 125 mg/kg and
higher in rats were associated with histological changes in the liver
which were reversible when the drug was discontinued. In dogs,
doses of 20 mg/kg were also associated with hepatic chaeges;
however, these changes were reversible with continued dosing.
Drug Interaction. Pharmacologic studies indicate that there
may be additive effects in prolonging AV conduction when using
beta-blockers or digitalis concomitantly with CARDIZEM (See
WARNINGS).
Controlled and uncontrolled domestic studies suggest that con-
comitant use of CARDIZEM and beta-blockers or digitalis is usually
well tolerated. Available data are not sufficient, however, to predict
the effects of concomitant treatment, particularly in patients with left
ventricular dysfunction or cardiac conduction abnormalities. In healthy
volunteers, dlltiazem has been shown to increase serum digoxin
levels up to 20%.
Carcinogenesis, Mutagenesis, Impairment ol Fertility. A
24-month study in rats and a 21-month study in mice showed no
evidence of carcinogenicity. There was also no mutagenic response
in in vitro bacterial tests. No intrinsic effect on fertility was observed
in rats
Pregnancy. Category C. Reproduction studies have been con-
ducted in mice, rats, and rabbits Administration of doses ranging
from five to ten times greater (on a mg/kg basis) than the daily
recommehded therapeutic dose has resulted in embryo and fetal
lethality. These doses, in some studies, have been reported to cause
skeletal abnormalities. In the perinatal/postnatal studies, there was
some reduction in early individual pup weights ahd survival rates
There was an Increased incidence of stillbirths at doses of 20 times
the human dose or greater
There are no well-controlled studies in pregnant women; therefore,
use CARDIZEM in pregnant women only if the potential benefit
justifies the potential risk to the fetus
Nursing Mothers. It is hot known whether this drug is excreted
in human milk. Because many drugs are excreted in human milk,
exercise caution when CARDIZEM is administered to a nursing
woman if the drug's benefits are thought to outweigh its potential
risks in this situation.
Pediatric Use. Safety and effectiveness in children have not
been established.
ADVERSE REACTIONS
Serious adverse reactions have been rare in studies carried out to
date, but it should be recognized that patients with impaired ventricu-
lar function and cardiac conduction abnormalities have usually been
excluded.
In domestic placebo-controlled trials, the incidence of adverse
reactions reported during CARDIZEM therapy was not greater than
that reported during placebo therapy.
The followihg represent occurrences observed in clinical studies
which cah be at least reasonably associated with the pharmacology
of calcium influx inhibition. In many cases, the relationship to
CARDIZEM has not been established. The most common occurrences,
as well as their frequency of presentation, are; edema (2 4%).
headache (2.1%), nausea (1.9%), dizziness (1.5%), rash (1.3%),
asthenia (1.2%), AV block (1.1%), In addition, the following events
were reported infrequently (less than 1%) with the order of presenta-
tion corresponding to the relative frequency of occurrence.
Cardiovascular:
Nervous System:
Gastrointestinal:
Dermatologic:
Other:
Flushing, arrhythmia, hypotension, bradycar-
dia. palpitations, congestive heart failure,
syncope
Paresthesia, nervousness, somnolence,
tremor, insomnia, hallucinations, and amnesia.
Constipation, dyspepsia, diarrhea, vomiting,
mild elevations of alkaline phosphatase, SCOT,
SGPT, and LDH.
Pruritus, petechiae, urticaria, photosensitivity.
Polyuria, nocturia.
The following additional experiences have been noted:
A patient with Prinzmetal's angina experiencing episodes of
vasospastic angina developed periods of transient asymptomatic
asystole approximately five hours after receiving a single 60-mg
dose of CARDIZEM
The following postmarketing events have been reported infre-
quently in patients receiving CARDIZEM: erythema multiforme; leu-
kopenia; and extreme elevations ol alkaline phosphatase, SCOT,
SGPT, LOR, and CPK. However, a definitive cause and effect between
these events and CARDIZEM therapy is yet to be established.
OVERDOSAGE OR EXAGGERATED RESPONSE
Overdosage experience with oral dlltiazem has been limited.
Single oral doses of 300 mg of CARDIZEM have been well tolerated
by healthy volunteers In the event of overdosage or exaggerated
response, appropriate supportive measures should be employed in
addition to gastric lavage. The following measures may be considered:
Bradycardia
High-Degree AV
Block
Cardiac Failure
Hypotension
Administer atropine (0.60 to 1.0 mg). If there
is no response to vagal blockade, administer
isoproterenol cautiously.
Treat as for bradycardia above. Fixed high-
degree AV block should be treated with car-
diac pacing.
Administer inotropic agents (isoproterenol,
dopamine, or dobutamine) and diuretics.
Vasopressors (eg. dopamine or levarterenol
bitartrate).
Actual treatment and dosage should depeod on the severity of the
clinical situation and the judgment and experience of the treating
physician.
The oral/LDjo's in mice and rats range from 415 to 740 mg/kg
and from 560 to 810 mg/kg, respectively. The intravenous LD^'s in
these species were 60 and 38 mg/kg, respectively. The oral LDs,, in
dogs Is considered to be in excess of 50 mg/kg, while lethality was
seen in monkeys at 360 mg/kg. The toxic dose in man is not known,
but blood levels in excess of 800 ng/ml have not been associated
with toxicity.
DOSAGE AND ADMINISTRATION
Exertional Angina Pectoris Due to Atherosclerotic Coro-
nary Artery Disease or Angina Pectoris at Rest Due to Coro-
nary Artery Spasm. Dosage must be adjusted to each patient's
needs. Starting with 30 mg four times daily, before meals and at
bedtime, dosage should be increased gradually (given in divided
doses three or tour times daily) at one- to two-day intervals until
optimum response is obtained Although Individual patients may
respond to any dosage level, the average optimum dosage range
appears to be 180 to 240 mg/day. There are no available data concern-
ing dosage requirements in patients with impaired renal or hepatic
function. If the drug must be used in such patients, titration should be
carried out with particular caution.
Concomitant Use With Other Antianginal Agents:
1 Sublingual NTG may be taken as required to abort acute
anginal attacks during CARDIZEM therapy.
2 Prophylactic Nitrate Therapy -CARDIZEM may be safely
coadministered with short- and long-acting nitrates, but there
have been no controlled studies to evaluate the antianginal
effectiveness of this combination.
3. Beta-blockers. (See WARNINGS and PRECAUTIONS.)
HOW SUPPLIED
Cardizem 30-mg tablets are supplied in bottles of 100 (NDC
0088-1771-47) and in Unit Dose Identification Paks of 100 (NDC
0088-1771-49) Each green tablet is engraved with MARION on one
side and 1771 engraved on the other. CARDIZEM 60-mg scored
tablets are supplied in bottles of 100 (NDC 0088-1772-47) and in Unit
Dose Identification Paks of 100 (NDC 0088-1772-49) Each yellow
tablet is engraved with MARION on one side and 1772 on the other.
Issued 4/1/84
Another patient benefit product from
PHARMACEUTICAL DIVISION
MARION
LABORATORIES, INC
KANSAS city, MISSOURI 64137
600mg1dblets
Upjohn
The Upjohn Company • Kalamazoo, Michigan 49001 USA
j-4044 January 1984
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A Public Service of This Publication
Before prescribing, see complete prescribing information in SK&F CO.
literature or POR. The following is a brief summary.
* WARNING
This drug is not indicated for initial therapy of edema or hypertension.
Edema or hypertension requires therapy titrated to the individual. If this
combination represents the dosage so determined, its use may be
more convenient in patient management. Treatment of hypertension
and edema is not static, but must be reevaluated as conditions in
each patient warrant.
Contraindications: Concomitant use with other potassium-sparing agents
such as spironolactone or amiloride. Further use in anuria, progressive
renal or hepatic dysfunction, hyperkalemia. Pre-existing elevated serum
potassium. Hypersensitivity to either component or other sulfonamide-
derived drugs.
Warnings: Do not use potassium supplements, dietary or otherwise, unless
hypokalemia develops or dietary intake of potassium is markedly impaired.
If supplementary potassium is needed, potassium tablets should not be
used. Hyperkalemia can occur, and has been associated with cardiac irregu-
larities. It is more likely in the severely ill, with urine volume less than
one liter/day, the elderly and diabetics with suspected or confirmed renal
insufficiency. Periodically, serum K'*’ levels should be determined. If hyper-
kalemia develops, substitute a thiazide alone, restrict K"*" intake. Asso-
ciated widened QRS complex or arrhythmia requires prompt additional
therapy. Thiazides cross the placental barrier and appear in cord blood.
Use in pregnancy requires weighing anticipated benefits against possible
hazards, including fetal or neonatal jaundice, thrombocytopenia, other
adverse reactions seen in adults. Thiazides appear and triamterene may
appear in breast milk. If their use is essential, the patient should stop
nursing. Adequate information on use in children is not available. Sensitivity
reactions may occur in patients with or without a history of allergy or
bronchial asthma. Possible exacerbation or activation of systemic lupus
erythematosus has been reported with thiazide diuretics.
Precautions: The bioavailability of the hydrochlorothiazide component of
Dyazide' is about 50% of the bioavailability of the single entity. Theoreti-
cally, a patient transferred from the single entities of Dyrenium (triamterene,
SK&F CO.) and hydrochlorothiazide may show an increase in blood pressure
or fluid retention. Similarly, it is also possible that the lesser hydro-
chlorothiazide bioavailability could lead to increased serum potassium levels.
However, extensive clinical experience with 'Dyazide' suggests that these
conditions have not been commonly observed in clinical practice. Do
periodic serum electrolyte determinations (particularly important in patients
vomiting excessively or receiving parenteral fluids, and during concurrent
use with amphotericin B or corticosteroids or corticotropin [ACTH]).
Periodic BUN and serum creatinine determinations should be made,
especially in the elderly, diabetics or those with suspected or confirmed
renal insufficiency. Cumulative effects of the drug may develop in patients
with impaired renal function. Thiazides should be used with caution in
patients with impaired hepatic function. They can precipitate coma in
patients with severe liver disease. Observe regularly for possible blood
dyscrasias, liver damage, other idiosyncratic reactions. Blood dyscrasias
have been reported in patients receiving triamterene, and leukopenia,
thrombocytopenia, agranulocytosis, and aplastic and hemolytic anemia
have been reported with thiazides. Thiazides may cause manifestation of
latent diabetes mellitus. The effects of oral anticoagulants may be
decreased when used concurrently with hydrochlorothiazide: dosage adjust-
ments may be necessary. Clinically insignificant reductions in arterial
responsiveness to norepinephrine have been reported. Thiazides have also
been shown to increase the paralyzing effect of nondepolarizing muscle
relaxants such as tubocurarine. Triamterene is a weak folic acid antagonist.
Do periodic blood studies in cirrhotics with splenomegaly. Antihypertensive
effects may be enhanced in post-sympathectomy patients. Use cautiously
in surgical patients. Triamterene has been found in renal stones in asso-
ciation with the other usual calculus components. Therefore, Dyazide'
should be used with caution in patients with histories of stone formation.
A few occurrences of acute renal failure have been reported in patients on
Dyazide' when treated with indomethacin. Therefore, caution is advised in
administering nonsteroidal anti-inflammatory agents with 'Dyazide'. The
following may occur: transient elevated BUN or creatinine or both, hyper-
glycemia and glycosuria (diabetic insulin requirements may be altered),
hyperuricemia and gout, digitalis intoxication (in hypokalemia), decreasing
alkali reserve with possible metabolic acidosis. 'Dyazide' interferes with
fluorescent measurement of quinidine. Hypokalemia is uncommon with
Dyazide', but should it develop, corrective measures should be taken such
as potassium supplementation or increased dietary intake of potassium-
rich foods. Corrective measures should be instituted cautiously and serum
potassium levels determined. Discontinue corrective measures and
Dyazide' should laboratory values reveal elevated serum potassium.
Chloride deficit may occur as well as dilutional hyponatremia. Concurrent
use with chlorpropamide may increase the risk of severe hyponatremia.
Serum PBI levels may decrease without signs of thyroid disturbance. Cal-
cium excretion is decreased by thiazides. 'Dyazide' should be withdrawn
before conducting tests for parathyroid function.
Thiazides may add to or potentiate the action of other antihypertensive
drugs.
Diuretics reduce renal clearance of lithium and increase the risk of lithium
toxicity.
Adverse Reactions: Muscle cramps, weakness, dizziness, headache, dry
mouth; anaphylaxis, rash, urticaria, photosensitivity, purpura, other dermat-
ological conditions; nausea and vomiting, diarrhea, constipation, other
gastrointestinal disturbances; postural hypotension (may be aggravated by
alcohol, barbiturates, or narcotics). Necrotizing vasculitis, paresthesias,
icterus, pancreatitis, xanthopsia and respiratory distress including pneu-
monitis and pulmonary edema, transient blurred vision, sialadenitis, and
vertigo have occurred with thiazides alone. Triamterene has been found in
renal stones in association with other usual calculus components. Rare
incidents of acute interstitial nephritis have been reported. Impotence has
been reported in a few patients on 'Dyazide', although a causal relationship
has not been established.
Supplied: ‘Dyazide’ Is supplied as a red and white capsule, in bottles of
1000 capsules: Single Unit Packages (unit-dose) of 100 (intended for
institutional use only); in Patient-Pak™ unit-ot-use bottles of 100.
BRS-DZ:L39
In Hypertension*...
When Need to
Conserve K+
Remember the Unique
Red and White Capsule:
^ur Assurance of
Serum K+ and BUN should be checked periodically (see Warnings and Precautions).
Potassium- Sparing
Diazn^
25 mg Hydrochlorothiazide/50 mg Triamterene/SKF
Over 19 Years of Confidence
a product of
SK&F CO.
Carolina, P.R. 00630
The unique
red and ■vviiite
Dyazide® capsule:
■feur assurance of
SK&F quality.
C SK&F Co , 1983
On nitrates,
but angina still
strikes...
Aftera nitrate,
add isopupc
(verapamil HCl/Knoll)
To protect your patients, as well as their quality of life,
add Isoptin instead of a beta blocker.
First, Isoptin not only reduces myocardial oxygen demand
by reducing peripheral resistance, but also increases coro-
nary perfusion by preventing coronary vasospasm and
dilating coronary arteries — both normal and stenotic.
These are antianginal actions that no beta blocker
can provide.
Second, Isoptin spares patients the
beta-blocker side effects that may
compromise the quality of life.
With Isoptin, fatigue, bradycardia and mental
depression are rare. Unlike beta blockers,
Isoptin can safely be given to patients with
asthma, COPD, diabetes or peripheral
vascular disease. Serious adverse
reactions with Isoptin are rare
at recommended doses; the
single most common side
effect is constipation (6.3%)
Cardiovascular contra-
indications to the use of
Isoptin are similar to those
of beta blockers: severe
left ventricular dysfunction,
hypotension (systolic pres-
sure <90 mm Hg) or cardio-
genic shock, sick sinus syndrome
(if no artificial pacemaker is present)
and second- or third-degree AV block.
So, the next time a nitrate is not enough, add
Isoptin ... for more comprehensive antianginal
protection without side effects which may
cramp an active life style.
ISOPTIN. Added
antianginal protection
without beta-blocker
side effects.
Please see brief summary on following page
isoPTii<r
(verapamil HCI/Knoll)
80 mg and 120 mg scored, film-coated tablets
Contraindications; Severe left ventricular dysfunction (see Warnings), hypo-
tension (systolic pressure < 90 mm Hg) or cardiogenic shock, sick sinus syn-
-drome (except in patients with a functioning artificial ventricular pacemaker),
2nd- or 3rd-degree AV block Warnings; ISOPTIN should be avoided in patients
with severe left ventricular dysfunction (e g , ejection fraction < 30% or
moderate to severe symptoms of cardiac failure) and in patients with any
degree of ventricular dysfunction if they are receiving a beta blocker (See
Precautions.) Patients with milder ventricular dysfunction should, if possible, be
controlled with optimum doses of digitalis and/or diuretics before ISOPTIN is
used. (Note interactions with digoxin under Precautions.) ISOPTIN may occa-
sionally produce hypotension (usually asymptomatic, orthostatic, mild and con-
trolled by decrease in ISOPTIN dose) Elevations of transaminases with and
without concomitant elevations in alkaline phosphatase and bilirubin have been
reported. Such elevations may disappear even with continued treatment, how-
ever, four cases of hepatocellular injury by verapamil have been proven by re-
challenge Periodic monitoring of liver function is prudent during verapamil
therapy. Patients with atrial flutter or fibrillation and an accessory AV pathway
(e g W-P-W or L-G-L syndromes) may develop increased antegrade conduction
across the aberrant pathway bypassing the AV node, producing a very rapid
ventricular response after receiving ISOPTIN (or digitalis). Treatment is usually
D.C. -cardioversion, which has been used safely and effectively after ISOPTIN
Because of verapamil's effect on AV conduction and the SA node, 1° AV block
and transient bradycardia may occur. High grade block, however, has been
infrequently observed. Marked 1° or progressive 2° or 3° AV block requires a
dosage reduction or, rarely, discontinuation and institution of appropriate
therapy depending upon the clinical situation Patients with hypertrophic car-
diomyopathy (IHSS) received verapamil in doses up to 720 mg/day It must be
appreciated that this group of patients had a serious disease with a high mor-
tality rate and that most were refractory or intolerant to propranolol A variety
of serious adverse effects were seen in this group of patients including sinus
bradycardia, 2° AV block, sinus arrest, pulmonary edema and/or severe hypo-
tension Most adverse effects responded well to dose reduction and only rarely
was verapamil discontinued Precautions; ISOPTIN should be given cautiously
to patients with impaired hepatic function (in severe dysfunction use about
30% of the normal dose) or impaired renal function, and patients should be
monitored for abnormal prolongation of the PR interval or other signs of exces-
sive pharmacologic effects. Studies in a small number of patients suggest that
concomitant use of ISOPTIN and beta blockers may be beneficial in patients
with chronic stable angina. Combined therapy can also have adverse effects on
cardiac function. Therefore, until further studies are completed, ISOPTIN should
be used alone, if possible. If combined therapy is used, close surveillance of vital
signs and clinical status should be carried out Combined therapy with ISOPTIN
and propranolol should usually be avoided in patients with AV conduction
abnormalities and/or depressed left ventricular function. Chronic ISOPTIN treat-
ment increases serum digoxin levels by 50% to 70% during the first week of
therapy, which can result in digitalis toxicity. The digoxin dose should be re-
duced when ISOPTIN is given, and the patients should be carefully monitored to
avoid over- or under-digitalization. ISOPTIN may have an additive effect on
lowering blood pressure in patients receiving oral antihypertensive agents,
Disopyramide should not be given within 48 hours before or 24 hours after
ISOPTIN administration Until further data are obtained, combined ISOPTIN and
quinidine therapy in patients with hypertrophic cardiomyopathy should prob-
ably be avoided, since significant hypotension may result Clinical experience
with the concomitant use of ISOPTIN and short- and long-acting nitrates sug-
gest beneficial interaction without undesirable drug interactions Adequate ani-
mal carcinogenicity studies have not been performed. One study in rats did not
suggest a tumorigenic potential, and verapamil was not mutagenic in the Ames
test. Pregnancy Category C. There are no adequate and well-controlled studies
in pregnant women. This drug should be used during pregnancy, labor and
delivery only if clearly needed. It is not known whether verapamil is excreted in
breast milk; therefore, nursing should be discontinued during ISOPTIN use.
Adverse Reactions; Hypotension (2,9%), peripheral edema (1 7%), AV block:
3rd degree (0 8%), bradycardia: HR < 50/min (11%), CHE or pulmonary
edema (0 9%), dizziness (3 6%), headache (18%), fatigue (11%), constipa-
tion (6 3%), nausea (16%), elevations of liver enzymes have been reported
(See Warnings.) The following reactions, reported in less than 0 5%, occurred
under circumstances where a causal relationship is not certain: ecchymosis,
bruising, gynecomastia, psychotic symptoms, confusion, paresthesia, insomnia,
somnolence, equilibrium disorder, blurred vision, syncope, muscle cramp, shaki-
ness, claudication, hair loss, macules, spotty menstruation How Supplied;
ISOPTIN (verapamil HCI) is supplied in round, scored, film-coated tablets con-
taining either 80 mg or 120 mg of verapamil hydrochloride and embossed with
"ISOPTIN 80" or "ISOPTIN 120" on one side and with "KNOLL" on the reverse
side Revised August, 1984 2385
KNOLL PHARMACEUTICAL COMPANY
knou 30 NORTH JEFFERSON ROAD, WHIPPANY, NE\A/ JERSEY 07981
2406
EMPLOYEES
APPRECIATE
THE PAYROLL
SAVINGS PLAN.
JUSTASK
THE PEOPLE AT
E-SYSTEMS.
“Bonds are a good
liquid investment,
and if I don’t use
them, they continue
to earn interest.”
— L.A. Fulcher
“I put myself and
my children through
school with Savings
Bonds. They’re
great!”
—Ken Sclater, Jr.
“1 save them, but
when 1 want some-
thing extra, 1 know
they’re there. They’re
great for emergencies.”
—Jose Acosta
U.S. Savings Eksnds now offer
higher, variable interest rates and a
guaranteed return. Your employees
will appreciate that. They’ll also
appreciate your giving them the
easiest, surest way to save.
For more information, write to:
Steven R. Mead, Executive Director,
U.S. Savings Bonds Division, Depart-
ment of the "Treasury, Washington, DC
20226.
as. SAVINGS bondsSl.
Paying BetterThan Ever " ^
A public service of this puhlicanon
STATE GOVERNMENT AGENCIES
A VALUABLE REFERENCE FOR PRACTICING PHYSICIANS AND ALLIED HEALTH PERSONNEL
AS OF MAY 15, 1985
Department of Health and Social Services
1 W Wilson St, Madison, Wis 53702 • Tel 608/266-3681
EXECUTIVE STAFF
SECRETARY
Linda Reivilz 266-3681
DEPUTY SECRETARY
John Torphy 266-368 1
DIVISION ADMINISTRATORS
Peter Tropman 266-8402
Policy and Budget
Nate Harris 266-3173
Management Seniices
Walter Dickey 266-2471
Corrections
Michael Moore 266-8740
Care and Treatment Facilities
Kathryn Morrison 266- 1511
Health
Gerald Berge 266-2701
Community Services
Patricia Kallsen 266- 1281
Vocational Rehabilitation
DIVISION OF HEALTH
1 W Wilson St; Room 234
PO Box 309
Madison, Wis 53701
Tel 608/266-1511
Note; Use box number on First Class Mail
for all bureaus.
ADMINISTRATOR
Kathryn Morrison
ASSISTANT ADMINISTRATOR
for Public Health Services
William Schmidt
ASSISTANT ADMINISTRATOR
for Health Administration
John Chapin
OFFICE OF MANAGEMENT
AND POLICY
Dave Mills
BUREAUS
Planning & Development . . . 266-2020
• Staffing of Health Policy Council and
its committees
• Development of State Health Plan
• Liaison with Health Systems Agencies
and review of their plans and budgets
• Coordination of categorical health plan-
ning process
• Review of categorical health plans
• Liaison with agencies (public and pri-
vate) that implement the State Health
Plan
• Service licensure
• Development of health facilities plan
• Review of categorical grants appeal
Health Care Financing 266-2522
• Administration of the Medical Assist-
ance Program
• EPSDT — Early and periodic screening,
diagnosis and treatment for children and
other screening activities
Quality Compliance 266-8847
• Title 18 and Title 19 certification
• Hospital and nursing home standard set-
ting and enforcement
• Patient care evaluation
• Construction and plan review
• Development of facilities standards
Community Health
& Prevention 266-1251
• Development and promotion of preven-
tion programs
• Standard epidemiology
• Environmental epidemiology
• Immunization activities
• Communicable diseases
• Chronic diseases
• Participation in preventive efforts with-
in and outside the Department of Health
and Social Services
• Promotion of research into major causes
of illness and death and sponsorship of
demonstration projects designed to re-
duce and eliminate root causes
• Laboratory certification
• Public health nursing
• Public health nutrition
• Dental health
• Maternal and child health
• Eamily planning
Correctional Health Services 266-5718
• Assurance of sufficient levels of physical
health care for all inmates in correctional
institutions and at Central State Hos-
pital
• Management of the provision of such
services to insure effectiveness and effi-
ciency
• Recruitment and staffing of health care
positions in the correctional institutions
Environmental Health 266-9377
(1400 E Washington Ave, Madison 53702)
• Certification of Grade A milk
• Inspection of hotels, restaurants and
food vending services where not per-
formed by local public health agencies
• General environmental sanitation
• Recreational inspection
• Radiation protection
• Occupational health services
• Development of emergency medical ser-
vices systems
Health Statistics 266-1939
• Vital Statistics
• Resource data
• Demographic and special analysis
• Services data
REGIONAL OFFICES
MADISON 53704
3518 Memorial Dr
Tel 608/249-8928
MILWAUKEE 53202
819 North 6th St, Rm 860
Tel 414/224-4860
GREEN BAY 54301
200 N Jefferson
Tel 414/497-3219
EAU CLAIRE 54701
Eau Claire State Office Building, 136
718 W Clairemont Ave
Tel 715/836-5362
Tel 715/836-4752 (Long Term Care)
RHINELANDER 54501
1853 N Stevens St; PO Box 1 165
Tel 715/362-7800
Note: Use box numbers on First Class Mail
continued next page
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
143
DEPARTMENT OF HEALTH AND SOCIAL SERVICES continued
DIVISION OF COMMUNITY
SERVICES
state Office: 1 W Wilson St
PO Box 7851
Madison, Wis 53707
Tel: 608/266-2701
ADMINISTRATOR’S OFFICE
Administrator 266-2701
Gerald Berge
Deputy Administrator 266-2701
Public Information 267-9230
Peggy Schmitt
Assistant Administrator 266-2701
Bernard Stumbras
BUREAUS
Community Aids
Administration 266-9707
William Griffin
Community Programs 266-3719
Gerald Born
• Alcohol and Other
Drug Abuse 266-3719
Larry Monson
• Developmental Disabilities . . 266-2862
Kary Hyre
• Hearing Impaired 267-7802
Herbert Picked
• Mental Health 266-3249
David Goodrich
• Coordinator for Blind
and Vision Impaired 266-5600
Michael Nelipovich
• Office of Physical
Disabilities 267-9582
Dan Johnson
Economic Assistance 266-3035
Mary South wick
• Planning and
Implementation 266-2850
Mary Ann Cook
• Program Compliance 266-2693
Jacqueline Rader
• Child Support 266-0528
Duane Campbell
Human Resources 266-3443
Severa A ustin
• Aging 266-2536
Donna McDowell
• Children, Youth
and Families 266-6946
Michael Becker
• Wisconsin Resettlement 266-8354
Susan Levy
• Coordinator for
Indian Affairs 266-5862
Nancie Young
• Coordinator for
Hispanic/Migrants . . . .414/224-1877
John Enriquez
• Coordinator for
Economic Opportunity 266-0073
Robert Neal Smith
Social Security Disability
Insurance 266-1981
William Griffin
continued next page
Controlled Substances
Board 266-7586
June L Dahl, PhD, Chairman,
Professor of Pharmacology,
University of Wisconsin-Madison
David P Donarski, MD, Green Bay
Bronson C LaFollette, Attorney
General, State of Wisconsin,
Madison
Linda Reivitz, Secretary, Dept of
Health and Social Services,
Madison
Pamela Ploetz, RPh, Chairman,
Pharmacy Examining Board,
Madison
Vern Ausman, Secretary, Dept of
Agriculture, Trade and Con-
sumer Protection, Madison
* ♦ *
STAFF; David E Joranson, Con-
trolled Substances Policy Specialist,
Controlled Substances Board,
Bureau of Community Programs,
Department of Health and Social
Services, 1 West Wilson St, PO Box
785 1 , Madison, Wis 53707 (ph 608 /
266-7586)
DIVISION OF HEALTH
Regions
Center for Health
Statistics
Division of Health
The Center is the custodian of
birth, death, marriage and divorce
records for the state (ss. Chapter 69).
Also, the Center has a contract with
the National Center for Health Sta-
tistics for collection of vital statistics
and partial funding from the Health
Care Financing Administration for
the collection of data on hospital dis-
charge, health manpower, and
health facilities. Several other proj-
ects are being carried out in areas
such as cancer reporting, blood
alcohol reporting. Another of the
Center’s activities is the production
of annual population estimates for
Wisconsin counties. . .a part of the
Federal-State Cooperative Program
of the Bureau of the Census. Inquir-
ies may be made to: Raymond D
Nashold, Director, Center for
Health Statistics, PO Box 309,
Madison, WI 53701 .
144
WISCONSIN MEDICAL JOURNAL, JUNE 1983: VOL. 84
DEPARTMENT OF HEALTH AND SOCIAL SERVICES continued
DIVISON OF COMMUNITY SERVICES
continued
OFFICES
Internal Operations 266-3782
Mark Hoover
Management Information . . . .266-7936
Richard Pedersen
Program Initiatives 266-9304
Thomas Hamilton
REGIONAL OFFICES
WESTERN
Terry WiUkom, Director
Box 228, 718 West Clairemont Ave,
Eau Claire 54702
Tel 715/836-2157
EASTERN
Lewis McCauley, Director
Box 3730, 200 North Jefferson HAX 1
Green Bay 54303
Tel 414/497-3043
SOUTHERN
John Erickson, Director
3601 Memorial Dr, Madison 53704
Tel 608/249-0441
MILWAUKEE
Charles Holton, Acting Director
819 North 6th St, Milwaukee 53203
Tel 414/224-4563
SOUTHEASTERN
Charles Holton, Director
Box 1258, 141 NW Barstow
Waukesha 53187
Tel 414/548-6059
NORTHERN
Barbara Voltz
1853 N Stevens St
PO Box 697
Rhinelander 54501
Tel 715/362-7800
DISTRICT OFFICES
FOND DU LAC 54935
485 South Military Road, Box 1069
Tel 414/922-6810
ASHLAND 54806
601 2nd St, West, Box 72
Tel 715/682-3405
WISCONSIN RAPIDS 54494
1681 Second Ave, South, Box 636
Tel 715/423-4305
LaCROSSE 54601
3550 Mormon Coulee Road, Box 743
Tel 608/785-9453
DIVISION OF
VOCATIONAL
REHABILITATION
state Office: 1 W Wilson, Rm 830
POB 7852, Madison, Wis 53707
Tel: 608/266-1281
Administrator 266-5466
Patricia G Kallsen
Deputy Administrator 266-2 1 68
Kenneth T McClarnon
BUREAUS
Client Services
John H Biddick, Regional
Administrator 266-1283
Olaf Brekke, Regional
Administrator
R F Truesdell, Regional
Administrator
R R VanDeventer, Regional
Administrator
Operations and Planning
Vacant, Director
Patrick Mommaerts, Assistant
Bureau Director 266-2956
• Planning and Program Support
Section
Susan Kidder, Chief 267-7840
• Employment and Resources Section
Patrick Mommaerts, Assistant
Bureau Director/Section Chief
• Workshop for the Blind
John Baumgart, Director
414/778-5807
Governor’s Committee for
People with Disabilities
Ellen Daly, Director 266-5378
266-2380
266-0589
266-0605
FIELD OFFICES
L E Opheim, Supervisor
517 Walker Ave
Eau Claire 54701
Tel 715/836-4263
Paul Monzel, Supervisor
820 S Main St
POB 1438
Fond du Lac 54935
Tel 414/921-5883
Roger Siegworth, Supervisor
200 N Jefferson St
Green Bay 54301
Tel 414/497-3417
H'ayne Olson, Supervisor
101 South Main St
Janesville 53545
Tel 608/755-2780
Willie Riley, Supervisor
lll5-56th St
Kenosha 53140
Tel 414/656-6453
John Purcell, Supervisor
333 Buchner PI
La Crosse 54601
Tel 608/785-9500
Manuel Lugo, Supervisor
160 Westgate Mall
Madison 5371 1
Tel 608/266-3655
William R Newberry, Supervisor
2430 N Murray Ave
Milwaukee 5321 1
Tel 414/963-2440
Noreen Rvan, Supervisor
6815 W Capital Dr
Milwaukee 53216
Tel 414/438-4881
Frank Broder, Supervisor
3501 S Howell St
Milwaukee 53207
Tel 414/769-2600
Jeanne Leland, Supervisor
9401 W Beloit Rd, Rm 408
Milwaukee 53227
Tel 414/546-8340
James Mather, Supervisor
1000 Oregon St
Oshkosh 54901
Tel 414/424-2028
Martin J Eft, Supervisor
3 1 1 E Wisconsin
Portage 53901
Tel 608/742-8594
Sharlene Hatcher, Supervisor
5200 Washington Ave
Racine 53406
Tel 414/636-3388
Roger Tooke, Supervisor
130 South Stevens, POB 894
Rhinelander 54501
Tel 715/369-3930
Michael Schroeder, Supervisor
1 1 E Eau Claire
Rice Lake 54868
Tel 715/234-6806
George Herrmann, Supervisor
1428 N 5th
Sheboygan 53081
Tel 414/459-3883
Leroy Forslund, Supervisor
917 Tower Ave
Superior 54880
Tel 715/392-8171
K F Krumnow, Supervisor
141 NW Barstow
Waukesha 53187
Tel 414/548-5850
Kenneth Crass, Supervisor
2416 Stewart Sq
Wausau 54401
Tel 715/845-9261
John Roemer, Supervisor
1810-9th St, S
Wisconsin Rapids 54494
Tel 715/424-1 100
continued next page
WISCONSIN MEDICAL JOURNAL, JUNE 198,S;VOL. 84
45
DEPARTMENT OF HEALTH AND SOCIAL SERVICES continued
DIVISION OF CARE
AND TREATMENT
FACILITIES
state Office: 1 W Wilson St
PO Box 7851
Madison, Wis 53707
Tel: 608/266-8740
Administrator 266-8740
Michael J Moore
Deputy Administrator 267-7921
Gerald E Dymond
Program Support 267-2254
• Child Caring Institutions . .266-5774
Robert Lizon
• Forensics Services 266-1856
Marvin Chapman, MD
• Client Advocacy 266-2713
Joy Sch wert
Barbara LaFollette
• Management Services 267-2254
Donald Pahnke
• Affirmative Action /Civil
Rights Compliance 266-3993
Pickens Winters Jr
• Wisconsin Resource
Center 414/426-4310
Robert Ellsworth
• Northern Wisconsin
Center 715/723-5542
Terry Willkoin
• Central Wisconsin Center . 249-2151
Richard C Scheerenberger PhD
• Southern Wisconsin
Center 414/878-2411
Nancy Gettelfinger
• Mendota Mental Flealth
Institute 241-2411
Terence Schnapp
• Winnebago Mental Health
Institute 414/235-4910
H David GoersM
Department
of Regulation
and Licensing
1400 E Washington Ave
PO Box 8936
Madison, Wis 53708
Tel 608/266-2112
Barbara Nichols, Secretary 266-8609
Bernard F Mrazik, Deputy Secretary
Dari E Drummond, Executive Assistant
BUREAU OF HEALTH
PROFESSIONS (Partial listing)
General Number 267-721 1
Medical Examining Board
Susan F Behrens, MD (1985), Beloit
Chairman
William J Hisgen, MD (1986), Madison
Vice Chairman
Gwen Jackson (1988), Milwaukee
Secretary
William E Walker, MD (1987),
Whitefish Bay
Joseph L Ousley, MD (1988), Marshfield
Patricia R Raftery, DO (1986), Sparta
Helen H Ahn, MD (1988), Tomah
Sarah J Pratt, MD (1987), Sheboygan
George W Arndt, MD (1985), Neenah
Judy Crain (1988), Green Bay
EXECUTIVE STAFF
Barbara Livingston, Madison . . 266-0483
Bureau Director
Deanna Zychowski, Madison . . . 266-2811
Administrative Assistant
* * *
Physical Therapist Examining Council
Council on Physician’s Assistants
Podiatry Examining Council
Dentistry Examining Board
Tel 608/266-1396
Frank Shuler, DDS Clinton
Chairman
Helen Hensler Milwaukee
Vice Chairman
Gerard Schmidtke, DDS lola
Secretary
David Crane, DDS Chippewa Falls
Kathleen Kelly, DDS Madison
Coleman Getler, DDS Glendale
Diane Bergschneider, RDH . Milwaukee
STAFF
Ron Sommer, Bureau Director
Don Rittel, Legal Counsel
Mary J Schiller, Program Assistant
Pam Stach, Attorney
Sue Schaut, Investigator
* 4c ♦
Pharmacy Examining Board
Tel 608/266-8794
Pamela A Ploetz, RPh (1986), Madison
Chairman
Kenneth Schaefer, RPh (1987), Mosinee
Vice Chairman
Frankie Fuller (Public Member) (1986),
Secretary
D Jack Myers, RPh (1988), Madison
Katherine A Rhoades (Public Member)
(1988), Wausau
Charles W Lang Jr, RPh (1989), Viroqua
Meredith "Bud” Nelson, RPh (1985),
Merrill
BUREAU OF NURSING
Paula R Possin, Director 267-7223
Board of Nursing
John Bartkowski, 7?A'(1986)
Chairman Milwaukee
Suzanne Schuler, /?N(1987)
Vice Chairman Wauwatosa
Debora K Bergeron, LPN (1986)
Secretary Chippewa Falls
Mary Ann Clark, 7?A'(1986)
Cumberland
Shirley Berger, /?7V(1987)
Stevens Point
Jane Travis, 7?N(1988)
Onalaska
Ellen Ryan (1987) (Public Member)
lola
Steven Schaefer (1985)
Public Member Madison
Annie McMorrIs, Z,PN(1985)
Milw'aukee ■
Department of
Industry, Labor &
Human Relations
PO Box 7946, 201 E Washington Ave
Madison, Wis 53707
Tel 608/266-7552
Secretary’s Office
Howard S Bellman, Secretary .... Madison
Helene M Nelson,
Deputy Secretary Madison
Toya M McCosh,
Executive Assistant Madison
Divisions
Worker’s Compensation 266-1340
Carol A Lobes, Administrator
Job Service 266-8561
John Adams, Administrator
Safety and Buildings 266-3151
Ed McClain, Administrator
Equal Rights 266-6860
Merry F Tryon, Administrator
Apprenticeship and Training . . . .266-3133
Charles T Nye, Administrator
Unemployment Compensation .266-7074
Edwin M Kehl, Administrator
Administration 266-1024
Michael E Lovejoy, Administrator ■
146
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
Health Policy Council
The Governor’s Health Policy Council is the chief health policy advisory body in the state and is primarily responsible for
the coordination of the five area health systems plans into what ultimately becomes the triennial State Health Plan. The Council
also advises the Department of Health and Social Services staff on major health issues and periodically reviews various statewide
plans for the use of Federal grant health funds. In 1 982 two Health Systems Agencies— the Northeastern Agency and the Lake
Winnebago Agency — disbanded. This removed eight (8) HSA seats on the Council. Since state law requires a 60% HSA to
40% Governor at-large ratio on the Council, the at-large seats were reduced by four (4). The Council now has a total of 35
members — 20 HSA-nominated representatives, 14 at-large representatives, and 1 ex-officio VA representative.
Chairman, HPC
Harold C Ristow, La Crosse 54601
Tel 608/788-0027
Vice Chairman, HPC
Roger Baird, Menasha 54952
Tel 414/734-8960
Marlene Baron, Ashland 54806
Tel 715/835-1285 or 682-6781
John Blahnik Washburn 54891
Tel 715/373-2621 or 373-2526
Judith Blank, Madison 53703
Tel 608/257-8403 or 263-8815
William J Boyle, Eau Claire 54701
Tel 715/832-3938
David B Carlson, Rhinelander 54501
Tel 715/369-1414 or 369-2288
Ernest P Celebre, Kenosha 53142
Tel 414/552-9512 or 656-301 1
Flora Cohen, Milwaukee 5321 1
Tel 414/645-6616 or 332-8905
John O Danielson, Superior 54880
Tel 715/392-8386
Michael Daun, Milwaukee 53210
Tel 414/258-2745
Dolores Ecker, Chilton 53014
Tel 414/439-1260 or 849-9490
Ruth R Gedwardt, Racine 53403
Tel 414/634-6951 or 637-1341
Norman N Gill, Milwaukee 53217
Tel 414/224-6842 or 325-1545
Phyllis Huffman, Wisconsin Rapids 54494
Tel 715/423-1441
Stephen Kearney, Oshkosh 54901
Tel 414/235-4910
David Kindig, MD, Madison 53706
Tel 608/263-4163
Donald W Kolek, Ashland 54806
Tel 715/682-5271 or 682-6875
Ben R Lawton, MD, Marshfield 54449
Tel 715/387-5511 or 387-5709
Marilyn McCarty, New Richmond 54017
Tel 715/246-4003 or 246-6561
Paul F Meszaros, Ladysmith 54848
Tel 715/532-5511 (ext 297) or 532-5731
George A Million, Wausau 54401
Tel 7 1 5 / 848- 1 406 or 842- 1 229
Florence H Mineau, West Bend 53095
Tel 414/338-0826
Naomi Nash, Wisconsin Rapids 54494
Tel 715/423-6892
Edmund A Nix, La Crosse 54601
Tel 608/784-8100
John Petersen, MD, Wauwatosa 53226
Tel 414/257-5891 or 476-2375
Kathleen M Rivera, Wauwatosa 53226
Tel 414/771-5833 or 271-8210
Werner J Schaefer, Milwaukee 53213
Tel 414/476-5283
Eileen Taylor, Lake Mills 53551
Tel 414/674-2500 (ext 190) or 648-5352
Artha Jean Towell, Madison 53705
Tel 608/233-9068
Mary Turnquist, Wausau 54401
Tel 715/842-3343 or 842-1871
Salvador G de Usabel, Madison 53717
Tel 608/266-5462 or 833-3647
Bradley S Wilson, Bayside 53217
Tel 414/226-5000 or 351-2648
Joan M Zeiger, Milwaukee 53202
Tel 414/276-8293
*Nathan L Geraths, Madison 53705
Tel 608/256-1901
*Ex-officio Member ■
MEDIGAP HOTLINE:
1-800-242-1060
Designed to answer health insurance questions.
• Health insurance and retirement
How will my insurance needs change when I reach
65?
What is a Medicare Supplement policy?
How do different policies compare in coverage? In
cost?
What policies are currently on the market?
• Health insurance for those over 65
Do 1 have good health care coverage?
Am 1 paying for too much insurance?
Can 1 replace my policy with a better one?
• Special kinds of health insurance
Are cancer policies worthwhile?
How do indemnity policies work?
Do I need a nursing home policy?
• Medical Assistance (Medicaid, M.A., Title
XIX)
Am I eligible for Medical Assistance?
Do I need private insurance with M.A.?
What does M.A. cover?
Where do I apply?
Medigap Hotline is a project of the Center for Public
Representation in Madison. It is available to Wiscon-
sin residents over age 65 or approaching retirement.
When the Hotline is not in operation, a recording will
give the scheduled times for calling.
WISCONSIN MEDICAL JOl'RNAL, JUNE 1985 : VOL. 84
147
WISCONSIN HEALTH SYSTEMS AGENCIES
(listed by district and serving the counties therein)
Federally designated, the seven Wisconsin HSAs are primarily responsible for areawide and regional health planning
and resource development activities in their respective health service areas. Either public or private nonprofit entities, the
consumer dominated HSAs (1) formulate Health Systems Plans; (2) initially review Certificate of Need Applications for in-
stitutional health services, equipment, and construction; (3) perform the first phase of Federally required “Appropriate-
ness Review”; and (4) serve as a screening body for the application of Federal Health Funds. Additionally, HSAs are
charged with the mandate to overcome access barriers to
towards the improved health of area residents.
District I: Health Planning Council, Inc (HPC), 995 Applegate
Road, Madison 53713
Joyce Mevis, President
Paul Fleer, E.xecutive Director (Ph 608/273-1809)
Counties: Columbia, Dane, Dodge, Grant, Green, Iowa, Jeffer-
son, LaFayette, Richland, Rock, Sauk
District 2: Southeastern Wisconsin Health Systems Agency, Inc
(SEWHSA), 735 W Wisconsin Ave, ^600, Milwaukee, Wisconsin
53233
Matthias Goebel, President
Kipton Kaplan, E.xecutive Director (Ph 414/271-9788)
Counties: Kenosha, Milwaukee, Ozaukee, Racine, Walworth,
Washington, Waukesha
District 3: Lake Winnebago Area Health Systems Agency, Inc
(LWAHSA) DHSS currently is performing functions since closing
of this district office July 1982.
Counties: Calumet, Fond du Lac, Green Lake, Marquette,
Outagamie, Waupaca, Waushara, Winnebago
District 4: Northeastern Wisconsin Health Systems Agency, Inc
(NEWHSA) DHSS currently is performing functions since closing
of this district office July 1982.
Counties: Brown, Door, Kewaunee, Manitowoc, Marienette,
Menominee, Oconto, Shawano, Sheboygan
treatment, avoid duplication of service, and generally strive
District 5; Western Wisconsin Health Systems Agency, Inc
(WWHSA), 907 Main Street, La Crosse, Wisconsin 54601
Sandra McCormick, President
Val Chilsen, Executive Director (Ph 608 / 785-9352)
Counties: Barron, Buffalo, Chippewa, Clark, Crawford, Dunn,
Eau Claire, Jackson, LaCrosse, Monroe, Pepin, Pierce, Polk,
Rusk, St. Croix, Trempealeau, Vernon
District 6: North Central Area Health Planning Association, Inc
(NCAHPA) 408 Third St, #202, Wausau, Wisconsin 54401
Archie Becker, President
George Snyder, Executive Director (Ph 715/845-3107)
Counties: Adams, Florence, Forest, Juneau, Langlade, Lincoln,
Marathon, Oneida, Portage, Taylor, Vilas, Wood
District 7: Health Systems Agency of Western Lake Superior, Inc
Ordean Building, Suite 202, 424 W Superior Street, Duluth,
Minnesota 55802
Harold Leppink, President
Wende Nelson, Executive Director
IVisconsin Counties: Ashland, Bayfield, Burnett, Douglas, Iron,
Price, Sawyer, Washburn
Minnesota Counties: Aitkin, Carlton, Cook, Itasca,
Koochiching, Lake, St. LouisB
PHYSICIAN MEMBERS OF WISCONSIN HEALTH SYSTEMS AGENCY BOARDS
District 1
Health Planning Council, Inc
*Carlos A Jar.xmillo. MD, POB 786, Monroe 53566
Jerry J Noren, MD, 610 N Walnut, Madison 53705
District 2
Southeastern Wisconsin Health Systems Agency, Inc
♦Carl S L Eisenberg. MD, 3003 W Good Hope Rd, Milwaukee
53217
District 3
(No office) (Responsibility of the Division of Health)
District 4
(No office) (Responsibility of the Division of Health)
♦Denotes member of SMS
District 5
Western Wisconsin Health Systems Agency, Inc
♦William D Bateman, MD, 134 N Leonard St, West Salem
54669
♦Lowell a Kristensen, MD, 1020 Lakeshore Dr, Rice Lake
54868
♦JOSEPH M TOBIN. MD, Box 224, Eau Claire 54701
♦JOSEPH B DURST, MD, 815 South 10th St, La Crosse 54601
♦Donald E Hoff, MD, UW-Eau Claire, Student Health Service,
Eau Claire 54701
District 6
North Central Area Health Planning Association, Inc
♦Maurice T Norman, MD, 1925 Townline Rd, Wausau 54401
♦Harold J Kief, MD, Rt #1, Box 1502, Rhinelander, 54501
♦WILLIAM J Mauer, MD, 1311 Lincoln Ave, Marshfield, 54449
District 7
Health Systems Agency of Western Lake Superior, Inc
GEORGE W Knabe, MD, 901 N Ninth St, Virginia, MN 55792
♦Harold B leppink, MD, 504 East Second St, Duluth, MN
55805 ■
148
WISCONSIN medical JOURNAL, JUNE 1985:VOL. 84
WISCONSIN PEER REVIEW ORGANIZATION (WiPRO)
WiPRO Board of Directors
David C Barnhart, PO Box 66, Manitowoc 54220
Irwin J Bruhn, MD, Rt 1, Box 64-A, Walworth 53184
Daniel F Cichon, DO, 2363 S 13th St, Milwaukee 53215
Thomas G Dehn, MD, 2000 W Kilbourne Ave, Milwaukee 53233
Conan Edwards, PhD, 224 Highland Ave, Madison 53705
George L Gay, MD, PO Box 28, Cambridge 53523
James E Glasser, MD, 1836 South Ave, La Crosse 54601
Herbert M Kauffman Jr, MD, 9200 W Wisconsin Ave,
Milwaukee 53226
John J Kief, MD, 1020 Kabel Ave, Rhinelander 54501
Maurice Kiley, 804 McBride Rd, Madison 53704
Craig Larson, MD, 509 W Wisconsin Ave, ^509, Milwaukee
53202
H B Maroney, PO Box 1109, Madison 53701
Toya M McCosh, PO Box 7946, Madison 53707
Donald H McDonald, MD, 19 S Third St, Winneconne 54986
Jonathan V Moulton, MD, 101 1 N Eighth St, Sheboygan 53081
Jane L Neumann, MD, 725 American Ave, Waukesha 53186
Lyle L Olson, MD, 517 Park PI, Darlington 53530
Marshall F Purdy, MD, 23 W Milwaukee St, Janesville 53545
Donald Smith, PO Box 548, Tomah 54660
David M Woeste, MD, 409 Spruce St, River Falls 54022
Officers
Thomas G Dehn, MD, Milwaukee, President
John J Kief, MD, Rhinelander, Vice-President
Maurice Kiley, Madison, Secretary-Treasurer
Donald J McIntyre, Chief Executive Officer, 330 E Lakeside,
Madison 53705
Greg E Simmons, Chief Operating Officer, 756 N Milwaukee St,
Milwaukee 53202
Southwest Regional Manager, Robert K Rogers, 330 East
Lakeside, Madison 53705
Southeast Regional Manager, Mike Rode, 756 N Milwaukee
St, Milwaukee 53202
North Central Regional Manager, Jon Griffith, 2404 Stewart
Square, Suite C, Wausau 54401
Northeast Regional Manager, Richard Priest, 2301 Riverside
Dr, Green Bay 54301
Northwest Regional Manager, Scott Layman, 405 S Farwell
St, Suite 16, Eau Claire 54701
WiPRO Regions
Southwest Regional Review Committee
John A Austin, MD, 5480 North Washington, Janesville, WI
53545 (608/755-3500)
Neil N Bard, MD, 1313 Seminary St, Richland Center, WI
53581 (608/647-6161)
James W Bayuk, MD, 1836 South Ave, La Crosse, WI 54601
(608/782-7300)
Richard A Damon, MD, 130 Warren St, Beaver Dam, WI 53916
(414/885-4433)
David D Gregory, MD, 910 Silver Lake Dr, Portage, WI 53901
(608/742-7161)
Roy S Horras, MD, 202 North Gammon Rd, Madison, WI
53717 (608/251-2371)
David P Kuter, MD, 703 14th St, Baraboo, WI 53913
(608/356-6656)
Robert A Starr, MD, 318 W Decker St, Viroqua, WI 54664
(608/637-3175)
Philip H Utz, MD, 700 West Ave, South, La Crosse, WI 54601
(608/785-0940)
Southeast Regional Review Committee
Gerald J Dorff, MD, 12011 West North Ave, Wauwatosa, WI
53226 (414/771-8228)
Joseph E Geenen, MD, 1333 College Ave, Racine, WI 53403
(414/637-7996)
Michael F Gorczynski, DO, 9330 West Greenfield, Milwaukee,
WI 53214 (414/771-2177)
Lee Huberty, MD, 6530 Sheridan, Kenosha, WI 53140
(414/658-1349)
Michael J Mally, MD, 1004 East Sumner, Hartford, WI 53027
(414/673-5745)
Jane L Neumann, MD, 725 American Ave, Waukesha, WI
53186 (414/544-2011)
Archebald R Pequet, MD, 10425 West North Ave, Wauwatosa,
WI 53226 (414/453-3420)
David Y Rosenzweig, MD, 8700 West Wisconsin Ave,
Milwaukee, WI 53226 (414/257-6355)
Richard Stone, MD, 227 East Silver Spring Dr, Milwaukee, WI
53217 (414/961-2020)
Northwest Regional Review Committee
F D Cook, MD, 2661 County Trunk “I”, Chippewa Falls, WI
54729 (715/723-1811)
Michael F Finkel, MD, 733 West Clairemonl Ave, Eau Claire,
WI 54701 (715/839-5203)
A A Koeller, MD, 206 6th Ave, West, Ashland, WI 54806
(715/682-6622)
Randall Linton, MD, 733 West Clairemont Ave,
Eau Claire, WI 54701 (715/839-5201)
Carrie Nelson, MD, Elmwood, WI 54740 (715/639-4151)
Leo K Nelson, MD, 208 Adams St, South, St Croix Falls, WI
54024 (715/483-3221)
James A Rugowski, MD, 733 West Clairemont Ave, Eau Claire,
WI 54701
C Malcom Scott, MD, 318 21st Ave, Superior, WI 54880
(715/389-3561)
David M Woeste, MD, 409 Spruce St, River Falls, WI 54022
(715/425-6701)
Northeast Regional Review Committee
Blaine W Claypool, MD, 424 East Longview Dr, Appleton, WI
54911 (414/739-4241)
Hugh F DeMorest, MD, 502 Surrey Lane, Neenah, WI 54956
(414/725-1269)
Robert E Johnson, MD, 1551 Dousman, Green Bay, WI 54303
(414/494-5611)
Donald H McDonald, MD, 19 South 3rd St, Winneconne, WI
54986 (414/582-4481)
Robert H Mikkelsen, MD, 10 Forest Ave, Fond du Lac, WI
54935 (414/921-7000)
continued next page
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
149
H'iPRO continued
Jonathan V Moulton, MD, 101 1 North 8th St, Sheboygan, WI
53081 (414/457-4461)
David A Satchell, MD, 600 York St, Manitowoc, Wl 54200
(414/682-0181)
Thomas W Schueppert, MD, 345 South 18th Ave, Sturgeon
Bay, Wl 54235
Joseph W Weber, MD, 525 High St, New London, Wl 54961
(414/982-3421)
North Central Regional Review Committee
Daniel Brick, MD, 2501 Main St, Stevens Point, Wl 54481
Norman Desbiens, MD, 1000 North Oak Ave, Marshfield, WI
54449 (715/387-5177)
Alonzo Giminez, MD, 270 E Marquette St, Berlin, Wl 54923
(414/361-1838)
Bahri Gungor, MD, 216 Sunset Place, Neillsville, WI 54456
Peter Hamel, MD, Rte 4, Box 191, Waupaca, WI 54981
Charles A Heuss, MD, 1111 Langlade Rd, Antigo, WI 54409
(715/623-3761)
Kim Hilliker, MD, Hemlock St, Box 470, Woodruff, WI 54568
(715/356-8000)
Rick Reding, MD, 2800 Westhill Dr, Wausau, WI 54401
(715/848-2811)
James Robinson, DO, 101 North Gibson St, Medford, Wl 54451
(715/748-3377) ■
HEALTH PROFESSIOHALS!
The Army Medical Department
represents the largest comprehensive
system of health care in the United
States and offers unique advantages
to the student, resident, and practi-
tioner in the following professions:
• Neurosurgery
• General Surgery
• Orthopedic Surgery
•Obstetrics & Gynecology
• Otolaryngology
• Anesthesiology
• Psychiatry
• Child Psychiatry
• Family Practice
• Emergency Medicine
• General Medicine
• Pediatrics
As an Army Officer, you will receive
substantial compensation, an annual
paid vacation, and participate in a
remarkable non-contributory retire
ment plan.
For more information just fill out
the attached form and mail. Or
call: (312) 926-2040/2147. (Collect
calls accepted.)
PLEASE SEND MORE INFORMATION ABOUT OPPORTUNITIES
IN THE ARMY MEDICAL DEPARTMENT
MAIL OR CALL:
ARMY MEDICAL DEPARTMENT, BLDG 142, ROOM 345
FT SHERIDAN, IL 60037 (312) 926-2040/2147
NAME AGE
ADDRESS
ZIP PHONE (AC)
SCHOOL ATTENDED/ATTENDING
GRADUATION DATE DEGREE
SPECIALTY AREA OF INTEREST
Medical School Scholarships are Available
ORGANIZATIONAL
Membership facts
Whether you’re just starting medical school, maintaining a
full-time practice, or retiring, SMS has a membership classi-
fication to fit your individual needs. Election to membership
by the County Medical Society in which your principal place
of practice is located carries with it membership in the State
Medical Society of Wisconsin and, if you wish, the American
Medical Association. If you qualify for resident membership
at the time of your election, your membership dues are
greatly reduced. This may also qualify you for reduced dues
the first two years of your practice. In addition, two-physician
families may be eligible for a $50 discount on total SMS
membership dues. Dues for regular membership in 1985 are
$455 for SMS, $330 for AMA, and county society dues vary.
A more detailed listing of SMS membership classifications and
their corresponding dues follows:
State Medical Society of Wisconsin
DESCRIPTION OF MEMBERSHIP
CLASSIFICATIONS
Regular Member in active practice. Some are regular mem-
bers that have reduced SMS and/or AMA dues because they
are new practitioners (first year or two out of residency).
Resident; Physician who at January 1 of dues year is in an
approved training program as a hospital resident or research
fellow who is licensed to practice medicine and surgery in
Wisconsin.
Military Service; Members who are serving in the U S. armed
forces (generally not to exceed five years).
Associate: Member whose dues are waived because of fi-
nancial hardship due to illness or disability. This classifica-
tion is temporary and is reviewed on an annual basis.
Life: Member who has held membership in a state medical
society for 50 years or is a Past President of the State Med-
ical Society of Wisconsin.
Honorary: Member who was named by the Board of Direc-
tors in recognition of long and distinguished senrice to Itie
cause of medicine.
Your membership in organized medicine will help insure
the continued “safety” of your practice and quality care
for all patients. Your voice will be heard through par-
ticipation. Membership in the State Medical Society of Wiscon-
sin also requires membership in the county medical society
(AMA membership is optionai but encouraged). For Regular,
Part-time Practice, or Over Age 70 membership classifi-
cations, dues may be paid in one lump sum or in two
equal installments: one-half of the total payable by Jan-
uary 1, the other half not later than May 15, 1985 which is
the removal date for those members who have not com-
pleted payment. You are urged to renew your membership.
Reti'^ed: Member who has completely retired from practice
(works less than 240 hours per year). All dues are waived
unless county society indicates they wish to charge county
dues.
Parl-time Practice; Physician, regardless of age, who prac-
tices 1,000 hours or less during the calendar year but does
not qualify for retired membership.
Over Age 70: Member in active practice who is over 70 years
of age as of January 1.
Candidate: Member attending a medical school in Wiscon-
sin or fulfilling a postgraduate obligation prior to eligibility
for licensure.
Scientific Fellow: The Board of Directors may by invitation
and unanimous consent confer upon any person engaged in
teaching of or research in one or more of the basic sciences
at an accredited college or university, and not holding the
degree of Doctor of Medicine or Osteopathy, the status of
Scientific Fellow.
Emeritus: Retired members who have chosen not to renew
their license.
1985 DUES AMOUNTS FOR THESE
CLASSIFICATIONS
SMS
AMA
COUNTY
Regular
$455
$330
Normal County Dues
Resident
45.50
45
Varies
Military Service
-0-
220 or 45
-0-
Associate
-0-
-0-
-0-
Life
-0-
-0-"
-0-
Honorary
-0-
-0-"
-0-
Retired
-0-
-0-"
-0-
Part-time Practice
227.50
330"
Normal County Dues
Over Age 70
227.50
-0-"
Normal County Dues
Scientific Fellow
-0-
.-0-
Emeritus
-0-
-0-"
Candidate —
Freshman Year
Medical Student
-0-
20
Varies
Sophomore and
Succeeding Medical
Student Years
10
20
Varies
Postgraduate — One
10
45
Varies
"Physicians in the following categories may be eligible for exemption from
paying AMA dues: (1) Financial hardship and/or disability, (2) Age 65-69 and
retired from the practice of medicine, (3) Over age 70 regardless of retirement
status.
State Society dues are prorated on a monthly basis for
those elected to membership July 1 through September 30.
Those elected after September 30 have no dues payable for
the balance of the year in which they are elected. AMA dues
follow the same pattern except prorating is on a semiannual
basis rather than monthly basis.
To begin the membership process, if your practice is or will
be located in Wisconsin, or you have any questions, you may
contact your local county society or call the Membership
and Communications Division of the State Medical Society,
if in Wisconsin: 1-800-362-9080 (Madison area number:
257- 6781 ).■
WISCONSIN MEDICAL JOURNAL, JUNE l985:VOL. 84
15
ORGANIZATIONAL
Doctor Scott installed SMS president
John K Scott, MD, Madison,
was installed as the 1985-86 presi-
dent of the State Medical So-
ciety during its Annual Meeting
in La Crosse, April 25-27. He suc-
ceeds Timothy T Flaherty, MD of
Neenah.
Doctor Treffert and Doctor Scott
Top priorities;
Malpractice reform,
membership
Outgoing President Timothy T
Flaherty, MD, in his address to
the House of Delegates during the
Annual Meeting, reminded his
colleagues that the top two pri-
orities for organized medicine are
malpractice reform and mem-
bership. "Our strength lies in our
unity and every physician must
recognize the need to be unified,"
he said. "We, as individual phy-
sicians and as an organization of
physicians, must continue to do
what is best for the patients of
Wisconsin; and 1 am confident
this will always prove best for the
physicians of Wisconsin."
The full text of his address ap-
pears elsewhere in this issue.*
Doctor Scott, an otolaryngolo-
gist-head and neck surgeon, is a
clinical professor of surgery at the
University of Wisconsin Medical
School and is a preceptor for the
fourth-year residency program at
Madison General Hospital. A
complete biographical sketch ap-
peared in the May issue.
In his address to the House of
Delegates, April 25, Doctor Scott
said physicians must be advo-
cates for patients. "Despite the
innumerable government regu-
lations and competitive schemes
we have today, the truest guard-
ian of good patient care remains
the physician with a good con-
science," he said. Full text of his
address appears elsewhere in this
issue.*
Election results
The House of Delegates April
26 reelected Duane W Taebel,
MD, La Crosse, speaker of the
House and John J Foley, MD,
Menomonee Falls, as treasurer
of SMS.
Reelected to serve as dele-
gates to the American Medical
Association for 1986 and 1987
were Henry F Twelmeyer, MD,
Wauwatosa; Richard W Ed-
wards, MD, Richland Center,
and Cornelius A Natoli, MD,
La Crosse. Timothy T Flaherty,
MD, Neenah, was elected a dele-
gate for 1985.
The House also confirmed the
election of 11 physicians to the
Society's Board of Directors.
Reelected to the Board were:
Jerome W Fons Jr, MD, Mil-
waukee; Cyril M Hetsko, MD,
Madison; J D Kabler, MD, Madi-
son; James J Tydrich, MD, Rich-
land Center; Jung K Park, MD,
Wisconsin Rapids, and Darold
A Treffert, MD, Fond du Lac.
Elected to the Board were Glenn
H Franke, MD, Milwaukee, Lu-
cille B Glicklich, MD, Mil-
waukee; Kenneth 1 Gold, MD,
Beloit; Joseph C DiRaimondo,
MD, Manitowoc, and Philip J
Happe, MD, Eau Claire.*
NEW DIRECTORS
District 1
Glenn H Franke, MD, Milwaukee
Born on June 9, 1928 in Mil-
waukee, Doctor Franke gradu-
ated from Northwestern Univer-
sity School of Medicine in 1953
and completed his internship and
residency at Columbia Hospital
in Milwaukee. He served in the
United States Navy from 1954-
1956. Doctor Franke served as
president of The Medical So-
ciety of Milwaukee County in
1982. He is a member of the SMS
Committee on Medicine and
Religion and the Committee on
Alcoholism and Other Drug
Abuse. Doctor Franke was
elected to the Board of Directors
in April 1985, for a three-year
term.
District 1
Lucille B Glicklich, MD
Milwaukee
Born on January 10, 1926 in
Fond du Lac, Doctor Glicklich
graduated from the University
of Wisconsin Medical School,
Madison, in 1950. Her internship
was served at Youngstown Hos-
pital Association, Ohio, and her
pediatric residency was com-
pleted at Milwaukee Children's
Hospital. Her psychiatric resi-
dency was completed at the VA
Hospital, Wood, and at Mil-
waukee Children's Hospital.
Doctor Glicklich is a member
of the SMS Commission on Pub-
lic Information. She is serving
52
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
NEW DIRECTORS
ORGANIZATIONAL
as president of The Medical So-
ciety of Milwaukee County for
the year 1985. Doctor Glicklich
was elected to the Board of Di-
rectors in April 1985 to fill the
unexpired term (1984-1987) of
Charles W Landis, MD.
District 2
Kenneth I Gold, MD, Beloit
Born in New York, New York,
on April 16, 1937, Doctor Gold
graduated from the State Uni-
versity of New York-Downstate
Center, Brooklyn, in 1961. His in-
ternship and residency were
completed at University Hos-
pitals, Columbus, Ohio. Doctor
Gold served in the United States
Navy from 1963-1965. He is a
member of the SMS Commission
on Continuing Medical Educa-
tion. Doctor Gold served as presi-
dent of the Wisconsin Society of
Charles W Landis, MD, Mil-
waukee, was elected president-
elect of the State Medical Society
during its Annual Meeting in La
Crosse, April 25-27.
A graduate of Indiana Univer-
sity School of Medicine, Doctor
Landis served his internship at
the University of Oregon and his
psychiatric residency at Indiana
University. In 1958 he became
certified by the American Board
of Psychiatry and Neurology.
Currently medical director and
chief-of-staff at St. Mary's Hill
Hospital in Milwaukee, he also
maintains a private psychiatric
practice.
The new president has been
active at all levels of organized
medicine. A past president of the
Medical Society of Milwaukee
County, Doctor Landis has been
a member of its Board of Direc-
tors since 1980.
Internal Medicine in 1980. He
was licensed to practice medicine
in Wisconsin in 1968. Doctor Gold
was elected to the Board of Direc-
tors in April 1985 for a three-year
term.
for a three-year term.
District 6
Joseph C DiRaimondo, MD
Manitowoc
Born July 14, 1939 in Rockford,
IL, Doctor DiRaimondo gradu-
ated from Washington Univer-
sity School of Medicine, St Louis,
MO, in 1965. His internship
and residency were completed at
University Hospitals (now UW
Hospital and Clinics), Madison.
Doctor DiRaimondo was licensed
to practice medicine in Wiscon-
sin in 1966. He has served on the
SMS Physicians Alliance Com-
mission since 1978. Doctor
At the state level, he has been a
member of the SMS Board of Di-
rectors since 1984 and has been a
member of the Society's House
of Delegates. His committee in-
volvements include serving as a
member or chairman of the
Society's Committee on Mental
Health since 1978, and serving as
a member of the Committee on
Alcoholism and Other Drug
Abuse.
Doctor Landis is a member and
past president of the Wisconsin
Psychiatric Association as well as
a member of the American Psy-
chiatric Association, Milwaukee
Neuropsychiatric Society, and the
American College of Psychiatry.
Doctor Landis has served on
boards or as a member of a num-
ber of civic, governmental, and
professional organizations. Pres-
ently, he is on the Board of Di-
rectors of the United Way of
DiRaimondo was elected to the
Board of Directors in April 1985
for a three-year term.
District 7
PhilipJ Happe, MD, Eau Claire
Born on May 13, 1938 in Min-
neapolis, MN, Doctor Happe
graduated from Creighton Uni-
versity Medical School, Omaha,
NB, in 1964. His internship was
served at Ancker Hospital (St
Paul Ramsey) St Paul, MN, and
his residency was completed at
Creighton University Affiliated
Hospitals in Nebraska. Doctor
Happe served in the United
States Air Force from 1965-1967
and was licensed to practice
medicine in Wisconsin in 1970.
Doctor Happe was elected to
the Board of Directors in April
1985 to fill an additional position
for District 7.m
is president-elect
Doctor Landis
Greater Milwaukee and is a
member of the Milwaukee Ro-
tary Club. In 1983 he received the
Milwaukee County Executive
Proclamation honoring him for
community service.*
Doctor Charles Landis, Milwaukee,
WISCONSIN MKDICALJOl RNAL, JUNK 1985: VOL. 84
53
ORGANIZATIONAL
Board of Directors April meeting highlights
In action April 24 and 27 dur-
ing the Annual Meeting in La
Crosse, the SMS Board of Di-
rectors:
• Voted to consolidate the
membership and activities of the
Commission on Governmental
Affairs and the Physicians Al-
liance Commission. This "new"
commission is charged with the
responsibility for the formulation
of Society policy, subject to Board
and House of Delegates review.
New Editorial Board
member
Andrew B Crummy Jr, MD,
Madison, was appointed to the
Editorial Board of the Wisconsin
Medical Journal by the SMS Board
of Directors at its meeting during
the Annual
Meeting, April
25-27, in La
Crosse. He suc-
ceeds Wayne J
Boulanger, MD,
Milwaukee, who
completed his
third 3-year term
thus was ineligi-
ble for reappointment.
Doctor Crummy is a 1955 grad-
uate from Boston University
Medical School and completed
his residency in radiology at Uni-
versity Hospitals (now UW Hos-
pital and Clinics), Madison. He
was licensed to practice medicine
in Wisconsin in 1958. He joined
the medical faculty of the Uni-
versity of Wisconsin Medical
School in 1963 and is a full pro-
fessor. He served as president of
the Wisconsin Radiological So-
ciety in 1972-1973.
The Board of Directors also
reappointed George W Kindschi,
MD of Monroe to the Editorial
Board. ■
in the broad areas of legislation,
political action, and socio-
economic issues. Current mem-
bers of the two commissions are
being contacted as to whether
they wish to serve on the new
commission.
• Received an update on SMS
membership and directed the
membership committee to look at
incentives for early payment of
dues.
• Made a number of appoint-
ments to SMS commissions and
committees. These appointments
appear elsewhere in this issue.
• Reelected Darold A Treffert,
MD, Fond du Lac, chairman of
the Board for 1985-86; Roger L
von Heimburg, MD, Green Bay,
vice chairman; Eugene J Nordby,
MD, Madison, and William T
Russell, MD, Sun Prairie, assist-
ant treasurers. William P Crow-
ley, MD, Madison, was ap-
pointed an assistant treasurer and
Earl R Thayer, Madison, was re-
elected secretary and general
manager.
• Reelected Wayne J Bou-
langer, MD, Milwaukee, editorial
director and Victor S Falk Jr,
MD, Edgerton, medical editor of
the Wisconsin Medical Journal.
Russell F Lewis, MD, Marsh-
field, and Raymond A McCor-
mick, MD, Green Bay, were re-
elected and R Buckland Thomas,
MD, Monroe, was elected as edi-
torial associates of WMJ. Andrew
B Crummy Jr, MD, Madison, was
elected to the Editorial Board.
Warning that the State Medical
Society must not "pull into its
professional shell" because it
doesn't have the ultimate authori-
ty for disciplining state phy-
sicians, SMS Secretary and Gen-
Doctor Treffert
A long, hard day. . .
George W Kindschi, MD, Mon-
roe, was reelected to the Editorial
Board.
• Set the following Board meet-
ing dates for 1985 and 1986:
June 29, 1985; August 24, 1985;
October 25, 1985 (Leadership
Conference October 26); Decem-
ber 14, 1985; March 1, 1986 and
April 16, 1986 in Milwaukee
during the 1986 SMS Annual
Meeting.
• Reappointed John J Kief,
MD, Rhinelander, as the at-large
member on the Executive Com-
mittee.
• Changed the SMS policy
concerning candidate member-
ship benefits to include monthly
copies of the Wisconsin Medical
Journal. ■
eral Manager Earl R Thayer
April 25 called upon the Society
to immediately engage in a vigor-
ous, organized, and public effort
to deal with the incompetent or
aberrant physician. continued
Doctor Crummy
SMS Secretary issues call for
tougher peer review
154
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
SMS SECRETARY
ORGANIZATIONAL
In his report to the Society's
House of Delegates, Thayer
urged the House to appoint a
special task force of SMS mem-
bers to work on a series of re-
forms to reduce malpractice.
Among the reforms suggested
by Secretary Thayer to improve
the Medical Examining Board's
and the Society's efforts in disci-
plining doctors were:
• Encouraging the Governor in
his appointments to the Board to
look for "quality of person and
practice character, not quantity of
political contribution" as the pri-
mary criterion.
• Expanding the Board by two
or three physicians and author-
izing it to delegate certain phy-
sician-care review functions to
contracted physicians in various
parts of the state.
• Providing civil immunity
without restriction to any phy-
sician who acts in good faith in
reporting alleged inappropriate
medical care or practice.
• Establishing, together with
the Patient's Compensation Fund
and all malpractice insurance car-
riers, a coordinated malpractice-
incident reduction program.
• Urging the Society's endorsed
medical liability company, as
well as others, to "seriously con-
sider mandatory participation in
risk-management programs" as
a condition for an individual
physician to get malpractice in-
surance.
• Establishing a system for data
collection and analysis of all
medical liability claims including
claims settled at any stage.
• Improving credentialing and
peer review processes of hospital
medical staffs.
• Integrating into the entire
peer review process the findings
of WiPRO and similar peer re-
view efforts undertaken on a pri-
vate basis.
• Initiating immediate discus-
sions with the Medical Exam-
ining Board, the Wisconsin Jus-
tice Department, independent
attorneys, and legislators to seek
a remedy to a legal process which
"seems so easily manipulated to
save the bad doctor."
"We cannot afford to wait for
someone else to start the action,"
Secretary Thayer said. "The
integrity of our dedicated phy-
sicians is at stake. The public says
this is your job, your responsi-
bility. They may not be totally
correct, but they are not totally
wrong either."
The full text of his address ap-
pears elsewhere in this issue.*
Some controls
needed
Addressing the SMS House of
Delegates during its Annual
Meeting April 25-27 in La Crosse,
newly-appointed AMA Senior
Deputy Executive Vice President
James S Todd, MD told Wiscon-
sin physicians that they are not
alone in facing a malpractice
crisis. He said some controls on
doctors are needed to help solve
the malpractice problem. "Satis-
The SMS House of Delegates
had a full agenda April 25 and 26
when it met in La Crosse for its
Annual Meeting. Among the
issues the House grappled with
were:
Task Force on Medical Care-
Referred the entire report to the
Board of Directors for review, im-
plementation, and report or
return to the House of Delegates
for action as necessary.
Peer Review— Called for the
appointment of a task force to
coordinate the Society's work in
discipline and peer review with
the current efforts of the state
Legislature and the Medical
Examining Board.
Medical Liability— Will ask the
AMA to undertake an inter-
James S Todd, MD
fied patients don't sue," he stres-
sed. Doctor Todd highlighted the
AMA's four-point program for
dealing with the issue which in-
cludes: 1) more internal monitor
ing and discipline, 2) coordi-
nation of legal defense activities,
3) reform of laws, and 4) public
education on the dangers of the
liability system.*
national study on solutions to the
medical liability problem.
CON /CER— Will continue to
seek repeal of the certificate-of-
need/capital expenditure review
law.
Cost Containment— Requested
that insurance companies pass
the results of cost containment
on to the citizens of Wisconsin in
the form of lower premiums.
Boxing— Will seek legislation
supporting the abolition of ama-
teur and professional boxing
in the state of Wisconsin and that
the State Medical Society edu-
cate the public concerning the
dangerous aspects of boxing.
continued
House of Delegates Highlights . . .
WISCONSIN MEDICAL JOURNAL. JUNE 1985: VOL. 84
55
ORGANIZATIONAL
HOUSE OF DELEGATES HIGHLIGHTS
Smokeless Tobacco — Sup-
ported placement of an "injur-
ious to health" message on the
packages of smokeless tobacco
products.
Happy Hours— Will seek legis-
lation to prohibit drinking es-
tablishments from offering in-
ducements (such as "happy
hours" and "two for one") to
excessive alcoholic beverage
consumption.
CME— Reaffirmed its position
in support of mandatory con-
tinuing medical education (CME)
for physicians.
Discipline— Supported ade-
quate funding for the Medical Ex-
amining Board and offer the
Board the assistance of the State
Medical Society for consultation
purposes in competence cases.
Home Health Care— Will seek
the establishment of minimum
criteria for home health care
agencies in Wisconsin.
Nursing Homes— Requested
state and federal governments to
reevaluate rules and enforce-
ment mechanisms for nursing
homes to allow the more efficient
delivery of medical care.
Health Care Bank— Directed
SMS to study the Health Care
Bank/IRA concept (a method of
providing health care coverage by
private savings) and submit a
report on its advantages and dis-
advantages at next year's House
of Delegates.
Nuclear Armaments — Pro-
posed that the United States and
Union of Soviet Socialist Re-
publics reduce nuclear arma-
ments; increase communication
between their governments in
respect to nuclear armaments,
and formulate a more compre-
hensive, verifiable nuclear test
ban treaty and an effective world-
wide policy of nonproliferation
of nuclear armaments.
Expert Witnesses— Referred
to the SMS Medical Liability
Committee a resolution calling
for SMS to maintain the require-
ment for expert witnesses at
panel hearings and that a joint
SMS-Wisconsin Bar Assn com-
mittee establish criteria to qualify
physicians as experts in order to
testify in a particular field.
Countersuits— Directed the
Society to consider introducing
legislation which would remove
the special injury element now
required by Wisconsin law for a
malicious prosecution counter-
suit and encourage physicians
to make use of the current frivo-
lous lawsuit statute.
Emergency Room Reimburse-
ment-Referred to the SMS
Board of Directors a resolution
putting SMS on record as op-
posing any attempt to modify
Wisconsin statute 146.301 which
provides that no hospital may
refuse emergency treatment to
any sick or injured person. The
resolution also directs staff to
negotiate the adoption of the
definition of "bona fide medical
emergency" with DHSS and that
the SMS Board assist in resolv-
ing the current conflict between
emergency care providers and
DHSS and HMOs as it regards
payment for services rendered.
Second Opinions— Requested
that the mandatory surgical
second opinion data already col-
lected by the Department of
Health and Social Services be
analyzed and made public to
determine if true savings have
resulted.
Decentralization of Health
Care— Directed the SMS Board
to consider a study on the cost
of decentralization of health care
in Wisconsin and report back to
the House of Delegates.
HMOs— Supported, in princi-
ple, a resolution requesting that
SMS promote physician input
into HMO systems and consider
the establishment of a unit within
the Society for physicians to con-
tact for advice and counsel re-
garding these new systems.
Monitoring of WiPRO-Re-
jected a resolution proposing a
monitoring mechanism of
WiPRO activities, but encour-
aged WiPRO to communicate
more effectively with physicians.
WiPRO hearings— Rejected a
resolution calling upon SMS to
"exert its influence" to cause a
return of the WiPRO reconsider-
ation hearings to their previous
on-site format.
1985 SMS Budget— Adopted
the 1985 SMS Budget.
1986 Dues— Recommended
that there be no change in SMS
member dues for 1986.
Unified membership — Re-
jected a resolution calling for a
return of unified membership
in Wisconsin.
Section on Therapeutic
Radiology— Created a specialty
Section on Therapeutic Radiolo-
gy. A delegate and alternate dele-
gate to the House of Delegates
will be elected by the SMS mem-
bers of that group acting as a sec-
tion of SMS.
Section on Gastroenterology —
Rejected a resolution calling for
the establishment of a specialty
Section on Gastroenterology.
Safe transport of hazardous
materials— Rejected a resolution
directing SMS to seek legislation
which would designate state de-
partmental responsibility to
assure hospital preparedness to
safely treat radiologically con-
taminated patients in the event of
a minor spent fuel accident. The
resolution also asked that the
Governor direct state officials to
identify hospitals located along
shipment routes and that the state
train personnel in the use of the
Radiation Accident Protocol,
provide funds for equipping these
hospitals, and periodically con-
duct emergency drills to assure
continued preparedness.
Cost containment at AMA
functions— Encouraged the AMA
to continue to emphasize cost
containment at all AMA func-
tions.
A complete summary of all
House actions appears elsewhere
in this issue.*
1S6
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
ORGANIZATIONAI.
Medical Museum season began May 1
When planning your summer
vacation this year, don't forget to
add the Fort Crawford Medical
Museum in Prairie du Chien to
your itinerary.
The museum, which opened
for the 1985 season on May 1, is
located at the reconstructed mili-
tary hospital at Fort Crawford, a
national historic landmark set in
the Mississippi River Valley.
Visitors to the museum com-
plex will see relics of nineteenth
century medicine in Wisconsin,
including displays depicting the
Indian Medicine Man, the mili-
tary fort physician, the family
doctor from "horse and buggy"
to present, great events in the
development of surgery, replicas
of physicians' offices of 1850 and
1900, and an old-time pharmacy.
This year will be a special one
for the museum as it will cele-
brate the 200th anniversary of the
birth of William Beaumont. Beau-
mont, a famous military surgeon,
was stationed at Fort Crawford
during the 1830s. The entire mu-
seum is a tribute to this surgeon,
who while at the Fort, performed
the now famous operations on
the "man with the hole in his
stomach," Alexis St Martin.
These experiments formed the
basis of our present day know-
ledge of the digestive system.
During the month of July, the
museum will feature a special
exhibit on Civil War photographs
and lithographs. The special
month on the Civil War will cul-
minate with the Annual Civil
War Encampment on July 27 and
28. On these days, the days of the
Civil War are recreated when
Civil War encampment groups
from throughout the Midwest
gather and set up historically ac-
curate Union and Confederate
camps on the museum grounds.
Also new this year is the Po-
mainville Reading Room in the
museum's administration build-
ing. This facility, which will be
open to the general public, is
named in honor of Leland Po-
mainville, MD, a Wisconsin Ra-
pids family physician who served
as treasurer of the State Medical
Society's Charitable, Educational
and Scientific Eoundation for
nearly 18 years until his resigna-
tion in March 1985.
Another portion of the museum
is dedicated to helping visitors
learn more about the workings
of the human body and how to
stay healthy. One of the more
popular exhibits there is the
transparent twins, lifesize female
models, one showing 25 organs
of the body and the other the 200
bone skeleton and the nervous
system. Their recorded messages
describe the function of each or-
gan and system which is illumi-
nated individually as it is dis-
cussed.
The museum also has several
"hands-on" exhibits, where visi-
tors can learn how to control their
future health. Physical fitness,
the dangers of drunk driving,
weight reduction, the birth of a
baby, nutrition, alcohol and
drugs, and immunization are all
featured here.
For the art enthusiast, the mu-
seum's administration building
has on display seven medical still-
life paintings by internationally
reknown artist Aaron Bohrod.
Done in Bohrod's famous
"trompe 1' oeil" (fool the eye)
style, the paintings depict various
disciplines of medicine such as
pediatrics, cardiology, infectious
diseases, and neurology-psy-
chology.
The Fort Crawford Medical
Museum will be open this year
from May 1 through October 31
from 10 am to 5 pm daily. Admis-
sion is $2.00 for adults, and 50
cents for children under 12.
Tour guides are avialable for
groups with advance reser-
vations. To make a reservation,
call or write: Medical Museum,
717 Beaumont Road, Prairie du
Chien, WI 53821. Phone: (608)
326- 6960. ■
FORT CRAWFORD MEDICAL MUSEUM
PRAIRIE DU CHIEN, WISCONSIN
Open daily May 1 through October 31
10 a.m. to 5 p.m.
Adults $2 Children $.50
Three building complex owned by the Charitable. Educational and Scientific
Foundation of the State Medical Society of Wisconsin.
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
157
ORGANIZATIONAL
Summary report of SMS House of Delegates
April 25-26, 1985, La Crosse, Wisconsin
The House deliberated 29 resolutions as well as
reports of officers, the Board of Directors, commis-
sions and committees, and the Task Force on
Medical Care. Refer to the April 1985 Wisconsin
Medical Journal for abstracts of resolutions 1
through 27 and their sources. Following is the text
of the House of Delegates reference committee
reports and indication of House action upon com-
mittee recommendations.
Reference Committee on National Issues
• Report BB of the Committee on Federal Legisla-
tion covers its attention to federal legislation af-
fecting physicians and health care and is recom-
mended for adoption.
Action: Adopted
• Report J of the Committee on Environmental
and Occupational Health outlines its activities
including the development of two resolutions
(3 and 4) which will be dealt with separately;
adoption of Report] recommended.
Action: Adopted
• Report K of the Liaison Committee on Health
Care Costs discusses its efforts with business,
labor, and others in cost containment; adoption re-
commended.
Action: Adopted
• Report R of the Joint Practice Committee
indicates it is currently attempting to develop and
prioritize specific objectives for its future; accept-
ance recommended.
Action: Accepted
• Report S of the Physician/Nurse Liaison Com-
mittee summarizes its activities including study of
the future educational needs of nurses; adoption
recommended.
Action: Adopted
• Resolution 1 concerns the Federal Nursing
Home Code; amended resolve proposed by the
reference committee as follows:
Resolved, That the State Medical Society, Ameri-
can Medical Association, and other interested
groups, request the state and federal governments
to reevaluate rules and enforcement mechanisms
for nursing homes to allow the more efficient
delivery of medical care.
Action: Adopted as amended
• Resolution 2 relates to Health Care Banks/IRAs;
amended resolve recommended by reference com-
mittee as follows:
Resolved, That SMS study the Health Care
Banks/IRA concept and work with advisors from
the public and private sectors to determine logis-
tical problems associated with it, and submit a re-
port to the House of Delegates in 1986.
Action: Adopted as amended
• Resolution 3 concerns Reduction of Nuclear
Armaments and was introduced by the Commit-
tee on Environmental and Occupational Health;
adoption recommended.
Action: Adopted
• Resolution 4 on Safe Transport of Hazardous
Materials introduced by the same committee was
also recommended for adoption.
Action: Defeated after discussion by a vote of
79-33.
• Resolution 5 concerns Cost Containment at
AMA Functions; substitute resolve recommended
by reference committee as follows:
Resolved, That the House of Delegates of the
State Medical Society of Wisconsin encourage the
AMA to continue to emphasize cost containment
at all AMA functions.
Action: Substitute adopted
Reference Committee on Organization
and Finances
• Report F, Commission on Public Information:
We take note of the "Doctor Al” TV series, com-
pliment the Commission on the TV series and the
158
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
SUMMARY REPORT
ORGANIZATIONAL
Healthwatch on medical professional liability, en-
courage dissemination of this information in the
future, and recommend adoption of the report.
Action: Adopted
• Report Q, Committee on Women Phy-
sicians: We recommend this report be adopted
and compliment the members of the committee
on its vitality and their efforts to involve more
women physicians in organized medicine.
Action: Adopted
• Report T, Secretary Thayer: We recommend this
report be adopted and express our gratitude to Mr.
Thayer for his efforts on behalf of the Society.
Furthermore, we recommend the entire report
that Mr Thayer gave to the House yesterday
be adopted and wish to identify the physicians' re-
view matter as an immediate priority for the So-
ciety and that this speech be published in the
Wisconsin Medical Journal.
Action: Adopted
• Report U, Board of Directors: This was consi-
dered in four segments:
1. Ad Hoc Committee on Nomination and Elec-
tion Procedures: We concur with the recommen-
dation of the Ad Hoc Committee and the Board
that the nomination and election process not be
changed.
Action: Adopted
2. Proposed 1985 Budget: We note that this in-
cludes a $47,000 deficit but in light of what are
considered to be adequate reserves, recommend
the budget be adopted.
Action: Adopted
3. 1986 Dues: In light of the current financial
situation of many physicians, we concur with the
conclusion reached in this part of the report and
recommend there be no change in dues for 1986.
However, at the same time we acknowledge
future dues increases will be necessary, using the
criteria established in prior years, to maintain
adequate financial stability.
Action: Recommendation adopted
4. The balance of Report U was reviewed. We
commend the Board for its diligent efforts and
recommend adoption.
Action: Adopted
• SMS Services, Inc. Informational Report: SMSSI
appears to be a good solid investment for the
Society and members should take note of the
many services provided.
Action: Report received
• President Flaherty's Report: We commend Doc-
tor Flaherty for his leadership and his outstanding
approach with the Task Force on Medical Care
and for his advocacy as a spokesman for the
Society.
Action: Report adopted
• President-elect Scott's Report: We thank Doctor
Scott for his report and look forward to a very
active year.
Action: Report adopted.
• Treasurer Foley's Report: We thank Doctor
Foley and the Finance Committee of the Board for
their diligent attention to the Society's financial
matters.
Action: Report received [Financial statements
printed in this issue]
• Resolution 6 on Unified Membership: We heard
testimony with the majority of it being against uni-
fied membership. As a result, we recommend
that prior actions of the House of Delegates be
reaffirmed that AMA membership be optional but
recommended.
Action: Resolution not adopted
• Resolution 7 on Establishment of Section on
Therapeutic Radiology and Resolution 8 on Es-
tablishment of Section on Gastroenterology: The
reference committee recommended adoption of
both.
Action: There was a request for division of the
question which resulted in adoption of Resolu-
tion 7 and rejection of Resolution 8.
• As an additional consideration on this subject, it
became apparent that the Society should have
some specific criteria for establishing Specialty
Sections in the future, and the reference commit-
tee reported a suggested amendment to Chapter
XI, Section 1, of the Bylaws for informational
purposes and with the understanding that it must
be introduced in 1986 [and acted upon] in order to
be effective at that time.
Action: Accepted as information
• Furthermore, we recommend the Board of Di-
rectors study the issue of proportionate represen-
tation in the House of Delegates based on Society
WISCONSIN MEDICAL JOl'RNAI., JUNE l985:VOL. 84
159
ORGANIZATIONAL
SUMMARY REPORT
membership in each specialty section and report
back to the House in 1986.
Action: Adopted
Reference Committee on
Scientific Activities
• Resolutions 9, 10 and 11 condemning boxing
as a poorly regulated activity. The reference com-
mittee noted the inability to legislate safety for
boxing participants and recommended the follow-
ing substitute resolution be adopted:
Resolved, That the State Medical Society of
Wisconsin educate the public concerning the dan-
gerous aspects of boxing; and be it further
Resolved, That the Society through elected legis-
latures introduce legislation supporting the aboli-
tion of amateur and professional boxing in the
state of Wisconsin.
Action: Substitute adopted
• Resolution 12 is concerned with possible effects
of smokeless tobacco and, if proven to be harm-
ful, advocates support of an "injurious to health"
message; adoption recommended.
Action: By motion from the floor, the reference
committee report was amended to change the
word "possible" to "demonstrated" and to strike
the words “if proven to be harmful;" resolution
and amendment adopted.
• Resolution 13 is concerned with inducements to
alcohol consumption. Because of testimony pre-
sented in open hearing which stated that "happy
hours" encourage the abuse of alcohol in a short
period of time, the committee recommended
amendment of the resolution by inserting the
words in parentheses;
Resolved, That the State Medical Society of Wis-
consin encourage the Legislature to enact laws
which would prohibit drinking establishments
from offering inducements (such as "happy
hours" and "two for one") to excessive alcoholic
beverage consumption.
Action: Adopted as amended
• Resolution 14 advocates continued support of
mandatory continuing medical education; adop-
tion recommended which reaffirms the position
of the State Medical Society.
Action: Adopted
• Resolution 15 recommends support of adequate
funding for the Medical Examining Board and ad-
vocates an offer of SMS consultation in incompe-
tence cases and a request of specialty societies for
like cooperation; adoption recommended which
reaffirms positions of the Society.
Action: Adopted
• Resolution 16 seeks establishment of minimum
criteria for home health care agencies in Wiscon-
sin; adoption recommended.
Action: Adopted
• Report A of the Commission on Continuing
Medical Education reports that the State Medical
Society has been accredited through June 1990.
The Commission has also dealt with preparation
for the 1985 Annual Meeting; accreditation of hos-
pitals and medical specialties within the state;
development of a CME Source Book; approval of
a program on treatment of hypertension, and re-
commendation of Herbert F Sandmire, MD, for
the Erwin R Schmidt Interstate Postgraduate
Teaching Award.
Action: Accepted
• Report D of the Commission on Mediation and
Peer Review details its various activities in media-
tion, peer review, the Statewide Impaired Phy-
sician Program whose formal linkage with the
Wisconsin Medical Examining Board through the
Coordinating Council on Physical Impairment
may be unique in the Nation; and the Medicaid
Medical Audit Committee which is under contract
to the State Department of Health and Social
Services to perform evaluations and to assist in
determining the acceptability or experimental
status of new medical procedures. The reference
committee lauds the work of the Commission and
particularly commends the establishment of an on-
going liaison with government in which it acts as
expert consultant.
Action: Accepted
• Report G of the Wisconsin Medical Journal Edi-
torial Board sets forth objectives to: a) place more
emphasis on information on current issues, b)
increase coverage of specialty and county medical
society activities, c) develop a Q and A feature to
focus on day-to-day problems confronting phy-
sicians in their treatment of patients, and d)
increase coverage of the Board of Directors, com-
missions and committees. The report also informs
us of news media coverage of WMJ articles and a
new front cover design.
Action: Accepted
160
WISCONSIN MEDICAL JOURNAL, JUNE 1985:VOL. 84
SUMMARY REPORT
ORGANIZATIONAI
• Report H of the Committee on Aging and Ex-
tended Care Facilities outlines concerns about nur-
sing home reimbursement for intravenous therapy
(at present not reimbursable by Medicare or Medi-
caid), planned review of the total nursing home
reimbursement schedule, and medication errors in
nursing homes. The Committee also reports dis-
cussions with the Coalition of Wisconsin Aging
Groups on physicians' services for low income el-
derly, independent elderly living, implications of
regulations, and experiences with HMO/PPOs and
DRGs, and its current focus on various com-
munity options of health care for the elderly.
Action: Accepted with an amendment that the
Board of Directors expand the scope of this com-
mittee to include home health care; further that
the Board change the name to the Committee on
Aging, Extended Care Facilities and Home
Health Care and direct this committee to address
in its 1986 report statewide home health care
issues including quality and accessibility of home
health care in our state as well as planned review
of the total home care reimbursement schedule
including reimbursement for home intraveneous
therapy.
• Report I of the Committee on Alcoholism and
Other Drug Abuse discusses review and input on
State Department of Health and Social Ser-
vices administrative rules concerning inpatient re-
sidential treatment facilities and patient rights, and
DHSS proposals for legislative changes in man-
dated benefits. Among other activities, the Com-
mittee was concerned with cosponsorship with
DHSS of a Citizens Conference on Alcoholism and
Other Drug Abuse, investigation of a review
course for addictionology credentialing, physician
education, support for a National Cocaine Sym-
posium, and cooperation with Alcoholics Anony-
mous.
Action: Accepted
• Report L of the Committee on Maternal and
Child Health discusses activity in regard to the
DBS alert, consultation with the Physicians Al-
liance staff in analyzing causes of birth-related
malpractice claims. Standards Development Pro-
ject for perinatal care and, with the Maternal
Child Health Coalition, review of the Healthy
Birth Program and monitoring the MCH block
grant. The Subcommittee on Maternal Mortality,
in order to reduce maternal deaths through study
of changing patterns and dissemination of infor-
mation to health care providers, seeks increased
information through the Bureau of Vital Statistics
and has developed improved data survey sheets.
Action: Accepted
• Report M of the Committee on Medicine and
Religion reports continued distribution of the
booklet, "The Ethics of Less Care," and cospon-
sorship with the Catholic Physicians Guild of the
annual Medicine and Religion Breakfast with a
talk on "Native American View of Medicine
and Religion.”
Action: Accepted
• Report O of the Committee on Safe Transpor-
tation expresses continued concern for blood al-
cohol levels considered legal and/or safe for driv-
ing and recommends that a positive publicity cam-
paign be conducted reiterating the Society's po-
sitions. As Medical Advisory Board to the State
DOT, the Committee reaffirmed Society op-
position to use of telescopic spectacles for driving,
and reviewed the heart disease reporting form
used by physicians and medical standards for
school bus operation. The Committee continues to
seek clarification of confidentiality of BAG tests
through legislation, and commended Frederick
Bunkfeldt, MD, on 21 years of service to the
Committee.
Action: Accepted
• Report P of the Committee on School Health
details testimony at Department of Public Instruc-
tion and legislative hearings in support of compre-
hensive school health education, work with the
Wisconsin Coalition for School Health Education
in development of a resource directory and a
research document on health problems of Wis-
consin school children, and executed and planned
public service announcements on responsible al-
cohol use. The Committee also monitored progress
on development of a curriculum guide which in-
cludes time allocations for health education, re-
viewed medical forms used by the Wisconsin
Conservation Corps, reviewed boxing rules, and
introduced resolution 1 1 to the House of Delegates
urging elimination of boxing.
Action: Accepted
WI.SCON.SIN MEDICAL JOURNAL, JUNE 1985: VOL, 84
16
ORGANIZATIONAL
SUMMARY REPORT
Reference Committee on
Socioeconomic Activities
• Report B of the Commission on Governmental
Affairs outlines legislative issues considered by it
during the past year. The 1985 Special Annual
Meeting Edition of Capitol Week supplements this
report (indicating SMS positions on items in the
Budget Bill, changes in the "Living Will" law,
interest on insurance claims, FT practice without
referral, seat belts, hospital privileges for oral
and maxillofacial surgeons) and other anticipated
legislation. We recommend adoption of Report B
and the CAPITOL Week supplement and commend
Doctor J D Kabler for his nine years of dedicated
leadership.
Action: Adopted
• Report C of the Commission on Health Plan-
ning describes its major issues. Under the direc-
tion of the Commission, the Health Manpower
Task Force, created by the 1984 House of Dele-
gates, prepared a report with recommendations
on physician supply in Wisconsin. The reference
committee commends the Commission and its
Health Manpower Task Force for its monumental
study, and recommends adoption.
Action: Adopted
• Report E of the Physicians Alliance Com-
mission and Medical Liability Committee outlines
the major policy initiatives undertaken (medical
liability, alternative delivery systems, physician
contracting, reimbursement issues, Medicare as-
signment, WMAP, peer review, joint ventures).
The MLC report summarizes the 19-point plan de-
veloped for liability reform. The reference com-
mittee commends Doctor Kenneth M Viste, Jr,
for his able direction of the activities of the Phy-
sicians Alliance Commission, and recommends
adoption.
Action: Adopted
• Report N of the Committee on Mental Health
describes activities which were directed at the
resolution of problems associated with the de-
livery of mental health services. The reference
committee commends Doctor Pauline Jackson for
her diligent and devoted service and recommends
adoption.
Action: Adopted
• Resolution 17 recommends that the State Med-
ical Society continue its efforts to maintain the
requirements for expert witnesses at panel hear-
ings and that a joint SMS- State Bar committee
establish criteria to qualify physicians as experts
for purposes of testimony in a particular field.
The committee supports the resolution in prin-
ciple and recommends that it be referred to the
Medical Liability Committee for further study.
Action: Referred
• Resolutions 18 and 19, both dealing with special
injury element of countersuits, were considered
together. Your reference committee recommends
a substitute resolve as follows:
Resolved, That the Society consider introducing
legislation which would remove the special injury
element now required by Wisconsin law for a
malicious prosecution countersuit and encourage
physicians to make use of the current frivolous
lawsuit statute.
Action: Substitute adopted
• Resolution 20 deals with an international scope
study on professional liability. The reference
committee recommends an amended resolve as
follows:
Resolved, That the State Medical Society of Wis-
consin ask the AMA to undertake a study on how
the liability situation is handled on an interna-
tional scope to include, but not be limited to,
English speaking countries.
Action: Adopted as amended
• Resolution 21 dealing with the appeal and moni-
toring mechanism for patients and their phy-
sicians is recommended for adoption, recognizing
that the Board of Directors of the Society has
already directed that the Physicians Alliance Com-
mission undertake a program to serve as a focal
point for the reporting and monitoring of incidents
involving DRGs, HMOs, third parties, and govern-
mental regulations which adversely affect the
ability to provide proper care for patients.
Action: Adopted
• Resolution 22 deals with the emergency depart-
ment reimbursement for treatment of HMO/
AFDC patients. The reference committee re-
cognizes the problems addressed in this resolu-
tion, but because of the complexities involved
recommends that it be referred to the Board of
Directors for further study.
Action: Referred with third resolve amended to
read "That the SMS Board of Directors assist
in resolving the current conflict between emer-
gency care providers and the DHSS and HMOs
as it regards payment for services rendered."
62
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
SUMMARY REPORT
ORGANIZATIONAL
• Resolution 23 recommends that the certificate
of need/capital expenditure review law be re-
pealed. The reference committee recommends ap-
proval, recognizing that the SMS Task Force on
Medical Care is also recommending repeal of the
CON/CER law.
Action: Adopted
• Resolution 24 recommends that the Society urge
the Secretary of the DHSS to fund a study on
mandatory surgical second opinion. Your refer-
ence committee recommends a substitute resolve
as follows;
House of Delegates 1985-86
Nominating Committee
(Elected by House April 25, 1985)
District
1
Jerome W Eons, Jr, MD Cudahy
1
Robert F Purtell, Jr, MD Milwaukee
1
John D Riesch, MD Menomonee Falls
1
Raymond E Skupniewicz, MD Racine
2
Sandra Osborn, MD Madison
2
James J Tydrich, MD Richland Center
3
Stephen B Webster, MD La Crosse
4
John E Thompson, MD Nekoosa
5
Kenneth M Viste, Jr, MD Oshkosh
6
Robert T Schmidt, Jr, MD Green Bay
7
Merne W Asplund, MD Bloomer
8
Joseph M Jauquet, MD Ashland
Specialty
Sections
Philip J Dougherty, MD Menomonee Falls
Attendance: 1064
Total attendance of the two-day scientific program
April 26-27, 1985 at the La Crosse Center was 1064.
Registration of physician members was 728, 22
nonmember physician registrants, and 44 guest physi-
cians, while the balance consisted of 1 29 technical ex-
hibitors; 32 scientific exhibitors; 45 interns, residents,
and medical students; and 64 guests (certified nurses,
physician spouses, and others).
The three sessions of the House of Delegates had
the following registrations: 121 first session; 128
second session; and 127 third session. There are 167
voting members of the House. House sessions were
held April 26-27, 1985.
Credentials Committee
Glenn M Seager, MD, La Crosse, Chairman
Emma K Ledbetter, MD, La Crosse
Jeffrey M Weber, MD, Milwaukee
Resolved, That the mandatory surgical second
opinion data already collected by the Depart-
ment of Health and Social Services be analyzed
and made public to determine if true savings
have resulted.
Action: Substitute adopted
• Resolution 25 recommends a study on the
cost of decentralization of heathcare in Wisconsin.
The reference committee recommends an amend-
ed resolve as follows:
Resolved, That the Board of SMS consider a
study on the cost of decentralization of healthcare
in Wisconsin and report back to the House of
Delegates.
Action: Adopted as amended
THANK YOU
The reference committees of the House of Dele-
gates are to be commended for their thoughtful
deliberations and thanked for a job ‘ ‘well done. ’ ’
Organization and Finances
William E Raduege, MD, Woodruff, Chairman
Charles E Pechous Jr, MD, Kenosha
Robert B Shapiro, MD, Madison
James L Basiliere, MD, Oshkosh
Richard G Roberts, MD, Darlington
Socioeconomic Activities
Norman J Schroeder 11, MD, Beaver Dam,
Chairman
Lucille B Glicklich, MD, Milwaukee
John A De Giovanni, MD, Prairie du Sac
Philip J Dougherty, MD, Menomonee Falls
John O Simestad, MD, Osceola
Scientific Activities
Raymond E Skupniewicz, MD, Racine, Chairman
Robert A Keller, MD, Sheboygan
Leon J Radant, MD, Mauston
Myron M Marlett, MD, Green Bay
Roland R Liebenow, MD, Lake Mills
National Issues
Dean D Miller, MD, Milwaukee, Chairman
John E Riesch, MD, Menomonee Falls
Kermit L Newcomer, MD, La Crosse
Jeffrey K Polzin, MD, Black River Falls
Edward A Burg Jr, MD, Milwaukee
Credentials
Glenn M Seager, MD, La Crosse, Chairman
Emma K Ledbetter, MD, La Crosse
Jeffrey M Weber, MD, Milwaukee
Duane W Taebel, MD
Speaker
WISCONSIN MEDICAL JOURNAL, JUNE 198,5 : VOL. 84
63
ORGANIZATIONAL
SUMMARY REPORT
• Resolution 26 requests that SMS promote phy-
sician input into HMO systems and consider the
establishment of a unit within the Society for phy-
sicians to contact for advice and counsel regarding
these new systems. The reference committee sup-
ports this resolution in principle and recommends
adoption recognizing that the SMS Task Force on
Medical Care has made a similar recommenda-
tion.
Action: Adopted
• Resolution 27 proposes a monitoring mech-
anism of WiPRO activities. The reference com-
mittee recommends rejection, but encourages
WiPRO to communicate more effectively with
physicians.
Action: Resolution rejected
• Resolution 28 (Director Hofbauer) deals with
WiPRO reconsideration hearings. The reference
committee recommends rejection on the basis
that it would not be a good use of financial
resources to return to on-site hearings and that
telephone conferences appear to be a workable
alternative.
Action: Resolution rejected
• Resolution 29 (Director Wood) addresses health-
care cost containment savings. The reference com-
mittee recommends adoption of a substitute re-
solve as follows:
Resolved, That the State Medical Society im-
plore all insurance companies to pass the results
of cost containment on to the citizens of Wiscon-
sin in the form of lower premiums.
Action: Substitute adopted, changing the word
"implore" to "request"
• Other Actions
• Task Force on Medical Care
At the first session members of the House
received an Executive Summary and Task Force
Report VII, as well as the reports of five work
groups and a report entitled "General Economic
Conditions Facing Physicians in Wisconsin." A
special hearing was conducted Friday morning,
April 26, by Task Force Chairman Flaherty and
the work group chairmen. At the second House
session Friday afternoon. President Flaherty
reported the recommendation that the Task Force
study in its entirety be referred to the Board of
Directors for further action and direction, with
probable referral back to the House for specific
policy issues. This was adopted by the House.
• Elected a Nominating Committee whose mem-
bership is published in this issue.
• Elected officers, AMA delegates and alter-
nates, and confirmed the elections of district di-
rectors, also reported in this issue.*
Doctor Flaherty turns over the presidency to Doctor Scott
164
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
THE FOLLOWING FINANCIAL STATEMENTS of the State Medical Society of Wisconsin are part of the Treasurer's Report
to the House of Delegates. The Annual Certified Audit, prepared by Bailey, Calmes & Co, certified public accountants, is
on file at Society headquarters. Members wishing to review the Audit may do so upon inquiry to the Secretary.
STATE MEDICAL SOCIETY OF WISCONSIN
Madison, Wisconsin
General Fund
BALANCE SHEET
December 31 , 1984
ASSETS
Current Assets
Cash (S 48,768.33)
Accounts Receivable — General
{Net of Doubtful Accounts) 36,662.73
Due from Affiliated Organizations 48,960.01
Due from Other Organizations for
Accrued Payroll and Vacation Pay 24,308.02
Commercial Paper 500,000.00
U.S. Government and Other Securities 1,223,912.32
Certificates of Deposit 500,000.00
Repurchase Agreement 70,000.00
Common Stock — At Cost (Market Value $91,773.00) 89,480.28
Cash Management Fund 151,000.00
Accrued Investment Income Receivable 45,332.01
Employee Travel Advances 1,500.00
Prepaid Expenses 19,437.33
Supplies Inventory 14,291.63
Total Current Assets $2,676,116.00
SURPLUS
Balance, January 1, 1984 $1,510,083.95
♦Excess Income Over Expense for the
Year Ended December 31, 1984
(SMS Only) 127,556.06
Subtotal $1,637,640.01
Plus: Increase in Value of Investment
in SMS Services, Inc 44,354.12
Balance December 31 , 1984 1,681,994.13
TOTAL LIABILITIES AND SURPLUS $3,430,770.30
♦Legal Reserve $ 20,116.00
Regular Operations 107,440.06
$127,556.06
STATE MEDICAL SOCIETY OF WISCONSIN
Madison, Wisconsin
General Fund
STATEMENT OF INCOME AND EXPENSE
Year Ended December 31, 1984
Fixed Assets
Real Estate — Office Building $1,093,595.12
Real Estate — Storage Building 1 13,386.25
Other Real Estate 91,792.59
Building Equipment 58,547.70
Furniture and Equipment 289,800.10
Data Processing Software 29,386.50
Subtotal $1,676,508.26
Less: Accumulated Depreciation 1,027,594. 1 1
Net Book Value 648,914.15
Less; Leasehold Improvements
Paid by Other Organizations . . 40,781 .25
INCOME
Membership Dues $1,905,858.95
Income From Invested Fund.s(l) 194,233.87
Annual Meeting Income 38,213.00
AM A Collection Fees 17,202.13
Wisconsin Medical Journal Advertising,
Subscriptions, and Reprint Income 81,433.80
Mailing Labels 7,658.15
Equipment and Building Rental 147,303.26
Contract Services Furnished Other Organizations 20,573.43
Duplicator, Cafeteria & Telephone
Recovered From Other Organizations 40,001.04
Other Income 4,982.26
TOTAL INCOME $2,457,459.89
Net Fixed Assets
608,132.90 EXPENSES
Other Assets
Investment in SMS Services, Inc $146,521.40
Total Other Assets 146,521.40
TOTAL ASSETS $3,430,770.30
LIABILITIES
Current Liabilities
Accounts Payable $ 37,752.36
Dues Field for the Section on Ophthalmology 428.81
Dues Payable to American Medical Association,
County Medical Societies and Other Organizations 123.67
Accrued Payroll Taxes and Other Payroll
Deductions 3,857.12
Accrued Property Taxes Payable 55,837.75
Accrued Sales Tax Payable 295.74
Accrued Income Tax Payable 1,840.00
Accrued Payroll and Vacation Pay 94,112.00
Accrued Health Incentive Plan 25,991.72
Accrued Retirement Plan Contributions Payable 18,975.85
Other Current Liabilities 600.00
Deferred Income:
Prepaid 1985 Annual Meeting Income $ 11,750.00
Prepaid 1985 Membership Dues 1,493,192.38
Prepaid Rental Income 4,018.77 1,508,961.15
Total Current Liabilities $1,748,776.17
Payroll $1,021,722.35
Payroll Related Costs 266,595.82
Travel Expenses 146,468.65
Telephone Expense 60,262.47
Conference Expense 86,504.31
Postage 65,900.47
Outside Services 52,591.77
Printing and Supplies 214,693.21
General Insurance 14,677.52
Association Dues 5,033.20
Resource Materials 6,474.78
Grants and Appropriations 13,765.00
Rent 1,827.00
Property Taxes 55,837.75
Repairs and Maintenance 21,621.61
Mail Service 32,021.61
Computer Rent 35,600.00
Depreciation 65,613.17
Speakers Expense 10,000.47
Legal Counsel 36,062.65
Certified Public Account Services 17,449.15
Actuarial Expense 15,948.00
Miscellaneous Expense r 7,752.61
Provision for Bad Debts 1,575.00
Utilities 61,270.80
Building Supplies 10,794.22
1984 Income Tax on WMJ Advertising
Income 1,840.24
TOTAL OPERATING EXPENSE .$2,329,903.83
EXCESS INCOME OVER EXPENSE $ 127,556.06
NOTE:
{ I) Income from Invested Funds includes a $10,000.00 dividend received
by the State Medical Society from SMS Services, Inc. during 1984.
ORGANIZATIONAL
DIRECTORS AWARD
Chairman of the Board of Directors, Darold
A Treffert, MD at left presenting the Directors
Award to Edward J Lennon, MD, and above
to Arnold L Brown, MD.
Medical School deans receive Directors Award
The deans of the two Wisconsin
medical schools were presented the
Directors Award of the State Medical
Society during its Annual Meeting in
La Crosse.
Arnold L Brown, MD, dean of the
University of Wisconsin Medical
School, Madison, and Edward J Len-
non, MD, dean of the Medi-
cal College of Wisconsin, Milwau-
kee, were the 49th and 50th re-
cipients of the award which is grant-
ed only on occasion to those "who
have served with outstanding dis-
tinction the science of medicine,
their fellow physicians, and the
public."
Excerpts from the award follow:
Arnold L Brown, MD:
For 25 years, Arnold "Bud"
Brown has built a career of medical
education. His dedication to this es-
sential element of American Medi-
cine is applauded by colleagues, ap-
preciated by students, and praised
by patients. In seeking to create "the
complete physician” from the raw
material of each student, he draws
from the wellspring of intelligence,
compassion and commitment that so
obviously shapes his own life.
Doctor Brown, a native of Woos-
ter, Ohio, is a 1949 graduate of the
Medical College of Virginia. In 1959
he joined the faculty of the Mayo
Clinic Graduate School of Medicine
in Rochester, Minnesota. He was
chairman of the Department of Path-
ology and Anatomy at the Clinic and
its medical school when he left in
1978 to assume the post of dean of
the UW Medical School in Madison.
He arrived when good times seem-
ed on the horizon. . .enrollment was
increasing, and a new hospital and
teaching facilities were nearly com-
pleted. However, medical education
was about to enter a new era, an era
of shrinking resources for medical
education. Yet in the face of this un-
certain societal commitment to
medical education. Doctor Brown
has proved himself to be more than
equal to the challenge. Under his
quiet, confident leadership, the UW
Medical School has maintained its
reputation for excellence in educa-
tion, research and patient care.
Through his involvement in state
and county medical society activities
he has demonstrated the benefits of
bridging the gap between "town and
gown."
Over the years, he has earned a
national reputation for his work in
cancer and he has served on several
national medical councils dealing
with heart disease, cancer and
stroke.
The future of medical care in Wis-
consin and the nation rests heavily
in the hands of the deeply dedicated
and highly sensitive teacher, clini-
cian, administrator who in this com-
bination of skills is known as medi-
cal educator. . .few so well exemplify
these characteristics of excellence as
our own Arnold L Brown.
Edward J Lennon, MD
For more than two decades, Ed-
ward J Lennon, MD, has displayed
a commitment to medicine and med-
ical education that is admired by col-
leagues, students, and patients alike.
Be it clinician, teacher, or adminis-
trator, he has approached each of
these roles with the same qualities of
intelligence, compassion, and de-
termination that he looks for in his
medical students.
A native of Chicago, Illinois, Doc-
tor Lennon graduated from North-
western University School of Medi-
cine in 1952.
Doctor Lennon began his associa-
tion with the Medical College of Wis-
consin in 1958 when he joined the
faculty as an instructor in medicine.
He was named assistant professor in
1961, associate professor in 1966,
and professor in 1968.
Since that time, he has become in-
creasingly involved in adminis-
tration. In 1978 Doctor Lennon was
named Dean and Academic Vice
President of the Medical College of
Wisconsin and in May 1984 he be-
continued
166
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
ORGANIZATIONAL
Outstanding medical students receive Houghton Award
The Houghton Award of the State
Medical Society's Charitable, Edu-
cational and Scientific Foundation is
given yearly to senior medical stu-
dents who "through scholastic
excellence, extracurricular achieve-
ment, and interest in medical or-
ganization show high promise of
becoming a complete physician.
This year's recipients are Thomas
Stauss of the University of Wis-
DIRECTORS AWARD continued
came the fourth President of the
College.
Described by friends and associ-
ates as bright, articulate, savvy,
and compassionate, with a healthy
sense of humor. Doctor Lennon has
made significant contributions over
the years in advancing the College's
programs, education, research, and
patient care to national prominence.
A man with a keen interest in
science and research, as well as the
socioeconomic aspects of medicine.
Doctor Lennon has been an articu-
late spokesperson for the profession
and has offered creative ideas re-
garding moderating healthcare costs,
organizing regional hospital systems,
and stressing the importance of
quality biomedical research by medi-
cal school faculty.
Doctor Lennon's leadership in
medical education has not been
limited to Wisconsin. He served as
the first chairman of the Council of
Deans of Private Freestanding Medi-
cal Schools, from 1979 to 1983, an
organization he helped establish to
study management and academic pro-
grams at thirteen US medical schools.
An active participant in organized
medicine. Doctor Lennon has sought
to improve communication between
academic and office-based phy-
sicians through his work on the Liai-
son Committee between the Medical
College of Wisconsin and the Medi-
cal Society of Milwaukee County.
If the future of medical care is
largely determined by the quality of
the men and women we train today
in our medical schools, what better
role model would we give them but
Edward J Lennon?H
consin Medical School and Nell
Davis of the Medical College of
Wisconsin.
The award, consisting of a check
for $250 and a plaque, was pre-
sented to Mr Stauss and Ms Davis
April 25 during the SMS Annual
Meeting.
Majoring in zoology, Thomas
Stauss received his Bachelor of
Science degree from the University
of Wisconsin-Madison. While an
undergraduate, Stauss was an ac-
complished athlete, having played
football for the Wisconsin Badgers
for four years. In 1977, 1978 and
1979 he was named to All Big 10
Academic First Team. In 1979, his
senior year, he was also nominated
for Big 10 Most Valuable Player.
That same year, he received the Ivy
Williamson Award for Outstanding
Achievement in Athletics and
Academics.
In 1980 he entered the Univer-
sity of Wisconsin Medical School
where his outstanding scholastic
performance continued. In his junior
year, Stauss was selected to the
national medical honor society
Alpha Omega Alpha.
Stauss is married and has two
children.
A native of Appleton, Wisconsin,
Nell Davis received her Bachelor of
Science degree from Beloit College
in 1978. After working in research
at the University of Massachusetts
Medical Center and then at the
Enzyme Institute of the University
of Wisconsin, she entered the Medi-
cal College of Wisconsin in 1981.
While in medical school, Ms Davis
was active in the local chapter of the
American Medical Student Asso-
ciation (AMSA); and during the
summer of 1983, she was a par-
ticipant in the AMSA Health Study
Tour of Pakistan. During the past
two years, she has been a member
of the Medical College of Wis-
consin's Student Affairs Committee
and in 1983-84 she served as its
chairman.
Besides medicine, Ms Davis is in-
terested in music. She plays trumpet
and sings in several choirs.
The Houghton Award was es-
tablished in 1968 by the late John
H Houghton, a Wisconsin Dells gen-
eral practitioner, to emphasize the
high ideals for future physicians.
Later, his brother, William J
Houghton, a Milwaukee surgeon,
added to the fund.B
Robert T Cooney, AID, president of the CES Foundation, at left below with Houghton Award
recipients Neil Davis and Thomas Stauss
WISCONSIN MEDICAL JOURNAL, JUNE 1985:VOL. 84
167
ORGANIZATIONAL
Corporation recognized for support of primary care
The Wisconsin Rural Rehabili-
tation Corporation (WRRC) of
Madison received a Special
Recognition Award from the
State Medical Society of Wis-
consin April 25 at the Annual
Meeting in La Crosse.
Receiving the award on behalf
of Wisconsin Rural Rehabilitation
Corporation was Mr Francis
Powers, WRRC secretary-
treasurer. The special recognition
award was given to the corpor-
ation "for its unique and con-
tinuing support to primary medi-
cal care as a keystone to improve-
ment of the quality of rural life
in Wisconsin.”
According to SMS President
Timothy Flaherty, MD, who
made the award presentation,
"the Wisconsin Rural Rehabili-
tation Corporation for many
years has been instrumental in
the advancement and promotion
of quality medical care for resi-
dents of rural Wisconsin through
its support of educational scholar-
ship programs for medical stu-
dents and residents."
For fourteen years, the cor-
poration has provided the chief
financial support for a Summer
Externship Program operated
jointly by the State Medical
Society's Charitable, Educational
and Scientific Foundation and the
Wisconsin Academy of Family
Physicians. This program, which
was begun in 1969, has each year
afforded some 30 freshman
medical students an opportunity
to spend eight weeks living and
working with family physicians
throughout Wisconsin during the
summer.
"This summer externship is
uniquely directed toward help-
ing to relieve physician shortages
in rural Wisconsin as well as im-
prove the level of health care in
these communities," says Doctor
Flaherty. "Several of these stu-
dents have finished their under-
graduate training, gone on to
family practice residency pro-
grams, and now practice as
family physicians in rural Wis-
consin and in communities
where there is a major need for
family doctors."
Just last year the administra-
tion of the program was assumed
solely by the newly created In-
stitute of Family Medicine and
continues with major support
from the Wisconsin Rural Rehab-
ilitation Corporation. Since its
first involvement in 1971, the
WRRC has contributed more
than $300,000 to support well
over 500 students in this learning
experience.
In addition, since 1973 the
corporation has given more than
Herbert F Sandmire, MD, a Green Bay obstetrician-gynecologist,
was honored with the Erwin R Schmidt Award of the Interstate Post-
graduate Medical Association of North America, April 25, during the
State Medical Society's Annual Meeting in La Crosse.
Doctor Sandmire received the award in recognition of "his outstand-
ing qualities as a teacher of medical students, to prepare them for
both the art of medicine, and in skills of diagnosis and treatment of
the ill and troubled," according to the Association.
Doctor Sandmire has been a preceptor for senior medical students
from the University of Wisconsin Medical School for 20 years and
during this time approximately 150 students have passed under his
tutelage. In addition, over the past five years he has housed and fed
the students in his home; thus providing exposure to the home life of
a private practicing physician.
In presenting the award to Doctor Sandmire, Interstate Trustee John
E Dettmann, MD, Green Bay, said, "his scientific and service con-
tributions to the community and his county and state medical societies
have provided an exemplary role model for the students.” He also
noted that Doctor Sandmire has also published several studies from his
practice.
The University of Wisconsin Medical School has called him "one of
the best preceptors the program has had since its inception in 1926."
Since 1966, the Erwin R Schmidt Interstate Teaching Award has
been presented to a physician who has served the profession with dis-
tinction as a practicing physician and teacher. It is named in honor of
Doctor Erwin R Schmidt, a former trustee of Interstate, who for many
years was chairman of the Department of Surgery at the University
of Wisconsin Medical School.*
Interstate Teaching
Award goes to
Doctor Sandmire
Doctor Sandmire (in background}
and Doctor Dettmann
168
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
SPECIAL RECOGNITION AWARD
ORGANIZATIONAL
Doctor Ftaherty and Mr Francis Powers
SPECIAL RECOGNITION AWARD continued
$340,000 in support to a Resi-
dent Family Physician Program
of the University of Wisconsin—
Madison Center for Health
Sciences. This program enables
residents in family medicine to
practice at rural clinic sites for
one to two months. The cor-
poration also contributed some
$240,000 each year to scholar-
ships of other types including
grants to students pursuing
medical and other health careers.
"Few organizations have acted
so generously to ensure the con-
tinuation of quality medical and
health services for rural Wis-
consin," according to Doctor
Flaherty. ■
Maryland physician
recipient of
Beaumont Award
"Seeing the Elephant: Medical
Problems on the Oregon-California
Trail" was the title of the presenta-
tion made by Peter D Olch, MD April
27 at the 1985 William Beaumont
Memorial Lecture. Doctor Olch is an
associate professor of Uniformed
Services University of the Health
Sciences, School of Medicine.
Established by the State Medical
Society of Wisconsin in 1957, the
William Beaumont Memorial Lec-
ture is designed to present to mem-
bers of the Society, distinguished
medical scientists whose research
and clinical experience may enrich
the knowledge and skills of Wiscon-
sin practitioners.
The lecture is given each year
during the surgery meeting of the
State Medical Society's Annual
Meeting. Doctor Olch received the
Beaumont Award from Stephen B
Webster, MD of La Crosse, vice
president of the Charitable, Educa-
tional and Scientific Foundation
which administers the Beaumont
Award Fund.B
Doctor Jowsey
delivers Elvehjem
Lecture
Jenifer Jowsey, DPhil, Healdsburg,
CA presented the 1985 Elvehjem
Memorial Lecture April 27 during
the Internal Medicine program at the
SMS Annual Meeting at the La
Crosse Center. Doctor Jowsey
spoke on "The Morphology and
Treatment of Osteoporosis."
The Elvehjem Memorial Lecture
was established in 1962 to honor
the memory of Conrad A Elvehjem,
PhD, the 13th president of the Uni-
Doctor Mullooly and Jenifer Jowsey, DPhil
versity of Wisconsin and an inter-
national authority in biochemistry.
A project of the State Medical
Society's Charitable, Educational
and Scientific Foundation, the lec-
ture is designed to perpetuate Doctor
Elvehjem's contribution to the
betterment of the health of the
people of Wisconsin and the continu-
ing medical education of physicians.
Doctor Jowsey was presented the
Elvehjem Award by John P Mul-
looly, MD, at the Spring Meeting of
the Wisconsin Society of Internal
Medicine and the American Col-
lege of Physicians.*
Doctor Webster and Doctor Olch, recipient of the Beaumont Award
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
169
ORGANIZATIONAL
Society honors long-time employee
One of the State Medical So-
ciety's most loyal and conscien-
tious employees, Joan Pyre, was
honored with the Presidential Ci-
tation of the State Medical So-
ciety April 25 in La Crosse.
In presenting the award to Miss
Pyre, SMS President Timothy T
Flaherty, MD, said:
"Joan is highly dedicated to her
work, to high ideals, and to the
medical profession. In this era
where attacking professionalism
is fashionable. . .the Citation al-
lows us as physicians to show our
appreciation to this woman of
our staff— a selfless person, gra-
cious, highly knowledgeable, es-
pecially skilled in helping others,
a dedicated Executive Assistant to
the Medical Society, its officers
and staff and the public they
serve."
Joan Pyre began her first full-
time employment in Madison in
1943 just out of advanced secre-
tarial training at Edgewood Col-
lege. She was secretary to the
Superintendent of the Milwaukee
Railroad at the depot offices on
West Washington Avenue.
After four years of "railroad-
ing" Joan returned to the Univer-
sity of Wisconsin for a Bachelors
of Business Administration de-
gree from the School of Com-
merce.
Joan began her first day of
work with the State Medical So-
ciety on February 6, 1951 as se-
cretary to Roy T Ragatz, the So-
ciety's Assistant Secretary in
charge of scientific programming.
After a year with Roy, Joan was
named Council and Committee
Secretary for the Society and As-
sistant to then Secretary Charles
H Crownhart. Her job was parti-
cularly challenging, said Doctor
Flaherty, because, at that time,
the Secretary of the Society was
also the General Manager of Wis-
consin Physicians Service, the
Blue Shield Plan of the State Med-
ical Society. "Those were turbu-
lent years. Joan had a ringside
seat to the intense, sometimes bit-
ter, competition between the
Blue Plans in Wisconsin. She was
combined recorder, technical ad-
visor, and "woman in the mid-
dle" confidant for medical society
leadership frequently in conten-
tion and seldom in unanimity,
but often innovative in the bur-
geoning era of medical and hos-
pital insurance in Wisconsin."
Those experiences, combined
with an almost unique natural
talent for detail, have won her
widespread admiration as "Miss
Memory," according to Doctor
Flaherty. "Few can challenge her
rare skill at recollection, even
fewer have refined this quality
to an art in which utility and en-
joyment are so satisfactorily com-
bined."
With the retirement of Mr
Crownhart in 1970, Joan helped
smooth the transition to the So-
ciety's next Secretary and Gen-
eral Manager, Earl Thayer. Short-
ly, she was named Executive As-
sistant. A bit later she was ap-
pointed Secretary to the Wiscon-
sin Delegation to the American
Medical Association.
President Doctor Flaherty, Presidential Cita-
tion recipient Joan Pyre, and Society
Secretary Earl R Thayer
The announcement of that ap-
pointment said, "Few, if any in
the Society, have a better know-
ledge of the system, the Society's
policies and programs, or the
technical aspects of the SMS and
AM A procedures and protocol."
Outside the office Joan is well
known for her fine alto voice in
the Diocesan Festival Choir of
Madison. This elite choral group
has several times toured Europe;
and with Joan in a quartet is a
popular addition to the Madison
area music scene.
"Certainly we in Wisconsin
Medicine are fortunate that Joan
continues as she started nearly 35
years ago— working on the rail-
road, all the live long day, every
working day and then some,"
said Doctor Flaherty. ■
Scientific
Exhibit Awards
The following scientific awards
were given special merit during the
1985 Annual Meeting of the State
Medical Society of Wisconsin:
First Place: Prevalance of Hearing
Impairment in a Physical Rehabili-
tation Hospital by Sacred Heart Re-
habilitation Hospital, Milwaukee.
Second Place: Laboratory Identifi-
cation of Thrombotic Risk by Col-
umbia Hospital, Milwaukee, and
Comparison of Minoxidil with
Hydralazine as Step HI Drug in
Hypertension by Wood Veterans
Administration Medical Center, Medi-
cal College of Wisconsin, and the
Upjohn Company.
Third Place: Prevention, Diagnosis,
Treatment and Rehabilitation of
Heart Disease by Wisconsin Heart
Institute and Gundersen Clinic Ltd, La
Crosse, and Autologous Blood Trans-
fusion by American Association of
Blood Banks Committee on Autolo-
gous Transfusion and St Mary's Hos-
pital Blood Transfusion Service, Mil-
waukee.*
170
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
ORGANIZATIONAI.
CES Foundation treasurer Richard W Edwards, MD with "Beaumont 500" Club members Karver L Puestow, MD
and Leonard B Torkelson, MD and Mrs Torkelson
The "Beaumont 500" Club
One of the most unique, educational and cultural in-
stitutions in the Midwest if not the nation, is the Fort
Crawford Medical Museum. It is far more than a
museum, it is a tribute to all Wisconsin physicians and
their role in securing the good health of the people of
the State of Wisconsin. It represents a unique concept
in the public education for prevention and treatment of
injury and disease, the nature of medical care, the im-
portance of the strong physician-patient relationship,
and emphasis on obtaining and keeping good health.
The restored Fort Crawford military hospital, and its
related museum in Prairie du Chien, is a tribute to Dr
William Beaumont; it is also a modern expression of his
1830s philosophy of the search for truth and improve-
ment in health. The museum has had more than 40,000
visitors since 1979, making it one of the most popular
attractions in the area. Yet the museum continues to
face financial hardships as well as some physical
problems.
To this end, the MMP Endowment Fund was es-
tablished in late 1981. This Fund has a goal of raising at
least $500,000, the corpus of which cannot be used for
any purpose other than to produce income earmarked
for operation and maintenance of this unique National
Historic Landmark.
The first 500 physicians or others who contribute
$1,000 or more to the Museum Endowment Fund will
join a select group known as the "Beaumont 500."
Such contributors will receive a specially designed
Beaumont Medallion. In addition to being a member of
the prestigious "Beaumont 500," those wHo contribute
$10,000 or more will receive a first edition copy of Dr
William Beaumont's famous book Experiments and Ob-
servations on the Gastric Juice and Physiology of Diges-
tion, written while Doctor Beaumont was stationed in
Prairie du Chien, 1829-1832, and published in 1833.
To date, 31 individuals have committed $1,000 each
to the Museum Endowment Fund. Through the con-
tinued generosity of Wisconsin physicians and their
spouses, the Fort Crawford Medical Museum can con-
tinue to familiarize our citizens— young and old— with
the fascinating people and events that have helped
shape Wisconsin Medicine.
It gives the CES Foundation great pleasure to be able
to thank the following for their continued support;
Mr and Mrs Robert B Murphy, Madison
Guy W Carlson, MD, Madison
W Bruce Fye, MD, Marshfield
Pauline M Jackson, MD, LaCrosse
Dr and Mrs William D Janssen, Mequon
Dr and Mrs Thomas A Leonard, Madison
Karver L Puestow, MD, Madison
John D Riesch, MD Menomonee Falls
Anonymous
Marion Crownhart, Madison
Eli M Dessloch, MD, Prairie du Chien
Melvin F Huth, MD, Baraboo
Michael F Ries, MD, Brownsville
Elizabeth A Steffen, MD, Racine
Kenneth M Viste, Jr, MD, Oshkosh
W Bradford Martin, MD, Whitehall
Mr and Mrs Earl R Thayer, Madison
Dr and Mrs K Alan Stormo, Fond du Lac
Dr and Mrs Chesley P Erwin, Milwaukee
Dr and Mrs Leonard B Torkelson, Baldwin
Leland C Pomainville, MD, Wisconsin Rapids
Mrs William D Hoard, Fort Atkinson
Dr and Mrs Ralph Hudson, Eau Claire
Roger L von Heimburg, MD, Green Bay
Dr and Mrs Richard W Edwards, Richland Center
Roy Selby, MD, LaCrosse
Dr and Mrs Bertram H Dessel, Wauwatosa
Mace Garrison Zinggeler, Venice, Florida
Dr and Mrs Benjamin H Brunkow, Monroe
Dr Robert T Cooney, Portage*
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
71
ORGANIZATIONAL
New Fifty-Year Club members
Physicians inducted into the Fifty-Year Club were presented
awards at the Board of Directors dinner April 24 during the
Annual Meeting of the State Medical Society. Those attend-
ing are shown above. Front row, left to right: Arthur D Bussey,
MD, Wauwatosa: Kenneth F Manz, MD, Neillsville; Albert H
Stahmer, MD, Wausau; Thorolf F Gundersen, MD, La
Crosse; Kermit W Covell, MD, Racine. Back row, left to
right: Hobart H Wright, MD, Wauwatosa; Stephen A Theisen,
MD, Fond du Lac; Frederick J Hofmeister, MD, Milwaukee;
Thomas J Doyle, MD, Superior; and Christopher R Dix, MD,
Elm Grove.
Others who became members this year are: Clement L
Budny, MD, Milwaukee; Garrett A Cooper, MD, Madison;
Howard L Correll, MD, Arena; Frank K Dean, MD, Madi-
son; Eli M Dessloch, MD, Prairie du Chien; Hilbert N
Dricken, MD, Milwaukee; Paul S Emrich, MD, Oshkosh;
Erwin E Grossman, MD, Milwaukee; Hubert D Grata, MD,
Sturgeon Bay; Robert H Gunderson, MD, Beloit; Frederick G
Hidde, MD, Sheboygan; William A Hilger, MD, Milwaukee;
Charles M Ihle, MD, Eau Claire, Harold O Jirsa, MD, Ocean
Springs, Mississippi; John W Johnson, MD, Withee; J Howard
Johnson, MD, Sun City, Arizona; Lawrence W Kaufman,
MD, Milwaukee; Charles P Kauth, MD, Port Washington;
Lawrence J Keenan, MD, Pond du Lac; Richard L Kennedy,
MD, Eau Claire; Charles K Kincaid, MD, Madison; Leslie G
Kindschi, MD, Monroe; Willard E Klockow, MD, Muscoda;
Edward E Krumbiegel, MD, Naples, Elorida; Esther C Kurtz,
MD, Madison; Howard J Laney, MD, Prescott; Mischa J
Lustok, MD, Milwaukee; Albert G Martin, MD, Sarasota,
Elorida; Ralph B Pelkey, MD, Crivitz; Albert E Rogers, MD,
Oconomowoc; Owen Royce Jr, MD, Milwaukee; Ernest V
Smith Jr, MD, Fond du Lac; Ruth S Stern, MD, Milwaukee;
Katherine W Stewart, MD, Eau Claire; Abe A Sverdlin, MD,
Milwaukee; Charles A Vedder, MD, Marshfield; William
L Waskow, MD, Phoenix, Arizona; Donald M Willson, MD,
Milwaukee; and Raymond G Yost, MD, Manitowoc. (Photo
by Ben Barteljm
The Wisconsin Medical Journal gratefully acknowledges publication support of this "Blue Book" issue
through a contribution from the Crownhart Memorial Account of the State Medical Society's
Charitable, Educational and Scientific Foundation.
172
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
ORGANIZATIONAI,
SMS Task Force
on Medical Care
Requested by the 1984 House
of Delegates, the State Medical
Society's Task Force on Medical
Care eventually involved 32 Task
Force members and 96 additional
Work Group members appointed
by SMS President Timothy T Fla-
herty, MD.
The Task Force was charged by
the House with an examination of
the major socioeconomic trends
and issues facing physicians in
Wisconsin. The Task Force con-
ducted its research and analysis
through five Work Groups on
Reimbursement and Delivery
systems. Quality of Care Is-
sues, Competition and Regula-
tion, Hospital-Medical Staff Re-
lations, and Physician Contract-
ing and Negotiations.
The Work Groups and ul-
timately the full Task Force offer-
ed over 120 recommendations on
how SMS should pursue a resolu-
tion of these socioeconomic prob-
lems. The recommendations
ranged from basic statements of
policy on such issues as capita-
tion payment for physician serv-
ices to proposals for a restruc-
turing of the Society and its staff
and financial resources to provide
contracting and negotiation serv-
ices to SMS members.
The entire package of Task
Force recommendations was ac-
cepted by the 1985 House of
Delegates for referral to the SMS
Board of Directors for study and
possible implementation.
Copies of the final reports of
each of the five Work Groups as
well as the Task Force's imple-
mentation strategy are avail-
able to Society members from the
Physicians Alliance Division at
SMS headquarters in Madison
(Phone 1-800-362-9080 or Madi-
son area 257 - 678 1 ) . ■
WISCONSIN MEDICAI.JOURNAI,, JUNE 1985; VOL. 84
73
ORGANIZATIONAL
"A full and promising
agenda already laid out
. . . one that offers firm direction for our
Society, focuses on opportunity as well as
problem, offers a positive outlook, and
creates a plan rich in reward for both
doctor and patient. ' '
Report of President Scott to the House of Delegates
.A.S I MOVE OUT of the comfortable shelter of being
"number 2" in the State Medical Society heirarchy,
1 can't help but consider what the next year holds, not
alone for me, but for all of us— and our patients. We
have been blessed this past year with the leadership
provided by Doctor Flaherty. We are all the better for
his spirit and his deeds. Thank you, Tim.
1 believe that I am arriving at the presidency of the
State Medical Society at a most favorable time— for me
and my beliefs. Moreover, I believe we are looking at
a time more favorable than the recent past for all
dedicated physicians and their patients.
This view may prompt some of you to wonder if 1
have lost touch with reality, that 1 am dreaming of
days gone by. Let me explain why 1 believe the future
favors both physician and patient, why 1 am full of
hope, not despair.
First, 1 come into the presidency with a full and
promising agenda already laid out for me. It is an
agenda put together by the Society's Task Force on
Medical Care.
To everyone's good fortune, nearly 140 physicians
of every diversity became part of this Task Force and
its work groups— young and old, rural and urban,
specialist and generalist, group and solo, employed
and independents, medical school and private prac-
titioners, the hope-less and the hope-full.
They have prepared an agenda that offers firm
direction for our Society, focuses on opportunity as
well as problem, offers a positive outlook, and creates
a plan rich in reward for both doctor and patient. I
congratulate each of you— physicians and staff— for
your role in the Task Force.
Not only am 1 favored to have such an agenda
handed to me on the brink of my inauguration, 1 am
favored with a deep sense of commitment by all on
the Task Force and the Board of Directors to help give
life and vigor to these new-born objectives.
Next, I believe there is a more favorable time ahead
for physicians, bright lights at the end of what so many
physicians regard as the dark tunnel of the future of
Medicine.
To be sure. Medicine no longer holds sacrosanct the
individual independence of action that led past genera-
tions of physicians to prize this profession.
But for all the changes— and more to come— 1 be-
lieve that tomorrow's physicians will quickly adjust
to greater institutionalization, closer affiliation with
groups and hospitals, a variety of for-profit as well as
non-profit entities, and even governmental agencies.
These may not be the highest order of my personal
preferences— after all 1 am now in my 27th year of
practice— but even this "old dog" can learn a few new
tricks.
1 have but to look at my own county— Dane— to see
the dramatic changes that have taken place in the re-
ordering of delivery mechanisms. Just two years ago
the 1,200 physicians in my county were competing in
the traditional sense with a collegiality that most
regarded as ideal. Today, Madison is regarded as the
hottest HMO town in America— some physicians have
folded— like farmers in economic distress— cut off
from their patient "market" and unable to withstand
the price wars of capitation. Others have been re-
markably flexible in adapting; hopefully without
sacrifice of quality or concern for the patient.
Statewide we have seen a tripling of enrollment in
HMOs and other "institutions" of medical care in the
past two years. There are now at least 25 HMOs or
other prepaid plans, plus their countless satellites with
74
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
REPORT OF PRESIDENT SCOTT
ORGANIZATIONAL
a total enrollment of almost 750,000 persons, nearly
15% of the state's population. And the growth con-
tinues at a record rate. No county, no town is so
isolated as to be unaffected by this movement.
I believe that the young men and women now
emerging into practice will come with well-conceived
and well-indoctrinated concepts of how to provide
quality medicine in a practice environment that some
of us today view as hostile.
Our system of medical education is already moving
to prepare them for a different business, social and
political climate than when we entered practice. That
is good— for I believe we will continue in our medical
schools to emphasize the basic elements of scientific
excellence in diagnosis and treatment— but now with
greater attention to the doctor's role in prevention on
the one hand and how to make the most of longevity,
on the other. In addition, I see specialization as emerg-
ing from the cacoon of its narrow pathology to view
the patient as a whole human being albeit with prob-
lems affecting its parts.
The time is favorable for a renaissance of
virtue in medical practice ... the truest guard-
ian of good patient care remains the physician
with a good conscience . . . virtue is an inevitable
companion of true competition. ' '
I believe that the time is favorable for a renaissance
of virtue in medical practice— virtue as understood by
my father, an EEN'T physician in Massillon, Ohio—
virtue honored by him throughout his more than 25
years of practice.
He believed as I do, the words of H L Mencken that
"conscience is the inner voice that warns us some-
body may be looking." In those days it was mostly
one's own conscience that stood guard over what was
good treatment and fair dealing for the patient.
Despite the innumerable government regulations and
competitive schemes we have today, the truest guar-
dian of good patient care remains the physician with
a good conscience.
Medicine is not practiced for governments. It is not
practiced for insurance companies or HMOs or PPOs
or IPAs. It is not practiced for hospitals, or for that
matter, doctors. Medicine is practiced for people.
It embodies a skill, and most of all a desire, by the
doctor to prevent disease or injury in human beings;
a dedication to give each patient the opportunity to
enjoy a better quality for his or her life.
I believe that the pressures of competitive practice
actually favor the growth of moral excellence in to-
day's practitioners. It is almost startling to note that
"marketing"— a term that makes most physicians
wince— turns out to be nothing more than good old
fashioned virtue in 20th century trappings.
All of a sudden, the medical literature is full of
admonitions to do right by the patient! Public relations
entrepreneurs are making a good living telling physi-
cians what they have been taught for centuries:
—Medical technology produces better results when
there is a good relationship between doctor and
patient.
—A majority of complaints by patients about their
physicians arise from a failure of communication.
—The patient expects to know what we are doing
to justify our charges.
—The patient has an absolute right to be told all the
reasonable details of his or her problem, options
for treatment and possible outcomes. Incidentally,
attention to this maxim can have a highly favor-
able impact on our malpractice dilemma.
—Showing care and concern for the patient speeds
recovery, offers satisfaction if not always hope,
and quite incidentally, beefs up the public's image
of the physician.
—Treat the patient as you would like to be treated.
—When all else fails and the patient's life is to end,
share in the grief of that time. After all, death is
a part of the physicians' life, and grieving has its
own way of healing.
Yes, I believe this is a favorable time for the exer-
tion of virtue, as old or as new as you wish to regard
it. I believe virtue is an inevitable companion of true
competition.
Price is seldom the deciding difference when a pa-
tient chooses from a host of technically excellent
professionals.
The real difference is in how the doctor feels for the
patient— something that isn't sold with ads, but is
sensed by the patient in face-to-face encounter with
the physician.
Finally, I believe that favorable times are ahead for
the patient. It is indeed true that getting care is increas-
ingly complex for the patient.
Substantial barriers of communications and under-
standing are imposed upon the patient by new
delivery systems and the conflicting messages he or
she receives from a technologically progressive but
outcome-imperfect profession, from a nation which
touts its medical achievements but heaps disdain upon
the integrity of its medical practitioners, from a
government which promises healthcare for the elderly
but delivers reduced benefits, baffling red tape, and
not-so-subtle hints of rationing yet to come.
But I believe that our own dedication to standards
of what is right for the patient will continue to move
our state and national health policy in a direction that
ultimately will see the patient as we see the patient— in
need and deserving of compassionate and skillful
WISCONSIN MEDICAL JOURNAL, JUNE 1985 : VOL. 84
175
ORGANIZATIONAL
REPORT OF PRESIDENT SCOTT
physicians— and the opportunity for reasonable
access, availability and cost in medical care.
These favorable trends for the patient are all the
more likely to be realized because of the new empha-
sis on another old virtue— the physician as advocate
for the patient. Let me illustrate:
Recently, the Board of Directors of the Society
approved and implemented what it calls the REACH
program— "Resource for Education and Awareness of
Community Health.” This program reaches out to the
public on behalf of the Society's member physicians
to tell the doctors' story, to educate, to inform, to urge
action for better health, to help patients obtain quality
care at reasonable cost.
I don't know who authored these words taken from
the REACH document, but they say exactly what I
believe every physician should say to his or her pa-
tients. I quote:
"I am your physician. I will speak for your interests
at all times, you have asked that I take care of you. I
will do so to the very best of my ability. You can trust
me to work for your best interests. There is no doubt
as to whom I am serving or what I am doing. I do it
for you."
With such a commitment to advocacy for our pa-
tients, the members of the State Medical Society-
strengthened by the advocacy services of their state
organization— can bring reality to the favorable out-
look I predict for medical care in Wisconsin.
Advocacy is not easy. It demands our constant atten-
tion. It might mean filing a suit to protect the right of
the patient to choose his or her own physician. There
will be time when even closed panel contracts,
thoughtfully entered into, may need to be broken for
the best interest of the patient.
It may mean protracted litigation or negotiation to
preserve the patient's rights to reasonable reimburse-
ment or benefits under some delivery system, some
DRG program, some government edict.
Advocacy is not always popular. It may mean— as
now— serious challenge to deeply ingrained precepts
of justice that are no longer able to contain the legal
and economic abuse which threatens our malpractice
system.
It may mean immediate, aggressive, and costly
analysis and attack on the newly announced regula-
tions for publication of hospital and doctor specific
data on treatment methods, outcomes, and charges—
data gathered by PROs still reeling from the rapid and
ever-changing onslaught of regulations requiring the
compilation of information from uncertain and un-
seasoned review systems designed more for cost con-
trol than for quality assessment.
Advocacy is often difficult. It demands— as at this
moment— that we confront our own inadequacies—
to recognize, and help our patients to understand that
we cannot guarantee perfect outcomes in the care we
provide. It demands that we face our own colleagues
whose techniques of intervention, however well in-
tended, fail to meet a standard of practice that we
recognize as giving the patient a reasonable oppor-
tunity for recovery or well-being. It demands that our
Medical Society openly and proudly set forth its own
program of patient protection from abuse or mal-
practice.
Advocacy is personal. When the patient reaches out
for solace, whether in fear or insecurity or grief, he
does not reach for a procedure manual. He does not
reach for the bylaws of the hospital or the HMO. He
reaches for his physician's hand . . . and he must not
reach in vain.
Ladies and Gentlemen of the House, you have put
your faith and trust in me as your president this year.
I have had good teachers in Dr Timothy Flaherty and
our Secretary Earl Thayer. I will do everything in my
power to uphold the excellence of leadership in our
State Medical Society. Advocacy for the patient is our
theme. A good doctor-patient relationship will survive
all the pressures that can be put upon the medical pro-
fession now or in the future. ■
176
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
ORGANIZATIONAL
"Our number one priority
is malpractice reform
. . . We have identified the problem,
we've identified the solutions, we need
action teams to talk to other practitioners,
to talk to employers, to talk to hospital
administrators, to talk to our attorneys,
and most importantly, to talk to our legis-
lators. ' '
Report of Outgoing President Flaherty to the House of Delegates
Thirteen months ago during our 1984 Annual
Meeting our theme questioned, "Whose responsibility
is the cost of medical care?" The moral dilemmas that
are faced by patients, physicians, hospitals, and third-
party payers as they grapple with healthcare costs
were debated and discussed under the guiding gavel
of the moderator. Dr John Simenstad. The questions
posed highlighted society's responsibility to ethically
provide every person with an adequate level of health-
care without excessive burden to anyone while simul-
taneously asking, "What is an adequate level of care?”
and "What will it cost?”
In my report to the House of Delegates I called for
increased physician involvement in Government as
Government becomes more involved in Medicine. I
defined our challenges as medical liability, competi-
tion, contracting, and Medicare assignment. You, the
House of Delegates, directed me to appoint a Special
Task Force on Medical Care to prepare policy and
strategy recommendations. Areas to be studied were
delivery systems, methods of reimbursement, how to
preserve quality of care, fair competition, medical staff
hospital relationships. Government controls on
healthcare, problems of medical liability, approaches
to negotiations with third-party carriers, and other
germane issues.
AMA President Dr Joseph Boyle addressed the
House of Delegates and his message was one of pa-
tient advocacy and the professional ethic.
Reflecting on that beginning, my term of office can
be likened to stepping into a prize-fighting ring with
you (SMS member physicians) in my corner and a
managerie of tag-team opponents on the other side of
the ring waiting to get in their punches. We, however,
landed the first blows repealing cardiac surgery de-
certification on March 28, and then watching the
Senate on March 29 floor the chiropractic bill (AB 824)
by a vote of 19-10. This re-emphasized President
Eisenhower's theme "Politics should be a part-time
occupation of all (physician) citizens." Prior to legis-
lative adjournment on April 6, SMS netted victories
with enactment of a bill revising the Patients Compen-
sation Fund, Malpractice Panels, and WHCLIP. How-
ever, these improvements in the Patients Compensa-
tion Panel System were too little and too late to divert
the cascading malpractice crisis. All in all, SMS had
a successful 1984 legislative session; the legislators
went home; and to paraphrase Will Rodgers, we felt
safer.
On April 16 and 171 participated in the first of many
forums on healthcare costs. This initial forum was
sponsored by Congressman Les Aspen and was en-
titled "Skyrocketing Health Care Costs— Whose Got
the Cure?" The audience for these seminars was
primarily senior citizens, a group with whom physi-
cians share many common goals and for whom we
have great respect reflecting on their unique contri-
bution to our society. We, as the audience heard an
alarming message from La Yarn Taylor of the House
Budget Committee and Joeyln McDonald, a legislative
assistant for Congressman Richard Gephardt of
Missouri. They, from their perspective, (budget and
Congress) painted a dismal picture for the Seniors, of
decreasing Federal resources for payment and increas-
ing demand produced by projections of dramatic
growth of eligible Medicare recipients. Representa-
tives of the local hospitals and I gave our perspectives.
Congressman Les Aspin refereed. We took a few
punches but also attracted many of the senior citizens
to our corner as they realized that we (Organized
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Medicine) were really their advocates.
In May the SMS Board of Directors "put up their
dukes" with the sponsorship of a new professional
liability insurance plan for the physician-members of
the State Medical Society. The Professionals, an arm
of PICO (an Ohio Medical Association sponsored plan)
presently has over 1,500 Wisconsin physician-sub-
scribers in its liability insurance program with SMS
physicians controlling claims management and under-
writing.
In late May and June Governor Earl and the Health
Policy Council, with the help of local HSAs, "set up
the rings" in a number of Wisconsin cities asking the
question, "What should the State Government do to
control healthcare costs?" SMS stepped into the ring
and delivered a salvo of replies. We recommended:
1. Sponsorship of medical liability reform
2. Repeal of CON
3. Support for legislative antitrust relief
4. Scientific study of supply of physicians and allied
health personnel
5. Reorganization of the Department of Health and
Social Services
6. Continued emphasis on patient cost-sharing in
health plans.
At the same time we delivered a "short jab" re-
minding those present that the SMS Board of Direc-
tors in January had supported a temporary freeze in
fees for Medicare, that became a National program in
February when the AMA called for a national physi-
cian fee freeze and 80% of American MDs said "Yes."
This has been estimated to have saved Americans 1.5
billion dollars in healthcare costs in 1984-85. Another
"jab" seemed to open the eyes to the fact that this
Society's physicians had provided thousands of dollars
in free care through free clinics and the ShareCare Pro-
gram in Wisconsin.
On June 19, another "fighter" entered the ring with
the appearance of the reorganized and merged Wis-
consin Peer Review Organization (WiPRO) receiving
the Medicare contract on June 27, 1984. Some physi-
cians believe that WiPRO sometimes tends to throw
punches indiscriminately; however, its "trainer,"
HCFA, may be responsible for teaching dirty tactics.
Between rounds, in June, Dr Patricia Stuff lost an
election but won the hearts of the AMA Delegates in
Chicago.
During the same time-frame. Congress tried to land
a "low blow" with mandated Medicare assignment.
However, the organizations of Medicine blocked that
illegal punch and neutralized it with a House of Rep-
resentatives floor vote. In the next round a small
clique of pugnacious Potomac pugilists tried to land
an identical "low blow" through a Congressional Con-
ference Committee with the "punch" being side-
stepped at the last second. With the encouragement
of the "Presidential Referee" and his cornerman, "the
Reverend Stockman," a combination of a rabbit
punch, thumb in the eye, and a blow just below the
inguinal ligament was delivered to American physi-
cians. Although disguised to the Medicare recipients,
the Medicare fee freeze and the participation scheme
had landed. The AMA jumped in the ring and filed a
legal protest in Indiana which is still to be resolved.
Back in the "Wisconsin corner," the Commissioner
of Insurance issued the PPO rules. SMS received a six-
year reaccreditation by the Council for continuing
medical education and I appointed 35 SMS members
to the Task Force and 129 SMS members to the five
work groups of the Special Task Force on Medical
Care. These physician volunteers represented all prac-
tice types and geographic distribution. Special Legis-
lative Council Committees on medical liability, pri-
mary prevention, bioethics, graduate medical educa-
tion, and nursing home regulations were appointed
with SMS members on each Council carrying our
message into the ring.
^ ‘Our strength lies in our unity and every physi-
cian must recognize the need to be unified. We,
as individual physicians and as an organization
of physicians, must continue to do what is best
for the patients of Wisconsin and I am confident
this will always prove best for the physicians of
Wisconsin. ' '
On August 8, the Insurance Commissioner, Thomas
Fox, grabbed the ring microphone and announced that
Wisconsin was facing a medical malpractice insurance
crisis (August, '84) that may be worse than the mid-70s
malpractice crisis. That announcement launched a
massive audience educational effort by SMS identify-
ing the specifics of the malpractice crisis.
Also in August, the "most distinguished" Legislative
Council Special Committee on Health Care Provider
Systems (on which I served) recommended the elimi-
nation of Blue Cross /Blue Shield United of Wiscon-
sin's tax exemption. The vote was 10-1 (Brad Wilson
of BC/ BS also served on the Council) to eliminate the
property, sales, gift and inheritance tax exemption
enjoyed by BC/BS.
AMA and SMS objected to the "stranglehold" at-
tempted by HCFA of the attestation requirements for
physicians relating to discharge hospital coding. This
objection was upheld and the "stranglehold" was
reduced to a "bearhug" attestation requirement.
On September 1, a "long looping, preadmission
review, right cross" was landed and for a month or
so Wisconsin physicians were hearing "busy signals"
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REPORT OF OUTGOING PRESIDENT FLAHERTY
ORGANIZATIONAL
in their ears or messages they had difficulty under-
standing.
Two clear messages were delivered by the SMS,
Auxiliary, and CESF Workshop on Health attended by
over 2,000 high school students and counselors: one
at UW-Stevens Point on dangers of substance abuse
and the other on the agony of teenage suicide at UW-
La Crosse; a true defensive effort on behalf of Wis-
consin's young adults.
In October the bell sounded for the next round to
be governed by the "Carolyn Davis participation
rules." AMA's counterpunching delayed the imple-
mentation of the rules to October 15 but the final deci-
sion as to their constitutionality awaits the judgment
of a Federal court.
On October 9 SMS landed one of its most "uplifting
blows," the effects of which are having a lasting
influence in Wisconsin. In a letter from Dr Darold
Treffert, Chairman of the Board of Directors and from
your President, SMS physicians were urged to offer
"special considerations" to all patients facing finan-
cial hardship. SMS physicians were asked to consider
accepting assignment or to offer reduced fees, when
appropriate. You have backed this punch with your
participation. This effort, on behalf of Wisconsin's less
fortunate citizen, has re-emphasized our commitment
to advocacy of our patients and has produced a chorus
of support in our corner by concerned Wisconsin
citizen organizations such as Wisconsin Coalition for
Aging.
Also in the Fall, the SMS Board of Directors leveled
a clean punch at HFCA over the tactics it used in im-
plementing the PRO legislation nationwide. HFCA
deserved the punch with their PRO contracting
process which created unrealistic and probably un-
achievable objections. This has the potential to mis-
lead the public and divide a profession already dedi-
cated to quality assurance, and further, to needlessly
open wounds that may develop into a malpractice
cancer.
On November 10 at our Leadership Conference a
champion of American Medicine, AMA President-
elect Harrison Rogers was brought into the ring and
he stressed the importance of physicians keeping their
national, state and county medical societies financially
viable during these times of rapid change in the
medical care system. He told our young "golden glove
fighters" (the medical students of today) of their
responsibility to protect the health of their patients
through their membership and support of medical
societies. His message is being heard around the
country with a dramatic increase in student member-
ships in the AMA.
The AMA, in December, tiring of the "illegal
blows," "bias of the Referee," and the sometimes
"inexplicable boos" from the crowd, voted to ban both
amateur and professional boxing. However, during
the same time, SMS was putting up a great defense
and also landing offensive blows in the Special Legis-
lative Council Malpractice Committee where
strengthened peer review, a cap of $1,000,000 on
awards and limitation of attorneys' fees to a sliding
scale were approved by the Legislative Council Com-
mittee.
We crowned a champion in Milwaukee. Dr Leo R
Weinshel was named 1985 Physician-Citizen of the
Year by the Wisconsin Chamber of Commerce for his
distinguished professional and community-oriented
career. As stated in his award, concern about people
and helping them has been a way of life for Doctor
Weinshel. Because of his example the community can-
not help but better understand and appreciate the role
of Medicine as well as the contributions made by the
medical community as a whole.
SMS sent a holiday message to Governor Earl as he
was making his budget shopping list. We objected to
his proposed increases in mandated insurance bene-
fits and expansion of mental health gatekeeper func-
tion. We urged him to increase funding for public
health activities and asked him to reconsider his HMO
promotion which will utilize state funds to subsidize
HMO premiums for low-income elderly.
January was a defensive round, participating in the
medical alert on diethylstilbestrol (DES), explaining
the delay in DPT boosters, testifying at the special joint
meeting of the Assembly and Senate Health Commit-
tees and participating in a panel concerning the issue
of uncompensated care. We objected to the proposed
elimination of CME requirements for medical li-
censing in Wisconsin and then were “floored” by the
one-two punch of a proposed 70% increase in
WHCLIP premiums and 160% increase in the Patients
Compensation Fund premium for 1985! We picked
ourselves off the canvas and counterpunched effec-
tively with facts included in our "Special Update on
Medical Liability" which was distributed to SMS
members, legislators and CEOs of Wisconsin's major
corporations. This produced a shower of letters on the
Insurance Commissioner and our legislators.
Dane County Circuit Court sent several trial lawyers
to the showers, halting their attempt to get SMS
records in a Milwaukee malpractice case. We picked
up the malpractice fight with offers of peer review
"punching power" to the Medical Examining Board
and to the Patients Compensation Fund to serve as a
resource to the MEB for screening panel cases, making
recommendations regarding prioritization, and also
determining if negligence has occurred in malpractice
settlements and panel awards. On March 10 we
marched around the ring with quarter-page news-
paper ads concerning reasonable expectations of
medical care. On March 28 more than "50 gladiators"
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representing county and specialty societies gathered
in Madison to review and develop malpractice
strategies.
Suddenly, out of a neutral corner, and while concen-
trating on the malpractice opponent, we were "rabbit
punched" with a blow delivered by a glove containing
a role of the Susan B Anthony dollars, bashing us into
a posture where physicians, hospitals, etc, must ac-
cept a continued physician and DRG payment freeze
in the spirit of unilaterally supporting the burden of
the Federal deficit dilemma. This continued freeze
beyond the legislative mandated fifteen months will
result in physicians being paid in 1986 at levels based
on 1982 charges. This now has produced concerns
among other groups, namely, the AARP, AFL-CIO,
and others.
This month we are trying to improve our "reach"
to produce better punching power. REACH, which
stands for Resource for Education and Awareness of
Community Health is the SMS program to improve
physician public communications. This brings us to
La Crosse, 1985, with our Annual Meeting dedicated
to "Cost-effective Care" of the geriatric population.
Wisconsin physicians are tired of being the object
of "low blows and rabbit punches." In resolutions 9,
10, and 11 we are now considering banning boxing.
No matter how we do it, Winston Churchill was
right; "there is so much yet to be done." Our number
one priority is malpractice reform and that's coming!
Let me share with you two excerpts from letters. First
is from Dr Ralph F Sortor who practices obstetrics and
gynecology in Hales Corners. It reads in part, "I am
concerned that we are the only individuals whose
license to do business in Wisconsin exists only so long
as we contribute to a Compensation Fund for all
citizens. You will note that Worker's Compensation
applies not to some, but to all employers. The pre-
mium proposed for 1985 is impossible. I cannot afford
the Patients Compensation Fund premium for doing
obstetrics. There is no way to raise my fees to cover
it. That $34,613 premium plus the interest on it, even
at the prime rate would cost me $3,274 per month,
plus all of my other overhead, just to stay in business.
I have practiced Ob-Gyn in this state for 27 years. I
have never had a civil judgment against me, not even
for malpractice. I have never had a case go to panel.
I have never had any private insurance carrier drop
me from its coverage. I have been a valuable construc-
tive citizen of the state. I should not be forced out of
business. (He concludes his letter with a quotation
from Thomas Jefferson's First Inaugural Address,
1801.) 'All, too, will bear in mind this sacred principle,
that though the will of the majority is in all cases to
prevail, that will, to be rightful must be reasonable;
that the minority possess their equal rights, which
equal laws must protect, and to violate would be
oppression.' "
The next letter is dated March 5, 1985 and is in
response to a physician constituent by State Repre-
sentative John D Medinger of La Crosse, the assistant
majority leader, and it says, "Thank you for your re-
cent letter expressing your strong concern about the
recommendation to dramatically increase payments
to the Patients Compensation Fund and other aspects
of our medical malpractice crisis. Like you, I am very
concerned about this situation. It is a problem that
affects all of us in the state, not just the medical com-
munity. It is also an immediate problem the Legisla-
ture will have to address in the next few months.
"You may know that I am a member of the Special
Study Committee on Medical Malpractice. We have
reviewed the problem and have looked at scores of
suggested changes in the system. At this time, it is too
early to accurately predict what will be recommended
by this study committee. We will meet again next
month. Physicians, lawyers, insurance company
representatives, members of the pubhc, and legislators
all have deep-felt convictions and various 'solutions.'
It is now time to quit studying the problem and to act.
"As you are probably aware, this letter, due to the
large amount of mail I have received on this subject,
is more or less a form letter. This, I must say to
everyone that I am perturbed and quite irked that
some of the letters I have received actually blame the
legislators for this crisis! I am not with you in the
operating room, I am not on the juries which grant
outrageous awards, I am not an insurance company
representative, and I have never advised anyone to
settle out of court for a huge award. I am not even a
lawyer!! What I am is your State Representative. Let's
not point fingers, let's work together. Identifying the
problem is easy. Now let's get on with the difficult
part.
"I want to assure you that you have my attention.
I will do all I can to improve the situation and to seek
an equitable solution for all concerned parties."
Thus, we (SMS) have identified the problem, we've
identified the solutions, we need action teams to talk
to other practitioners, to talk to employers, to talk to
hospital administrators, to talk to our attorneys, and
most importantly, to talk to our legislators.
The number 2 priority is membership; SMS does
represent all of the physicians of Wisconsin. I think it's
our responsibility as supporting members of SMS to con-
tact our nonmember colleagues and use the lobbying
credo, “If you can’t make him see the light, make him
feel the heat.” Our strength lies in our unity and every
physician must recognize the need to be unified. We, as
individual physicians and as an organization of physi-
cians, must continue to do what is best for the patients
of Wisconsin and I am confident this will always prove
best for the physicians of Wisconsin. ■
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ORGANIZATIONAL
"The problem of competence
or incompetence . . .
in some physicians . . . and what to do
about it. We must now cry out for public
support to change the laws as necessary
to permit legitimate peer review and
discipline by the medical society and
hospitals without fear of antitrust
violation. ' '
Report of Secretary Thayer to the House of Delegates
J\^Y REPORT TODAY DEALS with a Subject that has
long been with physicians. What's new about it is the
enormous attention it is attracting these days from the
media and legislators. It is rapidly becoming a key
issue in the resolution of the malpractice problem.
Thus, its importance cannot be underestimated. I
speak of the problem of competence or incompetence
in some physicians . . . and what to do about it.
I realize that I tread on sensitive ground. I am not
a physician. I cannot and do not attempt to judge the
competence of physicians.
But for thirty years plus, I have worked with physi-
cians, seen a great deal of good and some bad, been
faced with innumerable complaints about physician
care, heard the gripes of the public about this issue,
listened to physicians who literally beg for some
means to be relieved of the stigma that comes from
knowledge of aberrant practices. I have worked with
our Mediation and Peer Review Commission and our
Statewide Impaired Physician Program. Many states
have given up dealing with the former; as for the
latter, we have a model program with close and con-
tinuing linkage to the Medical Examining Board.
Like the physicians, I wince every time another
headline attacks the Medical Examining Board for
allegedly failing in its public responsibility to properly
"rout out the rotten few," as one news story declared.
Even though these attacks are against a state agency,
they are attacks, in effect, on physicians and their
competence.
I have just received letters from three highly
respected physicians, leaders of the profession by any
standard.
One of them says: "Legislators repeatedly tell me
that we have to clean up our own house before they
will act on the malpractice issue. They simply don't
know how difficult this is." He cited the situation of
a physician in his locality whose treatments he feels
are useless. He went on to say, "Neither my specialty
society nor myself will take this man on for fear of
countersuit. No physician can place his own life in
jeopardy in the effort to eliminate a malpractitioner
. . . under the current system."
Another doctor writes: "It is absolutely critical that
we develop an efficient avenue for ridding the medical
profession of the quacks, charlatans, and incompetent
practitioners that appear in our ranks. Everyone is
afraid to rise up and take action against them for good
reason . . . legal reprisal. This is a public issue, and it
is seriously threatening our profession. If we do not
help clean up our act, it will be difficult for us to main-
tain credibility with society in general whose aid we
must certainly solicit in order to effectively deal with
the current problems of malpractice."
Still another physician writes: "We must announce
our own private sector effort to do something about
this issue. The only agency that can truly analyze the
quality of one's work is another physician who is free
of any encumbrance that would interfere with the
effort. I am sure some of our members will wonder
why in hell we are dipping our fat heads into some-
thing so controversial, and I know that the majority
of physicians do a good job and should be praised.
Therefore, I feel that our effort would result in praise
for the good and doing something effective about the
bad."
Dealing with the incompetent or aberrant physician
has always posed a problem. In 1904—81 years ago—
the Wisconsin Medical Journal reported that the State
Medical Society was under fire from a group of its own
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REPORT OF SECRETARY THAYER
members because it was advocating that statutes be
enacted to require physicians to show evidence of
accredited medical school graduation before being
licensed in Wisconsin. To oppose the Society in its
well-intended effort for the public and professional
good, several physicians organized the Wisconsin
Medical Union— the first physician union in Wiscon-
sin, if not in the country. A circular put out by the
union said that its objective was "to unite the liberal
minded physicians," among them homeopaths, eclec-
tics, and physiomedical practitioners, for "mutual pro-
tection against unjust statutes."
The editor of the Medical Journal commented about
the officers of this union:
"One poses as an electro-therapeutist, but formerly prac-
ticed vita-therapy."
"A second is the graduate of a diploma mill whose
organizers have since served time in Joliet."
"A third and fourth are graduates of the famous Mil-
waukee Eclectic College which, in reality, existed only for
the sale of diplomas."
"A fifth is practicing under a certificate of registration
issued by the Wisconsin Board of Medical Examiners. He
bought a diploma from the Illinois Health University, but
perjured himself in obtaining a certificate of registration
by claiming that during the year 1898, he was practicing
in Wisconsin when as a matter of fact he was serving time
in Waupun for adultery."
The editor of the Medical Journal continued with
this concluding note: "We are told that this informa-
tion has long been in possession of the State Board of
Medical Examiners, but they have thus far neglected
to take any action on this matter."
The familiar ring of those words prompts me to sug-
gest that we dare not wait another 81 years to deal in
a forthright manner with the issue of the profession
policing itself. We must no longer excuse inaction by
the Medical Society or the hospital by saying, "FTC
won't let us do that." There is some truth in the ex-
cuse. But we must now cry out for public support to
change the laws as necessary to permit legitimate peer
review and discipline by the Medical Society and hos-
pitals without fear of antitrust violation.
We must openly confess to the public that the State
Medical Society, while it can and does discipline some
of its members for inappropriate practice actions, has
none of the ultimate clout necessary to remove a
physician from practice. Such authority rests only in
the hands of the Medical Examining Board which,
contrary to some publicity, is properly and totally
independent of the State Medical Society.
The Board is a state agency. The State Medical
Society is not. If the Society is to deal with the prob-
lem, it must be given the legitimate authority to do so.
If it is not given such authority, those who cry out for
the Society to "police itself" must cry out to the
Medical Examining Board or to the Legislature.
On the other hand, the Society cannot and must not
pull into its professional shell because it doesn't have
the ultimate authority. The Society instead must
openly, publicly, energetically, and immediately ex-
pand its present efforts in peer review to pursue a
vigorous, organized, and calculated effort:
1. To prevent or reduce the number and frequency
of malpractice suits by removing or reducing the
reasons for suits— a significant percentage of which,
according to physician-owned liability carriers, are
meritorious.
2. Identify and bring under review in a prompt and
decisive fashion those physicians whose conduct ap-
pears to represent standard practice— including, but
not limited to, those physicians for whom claims have
resulted in payment to plaintiffs on multiple occa-
sions.
3. Revamp our disciplinary procedures to a degree
that is acceptable to both an aware public and an
enlightened profession.
I suggest that the Society begin immediately with
appointment of a special task force of SMS members
supplemented with the necessary legal and other
talent to coordinate the Society's work in this field
with the current efforts of the state Legislature and the
Medical Examining Board. A number of proposals
should be considered:
1. Let us begin with the Governor. The credibility
of the Board as a disciplinary body and, to a substan-
tial degree, its ability to adequately perform its func-
tions will depend on the quality of the Governor's ap-
pointees. There have been occasions in past years
when those appointments were less than sterling. It
is time for the Governor to look only for quality of
person and practice, not quantity of political contribu-
tion, as the primary criterion for appointment to this
Board.
2. The workload of the Board falls heavily on eight
physicians of the current 10-member Board. They are
the principal individuals responsible to evaluate the
competence of physicians who come before them.
With the current volume of complaints filed with the
Board— some 300 per year— it may be necessary to ex-
pand by two or three the number of physicians on the
Board, or to authorize that Board to delegate certain
peer review functions to contracted physicians in
various specialties. The State Medical Society Medi-
caid Medical Audit Committee, which has such a con-
tractual relationship with the Wisconsin Department
of Health and Social Services, is regarded as a national
model of an effective way to accomplish necessary
review by competent individuals in a timely fashion
to serve the interests of the public. The Medical Exam-
ining Board should immediately consider such con-
tracting for its work.
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3. Civil immunity must be provided without equi-
vocation to all who act in good faith in any capacity
associated with bona fide peer review processes, in-
cluding protection for those who simply inform the
MEB of alleged inappropriate medical care or practice.
Without this protection, we will never have an effec-
tive investigative or disciplinary system.
4. SMS, together with the Patients Compensation
Fund and all primary carriers must jointly establish
a coordinated incident reduction program aimed at
better management of patient care, the use of widely
accepted malpractice prevention techniques, and
public education for better understanding of medical
liability, the risks of medical and surgical treatment,
and the role of over-expectation in the cause of liability
actions. A Fund fearful of a $74,000,000 deficit this
year certainly could spare at least $100,000 per year
to help stem the "flood" of alleged malpractice inci-
dents. By the way, let's put the situation in perspec-
tive. There are some 50,000,000 individual patient-
physician encounters in Wisconsin every year. Some
of these encounters, about 400 each year, lead to alle-
gations of malpractice. While each of those is unfor-
tunate, it must be noted that only 400 out of 50 million
encounters produce a result so serious as to initiate
litigation. One-third of these are soon dismissed as
without merit.
5. The Medical Society in its sponsored liability
plan, "The Professionals," and possibly the Patients
Compensation Fund for all practicing physicians
should seriously consider mandatory participation in
risk management programs as a condition of contin-
uing liability coverage. In fact, such a requirement
may be a useful replacement for the present law man-
dating general continuing medical education.
6. The SMS, with legislatively required support
from the Insurance Commissioner's Office, the MEB,
and the PCF, should undertake continuing data col-
lection and analysis of all medical liability claims in-
cluding claims settled at any stage. The absence of ac-
curate information on the etiology of medical liability
claims in Wisconsin is nothing short of appalling given
the enormity of the economic, legal, medical, and
social problems associated with this issue. Without
availability and analysis of this data, the reporting re-
quirements currently being proposed will produce
valuable information which may well go unutilized as
a critically needed management tool for the control of
medical malpractice.
7. Senator Van Sistine has called for improvements
in the credentialing and peer review process of hos-
pital medical staffs. The State Medical Society and
WHA have assured their cooperation. This is no small
task. We must get at it.
8. We must seek immediately some responsible
way to integrate into the entire peer review process
the findings of PRO (WiPRO) and similar peer review
efforts undertaken on a private basis. At the very least,
this requires the convening of a group representing the
SMS, WHA, MEB, PCF, PRO, and probably legislative
and insurance interests. Hospital specific data has now
been mandated for release to the public render Medi-
care. Private patient data is next.
9. We must pass laws permitting WHCLIP and the
Wisconsin Patient Compensation Fund to surcharge
physicians who have repeated malpractice settle-
ments or awards. This may be the fastest, easiest way
to control the problem.
10. Finally, and perhaps most importantly, SMS
should initiate immediate discussions with the
Medical Examining Board, the Wisconsin Justice
Department, independent attorneys, and members of
the Legislature to seek an end to the frustration so fre-
quently associated with the legal process of attempt-
ing to discipline physicians through the Medical
Examining Board. Highly competent and reputable
physicians are Justifiably cynical when the legal
process seems so easily manipulated to save the bad
doctor. It is said that all you need to beat the Board's
rulings is a lot of money and a good attorney. There
seems to be more truth than fiction in this remark. The
Medical Society must raise hell with such a system,
and the legal profession has the obligation to join in
seeking a remedy. We should invite its participation.
There are undoubtedly other possible solutions. But
we cannot afford to wait for someone else to start the
action. The integrity of our dedicated physicians is at
stake. The public says this is your job, your respon-
sibility. They may not be totally correct, but they are
not totally wrong either.
Last summer, I took my 17-year-old grandson on a
fishing trip to Canada. One sunny afternoon when we
tired of catching walleye, we let the boat drift in the
light breeze and contemplated the quiet and the
scenery. We had been discussing my work with the
Society. With some hesitation, my grandson asked,
"Just what is the Medical Society anyway?"
I was challenged to make a simple summary of the
Society's many functions. Finally, I said the Society
tries to do two things: "It tries to help doctors be better
doctors— and it tries to help patients be healthier."
There was a brief pause and my grandson said,
"Aren't those two the same thing?"
His perception of the Society should tell you as it
does me that it is time to get moving with this matter
of "policing ourselves." It will help you. It will help
your patients. And, in the end, aren't those two the
same thing? ■
WISCONSITv MEDICAL JOURNAL, JUNE 1985 : VOL. 84
183
ORGANIZATIONAL
Wisconsin Homecare Organization (WHO)
330 East Lakeside St, Madison
Phone (608) 257-6781
A non profit organization working
toward a goal of available, acces-
sible, quality homecare throughout
the State of Wisconsin in coopera-
tion with the state-operated agency
for enforcing home health licen-
sure standards: Bureau of Quality
Compliance.
THE NAVY SEARCH
FOR EXCELLENCE
The United States Navy Medical
Command desires physicians who
want to practice medicine . . . not
be business managers. The Navy
offers specialists quality clinical ex-
perience and professional growth,
a very comfortable lifestyle with-
out financial and administrative
worries, and the valuable time to
spend with family and friends
while planning the future.
• Flight Surgery • Orthopedic
• Anesthesiology Surgery
• Otolaryngology • General
• Neurology Surgery
• Psychiatry • Neurosurgery
LOCATIONS: 23 modern medical
facilities located along the east and
west coast, as well as nine hospitals
overseas, including those in Japan,
Spain, Italy and the Philippines.
BENEFITS: Varied clinical exper-
ience; 30 days annual vacation;
world travel benefits; full malprac-
tice, medical/dental coverage;
net starting salaries from $40,000
to $55,000; non-contributive
retirement package which yields
approximately $20,000 a year
after 20 years of service, or
$30,000 a year after 30 years.
MINIMUM QUALIFICA
TIONS: State license; US citizen;
excellent professional references.
For complete details, call or send
Curriculum Vitae to: Lt Nancy Hill,
Henry S Reuss Federal Plaza, 310
W Wisconsin Ave, Suite 450, Mil-
waukee, W1 53203; 414/291-1529
(Call Collect]
house of
BIDWELL, inc.
7954 West Harwood
and Watertown Plank Road
Milwaukee, Wisconsin 53213
ORTHOTIC
AND
PROSTHETIC
SERVICES
1-414-744-6250
Radio
dispatched
truck fleet
for
INDUSTRY, INSTITUTIONS,
SCHOOLS, ETC.
AUTHORIZED PARTS
AND SERVICE FOR
CLEAVER-BROOKS
Throughout Wisconsin
and Upper Michigan
SALES
Boiler room accessories
O2 trims
Cleveland controls
and Car automatic bottom
blowdown systems
SERVICE-CLEANING
ON ALL MAKES
Complete Mobile Boiler Room
Rentals
Stevens Point— 715/344-7310
Green Bay-414/494-3675
Madison— 608/249-6604
PBBS EQUIPMENT CORP.
5401 N Park Dr
PO Box 365
Butler, WI 53007
Phone: 414/781-9620
Family Enhancement Program
A Prevention program
encouraging families to help
themselves and others
• Parents Places are centers for
parents, providing opportunities
to share resources, concerns, and
information. Children are
welcome. Childcare is provided.
• CONNECT is for young parents
and their families. Parents under
21 may receive support from
trained volunteers and parti-
cipate in special programs.
• Parent Haven is a support net-
work and group for adults in
families that are experiencing
problem behaviors with
adolescents.
• Facilitator Workshops provide
training for volunteer, parents,
and others to lead support
groups.
• Support Groups and Parent
Workshops may include those
for Fathers, Stepkmilies, Parents
of Middle School Children, and
Parents of Teens.
• Middle School Parents
• Fathers Workshop
• StepFamilies Groups
• Parents of Teenage Parents
• Dane County Task Force for
the Prevention of Teenage
Pregnancy.
In Dane County . . .
• Parents Place West, 326 South
Segoe Rd, Madison, WI 53705 (at
Covenant Presbyterian Church).
OPEN: Tuesday mornings, 9:30-
12:00.
• Parents Place East, 2425 At-
wood Ave, Madison, WI 53704
(at the Atwood Community
Center]. OPEN: Friday morn-
ings, 9:30-12:00.
• Parents Place South, 605
Spruce St, Madison, WI 53715 (at
St Mark's Lutheran Church].
OPEN: Wednesday mornings,
9:30-12:00. OPEN: 'Tuesday eve-
nings, 7:30-9:30.
• Parent Haven 605 Spruce St,
Madison, WI 53715 (at St Mark's
Lutheran Church). OPEN: Tues-
day evenings, 7:30-9:30.
184
WISCONSIN MEDICAL JOURNAL. JUNE 1985 : VOL. 84
PHYSICIANS EXCHANGE
Family Practitioner. Marshfield Clinic
Department of Family Medicine is seek-
ing a BE/BC Family Practitioner for a
new position. The physician joining the
Clinic's expanding 5-member department
will enjoy the support of one of the na-
tion's largest multispecialty groups, share
the philosophy of family-oriented care
with a preventive focus, and enjoy full
hospital privileges but without the dis-
tractions of OB or surgical responsibili-
ties. Marshfield Clinic offers an excellent
salary plus extensive fringe benefits.
Please send curriculum vitae and the
names of several references to: E Grady
Mills, MD, Family Medicine Department
Chairman, Marshfield Clinic, Marshfield,
WI 54449 or call collect at 715/387-
5168. p6-8/85
Internist to join satellite of multi-
specialty clinic in Madison, Wisconsin.
Satellite is located ten miles from Mad-
ison and has one internist already prac-
ticing. Support from all departments anti-
cipated from multispecialty clinic. Fringe
benefits and salary attractive plus ex-
cellent working conditions, environment
and associates. New satellite is growing
and additional physician is needed to give
our patients quality care. Send resume to
Dept 556 in care of the Journal. p6-8/85
Obstetrician/Gynecologist, Board eli-
gible/certified, for Green Bay metropoli-
tan area. Large multispecialty clinic with
excellent salary and benefits. Call or
write: W J Mommaerts, Administrator,
West Side Clinic, sc, 1551 Dousman St,
Green Bay, WI 53403; ph 414/494-
5611 p6-9/85
Family Practice physician MD or DO
Board eligible or certified. Contact Leon
Gilman, 4957 West Fond du Lac Ave,
Milwaukee, WI 53216 or call 414/871-
7900. 6-8/85
RATES: 50« per word, with a minimum
charge of $20.00 per ad. BOXED AD
RATES: $25.00 per column inch.
DEADLINE: Copy must be received by the
15th of the month preceding month of issue;
e.g., copy for the August issue is due July 15.
Send copy to: Wisconsin Medical Journal,
Box 1109, Madison, Wisconsin 53701; or
phone (area code 608) 257-6781; or toll-free
in Wisconsin: 800/362-9080.
MEDICAL YELLOW PAGES
West Bend, Wisconsin, General Clin-
ic, a (18) physician multispecialty group,
is seeking physicians in the specialties of
Internal Medicine, Family Practice, OB/
GYN, and Pediatrics. First-year salary
guaranteed. Corporate membership pos-
sible after one year. Excellent fringe
benefits. Located in scenic, recreational
area with close proximity to Milwaukee.
Please contact Hans W Schmelzling, Ad-
ministrator, General Clinic, 279 S 17th
Ave, West Bend, WI 53095: ph 414/338-
1123. 6tfn/85
Family Practice Physician to share
existing practice and fully equipped
medical office in Waushara County. Sal-
ary plus incentives and opportunity for
eventual purchase of practice. Excellent
recreational area, a great place to live and
raise a family. Send inquiries to Roy
Grunwaldt, Administrator, Wild Rose
Hospital, PO Box 243, Wild Rose, WI
54984; ph 414/622-3257, ext 212.
6/85
Internist-Infectious Disease Phy-
sician. The Racine Medical Clinic, a pro-
gressive cluster corporation of 32 phy-
sicians, is currently seeking an Internist-
Infectious Disease physician. Full bene-
fits, unlimited earnings and a full and
exciting practice are offered. Please con-
tact: Roger D Lacock, Administrator,
Racine Medical Clinic, 5625 Washington
Ave, Racine, WI 53406; ph 414/886-
5000. 6tfn/85
Medical Director, Hackley Hospital,
Muskegon, Michigan. Hackley Hospital,
361-bed general hospital, is seeking a
Medical Director for Northwood Center,
the hospital's 48-bed inpatient psychia-
tric unit. Candidates should be Board-
certified, possess strong leadership skills
and a commitment to multidisciplinary
treatment. The Medical Director position
is a part-time position, allowing the Medi-
cal Director to develop a strong indepen-
dent practice. Excellent financial poten-
tial and ready access to boating, fishing,
and hunting. For immediate and confi-
dential consideration, please write: Ger-
ald O'Keefe, PhD, Horizon Health Man-
agement Company, llOOJorie Blvd, Suite
230, Oak Brook, IL 60521. p6/85
Cardiology— partnership available in
Waukegan, Illinois, between Chicago and
Milwaukee. Noninvasive and general in-
ternal medicine. Affiliated with two hos-
pitals, new office. Excellent first-year
salary, then partnership. Charles Nelson,
Fox Hill Associates, 250 Regency Court,
Waukesha, WI 53186; ph 414/785-6500.
p6/85
Versatile Surgeon wanted to comple-
ment aggressive family practice group in
rural northeastern Minnesota resort com-
munity. Well-equipped 40-bed hospital
with proven surgical practice volume.
Outstanding outdoor recreational op-
portunities with time off to enjoy it.
Reply with CV to E Johnson, Ely Medical
Center, Ltd, 224 East Chapman Street,
Ely, Mn 55731; ph 218/365-3151. 6tfn/85
Psychiatrist. Full-time adult staff posi-
tion in well-established HMO serving
over 210,000 people in one of the leading
metropolitan areas of the Midwest. Join
excellent staff of 35 psychotherapists and
seven psychiatrists. Outstanding bene-
fits, competitive salaries and a flexible
work week providing time for teaching
and other professional pursuits. Send cur-
riculum vitae to; Paul J Brat, MD, Med-
ical Director, Group Health, Inc, 2829
University Avenue Southeast, Min-
neapolis, Minnesota 55414. 6-7/85
Attractive opportunity for a Board
certified/eligible family physician to es-
tablish a new community practice. The
family practitioner will be eligible for
full-hospital privileges at Beloit Memorial
Hospital, a medium-sized acute care
facility. This opportunity offers a guaran-
teed financial and start-up package. In-
quiries or CV should be directed to
Gregory K Britton, Administrative Direc-
tor, Beloit Memorial Hospital, 1969 West
Hart Road, Beloit, Wisconsin 53511; ph
608/364-5104. p6-8;g9/85
Excellent opportunity for a Board cer-
tified or eligible internist to practice
in conjunction with an 8-member Inter-
nal Medicine Department of a 26-mem-
ber multispecialty group. The group is
located in southeastern Wisconsin, in a
city of 100,000 between two major
metropolitan areas of greater than one
million. If interested, please send CV to:
Stephen L Wagner, Kurten Medical
Group, 2405 Northwestern Ave, Racine,
WI 53404. All inquiries will be kept
confidential. 6tfn/85
Family Practice physician needed
to join five family practitioners and a
general surgeon. Immediate oppor-
tunity in west central Wisconsin near
La Crosse. $45,000 first year guarantee
plus incentive. Excellent recreational
area. Community hospital. Send CV
to William L Simpson, Administrator,
PO Box 250, Sparta, WI 54656; or phone
608/269-6731. p5-7/85
WISCONSIN MEDICAL JOURNAL. JUNE 1985; VOL. 84
185
MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
continued
Wisconsin, Southeast. Board eligible/
certified family physician sought for in-
dependent practice in rural community
of 2,400 located 20 miles from Milwau-
kee. 127-bed acute care facility located
10 minutes from newly renovated office.
Call coverage available with family prac-
tice group in area. Negotiable first-year
guarantee will be provided along with
competitive benefit package. Write or
call: Joe Scholl, Fox Hill Associates,
250 Regency Ct, Waukesha, WI 53186;
ph 414/785-6500 6/85
Full-time physician wanted for es-
tablished Urgent Care center affiliated
with regional hospital. Board eligibility
or certification in primary specialty re-
quired. Competitive salary. 45-hours per
week. Benefit package. Paid malpractice.
Incentives, medium-sized city. Family-
oriented progressive community. Quality
school system, cultural advantages. Uni-
versity, abundant outside recreational op-
portunities. Send CV to Dept 558 in care
of the Journal. p6-8/85
Internist. BC/BE to join Internal Medi-
cine Department of multispecialty group.
Excellent benefits and competitive salary.
Call or write: W J Mommaerts, Admini-
strator, West Side Clinic, sc, 1551 Dous-
man St. Green Bay, WI 53403;
ph 414/494-5611 p6-9/85
Family Practitioner needed to join
established Family Practice group in East
Central Wisconsin city of 50,000 on
beautiful Lake Winnebago. Competitive
salary, fringes, excellent recreation area.
Send CV to MS Knier, MD, 555 S Wash-
burn, Oshkosh, Wis 54901; 414/426-0265.
lOtfn/84
Board Eligible Orthopedic Surgeon to
join established orthopedic practice in
East Central Wisconsin. Contact Dept 553
in care of the Journal. 2tfn / 85
Otolaryngologist. BC/BE to join busy
ENT Department within 23-member
multispecialty group. Excellent benefits
and competitive salary. Call or write: W J
Mommaerts, Administrator, West Side
Clinic, sc, 1551 Dousman St, Green
Bay, WI 53403; ph 414/494-5611.
6-9/85
Family Physician wanted to join med-
ical clinic in small community in north-
western Wisconsin— salary or purchase
agreement. Excellent recreational, educa-
tional, and hospital advantages. Send cur-
riculum vitae to Dept 559 in care of
the Journal. 6-8/85
Wanted Board Certified Otolaryngol-
ogist. Head and neck surgeon. Join active
one-man practice. General otolaryngol-
ogy, head and neck surgery, facial plastic
surgery, nasal allergy. Computerized of-
fice with x-ray, audiologist, and hearing
aid dispensing. Northern Wisconsin near
Apostle Islands National Lakeshore. Con-
tact James A Hamp, MD, ENT Profes-
sional Associates, SC, 2101 Beaser Ave,
Suite 1, Ashland, WI 54806; ph 715/682-
9311. 4-9/85
Family Physicians, Ophthalmologist,
Orthopedist needed to join 30 physicians
of the Olmsted Medical Group of Roches-
ter. Opportunities available in main office
and satellites. Exceptional salary and
benefit package provided in a choice pro-
fessional and cultural community. Contact
James E Hartfield, MD, Medical Director,
210 Ninth Street SE, Rochester, MN
55903; ph 507/288-3443. 5-7/85
$100,000 + Guarantee
Plus other incentives for approved
physicians in the following specialties
in mid-Michigan community—
• Obstetrician-Gynecologist
• Orthopedic Surgeon
• General Surgeon
• Family Practitioners
• ENT
• Urologist
• Pediatrician
• Internists
Contact: Vice President of Professional Services
(517) 723-5211, ext. 1823
186
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
continued
Internist with or without subspecialty
interest. Board Certified or eligible, to
join six other internists in a well-estab-
lished, 23-man expanding multispecialty
group in prosperous lakeside south-
eastern Wisconsin city of 36,000. The
Internal Medicine Department currently
has subspecialties in cardiology, pul-
monary medicine, and medical on-
cology. Liberal fringe benefits. Initial
salary plus percentage as associate.
Full status in service corporation, with
incentive-oriented formula after first
year. Contact J F Kuglitsch, MD, Fond du
Lac Clinic, SC, 80 Sheboygan St, Fond
du Lac, Wis 54935; ph 414/923-7420
collect. 5tfn/85
OB/GYN, and internist to join seven-
doctor family practice clinic in Cloquet,
Minnesota, a community of 14,000 (30,
000) service area, located 20 minutes
from Duluth-Superior. Clinic facility is
located one block from modern, well-
equipped, 77-bed hospital. Cloquet
enjoys a stable economy (forest
products). Additionally our community
is noted for its excellent school system.
First-year salary guarantee; paid mal-
practice, health, and disability insur-
ance; vacation and study time. Con-
tact John Turonie, Administrator,
Raiter Clinic Ltd, 417 Skyline Blvd, Clo-
quet, Minnesota 55720. Telephone
218/879-1271. 4-6/85
Internist. BC/BE internist needed to
join four internists in multispecialty
group in NE Wisconsin. Competitive
salary and benefits. Both subspecialty
and general medicine inquiries welcome.
Send CV to Neil Binkley, MD, 1510 Main
St, Marinette, Wis 54143; ph 715/735-
7421. 5-7/85
Family Practitioner needed to join two
FPs at the Ellsworth, Wisconsin office
of a progressive eleven-physician group.
Liberal fringes and financial package.
Forty miles from metropolitan Min-
neapolis/St Paul. Contact R M Hammer,
MD, River Falls, W1 54022; ph 715/425-
6701 or 612/436-8809. 4tfn/85
Wisconsin-BC/BE Pediatrician to
assume an established position of a
pediatrician leaving. Join a three-man
pediatric department. Call or write:
David L Lawrence, MD, 92 E Division
St, Fond du Lac, WI 54935; ph 414/
921-0560. p3-8/85
Madison, Wisconsin. Experienced phy-
sician for ambulatory care center. Medic-
East, first and only independent ACC in
Madison. Now well established. Located
in heart of Eastside of Madison. Appli-
cants BC/BE demonstrated experience in
primary care, well-developed com-
munication skills. Competitive salary, ex-
cellent benefits, attractive practice setting.
Contact David A Goodman, MD, Medic-
East, 2810 E Washington, Madison, WI
53704; ph 608/244-1213. ltfn/85
Wanted— Qualified physician to prac-
tice emergency medicine in southeastern
Wisconsin. Our group is small and flexi-
ble. Salary is negotiable. If interested, send
CV to Associated Emergency Room Phy-
sicians, SC, 1131 Sherwood Lane, Cale-
donia, Wis 53108; ph 414/835-4489.
4-6/85
Family Physician and Internist, Pedi-
atrician, OB/GYN, Board eligible /certi-
fied. Full or part-time, to join a busy,
established group of physicians in Mil-
waukee. Attractive income. Send cur-
riculum vitae to PO Box 17366, Milwau-
kee, WI 53217. 2-7/85
Family Practice opportunity to join a
four-physician family practice group in
south central Wisconsin city of 15,000.
Pleasant community atmosphere within
TIV2 hours of Madison and Milwaukee.
Excellent recreational area. First year
guaranteed salary. Contact: Chad
Burchardt, Business Manager, Medical
Associates of Beaver Dam, Wis 53916; ph
414/887-7101. 5tfn/85
Physicians needed full or part-time to
perform light physicals. Milwaukee area.
Professional liability provided. Phone
414/344-2100, Ms Jenkins. lOtfn/84
FAMILY PRACTITIONERS
INTERNISTS, OB/GYN
The UW Office of Rural Health is seek-
ing primary care specialists for more
than 50 communities throughout Wis-
consin. Opportunities are available
throughout Wisconsin for Board certi-
fied physicians trained in US medical
schools and residencies.
CONTACT:
Laurie Glowac or Fred Moskol
New Physicians for Wisconsin
University of Wisconsin
Department of Family Medicine
777 S Mills St, Madison, WI 53715
Phone: 608/263-4095 7/84;6/85
Wanted— Board qualified— board cer-
tified obstetrician-gynecologist as an
associate. Modern well equipped facility.
Excellent starting salary and benefits in-
cluding profit sharing plan. Please contact
Elizabeth Allen Steffen, MD, 734 Lake
Ave, Racine, Wis 54303. 9tfn/83
Second Family Practitioner needed to
staff a satellite of a 38-physician multi-
specialty group in Kiel, a beautiful small
community in East Central Wisconsin. At-
tractive income arrangements, association
membership possible after one year, pen-
sion and profit sharing, extensive fringe
benefits. Contact R B Windsor, MD, 1011
North 8 St, Sheboygan, WI 53081; ph 414/
457-4461. c2tfn/85
Family Practice Physician to share fully
equipped medical office in central Wis-
consin city. Opportunity for partnership
and eventual purchase of practice. Excel-
lent recreational, educational, hospital,
and civic advantages. Send curriculum
vitae to Dept 503 in care of the Journal.
6tfn/ 82
Internist or Family Practitioner to join
two Internists and General Surgeon in
growing, established. Green Bay area
practice. Send CV to John Brusky, MD,
1203 South Military Ave, Green Bay, WI
53404. 7tfn/84
PHYSICIANS WANTED
Full or part-time PHYSICIANS
WANTED for emergency room
work throughout Wisconsin.
National Emergency Services
offers excellent income, paid
malpractice insurance, and
flexible scheduling. If you're
interested in exploring opportuni-
ties with NES and you would
like additional information, call
James Lucas at 1-800/537-3355.
5-7/85
US Air Force Medical Corps Cur-
rently has opportunities for specialty
physicians. Excellent benefits and
attractive practice settings world-
wide, ranging from small clinics to
1,000-bed medical centers. Positions
currently available include Family
Practice, Internal Medicine, Cardiol-
ogy, Psychiatry, General and Ortho-
pedic Surgery, Otorhinolaryngology,
as well as Aerospace Medicine. For
qualifications and more information
write to 310 W Wisconsin Ave, Suite
380, Milwaukee WI 53202-2278,
Attn: Capt Sealey or call 1-800/242-
USAF. 5-7/85
WISCONSIN MEDICAI. JOURNAL, JUNE 1 985: VOL. 84
187
MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
continued
Family Practitioner. The Racine Medi-
cal Clinic, a progressive cluster corpor-
ation of 31 -physicians is currently seek-
ing a family practitioner. Full benefits,
unlimited earnings, and a full and ex-
citing practice are offered. Please contact
Roger D Lacock, Administrator, Racine
Medical Clinic, 5625 Washington Ave,
Racine, WI 53406; ph 414/886-5000.
4tfn/85
Immediate opportunities for qualified
physicians who possess excellent clinical
and communication skills to join long-
standing group of Emergency Physicians.
Positions available in a popular Wiscon-
sin area bordering Illinois. If interested,
send resume to Barbara Wilczynski,
Medical Emergency, Service Associates
(MESA), SC, 15 S McHenry Road, Suite 2,
Buffalo Grove, IL 60090 or call collect
312/459-7304. 6tfn/83
Medical Director. New position in 50-
physician multispecialty clinic. To work
with administrative team and profes-
sional staff, plus part-time medical prac-
tice. For more information contact
James R Stormont, MD, The Monroe
Clinic, Monroe, Wis 53566; ph 608/328-
7000. p5-7/85
MEDICAL FACILITIES
Family Practice for sale in Milwaukee.
Ideal starter or satellite office. Excellent
patient goodwill. Fully equipped and fur-
nished three examining rooms, waiting
room, and office. Approximately 900 sq
ft. Contact Greg Rodenbeck, DDS, 1200
E Oklahoma Ave, Milwaukee, Wis 53207;
414/481-8111. glOtfn/84
Medical equipment, examining tables,
treatment tables, instrument cabinets,
etc. Available in June at no cost. Re-
tiring. Phone 414/284-2676. 5/85
Medical practice or equipment for
sale in Milwaukee. Completely equip-
ped, modern office with a modern
x-ray machine. I am retiring. Please
call 414/272-0250 or 414/962-9382 for
an appointment. 5/85
S W Florida Island Paradise
General practice with fully-
equipped medical building
on 5 acres.
Sterling Inti Investments
813/337-1616
p/85
Family Practice office available in
southwestern Wisconsin. Contact Dept
557 in care of the Journal. 6/85
Beaver Dam, Wisconsin. New medical
office 1250 or 2500 sq ft office space
available. Excellent opportunity for Der-
matology or Allergy practice. Call 414/
887-8887 or write PO Box 678, Beaver
Dam, WI 53916. 5-8/85
MISCELLANEOUS
Physicians Signature Loans to$50,000.
Up to 7 years to repay. Competitive fixed
rate, with no points, fees, or charges
of any kind. No prepayment penalties.
Prompt, courteous service. Physicians
Service Assn, Atlanta, GA. Toll-Free (800)
241-6905. lOeom/83
South West Florida
Real Estate investments,
commercial or residential.
Discrete professional
service.
Sterling Inti Investments
3049 Cleveland Ave, #255
Fort Myers, Florida 33901
813/337-1616 p/85
LA CROSSE HEALTH AND
SPORTS SCIENCE
SYMPOSIUM
October 30-November 2, 1985
"Four Conferences in One" de-
signed to provide you with the op-
portunity to listen, to observe, and
to interact with a 64-member
faculty composed of nationally re-
knowned speakers possessing an
overwhelming amount of expertise
in the specialty areas of:
• Cardiac Rehabilitation
• Exercise Testing and Prescription
• Obesity and Weight Control
• Orthopaedic and Sports Injuries
• Wellness in the Hospital and
Corporate Setting
In addition, pre-symposium work-
shops on related topics consisting
of lecture and practicum are of-
fered Tuesday pm, October 29 and
Wednesday am, October 30.
For detailed information write or
call: Philip K Wilson, Executive
Director, La Crosse Exercise Pro-
gram, 221 Mitchell Hall/UWL,
La Crosse, WI 54601; ph 608-785-
8686. 6/85
MEDICAL MEETINGS-
CONTINUING MEDICAL
EDUCATION
WISCONSIN
JULY 18-20, 1985: Wisconsin Society of
Obstetrics & Gynecology, Olympia Re-
sort, Oconomowoc. g2-6/85
JULY 25-27, 1985: 5th Annual Green
Lake Conference: Ambulatory Care. Info:
Patrick E Linton, Berlin Memorial Hos-
pital, 225 Memorial Dr, Berlin, WI 54923;
ph 414/361-1313.
g6-7/85
SEPTEMBER 6-8, 1985: Wisconsin
Society of Anesthesiologists, American
Club, Kohler. g5-8/85
SEPTEMBER 12-14, 1985: Wisconsin
Society of Internal Medicine/American
College of Physicians Annual Meeting—
30th Anniversary, the Pioneer Inn, Osh-
kosh. Info: Wisconsin Society of
Internal Medicine, 611 E Wells St, Mil-
waukee, Wis 53202; ph 414/276-6445.
Contact: Sandra M Koehler, Executive
Director. 5-8/85
SEPTEMBER 13-14, 1985: Wisconsin
Neurosurgical Society, Sheraton, Racine.
g5-8/85
THIS LISTING is compiled by the State
Medical Society of Wisconsin in coopera-
tion with others who wish to maintain a
centralized schedule of meetings and
courses of interest to Wisconsin physicians
and to avoid scheduling programs in conflict
with others. Hospitals, Clinics, Specialty
Societies, and Medical Schools are par-
ticularly invited to utilize this listing service.
There is a nominal charge for listing of Con-
tinuing Medical Education courses at the
following rates: 50<t per word, with a mini-
mum charge of $20.00 per listing.
BOXED LISTINGS: $25.00 per column
inch. Listings of other scientific meetings
will be included at the discretion of the
editors.
COPY DEADLINE tor listings is 15th of the
month preceding the month of publication;
e.g., copy for the August issue is due by July
15. Address communications to: Wisconsin
Medical Journal, Box 1109, Madison, Wis-
consin 53701; or phone (area code 608)
257-6781; or toll-free in Wisconsin; 800/
362-9080.
FOR LISTING of other meetings see the
January 4, 1985 issue of the Journal of the
American Medical Association: Continuing
Education Opportunities for Physicians for
period January 1985 through December
1985.
188
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
MEDICAL YELLOW PAGES
MEDICAL MEETINGS-
CONTINUING MEDICAL
EDUCATION
continued
SEPTEMBER 13-14, 1985: Wisconsin
Surgical Society, Paper Valley Hotel &
Conference Center, Appleton. g2-8/85
SEPTEMBER 27-28, 1985: Wisconsin
Neurological Society, Paper Valley
Hotel & Conference Center, Appleton.
g5-8/85
OCTOBER 10-11, 1985: Wisconsin
Chapter, American College of Emer-
gency Physicians, The Abbey, Lake
Geneva. g5-9/85
OCTOBER 30 NOVEMBER 2, 1985:
La Crosse Health and Sports Science Sym-
posium. Info: Philip K Wilson, Executive
Director, La Crosse Exercise Program, 221
Mitchell Hall/UWL, La Crosse, W1 54601;
ph 608/785-8686. g6-9/85
NOVEMBER 1, 1985: Wisconsin Ortho-
paedic Society, The Olympia Resort,
Oconomowoc. g6-10/85
SEPTEMBER 20-22, 1985: Wisconsin
Society of Otolaryngology— Head and
Neck Surgery, Apple Valley Motel, Apple-
ton. g6-9/85
SEPTEMBER 26, 1985: Folk Medicine
and Refugees. The Wisconsin Center,
Madison. Sponsored by Dept of Con-
tinuing Medical Education, University of
Wisconsin-Madison; Wisconsin Dept of
Health and Social Services, Division of
Health, Bureau of Community Health and
Prevention, Refugee Health Program; and
School of Medicine, University of Wis-
consin-Madison. AMA Category I, AAFP
Prescribed, AOA Category 2-D, and Uni-
versity of Wisconsin CEU's— all approxi-
mately six hours. Contact; Sarah Aslakson,
Dept of Continuing Medical Education,
Room 465B WARE Bldg, 610 Walnut St,
Madison, W1 53705; ph 608/263-2856.
6/85
Wisconsin Specialty
Society Meetings
• Wisconsin Society of Obstetrics &
Gynecology, July 18-20, 1985,
Olympia Resort, Oconomowoc
• Wisconsin Society of Anesthesiolo-
gists, Sept 6-8, 1985, American
Club, Kohler
• Wisconsin Society of Physical Medi-
cine & Rehabilitation, Sept 11, 1985,
Sheraton Inn, Milwaukee
• Wisconsin Society of Internal Medi-
cine/American College of Physi-
cians Annual Meeting, Sept 12-14,
1985, Pioneer Inn, Oshkosh
• Wisconsin Surgical Society, Sept
13-14, 1985, Paper Valley Hotel &
Conference Center, Appleton
• Wisconsin Neurological Society,
Sept 27-28, 1985, Paper Valley Hotel
& Conference Center, Appleton
• Wisconsin Society of Otolaryngology
—Head and Neck Surgery, Sept 20-
22, 1985, Apple Valley Motel, Apple-
ton
• Wisconsin Dermatological Society,
Oct 26, 1985, Froederdt Memorial
Lutheran Hospital, Milwaukee
• Wisconsin Orthopaedic Society,
Nov 1, 1985, The Olympia Resort,
Oconomowoc
OCTOBER 26, 1985: Wisconsin Derma-
tological Society, Froederdt Memorial
Lutheran Hospital, Milwaukee. g6-9/85
AUGUST 1-3, 1985: Practical Approaches
to Managing Trauma, Fox Hills Resort/
Conference Center, Mishicot. Info: Bonnie
Fifth Annual Green Lake Conference
Ambulatory Care
Thursday-Saturday, July 25-27, 1985
The Heidel House Resort & Conference Center
Green Lake, Wisconsin
Objective: To review basic principles and recent advances in am-
bulatory medicine.
Program topics
• The Primary Approach to Health Maintenance
• The Evaluation of Patients with Dizziness
• The Management of Sinusitis, Otitis and Pharyngitis
• Normal Weight Control in Obesity
• Outpatient Use of Antibiotics
• Cardiac Arrhythmias— To Treat or Not to Treat
• Acute Soft Tissue Injuries (Sports Medicine)
• Arthritis— The Treatment of Inflammation
• Dysfunctional Uterine Bleeding
Credit: As an organization accredited for Continuing Medical
Education, Berlin Memorial Hospital has certified this program
for 12 hours of Category I. This program has applied for 12 pre-
scribed hours by the American Academy of Family Physicians.
For more information contact: Patrick E Linton, Berlin
Memorial Hospital, 225 Memorial Drive, Berlin, Wiscon-
sin 54923; ph 414/361-1313.
k:
WISCONSIN MEDICAL JOURNAL. JUNE 1985 : VOL. 84
189
MEDICAL YELLOW PAGES
MEDICAL MEETINGS-
CONTINUING MEDICAL
EDUCATION
continued
Young CME, St Paul-Ramsey Medical
Center, 640 Jackson St, St Paul, MN
55101. g6-7/85
NOVEMBER 14-16, 1985 (Minnesota):
Clinical Strategies In Primary Care Medi-
cine, Radisson Plaza Hotel, St Paul. Info:
Bonnie Young, CME, St Paul-Ramsey
Medical Center, 640 Jackson St, St Paul,
MN 55101; ph 612/221-3977. g6-10/85
OTHERS
AUGUST 1-4, 1985: Second Annual St
Paul-Ramsey Trauma Conference (Fishing
& Family Recreation), Fox Hills Resort,
Mishicot. Info: St Paul-Ramsey Medical
Center, Continuing Medical Education,
640 Jackson St, St Paul, MN 55101; ph
612/221-3977. g3/85
AUGUST 1-4, 1985 (Georgia): Inter-
national Doctors in Alcoholics Anonymous
Annual Meeting. Hyatt Regency Hotel,
Savannah. Reservations may be made at
a later date when specific details and in-
structions are published. For further infor-
mation contact: Information Secretary,
IDAA, 1950 Volney Road, Youngstown,
Ohio 445 1 1 ; ph 2 1 6 / 782-62 1 6. g 1 2t f n / 84
SEPTEMBER 9-20, 1985 (Minnesota):
Third Annual Graduate Occupational
Health and Safety Institute, Earle Brown
Continuing Education Center, St Paul,
MN. Info: Bonnie Young, CME, St Paul-
Ramsey Medical Center, 640 Jackson St,
St Paul, MN 55101; ph 612/221-3977.
g6-8/85
SEPTEMBER 19-21, 1985 (Minne-
sota): Pulmonary and TB Update, Radisson
Plaza Hotel, St Paul. Info: Bonnie Young,
CME, St Paul-Ramsey Medical Center,
640 Jackson St, St Paul, MN 55101; ph
612/221-3977. g6-8/85
OCTOBER 17-18, 1985 (Minnesota):
Toxic Chemicals in the Workplace: Health,
Legal, and Regulatory Issues, Earle Brown
Continuing Education Center, St Paul.
Info: Bonnie Young, CME, St Paul-
Ramsey Medical Center, 640 Jackson St,
St Paul, MN 55101; ph 612/221-3977.
g6-9/85
OCTOBER 25, 1985 (Minnesota): Pro-
moting Healthy Lifestyles For Pregnant
Women, Earle Brown Continuing Educa-
tion Center, St Paul. Info: Bonnie Young,
CME, St Paul-Ramsey Medical Center,
640 Jackson St, St Paul, MN 55101; ph
612/221-3977. g6-9/85
OCTOBER 31 NOVEMBER 1, 1985
(Minnesota): Latest Trends in Patient
Management: Radiology and Urology,
Radisson Plaza Hotel, St Paul. Info: Bonnie
Young, CME, St Paul-Ramsey Medical
Center, 640 Jackson St, St Paul, MN
55101. g6-10/85
DECEMBER 7-1 1, 1985 (Florida): I2th
Annual Symposium "Ear, Nose and Throat
Diseases in Children: A 1985 Update, " Palm
Beach. Info: Sandra K Arjona, Dept of
Pediatric Otolaryngology, Children's
Hospital of Pittsburgh, 125 DeSoto St,
Pittsburgh, PA 15213; ph 412/647-5466.
6,8/85
UPCOMING CME PROGRAMS
SPONSORED BY ST PAUL-
RAMSEY MEDICAL CENTER
Practical Approaches
To Managing Trauma
Aug 1-3, 1985/Fox Hills Resort/
Conference Center, Mishicot, WI
Third Annual Graduate Occupational
Health and Safety Institute
Sept 9-20, 1985 /Earle Brown
Continuing Education Center,
St Paul, MN
Pulmonary and TB Update
Sept 19-21, 1985/Radisson Plaza Hotel,
St Paul, MN
Toxic Chemicals In The Workplace:
Health, Legal, and Regulatory Issues
Oct 17-18, 1985/Earle Brown
Continuing Education Center,
St Paul, MN
Promoting Healthy Lifestyles
For Pregnant Women
Oct 25, 1985/ Earle Brown
Continuing Education Center,
St Paul, MN
Latest Trends In Patient Management:
Radiology and Urology
Oct 31-Nov 1, 1985/
Radisson Plaza Hotel, St Paul, MN
4th Annual Update: Clinical
Strategies In Primary Care Medicine
Nov 14-16, 1985/
Radisson Plaza Hotel, St Paul, MN
Coronary Heart Disease:
A Comprehensive Review
of Principles And Practice
Dec 5-7, 1985 / Sheraton Midway Hotel,
St Paul, MN
Information and registration: Bonnie
Young, Continuing Medical Education,
St Paul-Ramsey Medical Center, 640
Jackson St, St Paul, MN 55101; ph
612/221-3977, 6/85
AMA
DECEMBER 8-11, 1985: Interim AMA
House of Delegates, Washington, DC.
JUNE 15-19, 1986: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 7-10, 1986: Interim AMA
House of Delegates, Las Vegas, NV.
JUNE21-25, 1987: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 6-9, 1987: Interim AMA
House of Delegates, Atlanta, GA.
JUNE 26-30, 1988: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 4-7, 1988: Interim House
of Delegates, Dallas, TX. ■
ADVERTISERS
Acme Laboratories 6
Advanced Technology Associates,
Inc 11
Medical Computer Systems
American Physicians Life 12
Centralized Billing Systems 130
Dista Products Co (Div of Eli
Lilly & Co) 13
Ceclor®
House of Bid well 184
Knoll Pharmaceutical Co . 140, 141, 142
Isoptin®
Marion Laboratories 135, 136
Cardizem®
MedFlight 7
Medical Protective Company 10
Navy Medical Programs 184
PBBS Equipment 184
Peppino's 6
PrimeCare Health Plan
of Wisconsin 9
Professionals Insurance
Company, The 17
Roche Laboratories 191, 192
Dalmane®
SK&F Company 139
Dyazide®
S & L Signal Company 6
SMS Services, Inc 16
Squibb & Sons,
Inc, E R 19, 20, 21, 22
Velosef®
United States Army Active 150
Upjohn Company, The 137, 138
Motrin® ■
190
WISCONSIN MEDICAL JOURNAL, JUNE 1985: VOL. 84
COMPLETE
LABORATORY
DOCUMENTATION . . . EXTENSIVE
CLINICAL PROOF
FOR THE PITEDiaADILITY
CONFIITMED BY EXPEP.IENCE
DMMAHEc
flurozepom HCI/Roche
THE COMPLETE HYPNOTIC
PROVIDES ALL THESE BENEFITS:
• Rapid sleep onset' "
• More total sleep time' "
• Undiminished efficacy for at least
28 consecutive nights' "
• Patients usually awake rested and refreshed'^
• Avoids causing early awakenings or rebound
insomnia after discontinuation of therapy' " "
Caution patients about driving, operating hazardous machinery or drinking
alcohol during therapy. Limit dose to 15 mg m elderly or debilitated patients
Contraindicated during pregnancy.
DALMAHE^
flurozepom HCI/Poche
References: 1. Kales J et al: Clin Pharmacol Ther
72:691 -697, Jul-Aug 1971 . 2. Kales A et al: Clin Phar-
macol Ther 78:356-363, Sep 1975 3. Kales A etai
Chn Pharmacol Ther 79:576-583, May 1976 4, Kales A
et al: Clin Pharmacol Ther 32:781-788, Dec 1982
5. Frost JD Jr, DeLucchl MR: J Am Gehatr Soc
27:541-546, Dec 1979. 6. Kales A. Kales JD: J Clin
Pharmacol 3:140-150, Apr 1983 7. Greenblatt DJ,
Allen MD, Shader Rl: Clin Pharmacol Ther 21 .355-361 ,
Mar 1977 8. Zimmerman AM: Curr Ther Res
73:18-22, Jan 1971. 9, Amrein R et al: Drugs Exp Clin
Res 9(1):85-99, 1983 10. Monti JM: Methods Find Exp
Clin Pharmacol 3:303-326, May 1981. 11. Greenblatt DJ
etal: Sleep 5(Suppl 1):S18-S27 1982. 12. Kales A
etal: Pharmacology 26:121-137. 1983.
DALMANE« ®
flurazepam HCI/Roche
Before prescribing, please consult complete
product information, a summary of which foiiows:
indications: Effective in all types of insomnia charac-
terized by difficulty in falling asleep, frequent nocturnal
awakenings and/or early morning awakening; in
patients with recurring insomnia or poor sleeping hab-
its; in acute or chronic medical situations requiring
restful sleep. Objective sleep laboratory data have
shown effectiveness for at least 28 consecutive nights
of administration. Since insomnia is often transient
and Intermittent, prolonged administration is generally
not necessary or recommended Repealed therapy
should only be undertaken with appropriate patient
evaluation.
Contraindications: Known hypersensitivity to fluraze-
pam HCI: pregnancy. Benzodiazepines may cause
fetal damage when administered during pr^nancy.
Several studies suggest an increased risk of congeni-
tal malformations associated with benzodiazepine use
during the first trimester. Warn patients of the potential
risks to the fetus should the possibility of becoming
pregnant exist while receiving flurazepam. Instruct
patient to discontinue drug prior to becoming preg-
nant. Consider the possibility of pregnancy prior to
instituting therapy.
Warnings: Caution patients about possible combined
effects with alcohol and other CNS depressants. An
additive effect may occur if alcohol is consumed the
day following use for nighttime sedation. This potential
may exist for several days following discontinuation
Caution against hazardous occupations requiring
complete mental alertness (e.g., operating machinery,
driving). Potential impairment of performance of such
activities may occur the day following ingestion. Not
recommend^ for use in persons under 15 years of
age Though physical and psychological dependence
have not been reported on recommended doses,
abrupt discontinuation should be avoided with gradual
tapering of dosage for those patients on medication
for a prolonged period of time. Use caution in adminis-
tering to addiction-prone Individuals or those who
might increase dosage.
Precautions: In elderly and debilitated patients, it is
recommended that the dosage be limited to 15 mg to
reduce risk of oversedation, dizziness, confusion and/
or ataxia. Consider potential additive effects with other
hypnotics or CNS depressants. Employ usual precau-
tions in severely depressed patients, or in those with
latent depression or suicidal tendencies, or In those
with impaired renal or hepatic function.
Adverse Reactions: Dizziness, drowsiness, light-
headedness, staggering, ataxia and falling have
occurred, particuTarly in elderly or debilitated patients.
Severe sedation, lethargy, disorientation and coma,
probably indicative of drug intolerance or overdosage,
have been reported. Also reported: headache, heart-
burn, upset stomach, nausea, vomiting, diarrhea,
constipation, Gl pain, nervousness, talkativeness,
apprehension, irritability, weakness, palpitations, chest
pains, body and joint pains and GU complaints. There
have also been rare occurrences of leukopenia, gran-
ulocytopenia, sweating, flushes, difficulty in focusing,
blurred vision, burning eyes, faintness, hypotension,
shortness of breath, pruritus, skin rash, dry mouth,
bitter taste, excessive salivation, anorexia, euphoria,
depression, slurred speech, confusion, restlessness,
hallucinations, and elevated SGOT, SGPT, total and
direct bilirubins, and alkaline phosphatase: and para-
doxical reactions, e g., excitement, stimulation and
hyperactivity.
Dosage: Individualize for maximum beneficial effect.
Adults: 30 mg usual dosage; 15 mg may suffice in
some patients Elderly or debilitated patients: 15 mg
recommended initially until response is determined
Supplied: Capsules containing 15 mg or 30 mg
flurazepam HCI.
Roche Products Inc.
Manati, Puerto Rico 00701
PROVEN IN
THE PATIENTS
HOME
DOCUMENTED
IN THE SLEEP
LABORATORY”...
FOR A COMPLETE
flurozepo
STANDS
15-MG/
5..
-v'C
-tf'
See precctSng page for references and summary trf product information.
Cof^nt^t C by Roche Products Inc. AU rights reserved.
2;
f
Official
Publication
of the
State Medical
Society
of Wisconsin
1 9 198o
The State Medical Society of Wisconsin . . .
created by the Territorial Legislature in 1841, represents
over 5700 member physicians in Wisconsin, comprising 55
county medical societies and 27 medical specialty sections.
The purpose of the Society is to "bring together the physi-
cians of the State of Wisconsin to advance the science and
art of medicine and the better health of the people of Wis-
consin, and to secure the enactment and enforcement of
just medical laws." The major activities of the Society in-
clude continuing medical education, peer review, legisla-
tion, community health education, scientific affairs, socio-
economics, health planning, services for physicians, opera-
tion of a Charitable, Educational and Scientific Foundation,
and publication of the Wisconsin Medical Journal.
f > /;•
■j
1985 Membership Directory
(see page 17)
JULY
1985
WISCONSIN
MEDICAL JOURNAL
( ^
ISSN 0043-6542 /Established 1903
Owned and published by
State Medical Society of Wisconsin
CONTENTS
July 1985
Medical Editor
Victor S Falk MD. Edgerton
Editorial Board
Victor S Falk MD, Edgerton Chairman
Melvin F Hath MD, Baraboo
M C F Lindert MD, Milwaukee
Andrew B Crummy Jr MD, Madison
Richard D Sautter MD, Marshfield
Dean M Connors MD, Madison
George W Kindschi MD, Monroe
Charles H Raine MD, Racine
Darrell L Witt MD, Wausau
Garrett A Cooper MD, Madison Emeritus
Editorial Director
Wayne J Boulanger MD, Milwaukee
Editorial Associates
R Buckland Thomas MD, Monroe
Russell F Lewis MD, Marshfield
Raymond A McCormick MD, Green Bay
Victor S Falk MD, Edgerton
Medical Editor
Staff
Earl R Thayer, Madison
Secretary-General Manager
State Medical Society of Wisconsin
H B Maroney II, Madison
Assistant Secretary-Corporate Counsel
State Medical Society of Wisconsin
Mrs Mary Angell, Madison
Managing Editor
Mrs Marjorie Stafford, Madison
Publications Assistant
Mrs Diane Upton, Madison
Editorial Assistant
NATIONAL ADVERTISING REPRESENTA-
TIVE: State Medical Journal Advertising
Bureau, Inc, 711 South Blvd, Oak Park, 111
60302. Ph 312/383-8800.
LOCAL (WISCONSINI ADVERTISING: Con-
tact: Mrs Mary Angell, Wisconsin Medical
Journal, Box 1109, Madison, Wis 53701, Ph
608/257-6781.
SUBSCRIPTION RATES: Members, $12.50
per year (included in dues): nonmembers,
$25.00, Single copy; current year, $2.00; pre-
vious years, $3.00. SPECIAL RATES: Foreign
and Canada, $30.00. Blue Book issue, $8.00.
Membership Directory issue, $15.00.
SECOND CLASS POSTAGE PAID at
Madison, Wisconsin, and at additional mail-
ing offices.
PUBLISHED MONTHLY. "Acceptance for
mailing at special rate of postage provided for
in Section 1103, Act of October 3, 1917.
Authorized August 7, 1918." Address all com-
munications to THE WISCONSIN MEDICAL
JOURNAL. Street address: 330 East Lakeside
Street. Mailing address: Box 1 109, Madison,
Wis 53701.
POSTMASTER: Send address changes to
Wisconsin Medical Journal, PO Box 1109,
Madison, Wis 53701.
COPYRIGHT 1985
State Medical Society of Wisconsin
SPECIAL FEATURES
President's Page
4 The urge to merge
John K Scott, MD
Madison
Editorials
5 It's confusing
Victor S Falk, MD
Edgerton
Madison medicine
Sharon R Manhart
Montrose, Colorado
Special
17 1985 Membership
Directory: State
Medical Society
of Wisconsin
News you can use
128 Board certification
increasing rapidly
Governor vetoes chiro-
practic coverage in
budget bill
WISCONSIN MEDICAL JOURNAL (ISSN 0043-6542) is the official publication of the State Medical
Society of Wisconsin, devoted to the interests of the medical profession and health care in Wisconsin.
Its affairs are handled by the Editorial Board, subject to policy direction of the Society's Board of
Directors. The Managing Editor is responsible for the production, business operation, and coor-
dination of contents as well as the final responsibility of the entire publication. The Editorial Director
IS responsible for Editorials. Unsigned Editorials express views consistent with the policies of the
State Medical Society of Wisconsin. Signed Editorials express personal views of the author for which
the Society takes no responsibility. Neither the Editors nor the State Medical Society will accept
responsibility for statements made or opinions expressed in the pages of the Journal. Indexed in
L'lndex Medicus," "Hospital Literature Index," and "Cambridge Scientific Abstracts."
I
V,
Vol. 84, No. 7
CONTENTS
ORGANIZATIONAL
115 County Medical Societies
List of Presidents and
Secretaries, and other
officers
118 Membership facts
121 Blue Book Update
Transposition of pages
Physicians Alliance
Commission
Task Force on Medical
Liability
Task Force on Physician
Review and Discipline
DEPARTMENTS
123 Medical Yellow PAGES:
Physicians exchange
Medical facilities
Medical meetings— con-
tinuing medical
education
Advertisers*
THE STATE MEDICAL SOCIETY OF WISCONSIN, created by the Territorial Legislature in 1841,
represents over 5700 member physicians in Wisconsin, comprising 55 county medical societies
and 27 medical specialty sections. The purpose of the Society is to "bring together the physicians
of the State of Wisconsin to advance the science and art of medicine and the better health of the
people of Wisconsin, and to secure the enactment and enforcement of just medical laws." The
major activities of the Society include continuing medical education, peer review, legislation,
community health education, scientific affairs, socioeconomics, health planning, services for
physicians, operation of a Charitable, Educational and Scientific Foundation, and publication of
the Wisconsin Medical Journal.
STATE MEDICAL
U SOCIETY
OF WISCONSIN
Officers
President: John K Scott, MD. Madison
President-Elect: Charles W Landis,
MD, Milwaukee
Secretary-General Manager:
Earl R Thayer, Madison
Treasurer: John J Foley, MD
Menomonee Falls
Board of Directors
Chairman: Darold A Treffert, MD
Fond du Lac
Vice Chairman: Roger L
von Heimburg, MD, Green Bay
First District
Jerome W Fons Jr, MD, Cudahy
Carl S Eisenberg, MD, Milwaukee
Thomas A Hofbauer, MD,
Menomonee Falls
Wayne H Konetzki, MD, Waukesha
Fredrick Wood Jr, MD. Kenosha
William L Treacy, MD, Milwaukee
Richard D Fritz, MD, Milwaukee
William J Listwan, MD, West Bend
Glenn H Franke, MD, Milwaukee
Lucille B Glicklich, MD, Milwaukee
Second District
J D Kabler, MD, Madison
Cyril M Fletsko, MD, Madison
James J Tydrich, MD, Richland Center
Alwin E Schultz, MD, Madison
Kenneth I Gold, MD, Beloit
Third District
Pauline M Jackson, MD, La Crosse
Fourth District
John J Kief, MD, Rhinelander
Jung K Park, MD, Wisconsin Rapids
W George Locher, MD, Wausau
Fifth District
Darold A Treffert, MD, Fond du Lac
Kenneth M Viste Jr, MD, Oshkosh
C William Freeby, MD, Appleton
Sixth District
Roger L von Heimburg, MD, Green Bay
Joseph C DiRaimondo, MD, Manitowoc
Seventh District
Marwood E Wegner, MD, St Croix Falls
Philip J Happe, MD, Eau Claire
Eighth District
Joseph M Jauquet, MD, Ashland
President: Doctor Scott
President-Elect: Doctor Landis
Past President: Timothy T Flaherty,
MD, Neenah
Speaker: Duane W Taebel, MD,
La Crosse
Vice Speaker: Vernon M Griffin, MD,
Mauston
PRESIDENT'S PAGE
The urge to merge
For SOME 20 YEARS I have been in the independent small group practice of
otolaryngology in Madison. Recently, in the face of what we perceive as the compe-
titive future of medical practice, I and my partners along with nearly 100 inde-
pendents, solos, and small groups of physicians, have decided to merge our separate
practices into a new group which will also form the physician core of a new HMO.
For me this is a traumatic experience; and I vow that it will not interfere with my
judgment as to what is best for my patients in the way of the care I give them. Yet, I
am concerned about the long-term effects of what we are doing and what others are
doing on a much grandeur scale.
This urge to merge is occurring all across our land. The huge Lovelace Clinic in
Albuquerque has just merged with Hospital Corporation of America. The Jackson
Clinic in Madison is talking an "arrangement" with Mayo Clinic in Rochester, Min- John K Scott, MD
nesota. The corporatization or conglomerizing of medicine is proceeding at a rapid
pace.
There are those who predict that by the year 2000 some 20 corporations will pro-
vide the medical and hospital care and insurance service for six out of every ten
Americans. The estimate is that at least half of these will be for-profit operations
with first loyalty to stockholders.
Is all this good for the patient?
New England Journal of Medicine editor Arnold Reiman says "no." For the past
five years Doctor Reiman has been a kind of Paul Revere, warning his colleagues of
the pitfalls of corporate medicine.
He fears the new money milieu will deny access to a large part of the population
who can't afford care because "if health care is distributed by income, that's what
markets do." He is repelled by the thought of physicians who involve themselves
financially in medical companies as stockholders or "owner entrepreneurs."
I agree with him that you can't have good medicine "for any patient unless doctors
work for their patients' interests first, last and foremost." As I said in my inaugural
address, now is the time for virtue in medical practice.
It is mostly one's own conscience that stands guard over that which is good treat-
ment and fair dealing for the patient despite the innumerable government regula-
tions and competitive schemes we have today. The truest guardian of good patient
care remains a physician with a good conscience.
Medicine is not practiced for governments, it is not practiced for insurance com-
panies or HMOs. It is not practiced for hospitals or for that matter, doctors. Medicine
is practiced for people. It embodies a skill and most of all, a desire by the doctor to
prevent disease or injury in human beings. . .dedication to give each patient the op-
portunity to enjoy a better quality for his or her life.
When the patient reaches out for help whether in fear or insecurity or grief, he
does not reach for a procedural manual. He does not reach for the bylaws of the hos-
pital or the HMO. He reaches for his physician's hand. He must not reach in vain.
Advocacy for the patient is our theme.
The patient's best hope, and our own, is that the physician's relationship with the
patient be one of such commitment that it will survive whatever pressures are put
upon it now or in the future by competition, market forces, or corporate and profit
motives. ■
4
WISCONSIN MEDICAL JOURNAL, JULY 1985: VOL. 86
Wayne J Boulanger, MD, Editorial Director
EDITORIALS
c
>
Unsigned editorials express views consistent with the policies of the State Medical Society of Wisconsin.
Signed editorials express personal views of the author for which the Society takes no responsibility.
It's confusing
Madison, our capital city, is
sometimes irreverently called
MAD city. It is also a hotbed of
HMOs. A recent rash of changes
there in the HMOs certainly must
be confusing to the average
patient.
U-Care is the HMO of the UW
Medical School physicians and it
dropped its affiliation with
Compcare which is the HMO
sponsored by Blue Cross-Blue
Shield United. It then joined the
Group Health Cooperative of
Central Wisconsin. Then the
physicians from Madison Gen-
eral Hospital dropped their con-
nection with Compcare and
formed a new HMO called Physi-
cian Health Plus Plan. Compcare
which is based in Milwaukee had
39,000 subscribers in Madison.
Wisconsin Physicians Service,
based in Madison, owns a third of
Physicians Plus Health Plan, an-
other third is owned by the doc-
tor's group, and the remaining
third by Madison General Hospi-
tal. Also, the Physicians Plus
Group includes 93 physicians,
mostly specialists and smaller
clinics in Madison, most of whom
had been previously signed up
with Compcare.
Prior to this affiliation, WPS
had lost out when HMOs were
developed in Madison about two
years ago. The two largest clinics
in Madison had previously
formed their own HMOs. One
other plan called HMO of Wis-
consin was formed by physicians
in smaller communities in several
counties nearby.
Although this all sounds very
confusing, the situation appears
very clear to the various plan and
clinic administrators. One was
quoted saying that a "very ag-
gressive marketing plan can be
expected." Another stated "when
everything is up for grabs like
this, you go after the business."
And a third one stated that "this
was the year we were hoping to
cut back on advertising ex-
penses; fat chance!"
We have been told in recent
years that medical marketing is
the name of the game. Some
game!
—Victor S Falk, MD, Edgerton
Madison medicine
The following letter is being re-
printed here with permission of
the author. It originally appeared
in the June 1985 issue of Madison
magazine.
* * ♦
My husband and I left Madison
nearly two years ago after 19
years in the practice of ENT sur-
gery (otolaryngology) with a fine
group of partners. This summer
his brother will leave Madison
after practicing anesthesia for 17
years with Madison Anesthesi-
ologists, Inc, the leader in the
field in Madison for 25 years.
You might ask what did these
two successful specialists have to
fear by staying in the changing
scene of Madison health care?
The answer is: probably nothing,
since their groups will go on with-
out them without dropping a
stitch, if you'll pardon the pun.
The financial losses are greater by
moving than by staying, for med-
icine there pays well no matter
what the plan.
Then why leave? The basic rea-
son: unhappiness. In spite of the
joy of treating patients, the busi-
ness of medicine in our lovely
city had degraded for the practi-
tioner in many ways, to the point
where the term "unhappiness in
the workplace" began to apply to
this most lofty of professions.
For the first time, the spectre of
competition placed the MD in the
position of arguing, haranging,
accusing, belittling and scheming
against his/her fellow profes-
sionals. Competition has always
been brisk among Madison doc-
tors, but suddenly much of the
competition was being managed
by the career health marketeer.
MDs, whose former idea of com-
petition was that "the cream will
rise to the top," suddenly knew
that success would be measured
by who had the slickest ads and
who could shave the bids to give
care for less while promising
more.
All this meant that MDs could
be jerked around through every
HMO enrollment season, that
large amounts of the medical ser-
vice dollar would be siphoned off
into advertising, that the mesmer-
izing of the patient pool would
hold equal importance with the
treating of the patient pool.
For many years, the Madison
"bubble" was an insulator from
the slings and arrows of big cities
or the cultural gap of small
towns. Now there's a realization
that Madison, unlike bigger or
smaller cities, is a truly captive
market. Gradually that same
bubble, by attracting too many
MDs and having a public over-
balanced by government employ,
began to entrap a unique medical
environment, with too many pro-
fessionals fighting over easily
herded public payrolls. The result
is a jungle in which a daily sur-
vival battle goes on under the
name of patient service.
—Sharon R Manhart, Montrose, Colorado
Editor's Note: President Scott's Page
in this issue also addresses similar
issues. ■
WISCONSIN MEDICAL JOURNAL, JULY 1985: VOL. 86
5
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BALANCED
Low incidence of side effects
CARDIZEM® (diltiazem HCl)
produces an incidence of adverse
reactions not greater than that
reported with placebo therapy,
thus contributing to the patient’s
sense of well-being.
•Cardizem is indicated in the treatment of angina pectoris due to
coronary arteiy spasm and in the management of chronic stable
angina (classic effort-associated angina) in patients who cannot
tolerate therapy with beta-blockers and/or nitrates or who remain
symptomatic despite adequate doses of these agents.
References:
1, Strauss VTE, McIntyre KM, Parisl AR et al: Safety and efficacy
of diltiazem hydrochloride for the treatment of stable angina
pectoris: Report of a cooperative clinical trial. Am J Cardiol
49:560-566, 1982.
2. Pool PE, Seagren SC, Bonanno JA, et al: The treatment of exercise-
inducible chronic stable angina with diltiazem: Effect on treadmill
exercise. Chest 78 (July suppl):234-238, 1980.
Deduces angina attack frequency*
42% to 46% decrease reported in
multicenter study
Increases exercise tolerance*
In Bruce exercise test,^ control
patients averaged 8.0 minutes to
onset of pain; Cardizem patients
averaged 9.8 minutes (P<.005).
GAKDEZEM
Cdiltiazem HCl)
THE BALANCED
CALCIUM CHANNEL BLOCKER
Please see full prescribing information on following page.
2/84
PROFESSIONAL USE INFORMATION
cofdizem.
(dilhozem HCI)
50 mg and 60 mg tablets
DESCRIPTION
CARDIZEM” (diltiazem hydrochloride) is a calcium ion influx
Inhibitor (slow channel blocker or calcium antagonist) Chemically,
diltiazem hydrochloride is l,5-Benzothiazepin-4(5H)one,3-(acetyloxy)
-5-[2-{dimethylamlno)ethyl]-2,3-dihydro-2-(4-methoxyphenyl)-,
monohydrochloride.(+) -cis- The chemical structure is
CHpCHpNiCHjIj
Diltiazem hydrochloride is a white to off-white crystalline powder
with a bitter taste It is soluble in water, methanol, and chloroform
It has a molecular weight of 450.98 Each tablet of CARDIZEM
contains either 30 mg or 60 mg diltiazem hydrochloride for oral
administration
CLINICAL PHARMACOLOGY
The therapeutic benefits achieved with CARDIZEM are believed
to be related to its ability to inhibit the influx of calcium ions
during membrane depolarization of cardiac and vascular smooth
muscle
Mechanisins of Action. Although precise mechanisms of its
antianginal actions are still being delineated. CARDIZEM is believed
to act in the followino ways
1 Angina Due to Coronary Artery Spasm; CARDIZEM has been
shown to be a potent dilator of coronary arteries both epicardial
and subendocardial Spontaneous and ergonovine-induced cor-
onary artery spasm are inhibited by CARDIZEM
2. Exertional Angina: CARDIZEM has been shown to produce
increases in exercise tolerance, probably due to its ability to
reduce myocardial oxygen demand This is accomplished via
reductions in heart rate and systemic blood pressure at submaximal
and maximal exercise work loads
In animal models, diltiazem Interferes with the slow inward
(depolarizing) current in excitable tissue It causes excitation-conbacbon
uncoupling in various myocardial tissues without changes in the
configuration of the action potential Diltiazem produces relaxation
of coronary vascular smooth muscle and dilation of both large and
small coronary arteries at drug levels which cause little or no
negative inotropic effect The resultant increases in coronary blood
flow (epicardial and subendocardial) occur in ischemic and nonischemic
models and are accompanied by dose-dependent decreases in sys-
temic blood pressure and decreases in peripheral resistance
Hemodynamic and Electrophyslologic Enacts. Like other
calcium antagonists, diltiazem decreases sinoatrial and atrioventricu-
lar conduction in isolated tissues and has a negative inotropic effect
in isolated preparations In the intact animal, prolongation of the AH
interval can be seen at higher doses.
In man. diltiazem prevents spontaneous and ergonovine-provoked
coronary artery spasm It causes a decrease In peripheral vascular
resistance and a modest fall in blood pressure and. in exercise
tolerance studies in patients with ischemic heart disease, reduces
the heart rate-blood pressure product lor any given work load
Studies to date, primarily in patients with good ventricular function,
have not revealed evidence of a negative inotropic effect; cardiac
output, election fraction, and left ventricular end diastolic pressure
have not been affected There are as yet few data on the interaction
of diltiazem and beta-blockers Resting heart rate is usually unchanged
or slightly reduced by diltiazem
Intravenous diltiazem in doses of 20 mg prolongs AH conduction
time and AV node functional and effective refractory periods approxi-
mately 20% In a study involving single oral doses of 300 mg of
CARDIZEM in six normal volunteers, the average maximum PR
prolongation was 14% with no instances of greater than first-degree
AV block Diltlazem-associated prolongation of the AH interval is not
more pronounced in patients with first-degree heart block In patients
with sick sinus syndrome, diltiazem significantly prolongs sinus
cycle length (up to 50% in some cases)
Chronic oral administration of CARDIZEM in doses of up to 240
mg/day has resulted in small increases in PR interval, but has not
usually produced abnormal prolongation There were, however, three
instances of second-degree AV block and one instance of third-
degree AV block in a group of 959 chronically treated patients
Pharmacokinetics and Metabolism. Diltiazem is absorbed
from the tablet formulation to about 80% of a reference capsule and
is subject to an extensive first-pass effect, giving an absolute
bioavailability (compared to inbavenous dosing) of about 40% CARDIZEM
undergoes extensive hepatic metabolism in which 2% to 4% of the
unchanged drug appears in the urine In vitro binding studies show
CARDIZEM is 70% to 80% bound to plasma proteins Competitive
ligand binding studies have also shown CARDIZEM binding is not
altered by therapeutic concentrations of digoxin. hydrochlorothiazide,
phenylbutazone, propranolol, salicylic acid, or warfarin. Single oral
doses of 30 to 120 mg of CARDIZEM result in detectable plasma
levels within 30 to 60 minutes and peak plasma levels two to three
hours after drug administration The plasma elimination half-life
following single or multiple drug administration is approximately 3.5
hours Desacetyl diltiazem is also present in the plasma at levels of
10% to 20% of the parent drug and is 25% to 50% as potent a
coronary vasodilator as diltiazem Therapeutic blood levels of
CARDIZEM appear to be in the range of 50 to 200 ng/ml There is a
departure from dose-linearity when single doses above 60 mg are
given, a 120-mg dose gave blood levels three times that of the 60-mg
dose There is no information about the effect of renal or hepatic
impairment on excretion or metabolism of diltiazem
INDICATIONS AND USAGE
1 Angina Pectoris Dun to Coronary Artery Spasm. CARDIZEM
is indicated in the treatment of angina pectoris due to coronary
artery spasm CARDIZEM has been shown effective in the
treatment of spontaneous coronary artery spasm presenting as
Prinzmetal's variant angina (resting angina with ST-segment
elevation occurring during attacks)
2 Chronic Stable Angina (Classic Efloit-Assoclated Angina).
CARDIZEM is indicated in the management of chronic stable
angina CARDIZEM has been effective in controlled trials in
reducing angina frequency and increasing exercise tolerance
There are no controlled studies of the effectiveness of the concomi-
tant use of diltiazem and beta-blockers or of the safety of this
combination in patients with impaired ventricular function or conduc-
tion abnormalities
CONTRAINDICATIONS
CARDIZEM is conbaindicated in (1) patients with sick sinus
syndrome except in the presence of a functioning venbicular pacemaker,
(2) patients with second- or third-degree AV block except in the
presence of a functioning ventricular pacemaker, and (3) patients
with hypotension (less than 90 mm Hg systolic).
WARNINGS
1 Cardiac Conduction. CARDIZEM prolongs AV node refrac-
tory periods without significantly prolonging sinus node recov-
ery time, except in patients with sick sinus syndrome This
effect may rarely result in abnormally slow heart rates (particularly
in patients with sick sinus syndrome) or second- or third-degree
AV block (six of 1243 patients for 0 48%). Concomitant use of
diltiazem with beta-blockers or digitalis may result in additive
effects on cardiac conduction. A patient with Prinzmetal's
angina developed periods of asystole (2 to 5 seconds) alter a
single dose of 60 mg of diltiazem
2 Congestive Heart Failure. Although diltiazem has a negative
inotropic effect in isolated animal tissue preparations, hemrx^namic
studies in humans with normal ventricular function have not
shown a reduction in cardiac index nor consistent negative
effects on contractility (dp/dt). Experience with the use of
CARDIZEM alone or in combination with beta-blockers in patients
with impaired ventricular function is very limited Caution should
be exercised when using the drug in such patients
3 Hypotension. Decreases in blood pressure associated with
CARDIZEM therapy may occasionally result in symptomatic
hypotension
4 Acute Hepatic ln|ury. In rare instances, patients receiving
CARDIZEM have exhibited reversible acute hepatic injury as
evidenced by moderate to extreme elevations of liver enzymes
(See PRECAUTIONS and ADVERSE REACTIONS.)
PRECAUTIONS
General. CARDIZEM (diltiazem hydrochloride) is extensively metab-
olized by the liver and excreted by the kidneys and in bile As with any
new drug given over prolonged periods, laboratory parameters should
be monitored at regular intervals The drug should be used with
caution in patients with impaired renal or hepatic function. In sub-
acute and chronic dog and rat studies designed to produce toxicity,
high doses of diltiazem were associated with hepatic damage. In
special subacute hepatic studies, oral doses of 125 mg/kg and
higher in rats were associated with histological changes in the liver
which were reversible when the drug was discontinued In dogs,
doses of 20 mg/kg were also associated with hepatic changes;
however, these changes were reversible with continued dosing
Drug Interaction. Pharmacologic studies indicate that there
may be additive effects in prolonging AV conduction when using
beta-blockers or digitalis concomitantly with CARDIZEM, (See
WARNINGS)
Controlled and uncontrolled domestic studies suggest that con-
comitant use of CARDIZEM and beta-blockers or digitalis is usually
well tolerated. Available data are not sufficient, however, to predict
the effects of concomitant treatment, particularly in patients with left
ventricular dysfunction or cardiac conduction abnormalities. In healthy
volunteers, diltiazem has been shown to increase serum digoxin
levels up to 20%
Carcinogenesis, Mutagenesis, Impairment el Fertility. A
24-month study in rats and a 21 -month study in mice showed no
evidence of carcinogenicity. There was also no mutagenic response
in in vitro bacterial tests No intrinsic effect on fertility was observed
in rats.
Pregnancy. Category C Reproduction studies have been con-
ducted in mice, rats, and rabbits. Administration of doses tanging
from five to ten times greater (on a mg/kg basis) than the daily
recommended therapeutic dose has resulted in embryo and fetal
lethality These doses, in some studies, have been reported to cause
skeletal abnormalities In the perinatal/postnatal studies, there was
some reduction in early individual pup weights and survival rates
There was an increased incidence of stillbirths at doses of 20 times
the human dose or greater
There are no well-controlled studies in pregnant women; therefore,
use CARDIZEM in pregnant women only if the potential benefit
justifies the potential risk to the fetus.
Nursing Mothers. It is not known whether this drug is excreted
in human milk. Because many drugs are excreted in human milk,
exercise caution when CARDIZEM is administered to a nursing
woman if the drug's benefits are thought to outweigh its potential
risks in this situation.
Pediatric Use. Safety and effectiveness in children have not
been established
ADVERSE REACTIONS
Serious adverse reactions have been rare in studies carried out to
date, but it should be recognized that patients with impaired ventricu-
lar function and cardiac conduction abnormalities have usually been
excluded
In domestic placebo-controlled trials, the incidence of adverse
reactions reported during CARDIZEM therapy was not greater than
that reported during placebo therapy
The following represent occurrences observed in clinical studies
which can be at least reasonably associated with the pharmacology
of calcium influx inhibition In many cases, the relationshm to
CARDIZEM has not been established The most common occurrences,
as well as their frequency of presentation, are edema (2 4%),
headache (21%), nausea (1.9%), dizziness (1.5%), rash (1.3%),
asthenia (1.2%), AV block (1.1%), In addition, the following events
were reported infrequently (less than 1%) with the order of presenta-
tion corresponding to the relative frequency of occurrence
Cardiovascular:
Nervous System
Gastrointestinal
Dermatologic
Other:
Flushing, arrhythmia, hypotension, bradycar-
dia. palpitations, congestive heart failure,
syncope
Paresthesia, nervousness, somnolence,
tremor, insomnia, hallucinations, and amnesia.
Constipation, dyspepsia, diarrhea, vomiting,
mild elevations of alkaline phosphatase. SCOT.
SGPT, and LDH
Pruritus, petechiae, urticaria, photosensitivity.
Polyuria, nocturia.
The following additional experiences have been noted:
A patient with Prinzmetal's angina experiencing episodes of
vasospastic angina developed periods of transient asymptomatic
asystole approximately five hours after receiving a single 60-mg
dose of CARDIZEM
The following postmarketing events have been reported infre-
quently in patients receiving CARDIZEM: erythema multiforme; leu-
kopenia; and extreme elevations of alkaline phosphatase, SCOT,
SGPT, LDH. and CPK However, a definitive cause and effect between
these events and CARDIZEM therapy is yet to be established
OVERDOSAGE OR EXAGGERATED RESPONSE
Overdosage experience with oral diltiazem has been limited
Single oral doses of 300 mg of CARDIZEM have been well tolerated
by healthy volunteers In the event of overdosage or exaggerated
response, appropriate supportive measures should be employed in
addition to gastric lavage The following measures may be considered:
Bradycardia
High-Degree AV
Block
Cardiac Failure
Hypotension
Administer atropine (0.60 to 1.0 mg) If there
is no response to vagal blockade, administer
isoproterenol cautiously.
Treat as for bradycardia above Fixed high-
degree AV block should be treated with car-
diac pacing.
Administer inotropic agents (Isoproterenol,
dopamine, or dobutamine) and diuretics.
Vasopressors (eg, dopamine or levarterenol
bitartrate).
Actual treatment and dosage should depend on the severity of the
clinical situation and the judgment and experience of the treating
physician.
The oral/LDso's in mice and rats range from 415 to 740 mg/kg
and from 560 to 810 mg/kg, respectively. The intravenous LDsn's in
these species were 60 and 38 mg/kg, respectively. The oral LDs, in
dogs is considered to be in excess of 50 mg/kg, while lethality was
seen in monkeys at 360 mg/kg The toxic dose in man is not known,
but blood levels in excess of 800 ng/ml have not been associated
with toxicity.
DOSAGE AND ADMINISTRATION
Exertional Angina Pectoris Due to Atherosclerotic Coro-
nary Artery Disease or Angina Pectoris at Rest Due to Coro-
nary Arta^ Spasm. Dosage must be adjusted to each patient's
needs Starling with 30 mg four times daily, before meals and at
bedtime, dosage should be increased gradually (given in divided
doses three or four times daily) at one- to two-day intervals until
optimum response is obtained Although individual patients may
respond to any dosage level, the average optimum dosage range
appears to be 180 to 240 mg/day. There are no available data concern-
ing dosage requirements in patients with impaired renal or hepatic
function. If the drug must be used in such patients, titration should be
carried out with particular caution
Concomitant Uso With Other Antianginal Agents;
1 Sublingual NTG may be taken as required to abort acute
anginal attacks during CARDIZEM therapy
2 Proph)flactlc Nitrate Therapy -CARDIZEM may be safely
coadministered with short- and long-acting nitrates, but there
have been no controlled studies to evaluate the antianginal
effectiveness of this combination.
3 Beta^lochers. (See WARNINGS and PRECAUTIONS.)
HOW SUPPLIED
Cardizem 30-mg tablets are supplied in bottles of 100 (NDC
0088-1771-47) and in Unit Dose Identification Paks of 100 (NDC
0088-1771-49). Each green tablet is engraved with MARION on one
side and 1771 engraved on the other CARDIZEM 60-mg scored
tablets are supplied in bottles of 100 (NDC 0088-1772-47) and in Unit
Dose Identification Paks of 100 (NDC 0088-1772-49). Each yellow
tablet is engraved with MARION on one side and 1772 on the other.
Issued 4/1/84
Another patient benefit product from
PHARMACEUTICAL DIVISION
MARION
LABORATORIES INC
KANSAS city. MISSOURI 64137
New
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The Upjohi
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K3l3n
lazoo, Mid
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Once-daily INDERAL LA
(propranolol HCI) for
smooth blood pressure
control without the
potassium problems
of diuretics
Once-daily INDERAL LA (propranolol HCI)
avoids the risk of diuretic-induced ECG ab-
normalities due to hypokalemia.' - In addi-
tion, INDERAL LA preserves potassium
balance without additive agents or supple-
ments while providing simple, well-tolerated
therapy with broad cardiovascular benefits.
Once-daily INDERAL LA
for the cardiovascular
benefits of the world's
leading beta blocker
Simply start with 80 mg once daily. Dosage
may be increased to 1 20 mg to 1 60 mg once
daily as needed to achieve additional control
Like conventional INDERAL tablets,
INDERAL LA should not be used in the
presence of congestive heart failure, sinus
bradycardia, heart block greater than first
degree, and bronchial asthma.
long acting
CAI-'^IJLES
The appearance of these capsules
IS a registered trademark
of Ayerst Laboratories
80 mg 120 mg 160 mg
Please see brief summary of prescribing information
on the next page for further details^
Once-daily
LA
(PROPRANOLOL HCI) ^CAPsuLes*^
BRIEF SUMMARY (FOR FULL PRESCRIBING INFORMATION, SEE PACKAGE CIRCULAR )
INDERAL'^ LA brand of propranolol hydrochloride (Long Acting Capsules)
DESCRIPTION. Inderal LA is formulated to provide a sustained release of propranolol
hydrochloride Inderal LA is available as 80 mg. 120 mg. and 160 mg capsules
CLINICAL PHARMACOLOGY. INDERAL is a nonselective beta-adrenergic receptor
blocking agent possessing no other autonomic nervous system activity It specifically com-
petes with beta-adrenergic receptor stimulating agents for available receptor sites When
access to beta-receptor sites is blocked by INDERAL. the chronotropic, inotropic, and
vasodilator responses to beta-adrenergic stimulation are decreased proportionately
INDERAL LA Capsules (80. 120. and 160 mg) release propranolol HCI at a controlled and
predictable rate Peak blood levels following dosing with INDERAL LA occur at about 6 hours
and the apparent plasma half-life is about 10 hours When measured at steady state over a 24-
hour period the areas under the propranolol plasma concentration-time curve (AUCs) for the
capsules are approximately 60% to 65% of the AUCs for a comparable divided daily dose of
INDERAL tablets The lower AUCs for the capsules are due to greater hepatic metabolism of
propranolol, resulting from the slower rate of absorption of propranolol. Over a twenty-four (24)
hour period, blood levels are fairly constant for about twelve (12) hours then decline
exponentially
INDERAL LA should not be considered a simple mg for mg substitute for conventional
propranolol and the blood levels achieved do not match (are lower than) those of two to four
times daily dosing with the same dose When changing to INDERAL LA from conventional
propranolol, a possible need for relitration upwards should be considered especially to
maintain effectiveness at the end of the dosing interval In most clinical settings, however,
such as hypertension or angina where there is little correlation between plasma levels and
clinical effect. INDERAL LA has been therapeutically equivalent to the same mg dose of
conventional INDERAL as assessed by 24-hour effects on blood pressure and on 24-hour
exercise responses of heart rate, systolic pressure and rate pressure product INDERAL LA
can provide effective beta blockade for a 24-hour period
The mechanism of the anlihypertensive effect of INDERAL has not been established
Among the factors that may be involved in contributing to the antihypertensive action are (1)
decreased cardiac output. (2) inhibition of renin release by the kidneys, and (3) diminution of
tonic sympathetic nerve outflow from vasomotor centers in the brain Although total peripheral
resistance may increase initially, it readjusts to or below the pretreatment level with chronic
use Effects on plasma volume appear to be minor and somewhat variable INDERAL has
been shown to cause a small increase in serum potassium concentration when used in the
treatment of hypertensive patients
In angina pectoris, propranolol generally reduces the oxygen requirement of the heart at
any given level of effort by blocking the catecholamine-induced increases in the heart rale,
systolic blood pressure, and the velocity and extent of myocardial contraction Propranolol
may increase oxygen requirements by increasing left ventricular fiber length, end diastolic
pressure and systolic ejection period The net physiologic effect of beta-adrenergic blockade
IS usually advantageous and is manifested during exercise by delayed onset of pain and
increased work capacity
In dosages greater than required for beta blockade, INDERAL also exerts a quinidine-like
or anesthetic-like membrane action which affects the cardiac action potential The signifi-
cance of the membrane action in the treatment of arrhythmias is uncertain
The mechanism of the antimigraine effect of propranolol has not been established Beta-
adrenergic receptors have been demonstrated in the pial vessels of the brain
Beta receptor blockade can be useful in conditions in which, because of pathologic or
functional changes, sympathetic activity is detrimental to the patient But there are also
situations in which sympathetic stimulation is vital For example, in patients with severely
damaged hearts, adequate ventricular function is maintained by virtue of sympafhetic drive
which should be preserved In the presence of AV block, greater than first degree, beta
blockade may prevent the necessary facilitating effect of sympathetic activity on conduction
Beta blockade results in bronchial constriction by interfering with adrenergic bronchodilator
activity which should be preserved in patients subject to bronchospasm
Propranolol is not significantly dialyzable
INDICATIONS AND USAGE. Hypertension: INDERAL LA is indicated in the manage-
ment of hypertension, it may be used alone or used in combination with other antihypertensive
agents, particularly a thiazide diuretic INDERAL LA is not indicated in the management of
hypertensive emergencies
Angina Pectoris Due to Coronary Atherosclerosis: INDERAL LA is indicated
tor the long-term management of patients with angina pectoris
Migraine: INDERAL LA is indicated for the prophylaxis of common migraine headache
The efficacy of propranolol in the treatment of a migraine attack that has started has not been
established and propranolol is not indicated for such use
Hypertrophic Subaortic Stenosis: INDERAL LA is useful in the management of
hypertrophic subaortic stenosis, especially for treatment of exertional or other stress-induced
angina, palpitations, and syncope INDERAL LA also improves exercise performance The
effectiveness of propranolol hydrochloride in this disease appears to be due lo a reduction of
the elevated outflow pressure gradient which is exacerbated by beta-receptor stimulation
Clinical improvement may be temporary
CONTRAINDICATIONS. INDERAL is contraindicated in 1) cardiogenic shock. 2) sinus
bradycardia and greater than first degree block, 3) bronchial asthma, 4) congestive heart
failure (see WARNINGS) unless the failure is secondary lo a tachyarrhythmia treatable with
INDERAL
WARNINGS. CARDIAC FAILURE Sympathetic stimulation may be a vital component sup-
porting circulatory function in patients with congestive heart failure, and its inhibition by beta
blockade may precipitate more severe failure Although beta blockers should be avoided in
overt congestive heart failure, if necessary, they can be used with close follow-up in patients
with a history of failure who are well compensated and are receiving digitalis and diuretics.
Beta-adrenergic blocking agents do not abolish the inotropic action of digitalis on heart
muscle
IN PATIENTS WITHOUT A HISTORY OF HEART FAILURE, continued use of beta blockers
can, in some cases, lead to cardiac failure Therefore, at the first sign or symptom of heart
failure, the patient should be digitalized and/or treated with diuretics, and the response
observed closely, or INDERAL should be discontinued (gradually, if possible)
IN PATIENTS WITH ANGINA PECTORIS, there have been reports of exacerbation of
angina and, in some cases, myocardial infarction, following abrupt discontinuance of
INDERAL therapy Therefore, when discontinuance of INDERAL is planned the dosage
should be gradually reduced over at least a few weeks, and the patient should be
cautioned against interruption or cessation of therapy without the physician’s advice If
INDERAL therapy is interrupted and exacerbation of angina occurs, it usually is advis-
able to reinstitute INDERAL therapy and take other measures appropriate tor the man-
agement of unstable angina pectoris Since coronary artery disease may be
unrecognized, it may be prudent to follow the above advice in patients considered at risk
of having occult atherosclerotic heart disease who are given propranolol for other
indications
Nonailergic Bronchospasm (e.g., chronic bronchitis, emphysema) —
PATIENTS WITH BRONCHOSPASTIC DISEASES SHOULD IN GENERAL NOT RECEIVE BETA
BLOCKERS INDERAL should be administered with caution since it may block bronchodila-
tion produced by endogenous and exogenous catecholamine stimulation of beta receptors
MAJOR SURGERY The necessity or desirability of withdrawal of beta-blocking therapy
prior to major surgery is controversial It should be noted , however, that the impaired ability of
the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthe-
sia and surgical procedures
The appearance of these capsules
120 ■■ 160 IS a registered trademark
mg mg of Ayerst Laboratories
INDERAL (propranolol HCI), like other beta blockers, is a competitive inhibitor of beta-
receptor agonists and its effects can be reversed by administration of such agents, e g ,
dobutamine or isoproterenol However, such patients may be subject to protracted severe
hypotension Difficulty in starting and maintaining the heartbeat has also been reported with
beta blockers
DIABETES AND HYPOGLYCEMIA Beta-adrenergic blockade may prevent the ap-
pearance of certain premonitory signs and symptoms (pulse rale and pressure changes) of
acute hypoglycemia in labile insulin-dependent diabetes In these patients, it may be more
difficult to adjust the dosage of insulin
THYROTOXICOSIS Bela blockade may mask certain clinical signs of hyperthyroidism
Therefore, abrupt withdrawal of propranolol may be followed by an exacerbation of symptoms
of hyperthyroidism, including thyroid storm Propranolol does not distort thyroid function tests
IN PATIENTS WITH WOLFF-PARKINSON-WHITE SYNDROME, several cases have been
reported in which, after propranolol, the tachycardia was replaced by a severe bradycardia
requiring a demand pacemaker In one case this resulted after an initial dose of 5 mg
propranolol
PRECAUTIONS. General Propranolol should be used with caution in patients with impaired
hepatic or renal tunction INDERAL (propranolol HCI) is not indicated for the treatment of
hypertensive emergencies
Beta adrenoreceptor blockade can cause reduction of intraocular pressure Patients
should be told that INDERAL may interfere with the glaucoma screening test Withdrawal may
lead to a return of increased intraocular pressure
Clinical Laboratory Tests Elevated blood urea levels in patients with severe heart disease,
elevated serum transaminase, alkaline phosphatase, lactate dehydrogenase
DRUG INTERACTIONS Patients receiving calecholamine-dejDleting drugs such as reser-
pine should be closely observed if INDERAL is administered The added catecholamine-
blocking action may produce an excessive reduction of resting sympathetic nervous activity
which may result in hypotension, marked bradycardia, vertigo, syncopal attacks, or orthostatic
hypotension
Carcinogenesis, Mutagenesis, Impairment of Fertility Long-term studies in animals have
been conducted to evaluate toxic effects and carcinogenic potential In 18-month studies in
both rats and mice, employing doses up to 150 mg/kg/day, there was no evidence of significant
drug-induced toxicity There were no drug-related tumorigenic effects at any of the dosage
levels Reproductive studies in animals did not show any impairment of fertility that was
attributable to the drug
Pregnancy Pregnancy Category C INDERAL has been shown to be embryotoxic in
animal studies at doses about 10 times greater than the maximum recommended human dose
There are no adequate and well-controlled studies in pregnant women INDERAL should
be used during pregnancy only if the potential benefit justifies the potential risk to the fetus
Nursing Mothers INDERAL is excreted in human milk Caution should be exercised when
INDERAL IS administered to a nursing woman
Pediatric Use Safety and effectiveness in children have not been established
ADVERSE REACTIONS. Most adverse effects have been mild and transient and have
rarely required the withdrawal of therapy
Cardiovascular bradycardia, congestive heart failure, intensification of AV block, hypo-
tension; paresthesia of hands, thrombocytopenic purpura, arterial insufficiency, usually of the
Raynaud type
Central Nervous System lightheadedness; mental depression manifested by insomnia,
lassitude, weakness, fatigue, reversible mental depression progressing to catatonia, visual
disturbances, hallucinations, an acute reversible syndrome characterized by disorientation for
time and place, short-term memory loss, emotional lability, slightly clouded sensorium. and
decreased performance on neuropsychometrics
Gastrointestinal nausea, vomiting, epigastric distress, abdominal cramping, diarrhea,
constipation, mesenteric arterial thrombosis, ischemic colitis
Allergic pharyngitis and agranulocytosis, erythematous rash, fever combined with aching
and sore throat, laryngospasm and respiratory distress
Respiratory bronchospasm
Hematologic, agranulocytosis, nonthrombocytopenic purpura, thrombocytopenic
purpura
Auto-Immune In extremely rare instances, systemic lupus erythematosus has been
reported
Miscellaneous, alopecia. LE-like reactions, psoriasitorm rashes, dry eyes, male impo-
tence, and Peyronie's disease have been reported rarely Oculomucocutaneous reactions
involving the skin, serous membranes and conjunctivae reported for a beta blocker (practolol)
have not been associated with propranolol
DOSAGE AND ADMINISTRATION. INDERAL LA provides propranolol hydrochloride in a
sustained-release capsule tor administration once daily If patients are switched from INDERAL
tablets to INDERAL LA capsules, care should be taken to assure that the desired therapeutic
effect IS maintained INDERAL LA should not be considered a simple mg for mg substitute for
INDERAL INDERAL LA has different kinetics and produces lower blood levels Retitration may
be necessary especially lo maintain effectiveness at the end of the 24-hour dosing interval
HYPERTENSION— Dosage must be individualized The usual initial dosage is 80 mg
INDERAL LA once daily, whether used alone or added to a diuretic The dosage may be
increased to 120 mg once daily or higher until adequate blood pressure control is achieved
The usual maintenance dosage is 120 to 160 mg once daily In some instances a dosage of 640
mg may be required The time needed tor full hypertensive response to a given dosage is
variable and may range from a few days to several weeks
ANGINA PECTORIS — Dosage must be individualized Starting with 80 mg INDERAL LA
once daily, dosage should be gradually increased at three to seven day intervals until optimum
response is obtained Although individual patients may respond at any dosage level, the
average optimum dosage appears to be 160 mg once daily In angina pectoris, the value and
safety of dosage exceeding 320 mg per day have not been established
If treatment is to be discontinued, reduce dosage gradually over a period of a few weeks
(see WARNINGS)
MIGRAINE— Dosage must be individualized The initial oral dose is 80 mg INDERAL LA
once daily The usual effective dose range is 160-240 mg once daily The dosage may be
increased gradually lo achieve optimum migraine prophylaxis If a satisfactory response is not
obtained within tour to six weeks alter reaching the maximum dose. INDERAL LA therapy
should be discontinued It may be advisable to withdraw the drug gradually over a period of
S6V6r3l W66ks
HYPERTROPHIC SUBAORTIC STENOSIS— 80-160 mg INDERAL LA once daily
PEDIATRIC DOSAGE— At this time the data on the use of the drug in this age group are too
limited to permit adequate directions tor use
REFERENCES
1. Holland OB, Nixon JV, Kuhnert L. Diuretic-induced ventricular ectopic
activity. Am J Med 1981:70:762-768 2, Holme I, Helgeland A, Hjermann
I, et al: Treatment of mild hypertension with diuretics The importance of ECG
abnormalities in the Oslo study and in MRFIT JAMA 1984,251 .1298-1299
AYERST LABORATORIES 9411/1184
New York, NY 10017
Ayersfe
Copyright © 1984 AYERST LABORATORIES
Division of AMERICAN HOME PRODUCTS CORPORATION
STATE MEDICAL SOCIETY OF WISCONSIN
1985
Membership Directory
as of July 1, 1985
Listed by county medical society in alphabetical order.
This directory includes member’s name, address, telephone number
(when provided), primary and secondary practice specialties, and Board
certified specialties and/or subspecialties. Every effort was made to pro-
vide accurate listing. Members received a verification form of member-
ship records for completion and return to the Journal office.
In the event of inaccuracies members are asked to contact the Member-
ship Department for followup correction in subsequent issues of the Jour-
nal. See further explanation on following pages.
Reprints $15.00, plus 5% sales tax in Wisconsin, unless tax-exempt
status declared.
COPYRIGHT 1985
State Medical Society of Wisconsin
Box 1109, Madison, Wisconsin 53701
2
COMPILATION INFORMATION
Information in this directory has been provided by the State Medical Society's Membership Department after each member was given the opportunity to verify
its accuracy by returning a Verification Form sent to all members of record at June 3, 1985. To save time and expense this year’s Directory has been produced
directly from the computer printout. Another change from previous years is the elimination of the asterisk for identifying specialties in which the member is
Board-certified.
This year the Membership Department has created a computer program which allows members to designate up to three specialties (primary specialty and
secondary specialties) in which they practice. These specialty designations appear in the Directory on the first line of each member listing before the slash
(/). Also on the first line after the slash, members are allowed to designate up to three specialties or subspecialties in which they are Board-certified.
The State Medical Society of Wisconsin recognizes the practice specialties as used by the American Medical Association in its American Medical Directory,
which includes data collected on Board certification from physicians themselves and from the American Board of Medical Specialties, which provides informa-
tion in the publication of the Directory of Medical Specialists. Only those certifications from the 23 Boards included in the Directory of Medical Specialists are
included in this Membership Directory.
Practice specialties and Board certifications have been provided by individual members who returned the Verification Form or previously had provided the
Membership Department with this information. In neither case has the specialty or certification designations been routinely verified with any other source. The
specialty codes used in this Directory are used for record-keeping and do not imply recognition or endorsement of any field of medicine. They are intended
for use in this Directory only and are not to be used for changing or updating other records. The State Medical Society of Wisconsin, its officers, agents, and
employees, make no claims as to accuracy, nor accept liability for information that may not be correct, or for errors and omissions.
CORRECTION FORM
Members whose information in this Membership Directory is not accurate are urged to submit changes to the Membership Depart-
ment on the form below. Such changes will be published in subsequent issues of the WMJ.
TO: Membership Department, State Medical Society of Wisconsin, PO Box 1109, Madison, Wisconsin
53701
Please correct the information used in the 1985 Membership Directory on your records as follows:
COUNTY MEDICAL SOCIETY
PRACTICE SPECIALTIES
(use codes from page 3)
1 1
1 1
1 1
1 1
1 1
PRIMARY
SECONDARY
SECONDARY
BOARD-CERTIFIED
SPECIALTIES
1 1
1 ^
(use codes from page 3)
1 ^
^ 1
1 1
TELEPHONE #
NAME
STREET SUITE/APT #.
PO BOX #
CITY STATE ZIP
SIGNED DATE
3
AMA codes for self-designated
PRACTICE SPECIALTIES
(primary and secondary)
□ A
Allergy
□ ABS
Abdominal Surgery
□ ADL
Adolescent Medicine
□ Al
Allergy & Immunology
□ AM
Aerospace Medicine
□ AN
Anesthesiology
□ BE
Bronchoesophagology
□ BLB
Blood Banking
□ CD
Cardiovascular Diseases
□ CDS
Cardiovascular Surgery
□ CHN
Child Neurology
□ CHP
Child Psychiatry
□ CLP
Clinical Pathology
□ CRS
Colon & Rectal Surgery
□ D
Dermatology
□ DIA
Diabetes
□ DMP
Dermatopathology
□ DR
Diagnostic Radiology
□ EM
Emergency Medicine
□ END
Endocrinology
□ FOP
Forensic Pathology
□ FP
Family Practice
□ GE
Gastroenterology
□ GER
Geriatrics
□ GP
General Practice
□ GPM
General Preventive Medicine
□ GS
General Surgery
□ GYN
Gynecology
□ HEM
Hematology
□ HNS
Head & Neck Surgery
□ HS
Hand Surgery
□ HYP
Hypnosis
□ ID
Infectious Diseases
□ IG
Immunology
□ IM
Internal Medicine
□ LAR
Laryngology
□ LM
Legal Medicine
□ MFS
Maxillofacial Surgery
□ N
Neurology
□ NA
Neuropathology
□ ND
Neoplastic Diseases
□ NEP
Nephrology
□ NM
Nuclear Medicine
□ NPM
Neonatal-perinatal Medicine
□ NR
Nuclear Radiology
□ NS
Neurological Surgery
' ■ NTR
Nutrition
OBG
Obstetrics & Gynecology
□ OBS
Obstetrics
□ OM
Occupational Medicine
□ ON
Oncology
□ OPH
Ophthalmology
" ORS
Orthopaedic Surgery
□ OS
Other; ie, physician designated
a specialty other than appearing
here
□ OT
Otology
□ OTO
Otorhinolaryngology
□ P
Psychiatry
r PA
Clinical Pharmacology
□ PD
Pediatrics
. PDA
Pediatric Allergy
PDC
Pediatric Cardiology
PDE
Pediatric Endocrinology
□ PDR
Pediatric Radiology
■ PDS
Pediatric Surgery
PH
Public Health
PHO
Pediatric-Hematology-Oncology
PM
Physical Medicine & Rehabilitation
PNP
Pediatric Nephrology
PS
Plastic Surgery
□ PTH
□ PUD
□ PYA
□ PYM
□ R
□ RHI
□ RHU
□ RIP
□ TR
□ TRS
□ TS
□ U
Pathology
Pulmonary Diseases
Psychoanalysis
Psychosomatic Medicine
Radiology
Rhinology
Rheumatology
Radioisotopic Radiology
Therapeutic Radiology
Traumatic Surgery
□ OPH American Board of Ophthalmology
□ OPH Ophthalmology
□ ORS American Board of Orthopaedic
Surgery
□ ORS Orthopaedic Surgery
□ AOS Adult Orthopaedic Surgery
□ OTO American Board of Otolaryngology
□ OTO Otolaryngology
□ PTH American Board of Pathology
Thoracic Surgery
□ PTH
Clinical Pathology
Urological Surgery
& Pathologic Anatomy
□ BLB
Blood Banking
□ CP
Chemical Pathology
□ CLC
Clinical Chemistry
□ CLP
Clinical Pathology
CERTIFICATIONS
□ DMP
Dermatopathology
□ FOP
Forensic Pathology
American Board of Allergy
□ HEM
Hematology
& Immunology
□ MC
Medical Chemistry
□ Al Allergy & Immunology
□ MMB
Medical Microbiology
□ NA
Neuropathology
American Board of Anesthesiology
□ PA
Pathologic Anatomy
□ AN Anesthesiology
□ RP
Radioisotopic Pathology
□ CCM Critical Care Medicine
□ PD American Board of Pediatrics
□ Al
□ AN
□ CRS American Board of Colon
& Rectal Surgery
□ CRS Colon & Rectal Surgery
□ ARS Anorectal Surgery
□ D American Board of Dermatology
□ D Dermatology
□ DMP Dermatopathology
□ EM American Board of Emergency
Medicine
□ EM Emergency Medicine
□ FP American Board of Family
Practice
□ FP Family Practice
□ IM American Board of Internal
Medicine
□ IM Internal Medicine
□ Al Allergy & Immunology
□ CD Cardiovascular Disease
□ CCM Critical Care Medicine
□ END Endocrinology &
Metabolism
□ GE Gastroenterology
□ HEM Hematology
□ ID Infectious Disease
C MON Medical Oncology
□ NEP Nephrology
□ PUD Pulmonary Disease
□ RHU Rheumatology
□ NS American Board of Neurological
Surgery
' NS Neurological Surgery
□ NM American Board of Nuclear
Medicine
□ NM Nuclear Medicine
□ OBG American Board of Obstetrics
& Gynecology
□ OBG Obstetrics & Gynecology
□ OBS Obstetrics
□ GYN Gynecology
□ CCM Critical Care Medicine
□ GON Gynecologic Oncology
r MFM Maternal & Fetal Medicine
□ RE Reproductive
Endocrinology
□ PD Pediatrics
□ CCM Critical Care Medicine
□ NPM Neonatal-Perinatal
Medicine
□ PDA Pediatric Allergy
□ PDC Pediatric Cardiology
□ PDE Pediatric Endocrinology
□ PHO Pediatric Hematology-
Oncology
□ PNP Pediatric Nephrology
□ PS American Board of Plastic Surgery
□ PS Plastic Surgery
□ PM American Board of Physical
Medicine & Rehabilitation
□ PM Physical Medicine &
Rehabilitation
□ PN American Board of Psychiatry
& Neurology
□ PN Psychiatry & Neurology
□ P Psychiatry
□ N Neurology
□ CHP Child Psychiatry
□ CHN Child Neurology
□ CCM Critical Care Medicine
□ GPM American Board of Preventive
Medicine
■ □ AM Aerospace Medicine
□ GPM General Preventive
Medicine
□ OM Occupational Medicine
□ PH Public Health
□ R American Board of Radiology
□ R Radiology
□ DR Diagnostic Radiology
□ TR Therapeutic Radiology
□ DNR Diagnostic-Nuclear
Radiology
□ GS American Board of Surgery
□ GS General Surgery
□ GVS General Vascular Surgery
□ PDS Pediatric Surgery
□ CCM Critical Care Medicine
□ TS American Board of Thoracic
Surgery
□ TS Thoracic Surgery
□ U American Board of Urology
□ U Urology
1
4
Key to CITIES in COUNTY MEDICAL SOCIETIES
City County Medical Society / ies
Adell— Sheboygan
Algoma — Door/Kewaunee
Alma — T rempealeau/ Jackson/Buffalo
Altoona — Eau Claire/Dunn/Pepin
Amery — Polk
Aniwa — Langlade
Antigo — Langlade
Appleton — Outagamie, Winnebago
Arcadia — Trempealeau/ Jackson/Buffalo
Arena — Milwaukee
Arkansaw — Pierce/ St Croix
Ashland — Ashland/Bayfield/lron
Baldwin — Pierce/St Croix
Baraboo — Sauk
Barron — Barron/Washburn/Burnett
Bayfield — Ashland/Bayfield/lron
Bayside — Milwaukee
Beaver Dam — Dodge, Jefferson
Belgium — Ozaukee
Belleville — Dane
Beloit — Rock
Berlin — Green Lake/Waushara
Big Bend — Waukesha
Black Earth — Dane
Black River Falls — Trempealeau/Jackson/
Buffalo
Blanchardville — Lafayette
Bloomer — Chippewa
Bonduel — Shawano
Boscobel — Grant
Boyd — Chippewa
Brillion — Calumet
Brodhead — Green
Brookfield — Milwaukee, Waukesha
Brooklyn — Green, Dane
Brown Deer — Milwaukee
Brownsville — Fond du Lac
Bruce — Rusk
Burlington — Kenosha, Milwaukee, Racine
Butte Des Morts — Winnebago
Cadott — Chippewa
Caledonia — Racine
Cambridge — Jefferson
Cameron — Barron/ Washburn/Burnett
Campbellsport — Fond du Lac
Cassville — Grant
Cedarburg — Ozaukee, Milwaukee,
Washington
Cedar Grove — Jefferson
Centuria — Dane
Chetek — Barron/Washburn/Burnett
Chilton — Calumet
Chippewa Falls— Chippewa
Clam Lake— Dane
Clear Lake — Polk
Clintonville — Waupaca
Colby — Clark
Columbus — Columbia/Marquette/ Adams,
Dodge
Cornell — Chippewa
Cottage Grove — Dane
Crandon — Forest, Wood
Crivitz — Marinette/Florence
Cross Plains — Dane
City County Medical Society / ies
Cuba City — Grant
Cudahy — Milwaukee
Cumberland — Barron/Washburn/Burnett
Darlington — Lafayette
Deerbrook — Langlade
Deerfield — Dane
De Forest — Dane
Delafield — Milwaukee, Waukesha
Delavan — Walworth
Denmark — Brown
DePere — Brown, Oconto
DeSoto — Trempealeau/ Jackson/ Buffalo
Dodgeville — Iowa
Dousman — Waukesha
Durand — Eau Claire/Dunn/Pepin,
Trempealeau/Buffalo/ Jackson
Eagle — Milwaukee
Eagle River — Oneida/ Vilas
East Ellsworth — Pierce/St Croix
East Troy — Walworth, Milwaukee
Eau Claire — Eau Claire/Dunn/Pepin,
Chippewa
Edgar — Marathon
Edgerton — Rock
Eleva — Eau Claire/ Dunn/ Pepin
Elkhart Lake— Sheboygan, Milwaukee
Elkhorn — Walworth
Ellsworth— Pierce/St Croix
Elm Grove — Milwaukee, Waukesha
Elmwood— Pierce/St Croix
Elroy — Juneau
Evansville — Rock
Fall Creek — Eau Claire/Dunn/Pepin
Fitchburg — Dane
Fond du Lac — Fond du Lac
Fontana — W alworth
Fort Atkinson — Jefferson
Fox Point — Milwaukee, Waukesha
Franklin — Milwaukee, Racine
Franksville — Racine, Kenosha
Frederic — Polk
Fredonia — Ozaukee, Dodge
Friendship — Columbia/Marquette/ Adams
Galesville — Trempealeau/ Jackson/Buffalo
Genesee Depot — Waukesha
Germantown — Waukesha, Milwaukee
Gillett — Oconto, Fond du Lac,
Oneida/Vilas
Glendale — Milwaukee
Glenwood City — Pierce/St Croix
Gordon — Douglas
Grafton — Ozaukee, Milwaukee
Grantsburg— Barron/ Washburn/ Burnett
Green Bay — Brown
Greendale — Milwaukee
Greenfield — Marathon
Green Lake — Green Lake
Greenwood — Clark
Greshem — Shawano
City County Medical Society / ies
Hales Corners — Milwaukee
Hartford — Washington
Hartland — Milwaukee, Waukesha
Hayward — Sawyer
Hazel Green — Grant
Hilbert — Calumet
Hollandale — Iowa
Holmen — La Crosse
Horicon — Dodge
Hortonville — Outagamie
Hudson — Pierce/St Croix
Hurley — Ashland/Bayfield/lron
lola — Waupaca
Jackson — Washington
Janesville — Rock
Jefferson — Jefferson
Jim Falls — Chippewa
Juneau — Dodge
Kaukauna — Outagamie
Kenosha — Kenosha
Kewaskum — Washington
Kewaunee — Door/Kewaunee
Kiel — Sheboygan
Kimberly — Outagamie
King — Waupaca
Kohler — Sheboygan
La Crosse — La Crosse
Lac du Flambeau — Oneida/Vilas, Wood
Ladysmith — Rusk
La Farge — Vernon
Lake Geneva — Walworth
Lake Mills — Jefferson
Lake Tomahawk — Oneida/ Vilas, Marathon
Lancaster — Grant
Land O’Lakes — Oneida/Vilas
Laona — Forest
Larsen — Winnebago
Little Chute — Outagamie
Lodi — Columbia/Marquette/ Adams,
Dane, Sauk
Loyal — Clark
Luxemburg — Brown
Madison — Dane
Manawa— Waupaca
Manitowoc — Manitowoc
Marathon — Marathon
Markesan — Dodge
Marinette— Marinette/Florence
Marion — Waupaca
Marshfield — Wood
Mauston — Juneau
Mayville— Dodge, Milwaukee
Mazomanie — Dane
McFarland— Dane
Medford — Price/Taylor
Menasha— Outagamie, Winnebago
Menomonee Falls— Washington, Waukesha
Milwaukee
Menomonie — Eau Claire/Dunn/Pepin
Mequon — Milwaukee, Ozaukee, Waukesha
Merrill — Lincoln
5
City County Medical Society / ies
Middleton — Dane, Sauk
Milton — Rock
Milwaukee — Milwaukee, Ozaukee,
Washington, Waukesha, Racine
Mineral Point — Iowa
Minocqua — Oneida/Vilas
Mishicot — Manitowoc
Mondovi — T rempealeau/ J ackson/ Buffalo,
Eau Claire/Dunn/Pepin
Monona— Dane
Monroe — Green
Montfort — Iowa
Monticello — Green
Montello — Columbia/Marquette/ Adams
Mosinee — Marathon
Mt Calvary — Fond du Lac
Mt Horeb— Dane
Mukwonago — Milwaukee, Waukesha
Muscoda — Grant
Muskego — Waukesha, Milwaukee
Nashotah — Waukesha, Milwaukee
Neenah — Outagamie, Winnebago
Neillsville — Clark
Nekoosa — Wood
New Berlin — Waukesha, Milwaukee
New Glarus— Green
New Holstein — Calumet
New Lisbon — Juneau
New London — Waupaca
New Richmond — Pierce/St Croix
Oconomowoc — Milwaukee, Waukesha
Oconto — Marinette/Florence, Oconto
Oconto Falls — Oconto, Brown
Ogema — Price/Taylor
Omro — Winnebago
Onalaska— Dodge, La Crosse
Oneida — Brown
Oostburg — Sheboygan, Milwaukee
Oregon — Dane
Orfordville— Rock
Osceola— Polk
Oshkosh — Winnebago, Fond du Lac
Osseo — Eau Claire/ Dunn/ Pepin
Owen — Clark
Oxford — Columbia/Marquette/ Adams
City County Medical Society / ies
Paddock Lake — Dodge
Park Falls — Price/Taylor
Peshtigo — Marinette/Florence
Pewaukee — Waukesha, Milwaukee
Phillips — Price/Taylor
Plain— Sauk
Platteville — Grant
Plover— Portage
Plum City — Pierce/St Croix
Plymouth — Sheboygan
Portage — Columbia/Marquette/ Adams
Port Washington — Ozaukee, Milwaukee
Pound— Marinette/Florence
Poynette — Dane
Prairie du Chien — Crawford
Prairie du Sac — Sauk
Prescott — Pierce/St Croix
Pulaski — Brown
Racine — Racine, Kenosha
Random Lake — Sheboygan
Reedsburg — Sauk, Monroe
Rhinelander — Oneida/Vilas
Rice Lake — Barron/Washburn/Burnett
Richfield — Washington
Richland Center — Richland
Ripon — Fond du Lac
River Falls — Pierce/St Croix
River Hills — Milwaukee, Waukesha
Rosholt — Portage
Rothschild — Marathon
St Croix Falls — Polk
Schofield — Marathon
Shawano— Shawano, Oneida/ Vilas
Sheboygan — Sheboygan
Sheboygan Falls — Sheboygan
Shell Lake — Barron/Washburn/Burnett
Shorewood — Milwaukee
Sister Bay — Door /Kewaunee
Slinger — Washington
Soldiers Grove — T rempealeau /
Jackson/ Buffalo
South Milwaukee — Milwaukee
Sparta — Monroe
Spooner — Barron/Washburn/Burnett
Spring Green — Sauk
Spring Valley — Pierce /St Croix
Stanley — Chippewa
Stevens Point — Portage
Stoughton — Jefferson, Dane
Sturgeon Bay — Door/Kewaunee
Sun Prairie — Dane
Superior — Douglas
City County Medical Society / ies
Theresa — Dodge
Thiensville — Ozaukee, Milwaukee
Tigerton — Shawano
Tomahawk — Lincoln, Marathon
Three Lakes — Milwaukee
Tomah — Monroe
Two Rivers — Manitowoc, Kenosha
Turtle Lake — Barron/ Washburn /Burnett
Union Grove — Racine
Valders — Manitowoc
Verona — Dane
Viroqua — Vernon, Trempealeau/
Jackson/ Buffalo
Walworth — Walworth
Washburn — Ashland/Bayfield/Iron
Waterloo — Jefferson
Watertown — Jefferson
Waukesha — Waukesha, Milwaukee
Waupaca — Waupaca, Outagamie
Waupun — Dodge, Fond du Lac
Wausau — Marathon
Wausaukee — Marinette/Florence
Wautoma — Winnebago
Wauwatosa — Milwaukee, Waukesha,
Ozaukee, Washington
West Allis — Milwaukee
West Bend — Washington, Walworth
Westby — Vernon, Trempealeau/
Jackson/ Buffalo
Westfield — Green Lake, Milwaukee
West Salem — La Crosse
Weyauwega — Waupaca
Whitefish Bay — Milwaukee
Whitehall — Trempealeau/ Jackson/Buffalo
Whitewater — Walworth, Jefferson
Wild Rose — Green Lake/Waushara
Wind Lake — Kenosha, Milwaukee
Winnebago — Winnebago
Winneconne — Winnebago
Wisconsin Dells — Columbia/Marquette/
Adams, Sauk
Wisconsin Rapids — Wood
Withee — Clark
Wonewoc — Juneau
Wood — Milwaukee
Woodruff— Marathon, Oneida/VilasH
THE STATE MEDICAL SOCIETY OF WISCONSIN
Created by the Territorial Legislature in 1841 . . . representing over 5,100 member physicians in Wisconsin, com-
prising 55 county medical societies and 25 medical specialty sections. The purpose of the Society is to “bring together
the physicians of the State of Wisconsin to advance the science and art of medicine and the better health of the people
of Wisconsin, and to secure the enactment and enforcement of just medical laws.” The major activities of the Society
include continuing medical education, peer review, legislation, community health education, scientific affairs, socio-
economics, health planning, services for physicians, operation of a Charitable, Educational and Scientific Foundation,
and publication of the Wisconsin MedicalJournal.
OFFICERS OF THE SOCIETY
PRESIDENT: John K Scott, MD, Madison
PRESIDENT-ELECT: Charles H' Landis, MD, Milwaukee
SECRETARY-GENERAL MANAGER: Earl R Thayer,
Madison
TREASURER: John J Foley, MD, Menomonee Falls
BOARD OF DIRECTORS
CHAIRMAN: Darold A Treffert, MD, Fond du Lac
VICE CHAIRMAN: Roger L von Heimburg, MD,
Green Bay
FIRST DISTRICT: Kenosha, Milwaukee, Ozaukee, Racine,
Walworth, Washington, Waukesha counties
Glenn H Franke, MD, Milwaukee
Jerome H' Fons Jr, MD, Cudahy
Carl S Eisenberg, MD, Milwaukee
Thomas A Hojbauer, MD, Menomonee Falls
Wayne H Konetzki, MD, Waukesha
Fredrick Wood Jr, MD, Kenosha
William L Treacy, MD, Milwaukee
Lucille B Glicklich, MD, Milwaukee
Richard D Fritz, MD, Milwaukee
William J List wan, MD, West Bend
SECOND DISTRICT: Adams, Columbia, Dane, Dodge,
Grant, Green, Iowa, Jefferson, Lafayette, Marquette,
Richland, Rock, Sauk counties
J D Kabler, MD, Madison
Cyril M Hetsko, MD, Madison
James J Tydrich, MD, Richland Center
Alwin E Schultz, MD, Madison
Kenneth / Gold, MD, Beloit
THIRD DISTRICT: Buffalo, Crawford, Jackson, Juneau,
LaCrosse, Monroe, Trempealeau, Vernon counties
Pauline M Jackson, MD LaCrosse
FOURTH DISTRICT: Clark, Florence, Forest, Langlade,
Lincoln, Marathon, Oneida, Portage, Price, Taylor,
Vilas, Wood counties
John J Kief, MD, Rhinelander
Jung K Park, MD, Wisconsin Rapids
W George L ocher, MD, Wausau
FIFTH DISTRICT: Calumet, Fond du Lac, Green Lake,
Outagamie, Waupaca, Waushara, Winnebago counties
Darold A Treffert, MD, Fond du Lac
Kenneth M Viste Jr, MD, Oshkosh
C William Freeby, MD, Appleton
SIXTH DISTRICT Brown, Door, Kewaunee, Manitowoc,
Marinette, Menominee, Oconto, Shawano, Sheboygan
counties
Roger L von Jieimburg, MD, Green Bay
Joseph C DiRaimondo, MD, Manitowoc
SEVENTH DISTRICT: Barron, Chippewa, Dunn, Eau Claire,
Pepin, Pierce, Polk, Rusk, St Croix, Burnett, Washburn
counties
Marwood E Wegner, MD, St Croix Falls
Philip J Happe, MD, Eau Claire
EIGHTH DISTRICT: Ashland, Bayfield, Douglas, Iron,
Sawyer counties
Joseph M Jauquet, MD, Ashland
PRESIDENT Scott; PRESIDENT-ELECT Landis;
PAST PRESIDENT Timothy T Flaherty, MD, Neenah
SPEAKER Duane W Taebel, MD, La Crosse; and
VICE SPEAKER Vernon M Griffin, MD, Mauston
DELEGATES TO THE AMERICAN MEDICAL
ASSOCIATION
Henry F Twelmeyer, MD, Wauwatosa
John K Scott, MD. Madison
Patricia J Stuff MD, Bonduel
DeLore Williams, MD. West Allis
Richard W Edwards, MD, Richland Center
Cornelius A Natoli, MD, La Crosse
Timothy T Flaherty, MD, Neenah
ALTERNATES TO THE AMA
Cyril M Hetsko, MD, Madison
John D Riesch, MD, Menomonee Falls
J D Kabler, MD, Madison
Kenneth M Viste Jr, MD, Oshkosh
John P Mullooly, MD, Milwaukee
Richard H Ulmer, MD, Marshfield
Charles W Landis, MD, Milwaukee
330 East Lakeside Street (PO Box 1109), Madison, Wisconsin 53701 / Telephone: (608) 257-6781
ASHLAND/BAYFIELD/IRON, BARRON/WASHBURN/BURNETT— 7
ASHLAND-BAYFIELD-IRON
IM / IM
MARK K BHLKNAP MD
923 SECOND AVENUE WEST
ASHLAND WI 54806
AN / AN
715-682-4322
CAROL A BLUM MD
2101 BEASER AVENUE
ASHLAND WI 54806
ORS / ORS
715-682-8183
JAMES D CHAMBERS MD
SUITE 6
2101 BEASER AVENUE
ASHLAND WI 54806
FP / FP
THOMAS C CUNNINGHAM MD
SUITE 101
206 SIXTH AVENUE WEST
ASHLAND WI 54806
R / R
MARKHAM J FISCHER MD
SUITE 4
2101 BEASER AVENUE
ASHLAND WI 54806
OTO HNS / OTO
JAMES A HAMP MD
ROUTE 1 BOX 163S
ASHLAND WI 54806
GP
715-682-4545
JOSEPH M JAUQUET MD
200 SEVENTH AVE WEST
ASHLAND WI 54806
FP / FP
ARLYN A KOELLER MD
206 SIXTH AVENUE WEST
ASHLAND WI 54806
U / U
KENNETH N KRUTSCH MD
ROUTE 2 BOX 344
WASHBURN WI 54891
FP GS / FP
715-373-2216
HARRY H LARSON MD
320 SUPERIOR AVENUE
WASHBURN WI 54891
DR R / R
ROBERT G LIND MD
SUITE 4
2101 BEASER AVENUE
ASHLAND WI 54806
AN
CHARLES R LONGSTRETH MD
ROUTE 1 BOX 163J
ASHLAND WI 54806
FP PUD / FP
715-561-2961
DOMINIC J MARTINETTI MD
327 SILVER STREET
POST OFFICE BOX 277
HURLEY WI 54534-0277
FP / FP
715-682-6622
JOHN P MC CUE MD
206 SIXTH AVENUE WEST
ASHLAND WI 54806
P / PN
WAYNE C MERCER MD
SUPERIOR AVENUE
POST OFFICE BOX 575
WASHBURN WI 54891
OPH / OPH
715-682-4515
KENNETH A MORROW MD
ROUTE 1 BOX 61A
ASHLAND WI 54806
GS
JAMES G NIBLER MD
206 SIXTH AVENUE WEST
ASHLAND WI 54806
ORS / ORS
715-682-8183
CLARK 0 OLSEN MD
SUITE 6
2101 BEASER AVENUE
ASHLAND WI 54806
FP / FP
715-682-2358
JOHN C OUJIRI MD
SUITE 2
2101 BEASER AVENUE
ASHLAND WI 54806
PTH CLP / PTH
715-682-4563
EUGENIA H PARKER MD
1615 MAPLE LANE
ASHLAND WI 54806
R / R
JOHN 0 PETERSON MD
SUITE 4
2101 BEASER AVENUE
ASHLAND WI 54806
FP / FP
THOMAS S PETRY MD
206 SIXTH AVENUE WEST
ASHLAND WI 54806
FP / FP
715-682-2358
DAVID M SAARINEN MD
SUITE 2
2101 BEASER AVENUE
ASHLAND WI 54806
DBG / OBG
715-682-5277
HOWARD N SANDIN MD
SUITE 9
2101 BEASER AVENUE
ASHLAND WI 54806
OPH / OPH
ROBERT J SNEED MD
POST OFFICE BOX 233
ASHLAND WI 54806
IM / IM
715-779-5525
PHILIP H SOUCHERAY MD
1002 WASHINGTON AVENUE
ROUTE 1 BOX 12C
BAYFIELD WI 54814
FP / FP
715-682-4545
ROBERT A STANLEY MD
200 SEVENTH AVENUE W
ASHLAND WI 54806
GS
IVAN TEQH MD
2101 BEASER AVENUE
ASHLAND WI 54806
FP / FP
PAUL VAN PERNIS MD
SUITE 2
2101 BEASER AVENUE
ASHLAND WI 54806
OBG / OBG
715-682-5277
EDWARD M VERNIER MD
2101 BEASER AVENUE
ASHLAND WI 54806
AN IM
715-682-4322
MARTIN G VICK MD
2101 BEASER AVENUE
ASHLAND WI 54806
BARRON-WASHBURN-BURNETT
GP
715-924-481 1
FREDERICK M BANNISTER MD
220 DOUGLAS STREET
CHETEK WI 54728
FP / FP
715-463-5317
MARK R BIXBY MD
POST OFFICE BOX 169
GRANTBBURG WI 54840
FP / FP
715-986-4101
JOEL A BORMANN DO
ROUTE 1 BOX 146
CUMBERLAND WI 54829
FP / FP
715-234-9031
LAWRENCE D CARLSON MD
1020 LAKESHORE DRIVE
RICE LAKE WI 54868
FP / FP
715-234-9031
LLOYD R COTTS MD
1020 LAKESHORE DRIVE
RICE LAKE WI 54868
FP / FP
MICHAEL M CRAGG MD
1020 LAKESHORE DRIVE
RICE LAKE WI 54868
IM / IM
CONRAD EASTWOLD III MD
1020 LAKESHORE DRIVE
RICE LAKE WI 54868
GP
715-234-2952
NOLAND A EIDSMOE MD
515 W MARSHALL STREET
RICE LAKE WI 54868
U / U
715-234-6874
EDWARD G ESCHENBAUM MD
1035 NORTH MAIN STREET
RICE LAKE WI 54868
FP / PP
715-458-4380
JAMES L ESSWEIN MD
1001 MAIN STREET
CAMERON WI 54822
FP / FP
DUANE L FLOGSTAD MD
209 FOURTH AVENUE WEST
SHELL LAKE WI 54871
OTO / OTO
715-234-6965
THOMAS G GERBER JR MD
1035 NORTH MAIN STREET
RICE LAKE WI 54868
FP / FP
715-635-2151
FREDERICK H GOETSCH MD
707 ASH STREET
SPOONER WI 54801
GP
AVERY C HALBERG MD
ROUTE 1
TURTLE LAKE WI 54889
FP GS / FP
715-463-5317
RICHARD L HARTZELL MD
POST OFFICE BOX 169
GRANTBBURG WI 54840-0169
ORS / ORS
715-234-9018
PATRICK M HEALY MD
1035 NORTH MAIN STREET
RICE LAKE WI 54868
FP / FP
715-234-9031
JOHN T HENNINGSEN MD
1020 LAKESHORE DRIVE
RICE LAKE WI 54868
FP GS / FP
715-234-9031
JOHN K HOYER MD
1020 LAKESHORE DRIVE
RICE LAKE WI 54868
GS / GS
715-234-9031
LYNN D KOOB MD
1020 LAKESHORE DRIVE
RICE LAKE WI 54868
FP / FP
715-234-9031
LOWELL A KRISTENSEN MD
1020 LAKESHORE DRIVE
RICE LAKE WI 54868
IM / IM
GEORGE H LIND MD
1905 HUEBBE PARKWAY
BELOIT WI 53511
FP / FP
THOMAS A L INGEN MD
POST OFFICE BOX 127
CUMBERLAND WI 54829
GP
715-822-2157
ROBERT E LUND MD
POST OFFICE BOX 127
CUMBERLAND WI 54829
FP / FP
715-822-2231
ROGER F MACY MD
POST OFFICE BOX 127
CUMBERLAND WI 54829
GP
715-234-9031
JAMES F MASER MD
1020 LAKESHORE DRIVE
RICE LAKE WI 54868
This membership roster is by county medical society with names listed in alphabetical order within each society. Information for each member
includes the following: Primary and secondary practice specialties preceding the slash (/) and Board-certified specialties and/or subspecialties
following the slash (some candidate members will not have specialty designation); followed by the telephone number when available, then the
member’s name and address. See preceding pages for further information.
8— barron/washburn/burnett, brown
GS ORS
KENNETH L MATSON MD
10738 SANTA FE DRIVE
SUN CITY AZ 85351
FP PD / FP
RUDOLF W MATZKE MD
707 ASH STREET
SPOONER WI 54801
FP / FP
715-234-9031
VOLDEMARS NARINS MD
1020 LAKESHORE DRIVE
RICE LAKE WI 54868
FP / FP
715-234-9031
MARK T NYMO MD
1020 LAKESHORE DRIVE
RICE LAKE WI 54868
GP
LESTER J OLSON MD
DH5
2767 SOUTH VIA DEL BAC
GREEN VALLEY AZ 85614
R / R
THOMAS M PELANT MD
113 NORTH MAIN STREET
RICE LAKE WI 54868
GS / GS
715-468-271 1
JAMES P QUENAN MD
209 FOURTH AVENUE WEST
SHELL LAKE WI 54871
AN
715-234-6580
DOUGLAS J RAETHER MD
1306 DUKE STREET
RICE LAKE WI 54868
P
715-822-8895
JOHN M RATHBUN MD
1655 OAK STREET
POST OFFICE BOX 235
CUMBERLAND WI 54829
GS / GS
N HANS RECHSTEINER MD
707 ASH STREET
SPOONER WI 54801
FP
MARK A RHOLL MD
435 SOUTH FIFTH STREET
BARRON WI 54812
FP / FP
715-822-2231
DONALD E RIEMER MD
POST OFFICE BOX 127
CUMBERLAND WI 54829
GP
715-537-3166
CLIVE J STRANG MD
1220 E WOODLAND AVENUE
BARRON WI 54812
GS / GS
715-822-2231
TED SUGIMOTO MD
POST OFFICE BOX 127
CUMBERLAND WI 54829
DR / DR
715-234-6452
RICHARD W SWANSON MD
1502 WEST MARSHALL
RICE LAKE WI 54868
FP / FP
715-924-481 1
HOWARD A THALACKER MD
220 DOUGLAS STREET
CHETEK WI 54728
FP ./ FP
GREGORY B THATCHER MD
209 FOURTH AVENUE WEST
SHELL LAKE WI 54871
FP / FP
715-234-9051
LESTER A THOMPSON MD
1020 LAKESHORE DRIVE
RICE LAKE WI 54868
GP
715-537-3166
RALPH C WHALEY MD
1220 WOODLAND AVENUE
BARRON WI 54812
IM / IM
PAMELA B WOLFE MD
1905 HUEBBE PARKWAY
BELOIT WI 53511
FP
THOMAS R YOUNGREN MD
POST OFFICE BOX 127
CUMBERLAND WI 54829
PD PHO / PD PHO
414-437-0431
STUART E ADAIR MD
900 S WEBSTER AVENUE
GREEN BAY WI 54301
GS
VAL D ADAMSKI MD
1313 SUMMER RANGE ROAD
DE PERE WI 54115
FP / FP
414-822-31 1 1
PERI L ALDRICH MD
POST OFFICE BOX Z
PULASKI WI 54162
GE IM / GE IM
414-433-0400
NARAYAN H AMARNANI MD
704 S WEBSTER AVENUE
GREEN BAY WI 54301
CD IM / CD IM
414-433-3640
LEWIS G ANTHONY MD
704 S WEBSTER AVENUE
GREEN BAY WI 54301
OBG / OBG
414-468-3444
STEPHEN D AUSTIN MD
704 S WEBSTER AVENUE
GREEN BAY WI 54301
PTH / PTH
414-433-3653
CHARLES F AWEN MD
POST OFFICE BOX 1700
GREEN BAY WI 54305-5000
IM / IM
414-468-5621
RAYMOND G BACHHUBER MD
1751 DECKNER AVENUE
GREEN BAY WI 54302
PD
KATHLEEN M BARKOW MD
821 SOUTH QUINCY
GREEN BAY WI 54301
ON IM / IM
GERALD K BAYER MD
336 WINDWARD DRIVE
GREEN BAY WI 54302
OBG / OBG
RICHARD C BECHTEL JR MD
704 S WEBSTER AVENUE
GREEN BAY WI 54301
OPH / OPH
414-432-9261
MICHAEL J BELSON MD
923 ELIZA STREET
GREEN BAY WI 54301
GS TS BE / GS
414-468-5621
THOMAS J BENO MD
1751 DECKNER AVENUE
GREEN BAY WI 54302
GS
JOHN C BISHOP MD
1203 S MILITARY AVENUE
GREEN BAY WI 54304
PTH / PTH
MARVIN D BLACKBURN JR MD
POST OFFICE BOX 1700
GREEN BAY WI 54305-5000
OPH / OPH
414-437-6505
CLARENCE L BLAHNIK MD
POST OFFICE BOX 8087
GREEN BAY WI 54308-8087
HEM IM / IM
414-494-561 1
JULES H BLANK MD
1551 DOUSMAN STREET
GREEN BAY WI 54303
FP / FP
414-494-9661
P BLOCHOWIAK MD
1745 DOUSMAN STREET
GREEN BAY WI 54303-3291
DR R / DR R
414-494-1600
PAUL R BOLICH MD
1586 ARAPAHOE COURT
GREEN BAY WI 54303
TQ PQ / PC
ROBERT G BRAULT MD
704 S WEBSTER AVENUE
GREEN BAY WI 54301
NS / GS
BRUCE C BRESSLER MD
704 S WEBSTER AVENUE
GREEN BAY WI 54301
IM / IM
414-494-4781
JOHN D BRUSKY MD
1203 S MILITARY AVENUE
GREEN BAY WI 54304
IM / IM
414-494-9661
CHARLES E BUCK MD
1745 DOUSMAN STREET
GREEN BAY WI 54303-3291
P
414-435-8920
JAMES F CAFFREY MD
130 EAST WALNUT STREET
GREEN BAY WI 54301
GS TS / GS TS
414-465-8621
THOMAS L CAIN MD
704 S WEBSTER AVENUE
GREEN DAY WI 54301
TR NM
414-336-9007
RAYMOND R CALAGUAN MD
3320 MIRANDA COURT
GREEN BAY WI 54305
OBG
414-468-3444
ROBERT A CAVANAUGH MD
704 S WEBSTER AVENUE
GREEN BAY WI 54301
FP / FP
414-433-3456
CHESTER W CRAWFORD MD
704 S WEBSTER AVENUE
GREEN BAY WI 54301
IM / IM
W MICHAEL CROSS MD
900 S WEBSTER AVENUE
GREEN BAY WI 54301
TR
LORENZO R CRUZ MD
3319 MIRANDA COURT
GREEN DAY WI 54301
P
414-435-8816
NORMA PICIO CRUZ MD
2131 S WEBSTER AVENUE
GREEN BAY WI 54301
GS CDS / GS
JAMES H CURL MD
404 POLARIS COURT
GREEN BAY WI 54302
PTH CLP / PTH
CHARLES F DAIS MD
1201 S MONROE AVENUE
GREEN BAY WI 54301
GS / GS
4 1 4 — 336— 1 2*53
HARRY H DANAHER MD
160 ROSEMONT DRIVE
GREEN BAY WI 54301-2613
CHP P / CHP P
414-468-1136
HOWARD W DAVIS MD
2900 ST ANTHONY DRIVE
GREEN BAY WI 54301
GP
414-468-5621
JOHN E DETTMANN MD
1751 DECKNER AVENUE
GREEN BAY WI 54302
P N / P N
414-435-8920
DAVID P DONARSKI MD
130 E WALNUT STREET
GREEN BAY WI 54301
CLP PTH / CLP
414-498-4659
JOHN H DRAHEIM MD
1726 SHAWANO AVENUE
GREEN BAY WI 54303
R / R
414-499-1428
LYLE H EDELBLUTE MD
POST OFFICE BOX 3006
GREEN DAY WI 54303
GP
MILO R ERICKSON MD
712 REDWOOD DRIVE
GREEN BAY WI 54304
GP
414-494-561 1
MANUEL J FALK MD
1551 DOUSMAN STREET
GREEN BAY WI 54303
CD IM / CD IM
414-432-6776
PETER A FERGUS MD
3319 CAMELIA COURT
GREEN BAY WI 54301
BROWN— 9
IM RHU / IM RHU
414-494-3421
ALAN G RINESILVER MD
123 N MILITARY AVENUE
GREEN BAY WI 54303
OPH OTO / OTD
414-435-1341
WILLIAM W FORD MD
321 GREENE AVENUE
GREEN BAY WI 54301
OPH / OPH
414-437-6505
W JAMES FOSTER MD
417 S MONROE AVENUE
POST OFFICE BOX 8087
GREEN BAY WI 54308
ORS / ORB
ALBERT L FREEDMAN MD
606 BELLIN BUILDING
130 EAST WALNUT STREET
GREEN BAY WI 54301
CD IM / IM
MATTHIAS A FUCHS MD
3216 DELAHAUT STREET
GREEN BAY WI 54301
OBG
DONALD J GALLAGHER MD
124 SIEGLER STREET
GREEN BAY WI 54303
OBG
JOHN C GALLAGHER MD
2568 TRILLIUM CIRCLE
GREEN BAY WI 54303
P
414-435-1103
JOHN V GEHRING MD
130 EAST WALNUT STRET
GREEN BAY WI 54301
GS CDS / GS
414-468-7913
THOMAS V GEOCAR IS MD
618 BORDEAUX AVENUE
GREEN BAY WI 54301
GS CDS / GS
414-494-3421
STEWART W GIFFORD MD
123 N MILITARY AVENUE
GREEN BAY WI 54303
GP GS
414-437-5431
JOHN R GOELZ MD
519 S MONROE AVENUE
GREEN BAY WI 54301
IM / IM
414-494-3421
JOSEPH B GRACE MD
123 N MILITARY AVENUE
GREEN BAY WI 54303
IM GE
414-437-0431
JEREMY R GREEN MD
900 S WEBSTER AVENUE
GREEN DAY WI 54301
IM
414-494-3421
RICHARD C GREENE MD
123 N MILITARY AVENUE
GREEN BAY WI 54303
P
414-435-8816
LED R GHIEBEN MD
2131 S WEBSTER AVENUE
GREEN BAY WI 54301
OPH / OPH
414-499-3102
PETER J GROESSL MD
1345 W MASON STREET
GREEN BAY WI 54303
NS
ROBERT A GRUE9EN MD
845 D S WEBSTER AVENUE
GREEN BAY WI 54301
GP
414-437-4366
JOHN M GUTHRIE MD
621 EAST WALNUT STREET
GREEN DAY 54301
GP EM
ARTHUR W HAINES MD
435 SHADY DRIVE
ROUTE 1
ONEIDA WI 54155
OBG
414-499-4855
THOMAS J HALLOIN MD
124 SIEGLER STREET
GREEN BAY WI 54303
CDS TB GS / TS GS
414-468-3574
IRWIN HARRIS MD
845 S WEBSTER AVENUE
GREEN BAY WI 54301
R / R
414-499-1428
LOREN E HART MD
POST OFFICE BOX 3006
GREEN BAY WI 54303
PTH / AP CLP
414-433-3653
STEPHEN D HATHWAY MD
POST OFFICE BOX 1700
GREEN BAY WI 54305-5000
PD / PD
GORDON D HAUGAN MD
1551 DOUSMAN STREET
GREEN BAY WI 54303
GP
414-863-2005
GEORGE V HERING MD
POST OFFICE BOX 188
DENMARK WI 54208
ORS / ORB
414-494-0523
JAMES A HINCKLEY MD
1551 DOUSMAN STREET
GREEN BAY WI 54303
OPH / OPH
414-437-6505
OLIVER M HITCH MD
417 S MONROE AVENUE
POST OFFICE BOX 8087
GREEN BAY WI 54308
IM / IM
HARRY W HOEGEMEIER MD
1551 DOUSMAN STREET
GREEN BAY WI 54303
AN OTO
CHANG-FUI HONG MD
383 SWISS HILL DRIVE
GREEN BAY WI 54302
PS
414-468-7333
HAROLD J HOOPS JR MD
704 S WEBSTER AVENUE
GREEN BAY WI 54301
ORS
RICHARD D HORAK MD
118 N MONROE STREET
GREEN BAY WI 54301
IM / IM
414-494-9661
KENNETH J HUJET MD
1745 DOUSMAN STREET
GREEN BAY WI 54303-3291
P / PN
EDWARD J JOHNSON MD
3033 NICOLET DRIVE
GREEN BAY WI 54302
AN
JOEL M JOHNSON MD
1591 ARAPAHOE COURT
GREEN BAY WI 54303-6760
AN
SAMUEL B JOHNSON MD
APT 206
3001 SOUTH WEBSTER
GREEN BAY WI 54301
IM / IM
414-494-561 1
ROBERT E JOHNSTON MD
1551 DOUSMAN STREET
GREEN BAY WI 54303
ORS / ORS
414-468-0246
WILLIAM D JONES MD
3131 RAVINE WAY
GREEN BAY WI 54301
DR / DR
414-469-1740
DAVID K JOSE MD
475 WILDWOOD DRIVE
GREEN BAY WI 54302
PD / PD
414-437-0431
G ROBERT KAFTAN MD
900 S WEBSTER AVENUE
GREEN BAY WI 54301
GP
ORRIS S KEISER MD
116 THIRD STREET
DE PERE WI 54115
PD 7 PD
W JOSEPH KELLNER MD
1821 S WEBSTER AVENUE
GREEN BAY WI 54301
ORS / ORS
414-468-0246
THOMAS G KEMPKEN MD
704 S WEBSTER AVENUE
GREEN BAY WI 54301
GS / GS
JACK A KILLINS MD
146 LAZARRE AVENUE
GREEN BAY WI 54301
GP
JOHN P KISER MD
2404 SANTA BARBARA DR
GREEN BAY WI 54303
IM / IM
PAUL D KOCH MD
3090 PINE RIDGE COURT
GREEN BAY WI 54301
IM / IM
414-468-5621
THOMAS P KOEHLER MD
1751 DECKNER AVENUE
GREEN BAY WI 54302
PD / PD
414-468-5621
DENNIS M KORGER MD
1751 DECKNER AVENUE
GREEN BAY WI 54302
IM / IM
414-494-5614
KENNETH R KUBSCH MD
1551 DOUSMAN STREET
GREEN BAY WI 54303
GP
414-863-2005
BERNARD KULKOSKI MD
POST OFFICE BOX 188
DENMARK WI 54208-0188
AN / AN
414-432-6373
JAY J KURITZ MD
2412 SANDY LANE
GREEN BAY WI 54302
HEM IM / HEM IM
414-435-4341
JAMES V LACEY MD
1821 S WEBSTER AVENUE
GREEN BAY WI 54301
IM CD / IM
414-494-3421
FREDERICK J LAMONT MD
123 N MILITARY AVENUE
GREEN BAY WI 54303
FP / FP
414-494-9661
PATRICK S S LEH MD
1745 DOUSMAN STREET
GREEN BAY WI 54303-3291
NA IM
RDVCE C LIN MD
2440 BRENNER PLACE
GREEN DAY WI 54301
ORS / ORS
ROLF S LULLOFF MD
2520 BETTY COURT
GREEN BAY WI 54301
GP
WALLACE MAC MULLEN MD
1751 DECKNER AVENUE
GREEN BAY WI 54302
GP
414-845-2351
HENRY E MAJESKI MD
206 MAIN STREET
POST OFFICE BOX C
LUXEMBURG WI 54217
GS
414-498-3252
ENRIQUE S MANABAT JR MD
812 SOUTH FISK STREET
GREEN BAY WI 54304
GS CDS / GS
414-494-1 557
DAVID A MANKE MD
1551 DOUSMAN
GREEN BAY WI 54303
U / U
414-437-9613
MYRON M MARLETT MD
2021 S WEBSTER AVENUE
GREEN BAY WI 54301
R / R
JOHN E MARTIN MD
POST OFFICE BOX 3006
GREEN BAY WI 54303
IM AI / IM AI
414-494-2323
JAMES R MATTSON MD
501 S MILITARY AVENUE
GREEN BAY WI 54303
PTH / PTH
414-433-8226
RAYMOND A MC CORMICK MD
1165 HILL DRIVE
ONEIDA WI 54155-9114
AN / AN
414-494-8477
AUSTIN R MC GUAN MD
1334 KELLOGG STREET
GREEN BAY WI 54303
10— BROWN
QRS / ORS
GEORGE E MC GUIRE MD
704 S WEBSTER AVENUE
GREEN BAY WI 54301
FP / FP
MICHAEL G MC HENRY MD
314 SEMINOLE LANE
GREEN BAY WI 54303
PTH CLP / PTH CLP
414-498-4662
JAMES A MC INTYRE MD
1726 SHAWANO AVENUE
GREEN BAY WI 54303
IM CD
414-435-4341
DAVID H MC KENNA MD
1821 S WEBSTER AVENUE
GREEN BAY WI 54301
FP
414-433-3456
WESLEY E MC NEAL MD
704 S WEBSTER AVENUE
GREEN BAY WI 54301
GP
4 1 4— 4PAS
GERALD B MERLINE MD
502 GEORGE STREET
DE PERE WI 54115
IM / IM
RODERICK L MEVES MD
705 N WINNEBAGO STREET
DE PERE WI 54115
PD
MARY C MEYER MD
1551 DOUSMAN
GREEN BAY WI 54303
PD / PD
414-437-9051
KENNETH C MICKLE MD
1821 S WEBSTER AVENUE
GREEN BAY WI 54301
OTO / OTO
414-497-9777
GARY T MILLER MD
1548 WESTERN AVENUE
GREEN BAY WI 54303
OTO / OTO
414-432-9261
JOHN M MILLS MD
923 ELIZA STREET
GREEN BAY WI 54301
GS / GS
414-494-9661
BERTRAM I MILSON MD
1745 DOUSMAN STREET
GREEN BAY WI 54303-3291
GP
414-494-9661
LOUIS MILSON MD
1745 DOUSMAN STREET
GREEN BAY WI 54503-3291
IM
STUART E MILSON MD
1745 DOUSMAN STREET
GREEN BAY WI 54303-3291
NM / NM
ALI A MOHAMMAD-ZADEH MD
1787 RAINBOW AVENUE
DE PERE WI 54115
ORS
WAYNE S MOHR MD
118 N MONROE AVENUE
GREEN BAY WI 54301
OBG / DBG
414-468-5621
RAYMOND J MURPHY MD
1751 DECKNER AVENUE
GREEN BAY WI 54302
AN
GEETHA MURTHY MD
3000 RAVINE WAY
GREEN BAY WI 54301
PD A PDA / PD
414-437-9051
RICHARD L MYERS MD
1821 S WEBSTER AVENUE
GREEN BAY WI 54301
OPH
GEORGE NADEAU MD
141 WEBSTER HEIGHTS DR
GREEN DAY WI 54301
ORS / ORS
414-336-8078
JAMES W NELLEN MD
POST OFFICE BOX 489
DE PERE WI 54115-0489
IM / IM
414-437-0431
WILLIAM L NELSON JR MD
900 S WEBSTER AVENUE
GREEN BAY WI 54301
NS / NS
HIRO NISHIOKA MD
704 S WEBSTER AVENUE
GREEN BAY WI 54301
IM GE / IM GE
414-494-9661
CHARLES NORDELL MD
1745 DOUSMAN STREET
GREEN BAY WI 54303-3291
FP
CLARENCE G NOVOTNY MD
120 SIEGLER
GREEN DAY WI 54303
P / P
414-435-8920
MICHAEL J O'NEILL MD
3239 DELAHAUT STREET
GREEN BAY WI 54301
ORS / ORS
MICHAEL D O'REILLY MD
1551 DOUSMAN STREET
GREEN BAY WI 54303
P CHP / P
414-435-8816
EDWARD S ORMAN MD
2131 S WEBSTER AVENUE
GREEN BAY WI 54301
OPH / OPH
414-437-6505
JOHN A OTTUM MD
417 S MONROE AVENUE
POST OFFICE BOX 8087
GREEN BAY WI 54308
NS
RICHARD C OUDENHOVEN MD
1059 BRIGHTON DRIVE
MENASHA WI 54952
IM CD / IM CD
414-433-3640
HOWARD J PALAY MD
400 ROSELAWN BLVD
GREEN BAY WI 54301
CD IM / IM
BHARAT Y PATHAKJEE MD
704 S WEBSTER AVENUE
GREEN BAY WI 54301
EM
414-336-5575
EARL E PETERS MD
ROUTE 3
LOST DAUPHIN ROAD
DE PERE WI 54115
GS / GS
414-468-7121
LOUIS D PHILIPP MD
704 S WEBSTER AVENUE
GREEN BAY WI 54301
IM / IM
414-432-4341
CHRISTOPHER C FINN MD
1821 S WEBSTER AVENUE
GREEN BAY WI 54301
OBG / OBG
414-437-4395
CARL R POLEY MD
1821 S WEBSTER AVENUE
GREEN BAY WI 54301
PD NPM / PD
414-437-0431
MICHAEL POREMBSKI MD
900 S WEBSTER AVENUE
GREEN BAY WI 54301
PD NPM
GERALD D PURDY MD
900 S WEBSTER AVENUE
GREEN BAY WI 54305
FP GP / FP
414-845-2351
HENRY C RAHR MD
346 WAGON WHEEL COURT
GREEN BAY WI 54302
IM HEM / IM
414-468-3422
JOHN H RANDALL MD
704 S WEBSTER AVENUE
GREEN BAY WI 54301
IM RHU / IM
JOHN J RANK MD
1551 DOUSMAN STREET
GREEN BAY WI 54303
P / P
414-435-8920
HAROLD J REINHARD MD
501 BELLIN BUILDING
130 EAST WALNUT STREET
GREEN BAY WI 54301
IM END / IM END
414-468-9588
BENSON L RICHARDSON MD
704 S WEBSTER AVENUE
GREEN BAY WI 54301
DR / R
JAMES E ROBINSON MD
2941 SOUTH RIDGE ROAD
GREEN BAY WI 54304
GP GS
ROBERT J ROSE MD
621 EAST WALNUT STREET
GREEN BAY WI 54301
P
414-437-3360
CLARENCE A ROTHE MD
2573 OAKWOOD AVENUE
GREEN BAY WI 54301
U GS
DAVID L SAMUEL MD
1551 DOUSMAN STREET
GREEN BAY WI 54303
PD NPM / PD NPM
414-437-0431
DAVID P SAMUELS MD
900 S WEBSTER STREET
GREEN BAY WI 54301
OBG / OBG
414-468-3444
HERBERT F SANDMIRE MD
704 S WEBSTER AVENUE
GREEN BAY WI 54301
GP
414-432-5569
WILLIAM J SCHIBLY MD
530 S IRWIN STREET
GREEN BAY WI 54301
U / U
JOHN C SCHIEBLER MD
2021 S WEBSTER AVENUE
GREEN BAY WI 54303
TR R
414-433-8184
SALLY M SCHLISE MD
1124 CASS STREET
GREEN BAY WI 54301
OPH / OTO
414-432-9261
ROBERT T SCHMIDT MD
923 ELIZA STREET
GREEN BAY WI 54301
N / N
414-468-6372
ROBERT T SCHMIDT JR MD
704 S WEBSTER AVENUE
GREEN BAY WI 54301
npQ / npQ
WILLIAM F SCHNEIDER MD
704 S WEBSTER AVENUE
GREEN BAY WI 54301
AN
JOHN P SCHUMACHER MD
POST OFFICE BOX 1081
GREEN BAY WI 54305
OPH / OPH
414-499-3102
KARL L SCHWIESOW MD
1345 WEST MASON STREET
GREEN BAY WI 54303
OBG / OBG
414-433-9000
FREDERICK G SEHRING MD
2301 RIVERSIDE DRIVE
GREEN BAY WI 54301
OBG / OBG
414-499-1222
RICHARD L SHAFFER MD
1061 WEST MASON STREET
GREEN BAY WI 54304
PD ADL Z PD
414-437-9051
DANIEL W SHEA MD
1821 S WEBSTER AVENUE
GREEN BAY WI 54301
FP
DONALD L SHERWOOD MD
1551 DOUSMAN STREET
GREEN BAY WI 54303
IM / IM
414-494-4781
GOWDAR S SHIVAMURTHY MD
1203 S MILITARY AVENUE
GREEN BAY WI 54304
IM / IM
414-437-0431
JOHN F SHRAKE MD
900 S WEBSTER AVENUE
GREEN BAY WI 54301
OBG / OBG
414-499-1222
DONALD R SIPES MD
1061 WEST MASON STREET
GREEN BAY WI 54303
PTH / PTH
DARRELL P SKARPHOL MD
2480 EDGEWOOD COURT
GREEN BAY WI 54301
BROWN, CALUMET, CHIPPEWA— 11
u / u
CHARLES C SMITH MD
2021 S WEBSTER AVENUE
GREEN DAY WI 54301
D DMP / D DMP
414-4R9-0696
MICHAEL J SMULLEN MD
1239 WEST MASON STREET
GREEN BAY WI 54304-2047
TS / TS
JOHN R SOETER MD
704 S WEBSTER AVENUE
GREEN DAY WI 54301
N / PN
STEPHEN V SOMERVILLE MD
SUITE 5B
704 S WEBSTER AVENUE
GREEN BAY WI 54301
AN / AN
414-432-6373
HWE JAE SONG MD
416 CROOKS STREET
GREEN DAY WI 54301
OPH / OPH
414-432-9261
ANATOL J STANKEVYCH MD
923 ELIZA
GREEN BAY WI 54301
DR / DR
414-336-5965
HAROLD E STINE MD
OAK RIDGE CIRCLE
ROUTE 5
DE PERE WI 54115
GS / GS
414-494-561 1
BRUCE J STOEHR MD
1551 DOUSMAN STREET
GREEN BAY WI 54303
FP ODG / FP
DONEL R SULLIVAN MD
905 S MONROE AVENUE
GREEN BAY WI 54301
IM
J SUNDLASS MD
2900 ST ANTHONY DRIVE
GREEN BAY WI 54301
GS CDS / GS
414-494-0580
JACK A SWELSTAD MD
704 S WEBSTER AVENUE
GREEN BAY WI 54301
OBG / ODG
414-437-0431
GEORGE J THEILER JR MD
900 S WEBSTER AVENUE
GREEN BAY WI 54301
DR / DR
414-336-6706
LOREN L THOMPSON MD
234 TERRACE COURT
GREEN BAY WI 54301
IM GE / IM GE
414-494-561 1
RONALD G THUNE MD
2690 TAMARACK CIRCLE
GREEN BAY WI 54303
OTO / OTO
414-494-561 1
RICHARD J TITULAER MD
1551 DOUSMAN STREET
GREEN DAY WI 54303
ORS / ORS
HUBERT A TRESSLER MD
118 N MONROE STREET
GREEN BAY WI 54301
U / U
414-433-6054
CHARLES W TROUP MD
704 S WEBSTER AVENUE
GREEN BAY WI 54301
U / U
414-437-9613
RICHARD H TROUP MD
2021 S WEBSTER AVENUE
GREEN BAY WI 54301
OPH OTO / OPH OTO
414-868-3779
WILSON J TROUP MD
LANIKAI VILLAS
329 S OCEAN BOULEVARD
DELRAY BEACH FL
33444-6722
OBG / OBG
414-437-4395
JOHN W UTRIE MD
1821 S WEBSTER AVENUE
GREEN BAY WI 54301
GP
FRANCIS B VANDE LOO MD
1819 RAINBOW AVENUE
DE PERE WI 54115
OTO / OTO
414-432-9261
S VANDER WOUDE MD
923 ELIZA STREET
GREEN BAY WI 54301
OBG
414-499-1222
EDWARD G VOGEL MD
1061 WEST MASON STREET
GREEN BAY WI 54303
GS / GS
414-437-0431
ROGER L VON HEIMBURG MD
900 S WEBSTER AVENUE
GREEN BAY WI 54301
ORS
DONALD L WACKWITZ MD
1551 DOUSMAN STREET
GREEN BAY WI 54303
IM GE / IM GE
414-433-0400
LEONARD J WAHL MD
704 S WEBSTER AVENUE
GREEN BAY WI 54301
GER IM / IM
414-822-311 1
FRED H WALBRUN MD
940 S ST AUGUSTINE ST
PULASKI WI 54162
FP / FP
4 1 4— 33A— 4DSS
BERNARD P WALDKIRCH MD
502 GEORGE STREET
DE PERE WI 54115
GP
RAYMOND M WALDKIRCH MD
502 GEORGE STREET
DE PERE WI 54115
AN
THOMAS P WALKER MD
1331 BELLEVUE - LOT Q
GREEN BAY WI 54302
R / R
414-494-1600
JOHN F WALLER lUS MD
ROUTE 2 BOX 136A
DENMARK WI 54208
IM / IM
414-435-4341
ROBERT E WAMPLER MD
1821 S WEBSTER AVENUE
GREEN BAY WI 54301
N / PN
WILLIAM M WANAMAKER MD
704 S WEBSTER AVENUE
GREEN DAY WI 54301
AN
SUSAN E WARACZYNSKI MD
3643 ULMCREST COURT
GREEN BAY WI 54301
R / R
ROGER C WARGIN MD
613 RIDGEVIEW COURT
GREEN BAY WI 54301-1439
PD / PD
JAMES R WARP INSKI MD
1551 DOUSMAN STREET
GREEN BAY WI 54303
R / R
FRANK M WEINHOLD III MD
425 ARROWHEAD DRIVE
GREEN DAY WI 54301
NS AM / NS
414-465-1900
ALAN F WENTWORTH MD
704 S WEBSTER AVENUE
GREEN BAY WI 54301
OTO / OTO
414-432-9261
DAVID M WINEINGER MD
923 ELIZA STREET
GREEN BAY WI 54301
PD HEM
414-437-0431
JAMES F WINSTON MD
900 S WEBSTER AVENUE
GREEN BAY WI 54301
GS / GS
414-435-4341
ROBERT G WOCHOS MD
1821 S WEBSTER AVENUE
GREEN BAY WI 54301
GP EM
414-846-3444
JAMES R P WONG MD
855 SOUTH MAIN STREET
OCONTO FALLS WI 54154
PD PDA / PD
414-437-0431
JOSEPH G ZONDLO MD
900 S WEBSTER AVENUE
GREEN BAY WI 54301
GS / GS
414-435-4341
KENNETH L ZUCKER MD
1821 S WEBSTER AVENUE
GREEN DAY WI 54301
CALUMET
FP / FP
414-756-531 1
WILLIAM J CARLSON MD
117 PARK AVENUE
BRILLJON WI 54110
FP / FP
414-756-2055
JULIO C DE ARTEAGA MD
133 WISCONSIN AVENUE
BRILLION WI 54110
GS CDS GYN / GS
414-849-2888
BADRI N GANJU MD
451 E BROOKLYN STREET
CHILTON WI 53014
PTH / PTH
JAMES H GLENN MD
1735 MEADOW LANE
LAS CRUCES NM 88005
PTH / PTH
414-849-2386
WILLIAM E HANNON MD
614 MEMORIAL DRIVE
CHILTON WI 53014
GP OTO
414-849-2331
KENNETH R HUMKE MD
26 SCHOOL STREET
CHILTON WI 53014
PS GS
414-849-4426
MARTIN H KLEIN MD
69 E BROOKLYN STREET
CHILTON WI 53014
GP
414-849-4112
JAMES W KNAUF MD
451 E BROOKLYN STREET
CHILTON WI 53014
GP
414-898-4412
FRANCIS P LARME MD
2101 MARY AVENUE
NEW HOLSTEIN WI 53061
R
414-849-9448
RICARTE E LOZADA MD
W 2143 DEBRA COURT
CHILTON WI 53014
GP EM
414-853-3203
JAMES C PINNEY MD
218 S EIGHTH STREET
HILBERT WI 54129
IM
ARTURO M YLAGAN MD
26 SCHOOL STREET
CHILTON WI 53014
CHIPPEWA
FP / FP
715-568-2110
MERNE W ASPLUND MD
1518 MAIN STREET
BLOOMER WI 54724
FP
715-644-5567
MYRNA A CASING MD
121 WEST EIGHTH AVENUE
STANLEY WI 54768
GP GS
ROBERTO L CASING MD
ROUTE 2 BOX 117-D
STANLEY WI 54768
AN / AN
FREDERICK D COOK MD
1315 RIDGEWOOD DRIVE
CHIPPEWA FALLS WI 54729
EM / EM
715-723-6625
STEVEN D COOK MD
601 W COLUMBIA STREET
CHIPPEWA FALLS WI 54729
ORS / ORS
GEORGE F: FLEMING MD
3203 STEIN BOULEVARD
EAU CLAIRE WI 54701
12— CHIPPEWA, CLARK, COLUMBIA/MARQUETTE/ADAMS
GP DBG
804-384-8703
E CROSBY GLENN MD
804 TRENTS FERRY ROAD
LYNCHBURG VA 24503-1122
GS
CAESAR R GONZAGA MD
127 W CENTRAL STREET
CHIPPEWA FALLS WI 54729
GP
EARL A HATLEBERG MD
321 CARSON STREET
CHIPPEWA FALLS WI 54729
FP / FP
715-239-6344
ROBERT L HENDRICKSON MD
POST OFFICE BOX 248
CORNELL WI 54732
OPH / OPH
715-723-9375
PETER W HOLM MD
2505 COUNTY HIGHWAY I
CHIPPEWA FALLS WI 54729
FP / FP
PAUL M IPPEL MD
2501 COUNTY TRUNK I
CHIPPEWA FALLS WI 54729
FP / FP
JOHN L LARSON MD
POST OFFICE BOX 187
BLOOMER WI 54724
IM / IM
715-723-8827
JOHN H LAYER MD
2503 COUNTY TRUNK I
CHIPPEWA FALLS WI 54729
FP
ROBERT S LEA MD
1102 DOVER STREET
CHIPPEWA FALLS WI 54729
OBG
SANG B LEE MD
890 HIGHWAY 178
CHIPPEWA FALLS WI 54729
GP
715-644-5542
ROBERT J MATHWIG MD
121 WEST EIGHTH AVENUE
POST OFFICE BOX 112
STANLEY WI 54768
GP
PAUL W MURPHY MD
308 17TH AVENUE
BLOOMER WI 54724
IM GP / IM
RICARDO S OBCENA MD
754 NORTH MAIN STREET
CADOTT WI 54727
FP / FP
715-839-7964
ALBON W OVERGARD MD
MT WASHINGTON CLUB
1930 CLEVELAND AV A236
EAU CLAIRE WI 54703
FP EM
715-723-4067
LYMAN W PICOTTE MD
1420 MILES STREET
CHIPPEWA FALLS WI 54729
ORS / ORS
A FREDERICK PROETT MD
2507 COUNTY HIGHWAY I
CHIPPEWA FALLS WI 54729
GP
BRUNO F RAHN MD
ROUTE 6 BOX 253
CHIPPEWA FALLS WI 54729
FP / FP
715-568-3153
GORDON H ROSENBROOK MD
1905 SOUTH MAIN STREET
BLOOMER WI 54724
GP / FP
715-644-5526
DOUGLAS A SALLIS MD
305 EAST FIRST AVENUE
STANLEY WI 54768
FP
CLARENCE SAMUELSON MD
ROUTE 1 BOX 49-A
PARK LANE DRIVE
JIM FALLS WI 54748
FP IM PUD / FP
715-289-4331
ROMULO M SANCHEZ MD
POST OFFICE BOX 305
CADOTT WI 54727
GP U
715-723-4498
JOHN J SAZAMA MD
658 HERITAGE COURT
CHIPPEWA FALLS WI 54729
U / U
715-835-6548
RICHARD C SAZAMA MD
3203 STEIN BOULEVARD
EAU CLAIRE WI 54701
TR R / TR R
715-723-8162
FRANKLIN H SWENSON MD
ROUTE 6 BOX 290
CHIPPEWA FALLS WI 54729
GS CDS
JOHN E WALZ MD
230 EAST FOURTH STREET
STANLEY WI 54768
PTH / PTH
715-726-3260
WARREN K WRIGHT MD
2661 COUNTY TRUNK I
CHIPPEWA FALLS WI 54729
GP
715-289-3321
CLARENCE E ZENNER MD
POST OFFICE BOX 61
CADOTT WI 54727
CLARK
GS ABS 7 GS
71 5-743-3231
NAZARIO R CAPATI MD
216 SUNSET PLACE
NEILLSVILLE WI 54456
AN GS
SAMPATH K CHENNAMANENI MD
604 EAST SECOND STREET
NEILLSVILLE WI 54456
IM ON / IM
7 1 5—743—323 1
RUPA CHENNAMANENI MD
216 SUNSET PLACE
NEILLSVILLE WI 54456
FP / FP
715-267-6600
RUSSELL A DEAN MD
134 SOUTH MAIN STREET
GREENWOOD WI 54437
FP / FP
715-743-3231
BAHRI 0 GUNGOR MD
216 SUNSET PLACE
NEILLSVILLE WI 54456
FP / FP
WILLIAM P HOPKINS MD
106 EAST FIFTH STREET
OWEN WI 54460
FP / FP
715-267-6600
GARY J JANSSEN MD
134 SOUTH MAIN STREET
GREENWOOD WI 54437
GP
715-229-2993
JOHN W JOHNSON MD
POST OFFICE BOX 154
WITHEE WI 54498
GP
715-223-2331
JAMES W KOCH MD
106 S SECOND STREET
COLBY WI 54421
FP PD / FP
RANI S KURAPATI MD
POST OFFICE BOX 338
LOYAL WI 54446
GP
715-743-3520
KENNETH F MANZ MD
604 WEST SECOND STREET
NEILLSVILLE WI 54456
IM CD / IM CD
7 1 5—743—3231
NARASIMHULU NEELAGARU MD
216 SUNSET PLACE
NEILLSVILLE WI 54456
GP
7 1 5-223—233 1
E DOLF PFEFFERKORN MD
COLBY WI 54421
PD A / PD
715-743-3231
REGANTI V R REDDY MD
216 SUNSET PLACE
NEILLSVILLE WI 54456
DR IM /DR R
715-743-3101
VANGALA J REDDY MD
216 SUNSET PLACE
NEILSVILLE WI 54456
COLUMBIA-MARQUETTE-ADAMS
OPH / OPH
608-742-8806
REED C ANDREW MD
POST OFFICE BOX 178
PORTAGE WI 53901-0178
GS
RENATO R BAYLON MD
POST OFFICE BOX 9
OXFORD WI 53952-0009
GP GS
608-742-6968
FREDRICK H BRONSON MD
ROUTE 2 BOX 133
PORTAGE WI 53901
GP
CLEMENT F CHELI MD
923 PARK AVENUE
COLUMBUS WI 53925
FP
608-742-7161
RICHARD E CHRISTIANSON MD
916 SILVER LAKE DRIVE
PORTAGE WI 53901
FP
608-253-1 171
HAROLD L CONLEY MD
820 BAUER STREET
WISCONSIN DELLS WI 53965
GP
608-742-7161
ROBERT T COONEY MD
916 SILVER LAKE DRIVE
PORTAGE WI 53901
OBG
RENATO C DIANCIN MD
545 DIX STREET
POST OFFICE BOX 203
COLUMBUS WI 53925
GS / GS
608-339-3326
MUHAMMED ESMAILI MD
POST OFFICE BOX 10
FRIENDSHIP WI 53934
GS / GS
RENATO T FAYLONA MD
SOUTH VINE STREET
WISCONSIN DELLS WI 53965
FP
FREDERICK W GISSAL MD
392 FUR DRIVE
WISCONSIN DELLS WI 53965
FP / FP
608-742-7161
DAVID D GREGORY MD
916 SILVER LAKE DRIVE
PORTAGE WI 53901
GP
608-742-4139
VICTOR C GUZMAN JR MD
POST OFFICE BOX 472
PORTAGE WI 53901
GP GS
THOMAS E HENNEY MD
916 SILVER LAKE DRIVE
PORTAGE WI 53901
GP
608-742-8238
KARL M HOFFMANN MD
DEPT/FAMILY PRACTICE
WV MEDICAL CENTER
MORGANTOWN WV 26506
OP OQ
608-592-4100
WALLACE G IRWIN MD
109 FIRST STREET
LODI WI 53555
FP / FP
608-339-3326
MARTIN L JANSSEN MD
POST OFFICE BOX 10
FRIENDSHIP WI 53934
IM / IM
414-623-2323
BRUCE A KRAUS MD
1511 PARK AVENUE
POST OFFICE BOX 310
COLUMBUS WI 53925
IM PUD
GUALBERTO B MEJIA MD
POST OFFICE BOX 9
OXFORD WI 53952-0009
GS CDS / GS
608-339-6350
MUZAFFAR B MIRZA MD
206 WEST LAKE STREET
POST OFFICE BOX 160
FRIENDSHIP WI 53934
GP IM
608-742-2131
JOSEPH W PAVELSEK MD
1508 NEW PINERY ROAD
PORTAGE WI 53901
COLUMBIA/MARQUETTE/ADAMS, CRAWFORD, DANE— 13
GP GS
414-623-5000
JOHN F POSER MD
635 PARK AVENUE
COLUMBUS WI 53925
IM / IM
414-623-5000
ROLF 0 F POSER MD
635 PARK AVENUE
COLUMBUS WI 53925
PD / PD
RAMAKRISHNAN SANKARAN MD
POST OFFICE BOX 10
FRIENDSHIP WI 53934
QS
RAHMATOLLAH SI MAN I MD
POST OFFICE BOX 10
FRIENDSHIP WI 53934
IM / IM
PAUL J SLAVIK MD
916 SILVER LAKE DRIVE
PORTAGE WI 53901
FP / FP
608-339-6350
CAROL D STODOLA MD
206 WEST LAKE STREET
POST OFFICE BOX 160
FRIENDSHIP WI 53934
ORS / ORS
608-742-8389
DONALD J TAYLOR MD
1015 W PLEASANT STREET
POST OFFICE BOX 387
PORTAGE WI 53901
GP
608-742-4242
STEWART F TAYLOR MD
108 EAST COOK STREET
POST OFFICE BOX 320
PORTAGE WI 53901
ORS
STEWART F TAYLOR JR MD
POST OFFICE BOX 387
PORTAGE WI 53901
GP
EDWARD F TIERNEY MD
316 WEST COOK STREET
PORTAGE WI 53901
DR
RAYMUNDO M VERZOSA MD
205 SADDLE RIDGE EST
PORTAGE WI 53901
GP GS OBG
608-742-4139
CELSO A VILLAVICENCIO MD
842 RIDGEVIEW COURT
PORTAGE WI 53901
FP / FP
RICHARD K WESTPHAL MD
POST OFFICE BOX 325
WISCONSIN DELLS WI 53965
CRAWFORD
GP ORS
608-326-6978
ELI M DESSLOCH MD
POST OFFICE BOX 89
PRAIRIE DU CHIEN WI 53821
FP / FP
608-326-6466
MICHAEL S GARRITY MD
610 EAST TAYLOR STREET
PRAIRIE DU CHIEN WI 53821
DANE
MARK K AASEN
526 WEST SHORE DRIVE
MADISON WI 53715-1624
CDS TS GS / GVS TS GS
KHOSRO AD IB MD
345 W WASHINGTON AVE
MADISON WI 53703
KENNETH P ADLER
529 WEST WILSON STREET
MADISON WI 53703
IM / IM
EDWIN C ALBRIGHT MD
3901 EUCLID AVENUE
MADISON WI 53711
FP
JOHN G ALBRIGHT MD
1912 ATWOOD AVENUE
MADISON WI 53704
AN / AN
608-263-8100
S CRAIGHEAD ALEXANDER MD
B6/387 CSC
600 HIGHLAND AVENUE
MADISON WI 53792
608-233-3041
UFUK FUSUN ALGAN
APT 4
4921 ASCOT LANE
MADISON WI 53711
OPH / OPH
608-263-7171
JAMES C ALLEN MD
F4/348 CSC
600 HIGHLAND AVENUE
MADISON WI 53792
OM
JOHN R ALLEN MD
795 LAKEWOOD BLVD
MADISON WI 53704
IM / IM
608-233-2082
ROBIN N ALLIN MD
802 HURON HILL
MADISON WI 53711
608-233-7687
JOHN K AMUZU
108 B EAGLE HEIGHTS
MADISON WI 53705
608-271-7678
JAMES R ANDERSEN
6606 REGIS ROAD
MADISON WI 53711
GS / GS
608-238-9070
A D ANDERSON MD
5110 MANITOWOC PARKWAY
MADISON WI 53705
OTO / OTO
608-257-3696
ASHLEY G ANDERSON JR MD
SUITE 350
20 SOUTH PARK STREET
MADISON WI 53715-1348
OPH
CHARLES J ANDERSON MD
314 ACADIA DRIVE
MADISON WI 53717
CRAIG D ANDERSON
POST OFFICE BOX 253
CENTURIA WI 54824-0253
GREGORY ANDERSON
933 W JOHNSON STREET
MADISON WI 53715
OS PUD
HENRY A ANDERSON MD
5101 CONEY WESTON PL
MADISON WI 53711
OM GPM / OM GPM
608-266-1253
HENRY A ANDERSON III MD
POST OFFICE BOX 309
ONE WEST WILSON
MADISON WI 53701
OBG / OBG
608-257-4386
JOHN M ANDERSON MD
SUITE 450
20 SOUTH PARK STREET
MADISON WI 53715
STEVEN P ANDERSON
701 SCHMITT PLACE
MADISON WI 53705
JOHN S ANDREWS
632 S ORCHARD STREET
MADISON WI 53715-1650
PD / PD
608-833-7500
CONRAD L ANDRINGA MD
202 SOUTH GAMMON ROAD
MADISON WI 53717
AN PD / PD
RICHARD C ANDRINGA MD
6511 OFFSHORE DRIVE
MADISON WI 53705
ON
715-794-2451
FRED J ANSFIELD MD
POST OFFICE BOX 41
CLAM LAKE WI 54517
R NM / R NM
608-255-4576
TAMNIT ANSUSINHA MD
SUITE 201
20 SOUTH PARK STREET
MADISON WI 53715
OPH / OPH
608-258-4520
RICHARD E APPEN MD
1025 REGENT STREET
MADISON WI 53715
P
608-256-5176
RICHARD B ARNESEN MD
920 CASTLE PLACE
MADISON WI 53703
SCOTT J ASCHENBRENER
933 W JOHNSON STREET
MADISON WI 53715-1023
MARK S ASPERHEIM
526 WEST SHORE DRIVE
MADISON WI 53715-1624
FP / FP
608-222-9777
BENJAMIN W ATKINSON MD
814 ATLAS AVENUE
MADISON WI 53704
AN / AN
608-263-8109
JOHN L ATLEE MD
B6/386 CSC
600 HIGHLAND AVENUE
MADISON WI 53792
R / R
DAVID T ATWELL MD
309 W WASHINGTON AVE
MADISON WI 53703
AN / AN
PAMELA G AVERY MD
6018 HAMMERSLEY ROAD
MADISON WI 53711
J MICHAEL BACHARACH
APT 1
2737 LYNNE TERRACE
MADISON WI 53705
608-257-9679
BRIAN G BACHHUBER
935 DRAKE STREET
MADISON WI 53715
AN / AN
MARK F BACKS MD
238 CARILLON DRIVE
MADISON WI 53705
GS / GS
KLAUS D BACKWINKEL MD
345 W WASHINGTON AVE
MADISON WI 53703
THOMAS P BAKER
APT 3S
213 NORTH HAMILTON
MADISON WI 53703
AN / AN
608-263-8110
BETTY J BAMFDRTH MD
B6/387 UW CSC
600 HIGHLAND AVENUE
MADISON WI 53792
CD IM / CD IM
GEORGE T BANDOW MD
1313 FISH HATCHERY RD
MADISON WI 53715
ORS / ORS
608-252-8458
HARVEY L BARASH MD
345 W WASHINGTON AVE
MADISON WI 53703
ORS / ORS
608-241-6567
WALTER BARANOWSKI MD
1912 ATWOOD AVENUE
MADISON WI 53704
EM / FP
BARBARA S BARNETT DO
APT 7
3226 CREEK VIEW
MIDDLETON WI 53562-1968
CD IM / CD IM
608-241-461 1
KAY M BARRETT MD
1912 ATWOOD AVENUE
MADISON WI 53704
OBG
608-257-4386
CINDY L BARRON MD
2302 GOLD DRIVE
MADISON WI 53711
AN / AN
608-238-4353
JOHN H BARSCH MD
146 NAUTILUS DRIVE
MADISON WI 53705
OTO
THAD E BARTEL MD
DEPT OTO
600 HIGHLAND AVENUE
MADISON WI 53792
ORS / ORS
608-238-931 1
DAVID H BARTLETT MD
2704 MARSHALL COURT
MADISON WI 53705
PD / PD
608-833-7500
WILLIAM H BARTLETT MD
213 CARILLON DRIVE
MADISON WI 53705
14— DANE
608-274-4183
ALFONSO J BASILS
APT 19
2902 CURRY PARKWAY
MADISON WI 53713
OPH / OPH
608-252-8422
RICHARD F BASKS MD
345 W WASHINGTON AVE
MADISON WI 53703
FP
414-738-0279
JOYCE M BAUER MD
3316 N RANKIN STREET .
APPLETON WI 54911-1427
FP / FP
608-263-7373
JOHN W BEASLEY MD
777 SOUTH MILLS STREET
MADISON WI 53715
IM BLB / IM
GARY A BECKER MD
POST OFFICE BOX 5905
MADISON WI 53705-0905
OTO HNS / OTO
608-257-3696
MICHAEL E BECKER MD
SUITE 350
20 SOUTH PARK STREET
MADISON WI 53715-1348
EM IM / IM
608-845-6095
PAUL W HECKFIELD MD
104 OAK COURT
VERONA WI 53593
PTH FP / FP
608-256-1901
DANIEL R BECKMAN MD
DEPT OF PATHOLOGY
600 HIGHLAND AVENUE
MADISON WI 53792
AN / AN
608-257-6464
RONALD E BEHLING MD
5855 SCHUMANN DRIVE
MADISON WI 53711
FP
608-837-9700
JOSEPH F BEHREND MD
850 SCHUSTER ROAD
SUN PRAIRIE WI 53590
I M /' I M
608-252-8023
ROBERT L BEILMAN MD
1313 FISH HATCHERY RD
MADISON WI 53715
608-251-7016
LAURIE B BEINE
APT 1
1714 ADAMS STREET
MADISON WI 53711-2142
608-233-8094
ERIN M BFIRNE
APT C
2206 KENDALL AVENUE
MADISON WI 53705
IM / IM
608-257-7875
ELSTON L BELKNAP JR MD
20 SOUTH PARK STREET
MADISON WI 53715
608-257-6944
STEVEN A BELL
1204 CHANDLER
MADISON WI 53715
GS OS / GS
608-263-1377
FOLKERT O BELZER MD
G5/359 CSC
600 HIGHLAND AVENUE
MADISON WI 53792
GP OM
GEORGE A BENISH MD
1206 SHERMAN AVENUE
MADISON WI 53703
OTO / OTO
608-222-5017
E MAXINE BENNETT MD
3110 WACHEETA TRAIL
MADISON WI 53711
P / PN
MARY C BERG MD
4801 HOLIDAY DRIVE
MADISON WI 53711
CDS TS / GS TS
608-263-5214
HERBERT A BERKOFF MD
H4/358 UW CSC
600 HIGHLAND AVENUE
MADISON WI 53792
608-263-5927
ALVIN L BERMAN PhD
1014 BELOIT COURT
MADISON WI 53705
CDS TS GS / CDS TS GS
608-252-8066
LOUIS C BERNHARDT MD
501 SHEARWATER ROAD
MADISON WI 53714
OTO / OTO
608-252-8414
NORVAL E BERNHARDT MD
345 W WASHINGTON AVE
MADISON WI 53703
PS / PS
608-257-2208
STEPHEN A BERNSTEN MD
7016 APPLEWOOD DRIVE
MADISON WI 53711
D / D
608-252-8173
JOHN R BERTRAM MD
1313 FISH HATCHERY RD
MADISON WI 53715
608-233-8905
LAWRENCE J BERTRAM
914 A EAGLE HEIGHTS
MADISON WI 53705-1602
608-257-4492
CATHERINE M BEST
540 WEST LAKESIDE ST
MADISON WI 53715
608-255-6654
MARK A BIGALKE
1534 ADAMS STREET
MADISON WI 53711-2138
GP
608-836-3488
MICHAEL L BISHOP MD
5625 HIGHLAND WAY
MIDDLETON WI 53562
PAMELA 0 BLACK
1820 FISHER STREET
MADISON WI 53713
IM
FREDERICK W BLANCKE MD
801 BUTTERNUT ROAD
MADISON WI 53704
IM
608-837-9503
JEFFREY B BLOCK MD
1501 IVORY DRIVE
SUN PRAIRIE WI 53590
OPH / OHH
608-257-4286
FRED G Bl UM JR MD
SUITE 400
ONE SOUTH PARK STREET
MADISON WI 53715
JAMES D BOBLIN MD
APT 4
509 NORTH 65TH STREET
MILWAUKEE WI 53213-4053
608-238-5621
SHELLEY K BOEHM
APT E
3319 HARVEY
MADISON WI 53705
NS / NS
608-252-8035
WOJCIECH M BOGDANOWICZ MD
1313 FISH HATCHERY RD
MADISON WI 53715
608-255-5440
GREGG A BOGOST
932 EAST MIFFLIN ST
MADISON WI 53703
608-273-0841
BRIAN J BOHLMANN
NO 225
4859 SHEBOYGAN AVENUE
MADISON WI 53705
608-238-8523
JOHN M BOHN MD
NO 24
2060 ALLEN BOULEVARD
MIDDLETON WI 53562
MICHAEL J BOHN
17B UNIVERSITY HOUSES
MADISON WI 53705
GS TS CDS / GS
608-255-6709
EDWARD I BOLDON JR MD
20 SOUTH PARK STREET
MADISON WI 53715
AN / AN
608-273-2642
JOHN C BONCYK MD
2306 TAWHEE DRIVE
MADISON WI 53711-4342
RHU IM / RHU IM
608-252-8511
ROBERT A BONEBRAKE MD
345 W WASHINGTON AVE
MADISON WI 53703
GS TS / GS
608-252-8064
RICHARD J BOTHAM MD
1313 FISH HATCHERY RD
MADISON WI 53715
EM IM / IM
608-263-5007
H MICHAEL BOWMAN MD
B4/341 UW CSC
600 HIGHLAND AVENUE
MADISON WI 53792
N OS OS / N
608-252-8531
STANLEY W BOYER MD
345 W WASHINGTON AVE
MADISON WI 53703
OTO HNS AM / OTO
608-263-7064
JAMES H BRANDENBURG MD
F4/218 UW CSC
600 HIGHLAND AVENUE
MADISON WI 53792
608-238-8047
MICHAEL BRAUN
1719 BAKER STREET
MADISON WI 53705
OPH / OPH
GEORGE H BRESNICK MD
F4/244
600 HIGHLAND AVENUE
MADISON WI 53792
DBG / DBG
BARBARA A BREW MD
345 W WASHINGTON AVE
MADISON WI 53703
IM / IM
608-249-8288
GARY R BRIDGWATER MD
3713 MILWAUKEE STREET
MADISON WI 53714
OPH / OPH
608-258-4520
FREDERICK S BRIGHTBILL MD
1025 REGENT STREET
MADISON WI- 53715
AN / AN
JAMES J BRILL MD
4925 FOND DU LAC TRAIL
MADISON WI 53705
OPH OTO HNS / OPH OTO
608-233-6571
BENJAMIN I BRINDLEY MD
1013 TUMALO TRAIL
MADISON WI 53711
608-238-2591
ANN M BRINGE
24 GRAND AVENUE
MADISON WI 53705
N / PN
DANIEL E BRITTON MD
345 W WASHINGTON AVE
MADISON WI 53703
JEFFREY W BRITTON
APT 314
425 PAUNACK PLACE
MADISON WI 53705-2357
ORS / ORS
608-252-8095
WILLIAM T BRODHEAD MD
1313 FISH HATCHERY RD
MADISON WI 53715
MICHAEL M BROOK
1719 BAKER AVENUE
MADISON WI 53705
PTH / PTH
608-263-4910
ARNOLD L BROWN MD
1217 MED SCIENCES CTR
1300 UNIVERSITY AVENUE
MADISON WI 53706
P
608-255-9040
JOSEPH G BROWN MD
812 OWEN ROAD
MADISON WI 53716
GE IM / IM
608-257-3008
THOMAS H BROWNING MD
SUITE 355
20 SOUTH PARK STREET
MADISON WI 53715-1348
EM / FP
608-251-2371
PATRICIA K BRUENS MD
309 W WASHINGTON AVE
MADISON WI 53703
IM
KAREN R BRUNGARD MD
345 W WASHINGTON AVE
MADISON WI 53703
DANE— 15
ON PA
608-263-5385
GEORGE T BRYAN MD
1302 GILBERT ROAD
MADISON WI 53711
608-27A-9800
DAVID A BUUCK
APT 1
2101 TRACEWAY DRIVE
MADISON WI 53713
OBG TR / OBG
DOLORES A BUCHLER MD
H4/634 CSC
600 HIGHLAND AVENUE
MADISON WI 53792
EM FP
608-252-8086
KATHRYN S BUDZAK MD
1313 FISH HATCHERY RD
MADISON WI 53715
ROBERT J BUGARIN
2290 HIGH RIDGE TRAIL
MADISON WI 53713
PDA AI PUD / PD AI
608-252-8000
DONALD A BUKSTEIN MD
1313 FISH HATCHERY RD
MADISON WI 53715
JAMES W BURHOP
5301 WESTPORT ROAD
MADISON WI 53704
A
MYRA E BURKE MD
APT 1202
no SOUTH HENRY STREET
MADISON WI 53703
AN / AN
RICHARD W BURNER MD
4705 COUNTY M
MIDDLETON WI 53562-2343
ROGER K DURR
APT 2
TEN S ORCHARD STREET
MADISON WI 53715-1335
AN / AN
608-263-8100
GEORGE L BUSH MD
B6/379 CSC
600 HIGHLAND AVENUE
MADISON WI 53792
IM / IM
608-255-4445
KENNETH L BUSSAN MD
20 SOUTH PARK STREET
MADISON WI 53715
OBG / OBG
608-251-2803
KENNETH R BYCE MD
SUITE 525
ONE SOUTH PARK STREET
MADISON WI 53715
REBECCA 1. BYERS
4008 HIAWATHA DRIVE
MADISON WI 53711
OBG
608-238-8799
BARBARA L CALHOUN MD
4344 HILLCREST CIRCLE
MADISON WI 53705
OTO EM GS
608-251-3628
DAVID A CAMPBELL MD
«*2
1125 RUTLEDGE STREET
MADISON WI 53703
FP / FP
608-271-2333
ROBERT E CAPE MD
5722 RAYMOND ROAD
MADISON WI 53711
PTH CLP / PTH CLP
608-833-7663
WILLIAM H CARD MD
707 SOUTH MILLS STREET
MADISON WI 53715
DONALD P CARLSON
2561 UNIVERSITY AVENUE
MADISON WI 53705
AN
SHEILA K CARLSON MD
SIX GLACIER COURT
MADISON WI 53705
R / R
THOMAS L CARTER MD
202 SOUTH PARK STREET
MADISON WI 53715
608-257-4416
STEVE CARY
933 W JOHNSON STREET
MADISON WI 53715
608-238-8376
MICHAEL K CASE
APT 5C
510 SHEPARD TERRACE
MADISON WI 53705
DAVID K CASSIDY
933 W JOHNSON STREET
MADISON WI 53715
NS / NS
608-255-4826
KRISADA CHANBUSARAKUM MD
ROOM 202
20 SOUTH PARK STREET
MADISON WI 53715
OPH / OPH
608-263-6644
SURESH R CHANDRA MD
F4/342 CSC
600 HIGHLAND AVENUE
MADISON WI 53792
DAVID W CHANG
2964 NORTH 85TH STREET
MILWAUKEE WI 53222-4718
GS
608-233-2148
SAMUEL L CHASE MD
1054 WOODROW STREET
MADISON WI 53711
JEFFREY J CHERNEY
NO 25
409 PALOMINO LANE
MADISON WI 53705
OBG / DBG
DENNIS D CHRISTENSEN MD
SUITE 280
ONE SOUTH PARK STREET
MADISON WI 53715
OBG / OBG
608-252-8048
ROBERT P CHRISTMANN MD
1313 FISH HATCHERY RD
MADISON WI 53715
PAUL CHU
1530 ADAMS STREET
MADISON WI 53711
608-233-8042
SANDRA CHU
APT 4
1805 UNIVERSITY AVENUE
MADISON WI 53705
PD CHN / PD
608-263-8551
RAYMOND W M CHUN MD
H4/450 UW CSC
600 HIGHLAND AVENUE
MADISON WI 53792
P / IM
PETER J CLAGNAZ MD
1313 FISH HATCHERY RD
MADISON WI 53715
ORS / ORB
608-263-1356
WILLIAM G CLANCY JR MD
G5/331 UW CSC
600 HIGHLAND AVENUE
MADISON WI 53792
IM
608-643-8651
NORMAN M CLAUSEN MD
9928 COUNTY TRUNK Y
ROUTE 1
MAZOMANIE WI 53560
P
GERALD L CLINTON MD
3535 TOPPING ROAD
MADISON WI 53705-1440
608-257-4416
RICHARD H COCHRANE
933 WEST JOHNSON
MADISON WI 53715
DR R / DR R
R MARSHALL COLBURN JR MD
4335 SCHNEIDER DRIVE
OREGON WI 53575
FP / FP
608-274-1 100
ROBERT L COLE MD
5714 ODANA ROAD
MADISON WI 53719
P
608-238-7343
FREDERICK W COLEMAN MD
2115 CHADBOURNE AVENUE
MADISON WI 53705
PD / PD
WENDY S COLEMAN MD
2115 CHADBOURNE AVENUE
MADISON WI 53705
608-238-7780
CATHERINE A COLLINGS
109 N SPOONER STREET
MADISON WI 53705-4083
DANIEL A COLLINS
1337 JENIFER STREET
MADISON WI 53703-3716
GP
608-829-3963
ROYDEN F COLLINS MD
15 RED MAPLE TRAIL
MADISON WI 53717
MICHAEL J COMBS
APT 4
1920 BIRGE TERRACE
MADISON WI 53705-2307
PTH / PTH
DEAN M CONNORS MD
707 SOUTH MILLS STREET
MADISON WI 53715
IM / IM
DAVID U COOKSON MD
4910 LAKE MENDOTA DR
MADISON WI 53705
PDC CD IM / PDC CD IM
608-256-3943
ROBERT J CORLISS MD
707 SOUTH MILLS STREET
MADISON WI 53715
IM AN / IM AN
608-263-9131
DOUGLAS B COURSIN MD
B6/387 UW CSC
600 HIGHLAND AVENUE
MADISON WI 53792
ORS / ORB
608-255-9414
ARCH E COWLE MD
TWO W GORHAM STREET
MADISON WI 53703
P / P
608-263-6067
DAVID G CRAWFORD MD
B6/257 UW CSC
600 HIGHl.AND AVENUE
MADISON WI 53792
D IM / D
DEREK J CRIPPS MD
F4/225 CSC
600 HIGHLAND AVENUE
MADISON WI 53792
JEFFREY H CRISPELL
2206 KENDALL AVENUE
MADISON WI 53705-3852
IM / IM
608-257-7107
LAURENCE G CROCKER MD
20 SOUTH PARK STREET
MADISON WI 53715
608-257-5583
DEBORAH v) CROWE
1121 BOWEN COURT
MADISON WI 53715
IM / IM
608-257-7107
WILLIAM P CROWLEY JR MD
20 SOUTH PARK STREET
MADISON WI 53715
R / R
ANDREW B CRUMMY JR MD
n4/T4A CSC
600 HIGHLAND AVENUE
MADISON WI 53792
U / U
608-263-1358
KENNETH B CUMMINGS MD
G5/335 UW CSC
600 HIGHLAND AVENUE
MADISON WI 53792
ORS
608-255-9414
MILFRED A CUNNINGHAM MD
TWO WEST GORHAM STREET
MADISON WI 53703
OBG MFM / OBG MFM
608-262-0198
LUIS B CURET MD
202 SOUTH PARK STREET
MADISON WI 53715
DR / DR
MICHAEL J CURTIN MD
SUITE 201
20 SOUTH PARK STREET
MADISON WI 53715
AI PD / AI PD
608-252-8510
MARSHALL E CUBIC MD
345 W WASHINGTON AVE
MADISON WI 53703
608-257-4297
DAVID CYPCAR
APT A
913 VILAS AVENUE
MADISON WI 53715
IM / IM
ALFRED D DALLY MD
2138 ROWLEY AVENUE
MADISON WI 53705
16— DANE
DR / H
MICHAEL G DAMM MD
1142 WABAN HILL
MADISON WI 53711
CD IM / IM
DANIEL DANAHY MD
37 OXWOOD CIRCLE
MADISON WI 53717
IM OPH
RONALD P DANIS JR MD
600 HIGHLAND AVENUE
MADISON WI 53792
HOLLY DASTGHEID
3816 N NEWHALL STREET
MILWAUKEE WI 53211
IM END / IM
608-252-8000
DONALD A DAUGHERTY MD
1313 FISH HATCHERY RD
MADISON WI 53715
IM RHU
608-233-4672
JAMES R DAVIDSON MD
222 WALNUT STREET
MADISON WI 53705
608-255-3793
CHRISTOPHER B DAVIES
1524 JEFFERSON STREET
MADISON WI 53711
OPH / OPH
608-258-4539
FREDERICK J DAVIS MD
424 NEW CASTLE WAY
MADISON WI 53704
FP / FP
608-263-5976
JAMES E DAVIS MD
777 SOUTH MILLS STREET
MADISON WI 53715
GE IM / GE IM
608-252-8418
JEFFREY D DAVIS MD
345 W WASHINGTON AVE
MADISON WI 53703
R / R
608-845-6991
JOHN B DAVIS MD
6420 SUNSET DRIVE
VERONA WI 53593
OPH / OPH
608-263-6071
MATTHEW D DAVIS MD
F4/340 CSC
600 HIGHLAND AVENUE
MADISON WI 53792
608-274-4548
DANIEL J DE BEHNKE
APT 212
4801 SHEBOYGAN AVENUE
MADISON WI 53705
CDS TS GS / TS GS
608-252-8000
DAVID G DE COCK MD
1313 FISH HATCHERY RD
MADISON WI 53715
608-273-3952
JANET R DEEGAN
APT 106
4859 SHEBOYGAN AVENUE
MADISON WI 53705
PS / PS
608-252-8488
VAUGHN DEMERGIAN MD
345 W WASHINGTON AVE
MADISON WI 53703
PA
608-241-7200
SUSANA R K de DENNIS MD
1301 SHERMAN AVENUE
MADISON WI 53703
JOHN DENNY
BOX 4005 UW MS
1300 UNIVERSITY AVENUE
MADISON WI 53706
STEPHEN R DERNLAN
APT 207
2022 TRACEWAY DRIVE
MADISON WI 53713-3594
FP F.M
714-770-6000
GERALD J DERUS MD
23962 ALICIA PARKWAY
MISSION VIEJO CA 92691
ROBERT J DE TROYE
2542 CHAMBERLAIN AVE
MADISON WI 53705-3829
OPH / OPH
608-263-7171
GUILLERMO B DEVENECIA MD
F4/384 CSC
600 HIGHLAND AVENUE
MADISON WI 53792
IM HEM / IM
RICHARD T DE WITT MD
345 W WASHINGTON AVE
MADISON WI 53703
PS GS /PS S
608-263-1367
DAVID G DIBBELL MD
G5/355 CSC
600 HIGHLAND AVENUE
MADISON WI 53792
OTO / OTO
PHILLIP A DIBBLE MD
1313 FISH HATCHERY RD
MADISON WI 53715
PUD IM / PUD IM
608-233-1259
HELEN AIRD DICKIE MD
501 CLIFDEN DRIVE
MADISON WI 53711
OBG
608-256-7781
KLAUS D DIEM MD
SUITE 307
20 SOUTH PARK STREET
MADISON WI 53715-2387
IM
608-257-7107
DONAt-D G DIETER MD
20 SOUTH PARK STREET
MADISON WI 53715
ON IM / MON IM
608-252-8000
CHARLES H DIGGS MD
1313 FISH HATCHERY RD
MADISON WI 53715
OPH OTO / OTO
608-244-5081
WALDO B DIMOND MD
APT 305D
1614 FORDEM AVENUE
MADISON WI 53704
IM / GPM OM
608-273-1315
VERNON N DODSON MD
3005 POST ROAD
MADISON WI 53713
IM / IM
608-233-9746
CHARLES A DOEHLERT MD
4410 REGENT STREET
MADISON WI 53705
AN
TERRENCE E DOELER MD
20 SOUTH PARK STREET
MADISON WI 53715
MICHAEL J DOLAN
147 LATHROP STREET
MADISON WI 53705
SYLNA YVONNE DOL INSKI
APT 338
4833 SHEBOYGAN AVENUE
MADISON WI 53705
N PD / PD
MARY K DOM INSKI MD
1313 FISH HATCHERY RD
MADISON WI 53715
GP
WILLIAM F DONLIN MD
150 RIVER STREET
BELLEVILLE WI 53508
OTO
S THOMAS DONOVAN MD
1313 FISH HATCHERY RD
MADISON WI 53715
OTO / OTO
TIMOTHY J DONOVAN MD
1313 FISH HATCHERY RD
MADISON WI 53715
PUD IM / PUD IM
608-241-461 1
WILLIAM N DONOVAN MD
1912 ATWOOD AVENUE
MADISON WI 53704
OPH / OPH
608-258-4520
RICHARD K DORTZBACH MD
1025 REGENT STREET
MADISON WI 53715
DAVID W DOZER
APT 8
2511 GRANADA WAY
MADISON WI 53713-2640
N OPH / N
608-255-4826
IVY J DREIZIN MD
SUITE 202
20 SOUTH PARK STREET
MADISON WI 53715
R NR NM / R NM
608-255-4573
STEPHEN DUDIAK MD
SUITE 201
20 SOUTH PARK STREET
MADISON WI 53715
OPH / OPH
PETER A DUEHR MD
3322 MOUND VIEW ROAD
VERONA WI 53593
PD PHO / PD PHO
PAUL F DVORAK MD
7102 COLONY DRIVE
MADISON WI 53717
608-788-2500
JAMES R EBBEN
1015 ADAMS PLACE
KIMBERLY WI 54136
OM GPM / OM GPM
608-256-1901
PAUL R EBLING MD
2500 OVERLOOK TERRACE
MADISON WI 53705
DAN L ECKLUND
907-C EAGLE HEIGHTS
MADISON WI 53705-1609
P / P
608-244-2411
LE ROY ECKLUND MD
3501 MEMORIAL DRIVE
MADISON WI 53704
N CHN PD / N PD
608-255-4826
FREDERICK S EDELMAN MD
20 SOUTH PARK STREET
MADISON WI 53715
R / R
JOHN S EDWARDS MD
202 SOUTH PARK STREET
MADISON WI 53715
MARK L EDWARDS
APT 2
4713 JENEWEIN ROAD
MADISON WI 53711
IM CD / IM
608-829-2178
BARRY A EFFRON MD
4 DUNRAVEN COURT
MADISON WI 53705
BRIAN J EGGENER
814B EAGLE HEIGHTS
MADISON WI 53705
N IM / N
608-263-7542
PETER L EICHMAN MD
H5/6 UW CSC
600 HIGHLAND AVENUE
MADISON WI 53792
AN / AN
DONALD M EILER MD
20 SOUTH PARK STREET
MADISON WI 53715
PD / PD
608-831-2720
RICHARD L ELLIS MD
2630 AMHERST ROAD
MIDDLETON WI 53562
NS / NS
THOMAS A DUFF MD
H4/336 CSC
600 HIGHLAND AVENUE
MADISON WI 53792
FP / FP
FRANKLIN N DUKERSCHEIN MD
ROUTE 1
5528 WILLIAMSBURG ROAD
OREGON WI 53575
R PD PDC / PD
ROBERT E DURNIN MD
SUITE 201
20 SOUTH PARK STREET
MADISON WI 53715
GS
DENNIS S DURZ INSKY MD
DEPARTMENT OF SURGERY
600 HIGHLAND AVENUE
MADISON WI 53792
MARY KAY ELLIS-METZ
914-B EAGLE HEIGHTS
MADISON WI 53705-1616
PETER D EMANUEL
824 VESTAVIA VILLA CT
BIRMINGHAM AL 35226-4011
608-238-0055
JOHNNY ENG
APT 1
1912 BIRGE TERRACE
MADISON WI 53705
ON HEM IM / HEM IM
608-252-8204
JAMES E ENGELER JR MD
1313 FISH HATCHERY RD
MADISON WI 53715
DANE— 17
EM PD / EM PD
C PETER ERSKINE MD
718 ONEIDA PLACE
MADISON WI 53711
SCOTT A ESCHER
1611 CHADBOURNE AVENUE
MADISON WI 53705
ANDREA ESPINOSA
APT A
2569 UNIVERSITT AVENUE
MADISON WI 53705
OBG
608-233-9476
MARGARET A ESTRIN MD
4410 REGENT STREET
MADISON WI 53705
D / D
DAVID K FALK MD
345 W WASHINGTON AVE
MADISON WI 53703
DAVID R FARLEY
APT 1
119 E JOHNSON STREET
MADISON WI 53703
FP PM / FP
608-263-3115
EUGENE S FARLEY JR MD
777 SOUTH MILLS STREET
MADISON WI 53715
CD IM / CD IM
608-252-8525
DENNIS JOHN FARNHAM MD
345 W WASHINGTON AVE
MADISON WI 53703
AN
CAROLYN J FARRELL MD
B6/387 UW CSC
600 HIGHLAND AVENUE
MADISON WI 53792
IM / IM
ROBERT X FARRELL MD
1313 FISH HATCHERY RD
MADISON WI 53715
BRADLEY J FEDDERLY
173 WEST BERGEN DRIVE
MILWAUKEE WI 53217-2306
608-238-2870
RAYMOND T FEDDERLY
APT 242
2302 UNIVERSITY AVENUE
MADISON WI 53705
PS / PS
THEODORE C FEIERABEND MD
CHRISTIAN MED COLLEGE
LUDHIANA PUNJAB
INDIA
608-274-7456
WILLIAM R FELTEN
2458 HIGH RIDGE TRAIL
MADISON WI 53713
JAMES R FELTES
705 SCHMITT PLACE
MADISON WI 53705-3519
FP
KAREN FENNEMA MD
1440 HIGHWAY 12 8< 18
DEERFIELD WI 53531
AN
ANDERS C FEX MD
5122 SUNRISE RIDGE TR
MIDDLETON WI 53562
OTO / OTO
WILLIAM W FINCH MD
SUITE 350
ONE SOUTH PARK STREET
MADISON WI 53715-1348
608-238-2591
KELLY A FINNANE
24 GRAND AVENUE
MADISON WI 53705-3706
DR R / R
608-274-0064
DAVID R FISHER MD
3113 ASHFORD LANE
MADISON WI 53713
P CHP / P CHP
608-238-9354
MARTIN B FLIEGEL MD
2727 MARSHALL COURT
MADISON WI 53705-2287
GP
WILLIAM J FOCKE MD
405 EAST HUDSON STREET
POYNETTE WI 53955
OBG / OBG
608-252-8229
JOSEPH S FOK MD
1313 FISH HATCHERY RD
MADISON WI 53715
OTO PS / OTO
608-263-7064
CHARLES N FORD JR MD
F4/270 UW CSC
600 HIGHLAND AVENUE
MADISON WI 53792
N P / N P
513-984-1739
FRANCIS M FORSTER MD
21 FALLEN BRANCH LANE
CINCINNATI OH 45241-3242
P / PN
FREDERICK A FOSDAL MD
2727 MARSHALL COURT
MADISON WI 53705
GS TS
OSCAR F FOSE ID MD
ROUTE 1
BLACK EARTH WI 53515
STEPHEN P FOX
APT A-11
6319 PHEASANT LANE
MIDDLETON WI 53562-2236
OPH / OPH
608-263-6414
THOMAS D FRANCE MD
F4/330 CSr
600 HIGHLAND AVENUE
MADISON WI 53792
GREGORY A FRANCKEN
APT 1
2126 ALLEN BOULEVARD
MIDDLETON WI 53562
MICHAEL O FRANK
C/0 UW MEDICAL SCHOOL
1300 UNIVERSITY AVENUE
MADISON WI 53706
OTO HNS / OTO
608-263-7064
TERRENCE W FRANK MD
DEPT OF OTO
600 HIGHLAND AVENUE
MADISON WI 53792
AN / AN
608-274-4403
NANCY C FREDERICKS MD
5609 BARTON ROAD
MADISON WI 53711
608-238-4502
O'ANN K FREDSTROM
2633 KENDALL AVENUE
MADISON WI 53705
FP / FP
608-764-5487
WILLIAM G FRITSCHEL MD
609 CENTRAL AVENUE
DEERFIELD WI 53531
608-231-1411
BRIAN J FROHNA
1726 REGFNT STREET
MADISON WI 53705
715-384-9587
THOMAS C GABERT
2015 E EMERALD STREET
MARSHFIELD WI 54449-2424
FP / FP
608-274-4042
ROBERT B GAGE MD
14 SHEFFORD CIRCLE
MADISON WI 53719
AN / AN
TIMOTEO L GALVEZ MD
POST OFFICE BOX 5367
MADISON WI 53705
P / P
608-233-7003
LEONARD J GANSER MD
475 AGNES DRIVE
MADISON WI 53711
608-274-9022
JAMES P GAP INSKI
APT 212
2401 POST ROAD
MADISON WI 53713
AN / AN
608-271-7095
GORDON M GARNETT MD
POST OFFICE BOX 4256
MADISON WI 53711
AN
JAMES G GARNETT MD
5835 SCHUMANN DRIVE
MADISON WI 53711
JEFFREY W GAVER
35059 WAYFAIR TRAIL
OCONOMOWOC WI 53066
GP OS
608-241-3451
CHRISTOPHER A GENCHEFF DO
2830 DRYDEN DRIVE
MADISON WI 53704
PD / PD
CHARLES H GEPPERT MD
1313 FISH HATCHERY RD
MADISON WI 53715
PD / PD
THOMAS V GEPPERT MD
1313 FISH HATCHERY RD
MADISON WI 53715
P PYM
608-263-7013
CARL J GETTO MD
F6/248 UW CSC
600 HIGHLAND AVENUE
MADISON WI 53792
EM
608-845-8458
TERRY F GEURKINK MD
1675 BARTLETT COURT
BELLEVILLE WI 53508
NS
608-271-6440
MARK J G I CHERT MD
5105 KNOX LANE
MADISON WI 53711
TR
608-251-0892
WILLIAM L GIESE MD
5435 LAKE MENDOTA DR
MADISON WI 53705
IM / IM
608-241-461 1
ROBERT D GILBERT MD
1912 ATWOOD AVENUE
MADISON WI 53704
ELLEN M GILBERTSON
APT 501
3009 UNIVERSITY AVENUE
MADISON WI 53705
IM CD / IM
608-257-5188
LAURENCE T GILES MD
20 SOUTH PARK STREET
MADISON WI 53715
P
SARI R GILMAN MD
6026 GREENTREE ROAD
MADISON WI 53711-3126
608-255-5515
J ROD GIMBEL
APT 404
104 SOUTH BROOKS
MADISON WI 53715
608-233-4299
MICHAEL J GITTER
2604 KENDALL AVENUE
MADISON WI 53705
R / R
608-238-5734
FARRELL F GOLDEN MD
3921 PLYMOUTH CIRCLE
MADISON WI 53705
NEAL S GOLDSTEIN
6502 GETTYBURG DRIVE
MADISON WI 53705
R / R
FRANK F GOLLIN MD
3114-2 CREEK VIEW DR
MIDDLETON WI 53562
OBG
608-256-7300
WILLIAM M GOODMAN MD
SUITE 225
ONE SOUTH PARK STREET
MADISON WI 53715
608-231-3847
DAVID C GOODSPEED
910 A EAGLE HEIGHTS
MADISON WI 53705
IM / IM
415-322-0608
ABRAHAM M GOTTLIEB MD
APT 103
101 ALMA STREET
PALO ALTO CA 94301
AN / AN
608-233-5298
RAND I FISHLEDER MD
5026 FLAMBEAU ROAD
MADISON WI 53705
AN / AN
JAMES H FITZPATRICK JR MD
488 RUSHMORE LANE
MADISON WI 53711
DR
RICHARD 0 FRIDAY MD
1050 WOODROW STREET
MADISON WI 53711
IM
608-833-7500
LISA C FRIEDMAN MD
202 SOUTH GAMMON ROAD
MADISON WI 53717
18— DANE
N / N
608-252-8152
ROBERT W GRAEBNER MD
1313 FISH HATCHERY RD
MADISON WI 53715
U / U
608-257-1454
RICHARD A GRAF MD
20 SOUTH PARK STREET
MADISON WI 53715
IM PYM / IM
608-263-3039
DAVID T GRAHAM MD
H4/410 UW CSC
600 HIGHLAND AVENUE
MADISON WI 53792
608-258-9711
LARRY D GRANT
APT IB
524 WEST WASHINGTON
MADISON WI 53703
608-233-7398
PAMELA J GRAY
APT A
2569 UNIVERSITY AVENUE
MADISON WI 53705
OTO HNS / OTO
608-252-8414
JUDITH N GREEN MD
POST OFFICE BOX 222
MADISON WI 53701-0222
AN OS / AN
RAY E GREEN MD
1835 WISCONSIN AVENUE
SUN PRAIRIE WI 53590
U / U
608-241-461 1
EARL B GREENBERG MD
1912 ATWOOD AVENUE
MADISON WI 53704
608-255-8485
GAYLINN M GREENWOOD
APT 1
315 N PINCKNEY STREET
MADISON WI 53703-2133
RICHARD J GRIESHOP
5013 FLAMBEAU ROAD
MADISON WI 53705
WILLIAM J GROH
214 THEIS STREET
PORT WASHINGTON WI
53074-1246
608-251-2201
KAY A GRULING
APT 104
1309 SPRING STREET
MADISON WI 53715
TIMOTHY E GUNDLACH
701 SCHMITT PLACE
MADISON WI 53705
608-251-8032
THOMAS R GUSE
APT 2
127 EAST JOHNSON ST
MADISON WI 53703
PD NPM / PD
GARY R GUTCHER MD
202 SOUTH PARK STREET
MADISON WI 53715
GS PDS / GS
JAMES E GUTENBERGER MD
1313 FISH HATCHERY RD
MADISON WI 53715
OTO
608-231-3746
REX S HABERMAN II MD
717 BRUCE COURT
MADISON WI 53705
608-238-3095
KAREN E HALLER
208 GRAND AVENUE
MADISON WI 53705
IM
JUANITA J HALLS MD
1218 BIRCH HAVEN CIR
MONONA WI 53716-3008
PM PD / PM
608-263-8635
DANIEL HALPERN MD
E3/352 UW CSC
600 HIGHLAND AVENUE
MADISON WI 53792
PS MS MFS / PS
608-257-2208
JOHN E HAMACHER MD
20 SOUTH PARK STREET
MADISON WI 53715
WILLIAM HAMMAN
APT 4
506 N FRANKLIN AVENUE
MADISON WI 53705
AN / AN
YOSHIO HANDA MD
306 ROBIN PARKWAY
MADISON WI 53705
GPM / GPM
608-271-2188
GEORGE H HANDY MD
APT 4
SIX WHITCOMB CIRCLE
MADISON WI 53711
OBG / OBG
GEORGE C HANK MD
1337 CHICAGO DRIVE
ROUTE 1
FRIENDSHIP WI 53934
P CHP HYP / PN
608-256-1996
MAREK J HANN MD
SUITE 403
20 SOUTH PARK STREET
MADISON WI 53715
BARBARA J HANSEN
5220 MANITOWOC PARKWAY
MADISON WI 53705
FP / FP
JOHN P HANSEN MD
3930 PLYMOUTH CIRCLE
MADISON WI 53705
PD / PD
608-263-1701
MARC F HANSEN MD
4201 WANETAH TRAIL
MADISON WI 53711
GS
JERRY M HARDACRE II MD
APT B
3508 LEATHERBURY LANE
INDIANAPOLIS IN
46222-2073
PD / PD
MARY N HARKNESS MD
10 TOWER DRIVE
SUN PRAIRIE WI 53590
PATRICIA J HARLEY
APT 333
4833 SHEBOYGAN AVENUE
MADISON WI 53705-2963
OM GS / GS
608-249-6924
SAMUEL B HARPER MD
THREE BAYSIDE DRIVE
MADISON WI 53704
IM RHU / IM RHU
608-252-8050
J HARRINGTON JR MD
SUITE 301
20 SOUTH PARK STREET
MADISON WI 53715
OTO / OTO
JAMES E HARRISON MD
1313 FISH HATCHERY RD
MADISON WI 53715
KEVIN HART
APT 3
1501 MARTIN STREET
MADISON WI 53713-1147
IM / IM
ROBERT C HARTMANN MD
2633 CHAMBERLAIN AVE
MADISON WI 53705
OTO A / OTO
THEODORE L HARTRIDGE MD
5501 TONYAWATHA TRAIL
MADISON WI 53716
715-345-1740
THOMAS S HARTZHEIM
420 MAPLE BLUFF ROAD
STEVENS POINT WI 54481
NM
605-829-2757
MOHAMMAD ABNE HASAN MD
254 GRAND CANYON DRIVE
MADISON WI 53705-4227
DIANE G HEATLEY
607 GLENWAY STREET
MADISON WI 53711
GREGG A HEATLEY
607 GLENWAY STREET
MADISON WI 53711
608-255-0532
BRIAN A HEBL
1010 GARFIELD
MADISON WI 53711
FP / FP
KAY A HEGGESTAD MD
4221 VENETIAN LANE
MADISON WI 53704
ORS / ORS
JACK D HE I DEN MD
20 SOUTH PARK STREET
MADISON WI 53715
FP / FP
608-836-1091
THOMAS F HEIGHWAY MD
2009 MAYFLOWER DRIVE
MIDDLETON WI 53562
MICHAEL J HEILI
1312 CHANDLER STREET
MADISON WI 53715
608-238-6670
JOHN T HEINRICH
APT 2
1937 UNIVERSITY AVENUE
MADISON WI 53705
OBG MFM / OBG MFM
608-262-3864
PERRY A HENDERSON MD
202 SOUTH PARK STREET
MADISON WI 53715
CD IM / CD IM
608-252-8000
ROBERT R HENDERSON MD
4927 TONYAWATHA TRAIL
MADISON WI 53716
IM
608-241-461 1
RICHARD J HENDRICKS MD
1912 ATWOOD AVENUE
MADISON WI 53704
TIFFANY E HENDRICKSON
4813 TERMINAL DRIVE
MC FARLAND WI 53558
OPH / OPH
608-873-3314
OR IN A HERMUNDSTAD MD
1520 VERNON STREET
STOUGHTON WI 53589
DOUGLAS E HERTFORD
2102 UNIVERSITY AVENUE
MADISON WI 53705-2331
OBG / OBG
PAUL A HERZOG MD
345 W WASHINGTON AVE
MADISON WI 53703
IM ID / IM
608-252-8000
CYRIL M HETSKO MD
1313 FISH HATCHERY RD
MADISON WI 53715
IM
NELS A HILL MD
4032 MANDAN CIRCLE
MADISON WI 53711
IM CD
PAUL H HINDERAKER MD
345 W WASHINGTON AVE
MADISON WI 53703
DAVID H HINKE
APT 1
402 GRAND AVENUE
MADISON WI 53705-3734
RHU IM / IM
THOMAS J HIRSCH MD
1313 FISH HATCHERY RD
MADISON WI 53715
AN
CHARLES W HIRSCHLER MD
20 SOUTH PARK STREET
MADISON WI 53715
IM / IM
608-257-7110
WILLIAM J HISGEN MD
20 SOUTH PARK STREET
MADISON WI 53715
MICHAEL J HODULIK
133 NORTH BEDFORD ST
MADISON WI 53703
AN / AN
PHILIP A HOFFMAN MD
20 SOUTH PARK STREET
MADISON WI 53715
JEFFREY J HOFFMANN
APT 12
15 COYNE COURT
MADISON WI 53715
608-849-8208
MARK T HOFFMANN
209 WEST THIRD STREET
WAUNAKEE WI 53597
AN / AN
LARRY H HOGAN MD
20 SOUTH PARK STREET
MADISON WI 53715
N / PN
608-252-8266
BASIL B HOLOYDA MD
NINE COLONY CIRCLE
MADISON WI 53717
DANE— 19
EM FP / FP
608-233-0027
MICHAEL C HOLT MD
5021 REGENT STREET
MADISON WI 53705
608-238-1751
MICHAEL R HOLT
5606 TREMPELEAU TRAIL
MADISON WI 53705
SHERRY L HOLTZMAN
4205 ST CLAIR STREET
MADISON WI 53711
PS
414-468-7333
DAVID E HOOPS
APT 5
905 WEST BADGER ROAD
MADISON WI 53713
PD
608-249-6055
CHARLES E HOPKINS MD
419 COLEMAN ROAD
MADISON WI 53704
JENNIFER E HOPPE
APT 1
113 SOUTH MILLS STREET
MADISON WI 53715-1309
EM / EM
ROY S HORRAS MD
18 PINEHURST CIRCLE
MADISON WI 53717
DR R / DR R
608-263-8336
LANNING W HOUSTON MD
UW CSC
600 HIGHLAND AVENUE
MADISON WI 53792
ORS / ORS
608-238-0397
JAMES M HUFFER MD
3968 PLYMOUTH CIRCLE
MADISON WI 53705-5212
MARK A HUFTEL
APT 3
513 N FRANKLIN AVENUE
MADISON WI 53705
608-255-7852
JEFFERY JOHN HUHN
APT 1
1022 REGENT STREET
MADISON WI 53715
IM GPM / IM
608-263-3083
VERNON B HUNT MD
J5/213 UW CSC
600 HIGHLAND AVENUE
MADISON WI 53792
PD PH
AMY L HUNTER-WILSON MD
APT 404
6209 MINERAL POINT RD
MADISON WI 53705
FP / FP
608-257-9700
MERLE A HUNTER MD
1 SOUTH PARK STREET
MADISON WI 53715
PAUL HUNTER
12003 W VERONA COURT
WEST ALLIS WI 53227
IM PUD / IM
608-252-8515
D WILLIAM HURST MD
345 W WASHINGTON AVE
MADISON WI 53703
OPH / OPH
608-251-2361
CLARE F HUTSON MD
1025 REGENT STREET
MADISON WI 53715
IM / IM
608-249-3261
ADOLPH M HOTTER MD
34 GOLF COURSE ROAD
MADISON WI 53704
GP
608-764-5183
CLAYTON L INGWELL MD
630 TERRACE ROAD
DEERFIELD WI 53531
PTH CLP / PTH CLP
608-262-1293
STANLEY L INHORN MD
465 HENRY MALL
MADISON WI 53706
CD
608-263-1530
HAYTHAM M A JAB I MD
H6/339 UW CSC
600 HIGHLAND AVENUE
MADISON WI 53792
OBG / OBG
608-256-7781
C ROBERT JACKSON MD
SUITE 307
20 SOUTH PARK STREET
MADISON WI 53715-2387
LOIS JACOBS
1275 LATHERS ROAD
OREGON WI 53575
AN / AN
PAUL M JACOBSEN MD
3159 SHADY OAK LANE
VERONA WI 53593
KIRK JACOBSON
APT 1
1324 MILTON STREET
MADISON WI 53715
EM
608-222-5947
STEVEN M JACOBSON MD
1307 WYLDHAVEN
MONONA WI 53716
PTH / PTH
608-233-3694
WALTER H JAESCHKE MD
2313 KENDALL AVENUE
MADISON WI 53705
SANJEEV JAIN
APT 3
230 LAKEl.AWN PLACE
MADISON WI 53703
AN / AN
LESLIE C JAMESON MD
B6/387 UW CSC
600 HIGHLAND AVENUE
MADISON WI 53792
FP / FP
608-256-3171
DON R JANICEK MD
333 W MIFFLIN STREET
MADISON WI 53703
FP / FP
715-267-6600
DAVID A JANSSEN
APT 10
5022 SHEBOYGAN AVENUE
MADISON WI 53705
608-274-3034
DEBRA L JARYSZAK
APT 112
5156 ANTON DRIVE
MADISON WI 53719
FP
DANIEL R JAR ZEMSKY MD
100 EAST NORTH STREET
DE FOREST WI 53532
NS / NS
608-263-1410
MANUCHER J JAVID MD
H4/346 CSC
600 HIGHLAND AVENUE
MADISON WI 53792
EM
608-836-8469
MARK W JEFFRIES MD
8150 OLD SAUK ROAD
CROSS PLAINS WI 53528
IM / IM
608-263-1771
NORMAN M JENSEN MD
6210 DAVENPORT DRIVE
MADISON WI 53711
DR R / R
STEVEN R JENSEN MD
600 HIGHLAND AVENUE
MADISON WI 53792
608-255-6701
AMIE C JEW
APT 2
1603 JEFFERSON STREET
MADISON WI 53711
IM GER
608-256-1901
KAY E JEWELL MD
2500 OVERLOOK TERRACE
MADISON WI 53705
OPH / OPH
ELMER E JOHNSON MD
4513 VERNON BOULEVARD
MADISON WI 53705
PETER R JOHNSON
933 W JOHNSON STREET
MADISON WI 53715
STEVEN D JOHNSON
APT ID
425 PAUNACK PLACE
MADISON WI 53705
D / D
STURE A M JOHNSON MD
10306 HUTTON DRIVE
SUN CITY AZ 85351
608-238-2212
DANIEL R JONES
309-C EAGLE HEIGHTS
MADISON WI 53705
PD / PD
608-833-3600
PATRICIA A JOO MD
345 W WASHINGTON AVE
MADISON WI 53703
DANIEL M JORGENSEN
APT 3
1501 MARTIN STREET
MADISON WI 53713-1131
PH / GPM
EDWIN H JORRIS MD
3315 SPRING MILL CIR
SARASOTA FL 33579
P
THOMAS S JOSEPHSON MD
SUITE 403
20 SOUTH PARK STREET
MADISON WI 53715
GYN / OBG
608-274-4100
DUS AN JOVANOVIC MD
5520 MEDICAL CIRCLE
MADISON WI 53719
FP / FP
608-837-4521
ROBERT N JUSTL MD
10 TOWER DRIVE
SUN PRAIRIE WI 53590
IM PYM / IM
608-262-1835
JD KABLER MD
1552 UNIVERSITY AVENUE
MADISON WI 53705
OPH / OPH
608-233-8592
JEROME G KADELL MD
4127 MANITOU WAY
MADISON WI 53711-3013
FP / FP
608-222-3404
SANDRA A KAMNETZ MD
5001 MONONA DRIVE
MADISON WI 53716
OPH / OPH
608-258-4520
ALBERT V KANNER MD
1025 REGENT STREET
MADISON WI 53715
608-233-8741
VIJAY K KANTAMNENI
APT D
3319 HARVEY STREET
MADISON WI 53705-3458
IM END
ELIZABETH KARLIN MD
4410 REGFNT STREET
MADISON WI 53705
PD / PD
PETER S KAROFSKY MD
H6/444 UW CSC
600 HIGHLAND AVENUE
MADISON WI 53792
GP
608-222-3404
EARL T KASKE MD
5001 MONONA DRIVE
MADISON WI 53716
LYNDA J KASPER
3865 NAKOMA ROAD
MADISON WI 53711-3015
P / P
608-256-1996
DAVID A KASUBOSKI MD
20 SOUTH PARK STREET
MADISON WI 53715
PD / PD
608-263-6235
MURRAY L KATCHER PhD MD
1130 SHOREWOOD BLVD
MADISON WI 53705
608-251-0844
DANIEL 1 KAUFER
420 N CARROLL STREET
MADISON WI 53703
608-238-2507
LISA M KAUFMAN
APT 2
1906 UNIVERSITY AVENUE
MADISON WI 53705
IM / IM
MARK A KAUFMAN MD
209 GLACIER DRIVE
MADISON WI 53705-2413
OPH / OPH
608-263-7171
PAUL L KAUFMAN MD
F4/328 CSC
600 HIGHLAND AVENUE
MADISON WI 53792
20— DANE
□BO
SCOTT W KAUMA MD
600 HIGHLAND AVENUE
MADISON WI 53792
ORS
JAMES S KEENE MD
F4/322 CSC
600 HIGHLAND AVENUE
MADISON WI 53792
FP OBG GS / FP
608-244-5561
JAY P KEEPMAN MD
3602 ATWOOD AVENUE
MADISON WI 53714
608-233-9572
JOHN M KEGGI
1606 HOYT STREET
MADISON WI 53705
GP
LLOYD S KELLOGG MD
650 SODEN STREET
OREGON WI 53575
AN
ALLEN D KEMP MD
20 SOUTH PARK STREET
MADISON WI 53715
608-873-6968
JUDY R KERSTEN
1408 FURSETH
STOUGHTON WI 53589
KEVIN L KETCHUM
APT 17
1323 W DAYTON STREET
MADISON WI 53715-2224
IM RHU / IM RHU
608-252-8511
FRANK W KILPATRICK MD
345 W WASHINGTON AVE
MADISON WI 53703
GPM / GPM
608-222-6131
CHARLES K KINCAID MD
3036 WAUNONA WAY
MADISON WI 53713
PH PD
DAVID A KINDIG MD
ROOM 707
610 WALNUT STREET
MADISON WI 53705
OPH IM / OPH
BARBARA E K KLEIN MD
DEPT OF OPHTHALMOLOGY
600 HIGHLAND AVENUE
MADISON WI 53792
OPH / OPH
608-263-6641
RONALD KLEIN MD
126 FOREST STREET
MADISON WI 53705
608-274-7602
HEIDI KLESSIG
4437 DONCASTER DRIVE
MADISON WI 53711
AN
THOMAS B KLOOSTERBOER MD
5752 MONT I CELLO WAY
MADISON WI 53719-1604
R NM / R NM
608-255-4573
IVAN KNEZEVIC MD
SUITE 201
20 SOUTH PARK STREET
MADISON WI 53715
CHRISTOPHER J KNUTH
APT 19
3554 CREEKWOOD DRIVE
LEXINGTON KY 40502-6555
P / P
608-238-9355
FRED H KOENECKE JR MD
2727 MARSHALL COURT
MADISON WI 53705
SCOTT C KOLBECK
APT 2
2028 FISH HATCHERY RD
MADISON WI 53713-1251
PD AI / PD AI
608-257-731 1
J BRENT KOOISTRA MD
ONE SOUTH PARK STREET
MADISON WI 53715
IM AI / IM AI
608-252-8133
WILLIAM L KOPP MD
1313 FISH HATCHERY RD
MADISON WI 53715
P / P
608-255-0694
JOHN F KOPPA MD
106 EAST DOTY STREET
MADISON WI 53703
FP / FP
608-222-7647
ROBERT F KORBITZ MD
410 MIDLAND LANE
MONONA WI 53716
FP / FP
PAUL A KORNAUS MD
TEN TOWER DRIVE
SUN PRAIRIE WI 53590
IM / IM
ANDREW L KOSSEFF MD
1313 FISH HATCHERY RD
MADISON WI 53715
R N / R
JOHN A KOZAREK MD
4214 YUMA DRIVE
MADISON WI 53711
FP / FP
608-838-3158
EDWARD J KRAMPER MD
5020 FARWELL STREET
MC FARLAND WI 53558
FORREST J KRAUSE
APT 12
1025 WEST BADGER ROAD
MADISON WI 53713
P
F GREGORY KREMBS MD
14 SOUTH BROOM STREET
MADISON WI 53703
AN / AN
608-256-1901
JOHN F KREUL MD
ANESTHESIOLOGY - B6050
2500 OVERLOOK TERRACE
MADISON WI 53705
608-251-2171
JO ANNE M KRIEGE
312 1/2 W WILSON ST
MADISON WI 53703
NS / NS
FREDERICK C KRISS MD
20 SOUTH PARK STREET
MADISON WI 53715
AI IM / AI IM
608-257-731 1
ROBERT J KRIZ MD
ONE SOUTH PARK STREET
MADISON WI 53715
GS T5 / GS TS
608-263-5215
GEORGE M KRONCKE MD
6006 GALLEY COURT
MADISON WI 53705
PM / PM
608-267-6176
ROBERT M KROUT MD
202 SOUTH PARK STREET
MADISON WI 53715
MICHAEL L KRUK MD
639 CASWELL STREET
TOLEDO OH 43609-1511
PM TR / PM
814-453-5602
VIDYA B KUDVA MD
137 WEST SECOND STREET
ERIE PA 16507
U
608-244-1908
MICHAEL E KUGLITSCH MD
4163 HIGHWAY TT
SUN PRAIRIE WI 53590
U / U
608-274-9317
PALMER R KUNDERT MD
4914 WHITCOMB DRIVE
MADISON WI 53711
608-271-0078
ESTHER C KURTZ MD
APT 318
6209 MINERAL POINT RD
MADISON WI 53705
OPH / OPH
608-238-7733
BURTON J KUSHNER MD
3416 BLACKHAWK DRIVE
MADISON WI 53705
US
CLEMENT L LACKE MD
APT 1211
no SOUTH HENRY STREET
MADISON WI 53703
MICHAEL J LAMBO
APT 3
1501 MARTIN STREET
MADISON WI 53713-1147
DIANA J LAMPSA
APT D
1664 MONROE STREET
MADISON WI 53711
P OTO / OTO
608-233-2352
JAMES F 1 AND MD
710 HURON HILL
MADISON WI 53711
608-257-4416
KEVIN A LANG
933 W JOHNSON STREET
MADISON WI 53715
OTO / OTO
608-257-4214
ROLLO D LANGE MD
20 SOUTH PARK STREET
MADISON WI 53715
NS / NS
608-257-4567
WERNER E LANGHEIM MD
20 SOUTH PARK STREET
MADISON WI 53715
TR
608-263-8500
PER LANGELAND MD
UW CSC, K4/B100
600 HIGHLAND AVENUE
MADISON WI 53792
D / D
LARRY R LANTIS MD
SUITE 540
ONE SOUTH PARK STREET
MADISON WI 53715
AN / AN
RAYMOND B LARAVUSO MD
B6/387 CSC
600 HIGHLAND AVENUE
MADISON WI 53792
D / D FP
608-263-6226
PAUL 0 LARSON MD
3583 RICHIE ROAD
VERONA WI 53593
PD OS
RENATA LAXOVA MD
1500 HIGHLAND AVENUE
MADISON WI 53705
IM / IM
608-252-8253
TIMOTHY E LECHMAIER MD
1313 FISH HATCHERY RD
MADISON WI 53715
OPH / OPH
608-258-4520
BRADLEY N LEMKE MD
1025 REGENT STREET
MADISON WI 53715
GS / GS
608-233-6782
KENNETH E LEMMER MD
111 VIRGINIA TERRACE
MADISON WI 53705
US
608-233-1359
THOMAS A LEONARD JR MD
5717 CENTURY AVENUE
MIDDLETON WI 53562
AN / AN
PETER F LEONOVICZ JR MD
3534 BLACKHAWK DRIVE
MADISON WI 53705
NS / NS
608-263-1410
ALLAN B LEVIN MD
H4/33B CSC
600 HIGHLAND AVENUE
MADISON WI 53792
U / U
608-252-8187
GARY M LICKLIDER MD
1313 FISH HATCHERY RD
MADISON WI 53715
RACHEL M LIDDELL
933 W JOHNSON STREET
MADISON WI 53715-1071
P CHP / P
608-274-0355
ROBERT E LINDEN MD
5534 MEDICAL CIRCLE
MADISON WI 53719-1298
608-238-8142
CARL A I INDGREN
1506 WOOD LANE
MADISON WI 53705
R NM / R NM
608-271-4494
RICHARD D LINDGREN MD
6006 GREEN TREE ROAD
MADISON WI 53711
PTH US / PTH
ANTON LINDNER MD
9 SOUTH ELLIOTT PLACE
BROOKLYN NY 11217
P / P
608-274-0355
RUDOLF W LINK MD
5534 MEDICAL CIRCLE
MADISON WI 53719-1298
STEVEN C LINK
406 H EAGLE HEIGHTS
MADISON WI 53705-2019
DANE— 21
P / P
608-274-0355
MARGARET L LITTLE MD
5534 MEDICAL CIRCLE
MADISON WI 53719
IM ON
608-831-4139
GREGORY v) LITTON MD
5542-3 CENTURY
MIDDLETON WI 53562
FP / FP
608-838-3158
STANLEY LIVINGSTON III MD
5020 FARWELL STREET
MC FARLAND WI 53558
FP
BALDWIN E LLOYD MD
524 WEST VERONA AVENUE
VERONA WI 53593
PD / PD
CHARLES C LODECK MD
ROOM 1217
1300 UNIVERSITY AVENUE
MADISON WI 53706
608-256-8214
SCOTT J LOESSIN
APT D
107 N RANDALL AVENUE
MADISON WI 53715
608-257-7447
JEAN M LOFTUS
APT 2
627 MENDOTA COURT
MADISON WI 53703
CD IM / IM
DONALD C LOGAN MD
1313 FISH HATCHERY RD
MADISON WI 53715
R / R
608-267-6094
RICHARD LOGAN MD
2147 MIDDLETON BCH RD
MIDDLETON WI 53562
TQ OQ / f'Q
B JACK LONGLEY MD
14 MERLHAM DRIVE
MADISON WI 53705
608-251-0018
PAUL D LOOMIS
APT 101
102 N ORCHARD STREET
MADISON WI 53715
FRANK E LOPEZ
2109 UNIVERSITY AVENUE
MADISON WI 53705
ALAN D LORENZ
8067 HIGHWAY G
VERONA WI 53593
608-756-1496
KIRSTEN LORENZEN
1007 RUTLEDGE STREET
MADISON WI 53703-3823
NS
JEFFREY A LOUIE MD
5730 NORFOLK DRIVE
MADISON WI 53719
N
608-255-4826
HOWARD S LUBAR MD
20 SOUTH PARK STREET
MADISON WI 53715
P / P
608-274-0355
HAROLD N LUBING MD
5642 LAKE MENDOTA DR
MADISON WI 53705
GYN GP / OBG
608-256-7781
WILLIAM V LUETKE MD
SUITE 307
20 SOUTH PARK STREET
MADISON WI 53715-2387
PD / PU
FRANCOIS M LUYET MD
345 W WASHINGTON AVE
MADISON WI 53703
AN
JOHN C LYDON MD
21 STONEHEDGE COURT
MADISON WI 53717
PYA P / P
608-256-2869
WILLIAM H LYONS MD
ROOM 701
30 WEST MIFFLIN STREET
MADISON WI 53703
608-273-2963
JAMES R MACKMAN
APT 118
5002 SHEBOYGAN AVENUE
MADISON WI 53705
ABS GB ON / GS
608-252-8477
SANFORD MACKMAN MD
345 W WASHINGTON AVE
MADISON WI 53703
WILLIAM MAC MILLAN
815 A EAGLE HEIGHTS
MADISON WI 53705
AN / AN
608-244-3067
RENATE E MADSEN MD
24 FULLER COURT
MADISON WI 53704
ORS / ORB
608-233-2192
HOWARD W MAHAFFEY MD
10 PARKLAWN PLACE
MADISON WI 53705
U / U
608-257-1454
JOHN H MAHLER MD
ROOM 405
20 SOUTH PARK STREET
MADISON WI 53715
608-257-2776
RANDALL J MALCHOW
APT 2
515 WEST DAYTON STREET
MADISON WI 53703
U / U
GHOLAM H MALEK MD
345 W WASHINGTON AVE
MADISON WI 53703
DR
608-263-8310
MARK D MALNOR MD
DEPT OF RADIOLOGY
600 HIGHLAND AVENUE
MADISON WI 53792
IM ON / IM ON
608-257-9700
FELIPE B MANALO MD
ONE SOUTH PARK STREET
MADISON WI 53715
AN / AN
608-798-4432
RICHARD A MANHART MD
ROUTE 2 MAURER ROAD
CROSS PLAINS WI 53528
PS / PS GS
608-221-2459
BRADLEY L MANNING MD
1 108 NISHISHIN TR NE
MADISON WI 53716
608-244-9166
DANIEL A MANSFIELD
APT 507
1622 FORDEM AVENUE
MADISON WI 53704-7105
608-592-3749
MICHAEL G MANSKE
3264 E HARMONY DRIVE
LODI WI 53555-1542
IM
ANDREW W MARCH MD
755 EAST MC DOWELL
PHOENIX AZ 85007
CR5
GORDON V MARLOW MD
4721 LAFAYETTE DRIVE
MADISON WI 53705
P / PN
JOHN R MARSHALL MD
D6/246 CSC
600 HIGHl.AND AVENUE
MADISON WI 53792
OTO GS
DOUGLAS W MARTIN MD
DEPT ENT
600 HIGHLAND AVENUE
MADISON WI 53792
CHRISTINE A MAXEY
APT 101
4829 SHEBOYGAN AVENUE
MADISON WI 53705
STEVEN L MAYER
541 NORTH 62ND STREET
WAUWATOSA WI 53213-4169
DIANE M MAYLAND
509 RIVERSIDE DRIVE
MADISON WI 53704
608-256-3402
STEVEN D MAYO
APT 1105
626 LANGDON STREET
MADISON WI 53703
IM / IM
WILLIAM J MC AWEENEY MD
345 W WASHINGTON AVE
MADISON WI 53703
ORS / ORS
ANDREW A MC BEATH MD
G5/327 CSC
600 HIGHLAND AVENUE
MADISON WI 53792
PD ADL / PD
608-833-3600
EDWARD B MC CABE MD
345 W WASHINGTON AVE
MADISON WI 53703
OPH / OPH
608-258-4520
PETER J MC CANNA MD
1025 REGENT STREET
MADISON WI 53715
AN / AN
608-271-4318
JOHN L MC CLUNG MD
20 SOUTH PARK STREET
MADISON WI 53715
FP / FP
DENNIS M MC CULLOUGH MD
777 SOUTH MILLS STREET
MADISON WI 53715
GS / GS
608-257-3753
JOHN P MC DERMOTT MD
SUITE 500
ONE SOUTH PARK STREET
MADISON WI 53715
OTO PS / OTO
MICHAEL H MC DONALD MD
1812 WAUNONA WAY
MADISON WI 53713
D / D
ROBERT A MC DONALD MD
1313 FISH HATCHERY RD
MADISON WI 53715
608-238-2591
JOAN M MC GRATH
24 GRAND AVENUE
MADISON WI 53705-3706
608-836-8481
MARY E MC GRATH
3709 HARRIER LANE
MIDDLETON WI 53562
U / U
608-257-1454
JAMES F MC INTOBH MD
20 SOUTH PARK STREET
MADISON WI 53715
608-873-7477
DEBORAH L P MC LEISH
917 EISENHOWER ROAD
STOUGHTON WI 53589
OBG / OBG
608-252-8444
PAUL A MC LEOD MD
345 W WASHINGTON AVE
MADISON WI 53703
OTO / OTO
WILLIS G MC MILLAN MD
SUITE 350
20 SOUTH PARK STREET
MADISON WI 53715-1348
414-527-8000
ROBERT C MEADE MD
2400 WEST VILLARD
MILWAUKEE WI 53209
608-257-4703
JAMES E MEADE
APT 1
113 SOUTH MILLS STREET
MADISON WI 53715
OPH / OPH
608-221-1596
WILLIAM E MEISEKOTHEN MD
5003 MONONA DRIVE
MADISON WI 53716
TS GS / TS GS
608-256-1901
JOHN T MENDENHALL MD
2500 OVERLOOK TERRACE
MADISON WI 53705
BARBARA K MENDEZ MD
108 N SPOONER STREET
MADISON WI 53705
SANDRA MENDEZ
920 B DEL MAR AVENUE
SAN GABRIEL CA 91776-2841
AN
ALAN J MERKOW MD
509 OZARK TRAIL
MADISON WI 53705
608-255-6701
BARBARA J MERZ
1603 JEFFERSON STREET
MADISON WI 53711
AN / AN
THOMAS J MESCHER MD
ROUTE 9
7862 PAULSON ROAD
VERONA WI 53593
22— DANE
U ON / U
608-263-4757
EDWARD M MESSING MD
G5/339 UW CSC
600 HIGHLAND AVENUE
MADISON WI 53792
608-238-8047
JOHN R MEURER
1719 BAKER AVENUE
MADISON WI 53705
P / P
608-256-1996
CHARLES T MEYER MD
SUITE 403
20 SOUTH PARK STREET
MADISON WI 53715
IM EM / IM
608-233-2381
KEITH C MEYER MD
5F UNIVERSITY HOUSES
MADISON WI 53705
FP
715-675-2114
MICHAEL J MEYER MD
1307 W WAUSAU AVENUE
WAUSAU WI 54401
TIMOTHY A MEYER
APT 111
2221 POST ROAD
MADISON WI 53713
PDC / PD
608-263-2852
THOMAS C MEYER MD
SUITE 450
610 N WALNUT STREET
MADISON WI 53706
FP EM / FP
THOMAS D MEYER MD
707 SOUTH MILLS STREET
MADISON WI 53715
FP / FP
BERNARD F MICKE MD
5714 ODANA ROAD
MADISON WI 53719
DOUGLAS W MIELKE
APT 212
2925 FISH HATCHERY RD
MADISON WI 53713-3159
P / P
608-274-0355
STANLEY MIEZIO MD
5534 MEDICAL CIRCLE
MADISON WI 53719-1298
MARY M MILBRATH
W296 N2180 GLEN COVE
PEWAUKEE WI 53072
N / PN
CHARLES E MILEY III MD
2115 MADISON STREET
MADISON WI 53711
JERRY J MILLER
2183 JOY LANE
LA CROSSE WI 54601-7172
414-679-1254
MARY J MISHEFSKE
S78 W20783 HILLENDALE
MUSKEGO WI 53150
608-233-0603
JULIE K MITBY
726 ONEIDA PLACE
MADISON WI 53711
GS OS
608-263-6226
FREDERIC E MOHS MD
3616 LAKE MENDOTA DR
MADISON WI 53705
MARY C MOORE
APT 2A
2102 UNIVERSITY AVENUE
MADISON WI 53705-2301
PAUL M MOORE
APT 201
2221 POST ROAD
MADISON WI 53713
CD IM / IM
JOHN H MORLEDGE MD
345 W WASHINGTON AVE
MADISON WI 53703
FP
608-437-8105
MARRIOTT T MORRISON MD
315 SOUTH FIFTH STREET
MOUNT HOREB WI 53572
FP
LUTHER J MORTON DO
1912 ATWOOD AVENUE
MADISON WI 53704
D / D
608-252-8460
HUBERT V MOSS JR MD
345 W WASHINGTON AVE
MADISON WI 53703
608-274-2792
MAUREEN MUECKE
#102
2921 S FISH HATCHERY
MADISON WI 53713
U / U
608-233-7923
JOHN J MUELLER MD
1527 WOOD LANE
MADISON WI 53705
608-255-9510
JAMES E MULLEN
517 SOUTH MILLS STREET
MADISON WI 53715
OBG
608-244-4330
MAUREEN A MULLINS MD
345 W WASHINGTON AVE
MADISON WI 53703
IM
JOHN W MURPHY MD
APT 2
19 BRIDGE STREET
YARMOUTH ME 04096
N
608-255-4826
M JOHN MURPHY MD
20 SOUTH PARK STREET
MADISON WI 53715
FP
608-839-4774
ALBERT J MUSA MD
4455 BAXTER ROAD
COTTAGE GROVE WI 53527
CD IM / CD IM
608-267-6259
W EUGENE MUSSER MD
202 SOUTH PARK STREET
MADISON WI 53715
GYN / OBG
608-252-8047
WILLIAM C MUSSEY MD
1313 FISH HATCHERY RD
MADISON WI 53715
OPH OS / OPH
608-263-1468
FRANK L MYERS MD
F4/348 CSC
600 HIGHLAND AVENUE
MADISON WI 53792
OPH / OPH
608-252-8012
CHARLES E NAHN MD
1313 FISH HATCHERY RD
MADISON WI 53715
BRUCE M NEAL
402 B EAGLE HEIGHTS
MADISON WI 53705
GP
DAVID L NELSON MD
1520 VERNON STREET
STOUGHTON WI 53589
FP
608-837-2236
EUGENE J NELSON MD
216 WES'I MAIN STREET
SUN PRAIRIE WI 53590
IM / IM
608-255-981 1
JOHN M NELSON MD
121 EAST WILSON STREET
MADISON WI 53703
608-256-5233
LORI A NELSON
24 GRAND AVENUE
MADISON WI 53705-3706
608-233-2094
JOHN G NEMCEK
2126 ALLEN BOULEVARD
MIDDLETON WI 53562
JAMES C NETTUM
2152 FOX AVENUE
MADISON WI 53711
GP
608-246-2270
CHARLES A NEUHAUSER MD
3434 E WASHINGTON AVE
MADISON WI 53704
MICHAEL NEUMAN
APT 401
530 W ARLINGTON PLACE
CHICAGO IL 60614-5917
PD / PD
KATHRYN P NICHOL MD
2753 MARSHALL PARKWAY
MADISON WI 53713
ORS / ORS
608-255-9414
WILLIAM R NIEDERMEIER MD
2 WEST GORHAM STREET
MADISON WI 53703
ORS / ORS
608-238-9311
EUGENE J NORDBY MD
2704 MARSHALL COURT
MADISON WI 53705
GP
AOQ— OTT — V 1
VINCENT W NORDHOLM MD
POST OFFICE BOX 247
STOUGHTON WI 53589
NED G NORDIN
POST OFFICE BOX 440
OCONTO WI 54153-0440
TOM F NOVACHECK
APT Kll
795 RHUE HAUS LANE
HUMMELSTOWN PA 17036-9765
PD
DOROTHY H W OAKLEY MD
3009 GRANDVIEW BLVD
MADISON WI 53713
PTH
TERRY D OBERLEY MD
522 SMI
420 N CHARTER STREET
MADISON WI 53706
CHP P / CHP P
608-238-9354
ROBERT E O'CONNOR MD
2727 MARSHALL COURT
MADISON WI 53705
FP
MARY M O'DWYER MD
6100 WINNEQUAH ROAD
MONONA WI 53716
608-251-5405
JAMES P.OFFORD
APT 12
2207 WOODVIEW COURT
MADISON WI 53713
GS
608-263-1378
MARTIN G O'GRADY MD
600 HIGHLAND AVENUE
MADISON WI 53792
CHRISTOPHER A OHL
933 W JOHNSON STREET
MADISON WI 53715
PATRICK O'LEARY
CT 2
2442 CHALET GARDENS
MADISON WI 53711
FP / FP
608-222-3404
MARK B OLINGER MD
5001 MONONA DRIVE
MADISON WI 53716
EM IM / EM IM
608-258-3215
MARK OLSKY MD
309 W WASHINGTON AVE
MADISON WI 53703
DR / DR
JAMES G OLSON MD
309 W WASHINGTON AVE
MADISON WI 53703
FP / FP
608-837-7913
JANET E OLSON MD
709 HANLEY DRIVE
SUN PRAIRIE WI 53590
PAMELA A OLSON
444 W WASHINGTON AVE
MADISON WI 53703
OBG / OBG
608-267-6306
RONALD W OLSON MD
202 SOUTH PARK STREET
MADISON WI 53715
STEVEN D O'MARRO MD
APT 42
835 NORTH CASS STREET
MILWAUKEE WI 53202-3930
608-233-8042
SUSAN R ONESON
APT 4
1805 UNIVERSITY AVENUE
MADISON WI 53705
DANIEL L ONGNA
705 SCHMITT PLACE
MADISON WI 53705
OPH / PD OPH
608-233-4931
GEORGE E OOSTERHOUS MD
121 STANDISH COURT
MADISON WI 53705
DANE— 23
CD IM / IM
608-263-5131
JUDITH E OR IE MD
H6/339 UW CSC
600 HIGHLAND AVENUE
MADISON WI 53792
PD / PD
608-241-/161 1
SANDRA L OSBORN MD
1912 ATWOOD AVENUE
MADISON WI 53704
608-255-9956
ANTHONY A OTTERS
APT 204
1314 W JOHNSON STREET
MADISON WI 53715
A IM / AI IM
608-257-731 1
JOHN J OUELLETTE MD
SUITE 600
ONE SOUTH PARK STREET
MADISON WI 53715
EDWIN M OVERHOLT
APT 305
3009 UNIVERSITY AVENUE
MADISON WI 53705
JEFFREY D PALARSKI
639 SUNSET AVENUE
KAUKAUNA WI 54130-1076
608-255-4235
EDWARD J PARDON
APT 3
1341 SOUTH STREET
MADISON WI 53715
FP EM / FP
608-835-3156
ROBERT M PASTER MD
726 NORTH MAIN STREET
OREGON WI 53575
STELLA F PATTEN MD
APT 1
2585 EUCLID HTS BLVD
CLEVELAND OH 44106-2760
FP / FP
608-256-3983
JEFFREY J PATTERSON DO
2532 BALDEN STREET
MADISON WI 53713
EM / EM
608-267-6206
MELVYN A PEARLMAN MD
202 SOUTH PARK STREET
MADISON WI 53715
STEVEN H PECK
526 WEST SHORE DRIVE
MADISON WI 53715-1624
OBG / OBG
BEN M PECKHAM MD
5975 WOODCREEK LANE
MIDDLETON WI 53562
ORS / ORS
608-252-8191
ERNEST A PELLEGRINO JR
1313 FISH HATCHERY RD
MADISON WI 53715
TS GS / TS
JOHN R PELLETT MD
G5/317 CSC
600 HIGHLAND AVENUE
MADISON WI 53792
608-251-0966
BARBARA A PESCHONG
APT 501
509 NORTH LAKE STREET
MADISON WI 53703
N P / N P
608-263-5420
HENRY A PETERS MD
600 HIGHLAND AVENUE
MADISON WI 53792
R / R
MARY E PETERS MD
4413 SOMERSET LANE
MADISON WI 53711
BRADLEY S PETERSON
APT 313
434 W MIFFLIN STREET
MADISON WI 53703-2532
OPH / OPH
608-257-1481
DONALD A PETERSON MD
20 SOUTH PARK STREET
MADISON WI 53715
N
WILLIAM G PETERSON MD
20 SOUTH PARK STREET
MADISON WI 53715
FP HYP / FP
608-241-9020
LYNN A PHELPS MD
1225 BURNING WOOD WAY
MADISON WI 53704
608-257-1715
RANDALL J PHILLIPS
APT 2
1909 MADISON STREET
MADISON WI 53711
R / R
JERALD H PIETAN MD
7833 OXTRAIL WAY
VERONA WI 53593
PTH CLP / PTH CLP
608-756-6000
PHILIP G PIPER MD
1000 MINERAL POINT RD
JANESVILLE WI 53545
NS / NS
FREDERICK R PITTS JR MD
COLON I A DEL PRADO
CUIDAD COLON DE MORA
C0S7A RICA
CHP P / P
608-238-7343
EVAN F PIZER MD
2725 MARSHALL COURT
MADISON WI 53705
ORS / PS
GEORGE J PLZAK MD
6018 S HIGHLANDS AVE
MADISON WI 53705
608-257-3333
SHELDON M POLONSKY
APT 205
1308 SPRING STREET
MADISON WI 53715
IM ID / IM
608-257-7107
MD FRANK POLYAK MD
20 SOUTH PARK STREET
MADISON WI 53715
GEORGE T POULLETTE
POST OFFICE BOX 358
WAUTOMA WI 54982-0358
DR NM / R
MYRON A POZNIAK MD
E3/311 UW CSC
600 HIGHLAND AVENUE
MADISON WI 53792
IM PUD / IM
GEOFFREY R PRIEST MD
345 W WASHINGTON AVE
MADISON WI 53703
PD
MARGARET J PROUTY MD
3110 WACHEETA TRAIL
MADISON WI 53711
IM GE / IM
608-256-8954
KARVER L PUESTOW MD
2113 ADAMS STREET
MADISON WI 53711
PD / PD
608-257-9700
NATHANIEL J PULVER MD
ONE SOUTH PARK STREET
MADISON WI 53715
M PATRICIA QUINLISK
1932 UNIVERSITY AVENUE
MADISON WI 53705
IM
608-233-4764
ABRAHAM A QUISLING MD
1918 ROWLEY AVENUE
MADISON WI 53705
IM
SVERRE QUISLING MD
APT 16
SIX WHITCOMB CIRCLE
MADISON WI 53711
WENDY S RACH
APT 1
413 S CHARTER STREET
MADISON WI 53715
NOEL A RADCLIFFE
21 EAST BADGER ROAD
MADISON WI 53713-2701
GS / GS
608-222-3404
JOHN P RAHM JR MD
5001 MONONA DRIVE
MADISON WI 53716
R / R
PHILIP P RANK MD
309 W WASHINGTON AVE
MADISON WI 53703
AN
MITCHELL A RAPKIN MD
810 BLUE RIDGE PARKWAY
MADISON WI 53705
IM ID / IM ID
608-252-8510
RICHARD M REICH MD
4117 E WASHINGTON AVE
MADISON WI 53704
GE IM / GE IM
608-257-3008
MARK REICHELDERFER MD
SUITE 355
20 SOUTH PARK STREET
MADISON WI 53715-1348
GP
608-231-1759
JOHN L RENS MD
APT 4
1659 CAPITAL AVENUE
MADISON WI 53705
608-271-7060
KRISTEN RIBBENS
APT 21
3001 W BELTLINE HWY
MADISON WI 53713
R / R
FREDERICK M RICH MD
5530 MEDICAL CIRCLE
MADISON WI 53719
JOSEPH V RICHARDS
ROUTE 1 BOX 408
POPLAR WI 54864-9704
IM / IM
608-257-7107
ANTHONY J RICHTSMEIER MD
20 SOUTH PARK STREET
MADISON WI 53715
D / D
608-241-461 1
HAL B R IDGWAY MD
1912 ATWOOD AVENUE
MADISON WI 53704
FP / FP
608-837-2206
LEE M ROBAK MD
1270 WEST MAIN STREET
SUN PRAIRIE WI 53590
P IM / IM
608-252-8226
KENNETH I ROBBINS MD
1313 FISH HATCHERY RD
MADISON WI 53715
IM
608-831-5009
MARK L ROBBINS MD
7345 CENTURY PLACE
MIDDLETON WI 53562
P
JOHN A ROBERTS MD
1431 MORRISON STREET
MADISON WI 53703
ORS / ORS
608-257-3961
JOHN M ROBERTS MD
20 SOUTH PARK STREET
MADISON WI 53715
JAMES C ROBINSON
603L EAGLE HEIGHTS
MADISON WI 53705
IM / IM
608-241-4611
WILLIAM ROCK MD
1912 ATWOOD AVENUE
MADISON WI 53704
U
608-238-9554
PAUL N RODRIGUEZ MD
1727 NORMAN WAY
MADISON WI 53705
CONNIE L ROE
APT 1
1204 VILAS AVENUE
MADISON WI 53715
ORS / ORS
608-221-1875
JOHN S ROGERSON MD
2918 WAUNONA WAY
MADISON WI 53713
R DR / R DR
GEORGE F ROGGENSACK MD
1014 HILISIDE AVENUE
MADISON WI 53705
608-251-7719
DAVID C ROHDE
APT 101
4817 SHEBOYGAN AVENUE
MADISON WI 53705
ON HEM IM / MON HEM IM
608-252-8000
EDWARD J PRENDERGAST MD
1313 FISH HATCHERY RD
MADISON WI 53715
GS / GS
608-341-2477
MAURICE G RICE MD
1556 PINE STREET
STEVENS POINT WI 54481
OBG / OBG
608-257-4386
EVERETT L ROLEY MD
SUITE 408
20 SOUTH PARK STREET
MADISON WI 53715
24— DANE
ORS / ORS
608-252-8459
DAVID J ROLNICK MD
345 W WASHINGTON AVE
MADISON WI 53703
IM / IM
608-252-8133
JAMES W ROSE JR MD
1313 FISH HATCHERY RD
MADISON WI 53715
608-273-3886
MARGARET S ROSENBERG
APT 232
4833 SHEBOYGAN AVENUE
MADISON WI 53705
AMY M ROSENBLATT
APT 58
2924 HARVEY STREET
MADISON WI 53705
OPH / OPH
608-258-4520
HARRY ROTH MD
1025 REGENT STREET
MADISON WI 53715
LAURENCE ROTHSTEIN MD
6914 OLD SAUK COURT
MADISON WI 53717
IM / IM
608-256-8363
ROYAL ROTTER MD
1901 MONROE STREET
MADISON WI 53711
R / R
WAYNE M ROUNDS MD
6218 S HIGHLANDS AVE
MADISON WI 53705
FP
MARY G ROWE
7409 FARMINGTON WAY
MADISON WI 53717
N
608-263-5443
JACK M ROZENTAL MD
1745 NORMAN WAY
MADISON WI 53705
OBG / OBG
608-252-8160
KARL A RUDAT MD
1313 FISH HATCHERY RD
MADISON WI 53715
OBG
SHERWIN M RUDMAN MD
345 W WASHINGTON AVE
MADISON WI 53703
ORS / ORS
RONALD C RUDY MD
1313 FISH HATCHERY RD
MADISON WI 53715
608-271-3822
RANDY 0 RUMMLER
APT 4
2218 ALLIED DRIVE
MADISON WI 53711
FP / FP
WILLIAM T RUSSELL MD
304 N BRISTOL STREET
SUN PRAIRIE WI 53590
AN / AN
608-263-8111
DEN F RUSY MD
B6/387 UW CSC
600 HIGHLAND AVENUE
MADISON WI 53792
LYNN M RUSY
APT 10
2621 SMITHFIELD DRIVE
MADISON WI 53719
608-251-3132
ELLEN M RYAN
1321 ST JAMES COURT
MADISON WI 53715
IM / IM
608-252-8000
EDWARD K RYDER JR MD
1313 FISH HATCHERY RD
MADISON WI 53715
ORS / ORS
608-238-9311
KENNETH M SACHTJEN MD
2704 MARSHALL COURT
MADISON WI 53705
R / R
JOSEPH F SACKETT MD
E3/360 CSC
600 HIGHLAND AVENUE
MADISON WI 53792
P / P
608-274-0355
ROBERT J SALINGER MD
5534 MEDICAL CIRCLE
MADISON WI 53719-1298
LAUREL B SALTON
2925 HARVEY STREET
MADISON WI 53705
RAJIT SALUJA
6107 S ELAINE AVENUE
CUDAHY WI 53110-2916
608-255-7188
ROBERT T SALVIN
1017 OAKLAND AVENUE
MADISON WI 53711
608-274-9022
PATRICK J SANKOVITZ
APT 212
2401 POST ROAD
MADISON WI 53713
CHRISTOPHER R SARTOR I
702 EUGENIA AVENUE
MADISON WI 53705
AN / AN
608-263-8122
FRANK J SASSE MD
B6/387 UW CSC
600 HIGHLAND AVENUE
MADISON WI 53792
SCOTT A SASSE
APT 2
515 WEST DAYTON STREET
MADISON WI 53703-1907
DEREK A SCAMMELL
APT 224
4701 SHEBOYGAN AVENUE
MADISON WI 53705
KEVIN B SCAMMELL
516 MARIGOLD DRIVE
MADISON WI 53713
FP / FP
608-873-9431
FRANCIS M SCHAMMEL MD
214 B FORREST STREET
STOUGHTON WI 53589
608-836-7092
RANDI A SCHEA
5120 CONCORD DRIVE
MIDDLETON WI 53562
IM / IM
608-263-2556
WILLIAM E SCHECKLER MD
777 SOUTH MILLS STREET
MADISON WI 53715
FP / FP
608-845-8841
WILLIAM R SCHEIBEL MD
203 MELODY LANE
VERONA WI 53593
WILLIAM B SCHEIG
APT 8
2347 CHALET GARDENS RD
MADISON WI 53711
FP / FP
JAMES P SCHIEFFER MD
7429 HUBBARD AVENUE
MIDDLETON WI 53562
FP / FP
608-274-1100
RICHARD G SCHMELZER MD
5714 ODANA ROAD
MADISON WI 53719
AN
608-241-2607
CARL W SCHMIDT MD
49 LAKEWOOD GARDENS LN
MADISON WI 53704
FP / FP
608-837-4521
MARY H SCHMIDT MD
TEN TOWER DRIVE
SUN PRAIRIE WI 53590
FP / FP
PAUL L SCHMIDT MD
10 TOWER DRIVE
SUN PRAIRIE WI 53590
R / R
ROBERT C SCHMITZ MD
5314 FAYETTE STREET
Madison wi 53713
608-256-6844
JON DAWSE SCHNEIDER
APT 1
323 E JOHNSON STREET
MADISON WI 53703
GS / GS
608-873-7278
PHILLIP J SCHOENBECK MD
no EAST MAIN STREET
STOUGHTON WI 53589
PD / PD
608-263-6477
CHARLES D SCHOENWETTER MD
600 HIGHLAND AVENUE
MADISON WI 53792
EM
DANIEL K SCHOONOVER
312 BOONE ROAD
BLOOMSBURG PA 17815
ON
608-257-0561
JOHN M SCHROEDER MD
20 SOUTH PARK STREET
MADISON WI 53715
AN / AN
608-263-8104
MARK E SCHROEDER MD
B6/373
600 HIGHLAND AVENUE
MADISON WI 53792
MARTIN J SCHROEDER
APT C7
4850 WASHTENAW AVENUE
ANN ARBOR MI 48104-5812
MARY K SCHROTH
2635 CHAMBERLAIN AVE
MADISON WI 53705
ON / OBG
608-231-3441
ALWIN E SCHULTZ MD
222 NORTH MIDVALE BLVD
MADISON WI 53705
TIMOTHY K SCHULTZ
APT 603
3100 LAKE MENDOTA DR
MADISON WI 53705-1463
GS
608-241-461 1
JAMES T SCHULZ MD
1912 ATWOOD AVENUE
MADISON WI 53704
608-233-8094
MARY K SCHUMACHER
2206 KENDALL AVENUE
MADISON WI 53705
D / D
608-238-7179
DONALD S SCHUSTER MD
4414 REGENT STREET
MADISON WI 53705
N / N
608-263-5448
HENRY B SCHUTTA MD
DEPT OF NEUROLOGY
600 HIGHLAND AVENUE
MADISON WI 53792
608-251-3633
ROBERT L SCHWARTZ
1117 CATALPA CIRCLE
MADISON WI 53713
OTO / OTO
608-257-3696
JOHN K SCOTT MD
SUITE 350
20 SOUTH PARK STREET
MADISON WI 53715-1348
MARK P SCOTT
APT 204
112 NORTH MILLS STREET
MADISON WI 53715
JEFFREY L SEGAR
2635 CHAMBERLAIN AVE
MADISON WI 53705
FP
608-837-2206
NANCY J SELFRIDGE MD
1270 WEST MAIN STREET
SUN PRAIRIE WI 53590
JOHN V SELTHAFNER
2302 UNIVERSITY AVENUE
MADISON WI 53705
BRUCE E SEMANS
POST OFFICE BOX 9872
MADISON WI 53715
OTO GS
608-238-0399
ARIF J SHAIKH MD
APT 30
2060 ALLEN BOULEVARD
MIDDLETON WI 53562
CDS TS GS / CDS TS GS
608-252-8006
JOHN M SHANNAHAN MD
1313 FISH HATCHERY RD
MADISON WI 53715
CHP / PN
608-274-0355
ROBERT B SHAPIRO MD
5534 MEDICAL CIRCLE
MADISON WI 53719-1298
DANE— 25
OBG END / ODG RE
608-263-1218
SANDER S SHAPIRO MD
H4/630 UW CSC
600 HIGHLAND AVENUE
MADISON WI 53792
MARK S SH ARSON
840 EAST GORHAM STREET
MADISON WI 53703
414-336-5515
MANSOOR SHARIFF
705 SCHMIDT PLACE
MADISON WI 53705
IM / IM
608-836-1644
GREGORY L SHEEHY MD
1205 CANTERBURY CIRCLE
MIDDLETON WI 53562
P
608-238-9354
EDWIN 0 SHELDON JR MD
2727 MARSHALL COURT
MADISON WI 53705
P N / P N
608-238-9354
RUTH T SHELDON MD
2727 MARSHALL COURT
MADISON WI 53705
NEP IM / NEP IM
608-258-3221
WELDON D SHELP MD
309 W WASHINGTON AVE
MADISON WI 53703
D / D
608-262-7793
PHILIP D SHENEFELT MD
2759 FLORANN DRIVE
MADISON WI 53711
KETAN K SHETH
APT 101
4817 SHEBOYGAN AVENUE
MADISON WI 53705-2910
N
608-252-8531
KARL E SHEWMAKE MD
345 W WASHINGTON AVE
MADISON WI 53703
FP / FP
608-222-3404
RICHARD W SHROPSHIRE MD
5001 MONONA DRIVE
MONONA WI 53716
EM FP / FP
608-221-8189
PHILIP M SHULTZ MD
5705 COVE CIRCLE
MONONA WI 53716-3009
PM / PM
608-267-6175
ROBERT A SI EVERT MD
202 SOUTH PARK STREET
MADISON WI 53715
JORGE L SIFUENTES
810-C EAGLE HGTS APTS
MADISON WI 53705
IM END / IM
CARL G SILVERMAN MD
345 W WASHINGTON AVE
MADISON WI 53703
DAVID J SIMENSTAD
APT 201
2221 POST ROAD
MADISON WI 53713
IM / IM
608-252-8133
PAUL 0 SIMENSTAD MD
1313 FISH HATCHERY RD
MADISON WI 53715
HENRY J SIMPSON
APT 1
1011 EMERALD STREET
MADISON WI 53715
IM GE / IM
608-263-4033
JOHN L SIMS MD
942 S MIDVALE BLVD
MADISON WI 53711
GS / GS
608-835-3152
RUSSELL P SINAIKO MD
5437 HIGHWAY M
OREGON WI 53575
U / U
IRA R SISK MD
606 NORTH SEGOE ROAD
MADISON WI 53705
OBG / OBG
608-252-8049
W JAMES SIVERHUS MD
1313 FISH HATCHERY RD
MADISON WI 53715
IM GER
SIGURD E SIVERTSON MD
ROOM 1245A
1300 UNIVERSITY AVENUE
MADISON WI 53706
608-255-6167
KATHERINE K SKAGGS
1143 ERIN STREET
MADISON WI 53715
608-256-6833
JULIE C SKINNER
1222 CHANDLER STREET
MADISON WI 53715
GS / GS
608-222-8041
EUGENE E SKROCH MD
710 FROST WOODS ROAD
MADISON WI 53716
ORS / ORS
JAMES S SLATTERY MD
2 WEST GORHAM STREET
MADISON WI 53703
608-251-8561
MARCIA J SLATTERY
APT 302
746 WEST MAIN STREET
MADISON WI 53715
AN / AN
608-263-8116
VERA SLAVIC-SVIRCEV MD
B6/356 CSC
600 HIGHLAND AVENUE
MADISON WI 53792
GS TS / GS
608-256-4656
DEAN B SMITH MD
20 SOUTH PARK STREET
MADISON WI 53715
PD / PD
608-241-4611
GREGORY G SMITH MD
1912 ATWOOD AVENUE
MADISON WI 53704
P / P
608-274-0355
MAX M SMITH MD
5534 MEDICAL CIRCLE
MADISON WI 53719-1298
JEFFREY SMUKALLA
8464 SOUTH JEAN AVENUE
OAK CREEK WI 53154-3217
SEAN M SMULLEN
313 WEST WILSON STREET
MADISON WI 53703
PS D / D
STEPHEN N SNOW MD
3412 CRESTWOOD DRIVE
MADISON WI 53705
FP / FP
608-263-6585
CATHERINE SODERQUIST MD
777 SOUTH MILLS STREET
MADISON WI 53715
MATTHEW A SOLBERG
APT 1
101 1 EMERALD STREET
MADISON WI 53715
ORS HS
608-238-9311
DAVID A SOLFELT MD
2704 MARSHALL COURT
MADISON WI 53705
GS
608-231-3100
PHILIP L SONDERMAN
SUITE 603
3100 LAKE MENDOTA DR
MADISON WI 53705
IM / IM
608-252-8133
DAVID A SORBER MD
1313 FISH HATCHERY RD
MADISON WI 53715
OBG / OBG
608-257-4386
JAMES P SPEICHINGER MD
20 SOUTH PARK STREET
MADISON WI 53715
AN / AN
608-263-9246
SCOTT R SPRINGMAN MD
DEPT OF ANESTHESIOLOGY
600 HIGHLAND AVENUE
MADISON WI 53792
PD / PD
PATRICIA V STAATS MD
345 W WASHINGTON AVE
MADISON WI 53703
EM / EM
608-233-8490
RICHARD L STALEY MD
4123 EUCLID AVENUE
MADISON WI 53711
IM
JOHN A STANCHER MD
2030 WESTBROOK LANE
MADISON WI 53711
GS / GS
608-263-1387
JAMES R STARLING MD
5509 TREMPEALEAU TRAIL
MADISON WI 53705
608-836-1970
THOMAS G STAUSS
5306 SOUTH RIDGEWAY
MIDDLETON WI 53562
TR ON / TR
608-263-8500
RICHARD A STEEVES MD
K4/B100 UW CSC
600 HIGHLAND AVENUE
MADISON WI 53792
R / R
DENNIS H STEFFEN MD
309 W WASHINGTON AVE
MADISON WI 53703
CHRISTOPHER P STEFFES
APT 138
4725 SHEBOYGAN AVENUE
MADISON WI 53705
DAVID I STEIN
2561 UNIVERSITY AVENUE
MADISON WI 53705
ROBERT D STEINER
SUITE 702
4817 SHEBOYGAN AVENUE
MADISON WI 53705
GS CD / GS
GEORGE P STEINMETZ JR MD
20 SOUTH PARK STREET
MADISON WI 53715
JEFFREY A STEPHENSON
509 RIVERSIDE DRIVE
MADISON WI 53704
GARY W STERKEN
3528 CROSS STREET
MADISON WI 53711
OPH / OPH
THOMAS S STEVENS MD
208 LATHROP STREET
MADISON WI 53705
PTH / PTH
DONALD J STEVENSON MD
3443 EDGEHILL PARKWAY
MADISON WI 53705
R / R
MICHAEL F STIEGHORST MD
SUITE 201
20 SOUTH PARK STREET
MADISON WI 53715
EM FP / FP
608-831-4066
PAUL M STIEGLER MD
TWO PINEHURST CIRCLE
MADISON WI 53717
JEFFREY J STODDARD
1910 ASOCIATION DRIVE
RESTON VA 22091
608-256-7281
JOSEPH STOECKL
APT 301
311 E JOHNSON STREET
MADISON WI 53703
AN / AN
RUTH A STOERKER MD
1910 WAUNONA WAY
MADISON WI 53713
608-238-9527
THOMAS R STOIBER
APT 15
2130 UNIVERSITY AVENUE
MADISON WI 53705
PTH / PTH
608-267-6267
DENNIS W STONE MD
36 SOUTH BROOKS STREET
MADISON WI 53715
MARK R STORM
3649 MARIGOLD CIRCLE
MIDDLETON WI 53562
CHARLES R STRANCKE
APT 118
22 LANGDEN STREET
MADISON WI 53703
IM
ROBERT A STRAUGHN MD
428 LILY DRIVE
MADISON WI 53713-2619
IM P
JOEL E STREIM MD
DEPT OF PSYCHIATRY
600 HIGHLAND AVENUE
MADISON WI 53792
26— DANE
AN / AN
608-233-6467
JOHN M SjTROHM MD
4626 KEATING TERRACE
MADISON WI 53711
JUDITH M STUCK I
1317 RUTLEDGE STREET
MADISON WI 53703
OPH / OPH
608-258-4520
RODNEY J STURM MD
1025 REGENT STREET
MADISON WI 53715
JOHN W SUMMERVILLE MD
APT 910
120 WEST THIRD AVENUE
SAN MATEO CA 94402-1547
PATRICK SURA
APT ID
602 N FRANKLIN AVENUE
MADISON WI 53705
DANIEL J SUTTON
1425 MOUND STREET
MADISON WI 53711
608-257-9679
MICHAEL SWEET
935 DRAKE STREET
MADISON WI 53715
CHP P / CHP P
608-263-6099
WILLIAM J SWIFT JR MD
B6/262 UW CSC
600 HIGHLAND AVENUE
MADISON WI 53792
AN / AN
W STUART SYKES MD
B6/387 UW CSC
600 HIGHLAND AVENUE
MADISON WI 53792
FP
608-837-5158
JOSEPH SYTY MD
107 CHURCH STREET
SUN PRAIRIE WI 53590
EM FP / FP
608-833-051 1
CHERYL J SZABO MD
7846 W OAKBROOK CIRCLE
MADISON WI 53717
OTO / OTO
608-244-7271
CHARLES R TABORSKY MD
240 LAKEWOOD BOULEVARD
MADISON WI 53704
IM AI / IM
608-767-2593
JOHN R TALBOT MD
5304 REEVE ROAD
MAZOMANIE WI 53560
MICHAEL D TARANTINO
1530 ADAMS STREET
MADISON WI 53711
LM EM D
608-271-8847
ALOYS L TAUSCHECK MD
2356 BLUE GRASS TRAIL
MADISON WI 53711
IM / IM
608-256-1901
BENTON C TAYLOR MD
3906 PRISCILLA LANE
MADISON WI 53705
AN / AN
CLAUDE A TAYLOR JR MD
6341 LANDFALL DRIVE
MADISON WI 53705
N 7 N
608-255-4826
CAMBER F TEGTMEYER JR MD
20 SOUTH PARK STREET
MADISON WI 53715
PD / PD
HORACE K TENNEY III MD
125 S WEBSTER STREET
POST OFFICE BOX 7841
MADISON WI 53707
D
608-221-8189
DIANE THALER MD
5705 COVE CIRCLE
MONONA WI 53716
IM / IM
608-833-3616
MICHAEL L THOM MD
345 W WASHINGTON AVE
MADISON WI 53703
608-238-6670
KEITH R THOMAE
SUITE 2
1937 UNIVERSITY AVENUE
MADISON WI 53705
608-233-2666
RICHARD S THOMAS
901 COLUMBIA ROAD
MADISON WI 53705
FP / FP
608-222-3404
STEPHEN C THOMAS MD
5001 MONONA DRIVE
MADISON WI 53716
CHARLES THOMPSON
APT 301
112 NORTH MILLS STREET
MADISON WI 53715
P N / P
608-263-6081
RICHARD J THURRELL MD
B6/256 CSC
600 HIGHLAND AVENUE
MADISON WI 53792
NS / NS
JAMES C TIBBETTS MD
20 SOUTH PARK STREET
MADISON WI 53715
AN / AN
BONNIE M TOMPKINS MD
1919 ARLINGTON PLACE
MADISON WI 53705
OBG
608-256-7781
JAMES B TORHORST MD
SUITE 307
20 SOUTH PARK STREET
MADISON WI 53715
GP U
608-241-4445
THOMAS W TORMEY JR MD
2453 ATWOOD AVENUE
MADISON WI 53704
PD / PD
608-252-8181
ORDEAN L TORSTENSON MD
1313 FISH HATCHERY RD
MADISON WI 53715
N
608-249-2151
JOHN B TOUSSAINT MD
317 KNUTSON DRIVE
MADISON WI 53704
OPH
NORBERT F TOUSSAINT JR MD
5838 TIMBERLAND TRAIL
FITCHBURG WI 53711
NS GS / NS
608-252-8230
STEVEN M TOUTANT MD
1313 FISH HATCHERY RD
MADISON WI 53715
RICHARD W TSCHOEKE
1425 MOUND STREET
MADISON WI 53711-2221
FP / FP
608-837-2206
MARC D TUMERMAN MD
1270 WEST MAIN STREET
SUN PRAIRIE WI 53590
CDS GS / GVS GS
608-263-1388
WILLIAM D TURNIPSEED MD
H4/330 UW CSC
600 HIGHLAND AVENUE
MADISON WI 53792
PTH CLP / PTH CLP
608-258-3228
DEBORAH M TURSKI MD
309 W WASHINGTON AVE
MADISON WI 53703
R / R
PATRICK A TURSKI MD
DEPT OF RADIOLOGY
600 HIGHLAND AVENUE
MADISON WI 53792
GP
608-256-0523
J KENT TWEETEN MD
333 W MIFFLIN STREET
MADISON WI 53703
P / P
608-833-3554
GILBERT B TYBRING MD
7109 COLONY DRIVE
MADISON WI 53717
JOHN L UDELL
203 J EAGLE HEIGHTS
MADISON WI 53705
P
DEBORAH M UMSTEAD MD
DEPT OF PSYCHIATRY
600 HIGHL.AND AVENUE
MADISON WI 53792
608-238-0870
MARK A URBAN
505 N BLACKHAWK AVENUE
MADISON WI 53705
P
WALTER J URBEN MD
1219 WELLESLEY ROAD
MADISON WI 53705
608-257-4416
SONIA VALDIVIA
933 W JOHNSON STREET
MADISON WI 53715
CRAIG L VANDE LIST
436 W WASHINGTON AVE
MADISON WI 53703
DAVID A VAN DE LOO
115 W BLODGETT STREET
MARSHFIELD WI 54449-2157
IM GE / IM
JAMES E VANDER MEER MD
1313 FISH HATCHERY RD
MADISON WI 53715
CAROL J VAN PETTEN
GENERAL DELIVERY
FRESNO CA 93706-9999
PD / PD
307-487-5041
HART E VAN RIPER MD
L206
6015 SOUTH VERDE TRAIL
BOCA RATON FL 33433-2437
JEROME VAN RUISWYK
APT 2
2956 NORTH 76TH STREET
MILWAUKEE WI 53222-5010
IM
JONATHAN W VAN ZILE MD
870 TERRY PLACE
MADISON WI 53711
608-233-2779
DALE F VASLOW
POST OFFICE BOX 5649
MADISON WI 53705-0649
ABS TRS GS / GS
608-252-8477
ROLAND J VEGA MD
345 W WASHINGTON AVE
MADISON WI 53703
608-251-3633
PAUL A VEREGGE
1117 CATALPA CIRCLE
MADISON WI 53713
LYNN R VERGER
933 W JOHNSON STREET
MADISON WI 53715
PIERO VERRO
1119 EMERALD STREET
MADISON WI 53715-1637
ROBERT E VLACH JR
APT 6
6710 SCHROEDER ROAD
MADISON WI 53711-2323
ORS / ORS
GEORGE H VOGT MD
20 SOUTH PARK STREET
MADISON WI 53715
FP / FP
608-271-2333
VICTORIA A VOLLRATH MD
5722 RAYMOND ROAD
MADISON WI 53711
OPH / OPH
608-263-6646
INGOLF H L WALLOW MD
84/370 CSr
600 HIGHLAND AVENUE
MADISON WI 53792
GP
EUGENE J WALSH MD
2830 DRYDEN DRIVE
MADISON WI 53704
P / P
608-836-3959
JUDITH D WALTON MD
6411 MOUND DRIVE
MIDDLETON WI 53562
RICKY J WANIGER
2322 HIGH RIDGE TRAIL
MADISON WI 53713
DEBORAH L WANTA
APT 5
3105 STEVENS STREET
MADISON WI 53705
JACQUELINE WARNER
702 EUGENIA AVENUE
MADISON WI 53705
FP / FP
608-263-7682
JAMES D WARRICK MD
777 SOUTH MILLS STREET
MADISON WI 53715
DANE, DODGE— 27
IM
608-252-8522
LOUIS H WARRICK. JR MD
345 W WASHINGTON AVE
MADISON WI 53703
FP / FP
608-274-1 100
WALTER L WASHBURN MD
5714 ODANA ROAD
MADISON WI 53719
R / RP
602-971-9081
WILLIAM L WASKOW MD
4205 E PARADISE LANE
PHOENIX AZ 85032
IM / IM
608-252-8418
BLAKE E WATERHOUSE MD
345 W WASHINGTON AVE
MADISON WI 53703
ROBERT W WATERMAN
1317 RUTLEDGE STREET
MADISON WI 53703
AN / AN
DARWIN D WATERS MD
26 HERITAGE DRIVE
LAKE WYLIE SC 29710
U / U
608-252-8000
RAUL F WATERS MD
1313 FISH HATCHERY RD
MADISON WI 53715
OBG / OBG
608-835-3014
ALICE D WATTS MD
2402 LALOR ROAD
POST OFFICE BOX 98
OREGON WI 53575-0098
PD ADL / PD
608-251-6440
CURTIS R WEATHERHOGG MD
SUITE 303
20 SOUTH PARK STREET
MADISON WI 53715
DAVID R WEBER
APT D78
6339 PHEASANT LANE
MIDDLETON WI 53562
608-238-0396
MARIA T WEBER
221 ST CROIX LANE
MADISON WI 53705
U / U
608-252-8555
JOHN D WEGENKE MD
345 W WASHINGTON AVE
MADISON WI 53703
R / R
GENE P WEGNER MD
4815 TONYAWATHA TRAIL
MADISON WI 53716
ROBERT S WEHBIE
APT 408-B
EAGLE HEIGHTS
MADISON WI 53705
PS
608-271-0578
MICHAEL A WEINER MD
5520 MEDICAL CIRCLE
MADISON WI 53719
608-233-5428
SUZANNE M WEISNER
2925 HARVEY STREET
MADISON WI 53705
608-256-2445
ROBERT L WELCH
923 DRAKE STREET
MADISON WI 53715
IM / IM
608-257-7107
RICHARD 0 WELNICK MD
20 SOUTH PARK STREET
MADISON WI 53715
JOSEPH A WELS
APT 1
402 GRAND AVENUE
MADISON WI 53705-3734
GS
608-241-461 1
RONALD D WENGER MD
1912 ATWOOD AVENUE
MADISON WI 53704
FP / FP
608-221-1501
PAUL A WERTSCH MD
4221 VENETIAN LANE
MADISON WI 53704
CHP P / CHP P
608-263-6097
JACK C WESTMAN MD
D6/292 CSC
600 HIGHLAND AVENUE
MADISON WI 53792
IM / IM
CARL B WESTON MD
345 W WASHINGTON AVE
MADISON WI 53703
LINDASUE WEYNAND
11 LARKIN STREET
MADISON WI 53705
GS
305-565-1468
ROBERT M WHEELER MD
2119 NE 16TH AVENUE
FORT LAUDERDALE FL 33305
ORS / ORS
608-257-3961
JOHN R WHIFFEN MD
20 SOUTH PARK STREET
MADISON WI 53715
ROBERT WHITCOMB
1534 ADAMS STREET
MADISON WI 53711
GYN GPM / OBG
608-256-7781
RAYMOND E WHITSITT MD
SUITE 307
20 SOUTH PARK STREET
MADISON WI 53715-2387
STEVEN L WIESNER
APT 2N
2651 NORTH DAYTON
CHICAGO IL 60614-2305
JAMES WILDE
1327 BOWEN COURT
MADISON WI 53715
TR NM / TR NM
608-263-8500
ALBERT L WILEY JR MD
K4/113B CSC
600 HIGHLAND AVENUE
MADISON WI 53792
IM PUD OM / IM
608-831-5410
JAMES M WILKIE MD
8075 OLD SAUK PASS RD
ROUTE 1
CROSS PLAINS WI 53528
CDS GS / CDS GS
WARREN A WILLIAMSON MD
6329 STONEFIELD ROAD
MIDDLETON WI 53562
608-251-3541
JOHN D WILSON
315 S ORCHARD STREET
MADISON WI 53715
DR / R
MARGARET C WINSTON MD
APT 3C
1029 SPAIGHT STREET
MADISON WI 53703
R / R
GEORGE W WIRTANEN MD
2884 TIMBERLANE
ROUTE 9
VERONA WI 53593
OPH / OPH
JAMES P WISE MD
SUITE 401
20 SOUTH PARK STREET
MADISON WI 53715
608-267-6250
LEXY A WISTENBERG
APT 445
1010 MOUND STREET
MADISON WI 53715
RICHARD J WITTCHOW
1751 RIVERWOOD LANE
WISCONSIN RAPIDS WI 54494
ORS / ORS
414-854-4541
RICHARD C WIXSON MD
739 LITTLE SISTER ROAD
SISTER BAY WI 54234
GS / GS
608-263-8604
WILLIAM H WOLBERG MD
K4 CSC
600 HIGHLAND AVENUE
MADISON WI 53792
AGNES WONG
534 SOUTH PARK STREET
MADISON WI 53715
NS / NS
608-252-8022
JOHN E WOODFORD MD
1313 FISH HATCHERY RD
MADISON WI 53715
OPH
JOHN J WOOG MD
APT 318
409 W EAU CLAIRE AVE
MADISON WI 53705
IM / IM
GARY WOROCH MD
1313 FISH HATCHERY RD
MADISON WI 53715
EM FP / FP
JACK C WORTHINGTON MD
818 OTTAWA TRAIL
MADISON WI 53711
R / R
STANLEY F WYNER MD
APT 406
1300 OAK CREEK DRIVE
PALO ALTO CA 94304
PD GE / PD
608-252-8181
MICHAEL R YAFFE MD
301 ACADIA DRIVE
MADISON WI 53717
GS TS / GS TS
608-263-1383
CHARLES E YALE MD
G5/357 CSC
600 HIGHLAND AVENUE
MADISON WI 53792
GE IM / IM
608-257-3008
DENNIS T YAMAMOTO MD
SUITE 355
20 SOUTH PARK STREET
MADISON WI 53715
TS CDS GS / TS GS
608-233-7720
WILLIAM P YOUNG MD
1239 WELLESLEY ROAD
MADISON WI 53705
PD / PD
608-244-4328
KOK-PENG YU MD
4117 E WASHINGTON AVE
MADISON WI 53704
608-274-8720
JOHN R ZANDT
APT 5
4613 THURSTON LANE
MADISON WI 53711
TERRY A ZARLING
660 BRANDT COURT
PEWAUKEE WI 53072-3502
KATHY L ZENTNER
105 N SPOONER STREET
MADISON WI 53705
N IM / N IM
608-255-4826
RONALD A ZEROFSKY MD
20 SOUTH PARK STREET
MADISON WI 53715
JEFFREY K ZIBELL
2458 HIGHRIDGE TRAIL
MADISON WI 53713-3630
JOSEPH D ZIRNESKIE
APT D
3319 HARVEY STREET
MADISON WI 53705
IM / IM
608-256-8363
MARVIN M ZOLOT MD
1901 MONROE STREET
MADISON WI 53711
PD N /PD
MARY L ZUPANC MD
DEPT OF NEUROLOGY
600 HIGHLAND AVENUE
MADISON WI 53792
DODGE
GS CDS TS / GS
414-885-5576
M AHMAD ALI MD
SUITE 102
130 WARREN STREET
BEAVER DAM WI 53916
PD FP
414-387-211 1
MICHAEL W BACHHUBER MD
410 SHORT STREET
MAYVILLE WI 53050
ORS
414-887-1645
RAFAEL BARAJAS MD
130 WARREN STREET
BEAVER DAM WI 53916
R / R
414-887-1505
JACK R BARTHOLMAI MD
ROUTE 4 BOX 182
BEAVER DAM WI 53916
GP GS
ROGER I BENDER MD
205 S UNIVERSITY AVE
BEAVER DAM WI 53916
28— DODGE, DOOR/KEWAUNEE
ORS / DRS
4 14-887-8491
JAMES S BERRY MD
130 WARREN STREET
BEAVER DAM WI 53916
GS / GS
414-885-5576
ROBERT F BOOCK, MD
SUITE 102
130 WARREN STREET
BEAVER DAM WI 53916
FP / FP
414-887-1753
CURTIS W BUSH MD
130 WARREN STREET
BEAVER DAM WI 53916
PTH
4 14—324—5543
VICTOR W CACERES MD
POST OFFICE BOX 511
WAUPUN WI 53963-0511
GS / GS
414-623-3040
CRAIG W CAMPBELL MD
1511 SOUTH PARK AVENUE
COLUMBUS WI 53925
FP / FP
414-887-7101
EDWARD F CODY MD
1200 N CENTER STREET
BEAVER DAM WI 53916
R / R
R SANFORD COOK MD
41 ROSEWOOD TRAIL
DE LAND FL 32724-1358
FP OBG / FP
414-398-2022
DOWE P CUPERY MD
POST OFFICE BOX 247
MARKESAN WI 53946
FP / FP
414-887-8836
STANLEY G CUPERY MD
130 WARREN STREET
BEAVER DAM WI 53916
FP / FP
414-885-4433
RICHARD A DAMON MD
130 WARREN STREET
BEAVER DAM WI 53916
OPH / OPH
414-887-1151
GEORGE E DAVIS MD
130 WARREN STREET
BEAVER DAM WI 53916
OPH
THAYER C DAVIS MD
130 WARREN STREET
BEAVER DAM WI 53916
GP
414-885-3614
GEORGE G DRESCHER MD
215 N CENTER STREET
BEAVER DAM WI 53916
OPH
ALAN A EHRHARDT MD
130 WARREN STREET
BEAVER DAM WI 53916
FP / FP
414-485-4341
DANIEL R ERICKSON MD
POST OFFICE BOX 127
ROUTE 1 HIGHWAY 28
HORICON WI 53032
ABS GS
414-885-9410
NORMAN W ERICKSON MD
1216 LAKE SHORE DRIVE
POST OFFICE BOX 352
BEAVER DAM WI 53916
ABS
WILLIAM E FUNCKE MD
130 WARREN STREET
BEAVER DAM WI 53916
P / P
414-887-8853
KENNETH C GRAUPNER MD
SUITE 3D
200 FRONT STREET
BEAVER DAM WI 53916
FP
414-386-4479
FREDERIC: G HAESSLY MD
107 E CENTER STREET
JUNEAU WI 53039
FP / FP
414-623-2240
CHARLES E HANSELL MD
1511 PARK AVENUE
POST OFFICE BOX 327
COLUMBUS WI 53925-0327
GP
FREDERIK A KARSTEN MD
514 EAST LAKE STREET
HORICON WI 53032
FP / FP
414-885-4747
WAQAR A KHAN MD
205 S UNIVERSITY AVE
POST OFFICE BOX 294
BEAVER DAM WI 53916
IM
GERALD H KLOMBERG MD
130 WARREN STREET
BEAVER DAM WI 53916
FP
414-488-3101
GREGORY P LANGENFELD MD
no SOUTH MILWAUKEE
POST OFFICE BOX 187
THERESA WI 53091-0187
GS CDS / GS
414-324-2601
R SCOTT LIEBL MD
14 BEAVER DAM STREET
WAUPUN WI 53963
GP
DARRELL L LINK MD
1200 N CENTER STREET
BEAVER DAM WI 53916
GS / GS
JOSEPH M MILITELLO MD
130 WARREN STREET
BEAVER DAM WI 53916
NM PTH / NM PTH
414-885-9231
RODOLFO MOLINA MD
130 WARREN STREET
BEAVER DAM WI 53916
AN / AN
414-885-5871
JANG BU PARK MD
BEAVER DAM COMM HOSP
BEAVER DAM WI 53916
GP
4 14-324—5545
WILLIAM J PETTERS MD
600 FERN STREET
WAUPUN WI 53963
OTO / OTD
414-887-1373
VICKI R PRELL MD
130 WARREN STREET
BEAVER DAM WI 53916
FP
414-885-4813
CHARLES L QUALLS MD
112 EAST MAPLE AVENUE
BEAVER DAM WI 53916
DR R / R
414-887-1 153
STEVEN J RAWLINS MD
116 MONROE STREET
BEAVER DAM WI 53916
PTH NM / PTH
414-885-9231
WILLIAM G RICHARDS MD
130 WARREN STREET
BEAVER DAM WI 53916
GP GS
ROB R ROBERTS MD
C/0 SALLY DUMAN
319 S MILWAUKEE STREET
FREDONIA WI 53021
PTH NM CLP / PTH CLP
414-885-9231
THEODORE ROWAN MD
130 WARREN STRET
BEAVER DAM WI 53916
IM PD / PD
414-887-7731
AYAZ M SAMADANI MD
148 WARREN STREET
POST OFFICE BOX 678
BEAVER DAM WI 53916
FP / FP
414-793-2281
NORMAN J SCHROEDER II MD
2219 GARFIELD STREET
TWO RIVERS WI 54241
GP
NORMAN H SCHULZ MD
130 WARREN STREET
BEAVER DAM WI 53916
FP
414-485-4636
JOHN A SMITH MD
1014 E WALNUT STREET
HORICON WI 53032
GP
414-885-9238
WILLIAM H SNOOK MD
130 WARREN STREET
BEAVER DAM WI 53916
FP / FP
414-843-2336
JAMES 0 STEELE MD
7001 236TH AVENUE
POST OFFICE BOX 342
PADDOCK LAKE WI
53168-0342
PTH CLP / PTH CLP
414-885-9231
JOHN F SULLIVAN MD
130 WARREN STREET
BEAVER DAM WI 53916
CD / IM
414-887-0359
JOHN A SZWEDA MD
130 WARREN STREET
BEAVER DAM WI 53916
FP DBS
414-324-5564
PETER W TIMMERMANS MD
200 E MAIN STREET
WAUPUN WI 53963
IM NEP
414-324-451 1
HER -LANG TU MD
14 BEAVER DAM STREET
WAUPUN WI 53963
FP / FP
ROBERT E URBANEK MD
1200 N CENTER STREET
BEAVER DAM WI 53916
FP / FP
ANDREW P VRABEC MD
605 EAST SOUTH STREET
POST OFFICE BOX 517
BEAVER DAM WI 53916
U / U
414-887-7654
KI JUN WHANG MD
130 WARREN STREET
BEAVER DAM WI 53916
PTH / PTH
EDWARD B WOHLWEND MD
130 WARREN STREET
BEAVER DAM WI 53916
DOQR-KEWAUNEE
FP GP / FP
414-487-5266
VALENTINO S ANCHETA MD
316 STEELE STREET
ALGOMA WI 54201
FP / FP
414-743-7261
JOHN J BECK MD
345 SOUTH 18TH AVENUE
STURGEON BAY WI 54235
FP / FP
414-743-6231
JEFFREY J BROOK MD
108 SOUTH TENTH AVENUE
STURGEON BAY WI 54235
IM / IM
DAVID G CONGER MD
BUILDING 7
30 NORTH 18TH AVENUE
STURGEON BAY WI 54235
R
ROLAND G EVENSON MD
535 S EIGHTH AVENUE
STURGEON BAY WI 54235
PTH / PTH
414-743-5566
WILLIAM FALLER MD
330 SOUTH 16TH PLACE
POST OFFICE BOX 466
STURGEON BAY WI 54235
FP / FP
414-743-721 1
WILLIAM J GAERTNER MD
345 SOUTH 18TH AVENUE
POST OFFICE BOX 447
STURGEON BAY WI
54235-0447
GP OBG
414-388-4022
FRANCIS GILBERT MD
1017 MILWAUKEE STREET
KEWAUNEE WI 54216
GS / GS
JOHN L HERLACHE MD
345 SOUTH 18TH AVENUE
STURGEON BAY WI 54235
GP
414-743-2113
WALTER S HOBSON MD
50 S MADISON AVENUE
STURGEON BAY WI 54235
PD / PD
414-743-7261
FERRIN C HOLMES MD
345 18TH AVENUE
STURGEON BAY WI 54235
DOOR/KEWAUNEE, DOUGLAS, EAU CLAIRE/DUNN/PEPIN— 29
FP
GLENN KIMMEL MD
1304 FIRST STREET
KEWAUNEE WI 54216
GS GP
ALFONSO G TAMAYO MD
1623 RHODE ISLAND
POST OFFICE BOX 107
STURGEON BAY WI 54235
OBG
715-392-S518
FRED G JOHNSON JR MD
704 E SEVENTH STREET
SUPERIOR WI 54880
FP / FP
715-398-3561
JON C STEPHENSON MD
318 21ST AVENUE EAST
SUPERIOR WI 54880
FP CD / FP
414-487-1660
JACK F MARCH MD
413 FOURTH STREET
ALGOMA WI 54201
FP / FP
EDWARD P MC AULIFFE MD
345 SOUTH 18TH AVENUE
STURGEON BAY WI 54235
U / U
414-743-6974
MICHAEL R MC FADDEN MD
342 LOUISIANA STREET
POST OFFICE BOX 447
STURGEON BAY WI
54235-0447
GS / GS
GEORGE D MULDER MD
345 SOUTH 18TH AVENUE
POST OFFICE BOX 447
STURGEON BAY WI
54235-0447
GP
414-388-3540
REYNOLD M NESEMANN MD
804 MILWAUKEE STREET
KEWAUNEE WI 54216
GP
DAVID E PAPENDICK MD
801 FOURTH STREET
ALGOMA WI 54201
OPH / OPH
414-743-9532
HANSI R PATIENCE MD
PARK FARM
2045 HIGHWAY S
STURGEON BAY WI 54235
GP
EDWARD H REGEHR MD
1304 FIRST STREET
KEWAUNEE WI 54216
FP / FP
GEORGE H ROENNING MD
345 SOUTH 18TH AVENUE
POST OFFICE BOX 447
STURGEON BAY WI 54235
OBG
FRED A ROHN MD
POST OFFICE BOX 447
STURGEON BAY WI 54235
R / R
414-743-1877
BARBARA A SANDEFUR MD
3772 N BAYSHORE DRIVE
STURGEON BAY WI 54235
ORS / ORS
THOMAS W SCHUEPPERT MD
345 SOUTH 18TH AVENUE
POST OFFICE BOX 447
STURGEON BAY WI
54235-0447
FP
414-743-6231
WELDON G SHEETS MD
108 SOUTH TENTH AVENUE
STURGEON BAY WI 54235
IM
414-743-7966
THOMAS M STEED MD
BUILDING 7
30 NORTH 18TH AVENUE
STURGEON BAY WI 54235
IM
JOAN A TRAVER MD
945 DAY SHORE DRIVE
BOX 146
SISTER BAY WI 54234
GP OBG
414-743-6268
NICHOLAS R WAGENER MD
POST OFFICE BOX 62
STURGEON BAY WI
54235-0062
DR R / DR R
414-743-3155
BRIAN D WAKE MD
1116 N THIRD AVENUE
STURGEON BAY WI 54235
GP ADL
414-743-2174
JOAN P WAKE MD
1 1 16 N THIRD STREET
STURGEON BAY WI 54235
FP / FP
414-487-2660
MARK 0 WEISSE MD
413 FOURTH STREET
ALGOMA WI 54201
GP
813-634-6373
ERIE W WITS MD
2218 GRENADIER DRIVE
SUN CITY CENTER FL 33570
FP / FP
414-388-4640
THOMAS M ZENNER MD
1304 FIRST STREET
KEWAUNEE WI 54216
IM
GENE G KARWDSKI MD
3600 TOWER AVENUE
SUPERIOR WI 54880
R / R
715-392-3053
JOHN A KNIGHTS MD
APT 8
2818 JOHN AVENUE
SUPERIOR WI 54880
GS / GS
ENZO KRAHL MD
1606 NORTH 28TH STREET
SUPERIOR WI 54880
EM / FP
DAVID M KRISTENSEN MD
BOX 218
GORDON WI 54838
IM
ANTONIO L LAO MD
3600 TOWER AVENUE
SUPERIOR WI 54880
GP
ISRAEL H LAVINE MD
3600 TOWER AVENUE
SUPERIOR WI 54880
IM / IM
715-392-811 1
ALFRED E LOUNSBURY MD
3600 TOWER AVENUE
SUPERIOR WI 54880
GP
JAMES P MC GINNIS MD
11109 PALMERAS DRIVE
SUN CITY AZ 85373
EAU CLAIRE-DUNN-PEPIN
R / R
715-832-6030
HERBERT M AITKEN MD
532 SUMMIT AVENUE
EAU CLAIRE WI 54701
OBG / OBG
715-835-4315
IRFANE M AL-KHATIB MD
SUITE IG
2125 HEIGHTS DRIVE
EAU CLAIRE WI 54701
IM / IM
715-839-4435
ALAN W BABCOCK MD
900 W CLAIREMONT AVE
EAU CLAIRE WI 54701
FP / FP
LARRY J BARTHEL MD
540 SEVENTH AVENUE
POST OFFICE BOX 202
DURAND WI 54736
PS GS / GS
715-833-2200
RALPH W BASHIOUM MD
826 SOUTH HASTINGS WAY
EAU CLAIRE WI 54701
GP
715-835-6862
PATRICK J BATES MD
1524 BELLINGER STREET
EAU CLAIRE WI 54703
DOUGLAS
R NM / R
715-392-8281
MOHAMED W AL-AZEM MD
14 WINDSOR STREET
SUPERIOR WI 54880
OPH OTO
715-392-4942
THOMAS J DOYLE MD
2626 OGDEN AVENUE
SUPERIOR WI 54880
FP / FP
715-392-9844
MAMDOUH E EL-WAKIL MD
2606 HAMMOND AVENUE
SUPERIOR WI 54880
PD / PD
715-392-8111
JON F FRANCO MD
3600 TOWER AVENUE
SUPERIOR WI 54880
NS / NS
RICHARD E FREEMAN MD
1017 EAST FIRST STREET
DULUTH MN 55805
GP
RICHARD P FRUEHAUF MD
1514 OGDEN AVENUE
SUPERIOR WI 54880
OBG
DOUGLAS R MEYER MD
3600 TOWER AVENUE
SUPERIOR WI 54880
GP
715-398-6612
CHARLES J PICARD MD
425 2 1ST AVENUE EAST
SUPERIOR WI 54880
U / U
715-392-811 1
K G RAMESH MD
3600 TOWER AVENUE
SUPERIOR WI 54880
IM / IM
715-392-811 1
ROBERT J REIBOLD MD
3600 TOWER AVENUE
SUPERIOR WI 54880
OBG
ANN M ROCK MD
3600 TOWER AVENUE
SUPERIOR WI 54880
FP / FP
CLARENCE M SCOTT MD
318 2 1ST AVENUE EAST
SUPERIOR WI 54880
FP / FP
ROBERT L SELLERS MD
318 2 1ST AVENUE EAST
SUPERIOR WI 54880
U / U
715-839-5222
BRUCE C BAYLEY MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
PTH / PTH
715-839-3205
WILLIAM J BECKFIELD MD
1221 WHIPPLE STREET
EAU CLAIRE WI 54702-4105
AN / AN
715-832-9098
ROBERT 0 BJURSTROM MD
379 WEST HEATHER COURT
EAU CLAIRE WI 54701
FP / FP
715-832-3401
DONALD V BLINK MD
2125 HEIGHTS DRIVE
EAU CLAIRE WI 54701
FP / FP
715-839-5222
JOHN T BOLLINGER MD
1428 CUMMINGS AVENUE
EAU CLAIRE WI 54701
N
715-839-5222
JAMES V BOUNDS JR MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
GP
715-394-7166
EDWARD G STACK JR MD
SUITE 421
1507 TOWER AVENUE
SUPERIOR WI 54880-2562
AN
DANIEL J BOWMAN MD
ROOM 207
727 KENNEY AVENUE
EAU CLAIRE WI 54701
30— EAU CLAIRE/DUNN/PEPIN
FP
715-839-5222
GARY P BRANDELAND MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
P / P
715-834-2751
EDWARD R BROUSSEAU MD
2712 STEIN BOULEVARD
POST OFFICE BOX 224
EAU CLAIRE WI 54702-0224
OPH / OPH
FRANK J BROWN MD
2302 HENDRICKSON DRIVE
EAU CLARIE WI 54701-6151
OBG / OBG
715-839-5222
RICHARD C BROWN MD
3824 NIMITZ AVENUE
EAU CLAIRE WI 54701
IM / IM
715-235-9671
STEVEN G BROWN MD
2211 STOUT ROAD
MENOMONIE WI 54751
ABS CRS GS
THOMAS E BROWN MD
APT 3
2223 COUNTRY CLUB WAY
ALBION MI 49224-9544
GP GS
715-672-4235
RICHARD J BRYANT MD
700 THIRD AVENUE WEST
DURAND WI 54736
FP / FP
715-235-9671
ROBERT BURGFECHTEL MD
2211 STOUT ROAD
MENOMONIE WI 54751
GS / GS
W GRAHAM CAMERON MD
5575 NORTH SHORE DRIVE
EAU CLAIRE WI 54701
OBG
715-839-5222
DANIEL M CLARK III MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
CD IM / CD IM
715-839-5222
JANICE CLARKE MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
AN
RICHARD N COCHRANE MD
ROOM 207
727 KENNEY AVENUE
EAU CLAIRE WI 54701
FP OM / FP
715-839-5175
PATRICK W CONNERLY MD
807 S FARWELL STREET
EAU CLAIRE WI 54701
AN
TIMOTHY J CROSS MD
ROOM 207
727 KENNEY AVENUE
EAU CLAIRE WI 54701
ORS / ORS
715-834-2701
CLAUDE D DAVIS MD
836 RICHARD DRIVE
EAU CLAIRE WI 54701
ORS
WILLIAM F DECESARE MD
2920 SHERWIN AVENUE
ALTOONA WI 54720
OPH / OPH
C THOMAS DOW MD
2302 HENDRICKSON DRIVE
EAU CLAIRE WI 54701-6151
U / U
715-835-6548
THOMAS J DOYLE JR MD
3203 STEIN BOULEVARD
EAU CLAIRE WI 54701
DR R / DR R
715-834-1505
ROBERT A DURST JR MD
727 KENNEY AVENUE
EAU CLAIRE WI 54701
IM / IM
715-839-5222
MARK E EDSTROM MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
FP / FP
715-839-5316
GENE G ENDERS MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54701-1510
AN
JOHN M EVANS MD
625 SHORE LINE COURT
EAU CLAIRE WI 54701
OBG / OBG
715-839-5222
ROBERT J FABINY MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
FP / FP
715-235-9671
MICHAEL D FEIGAL MD
2211 STOUT ROAD
MENOMONIE WI 54751
PTH / PTH
ROBERT J FINK MD
900 W CLAIREMONT AVE
EAU CLAIRE WI 54701
N / N
715-839-5203
MICHAEL F FINKEL MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
GP
7 t 5-834—2035
PATRICK J FINUCANE MD
1620 OHM AVENUE
EAU CLAIRE WI 54701
D
FREDERICK W FITZ MD
515 S BARSTOW STREET
EAU CLAIRE WI 54701
FP / FP
715-235-9671
CHARLES L FOLKESTAD MD
2211 STOUT ROAD
MENOMONIE WI 54751
IM
715-839-5222
LOUIS H ERASE MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
FP / FP
715-597-3131
BRADLEY G GARBER MD
774 EAST NINTH STREET
OSSEO WI 54758
FP / FP
715-597-3131
RICHARD D GARBER MD
774 EAST NINTH STREET
OSSEO WI 54758
AN / AN
BRETT L GARDNER MD
6520 SOUTH SHORE DRIVE
ALTOONA WI 54720
FP
SCOTT R GHINAZZI MD
774 EAST NINTH STREET
OSSEO WI 54758
FP / FP
715-832-3401
GUY G GIFFEN MD
2125 HEIGHTS DRIVE
EAU CLAIRE WI 54701
IM NEP / IM
MICHAEL GONZAGA MD
1030 OAK RIDGE DRIVE
EAU CLAIRE WI 54701
IM / IM
715-839-5222
DONALD R GRIFFITH MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI
54702-1510
PTH / PTH
715-839-4236
THOMAS W HADLEY MD
900 W CLAIREMONT AVE
EAU CLAIRE WI 54701
ORS / ORS
715-235-9671
JAMES H HAEMMERLE MD
2211 STOUT ROAD
MENOMONIE WI 54751
P
715-834-2751
KENNETH HALGRIMSON MD
2712 STEIN BOULEVARD
POST OFFICE BOX 224
EAU CLAIRE WI 54702-0224
IM RHU / IM
715-839-5222
PHILIP J HAPPE MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1550
OPH / OPH
WILLIAM F HAWN MD
1020 CUMMINGS AVENUE
EAU CLAIRE WI 54701
R NM / R NM
715-834-2416
FREDERICK W HENKE MD
1740 ROYAL COURT
EAU CLAIRE WI 54701
ORS / ORS
EDGAR 0 HICKS
836 RICHARD DRIVE
EAU CLAIRE WI 54701
GYN / OBG
715-834-1571
ELDON F HILL MD
2125 HEIGHTS DRIVE
EAU CLAIRE WI 54701
OPH / OPH
715-839-5222
DAVID K HOGUE MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
GS / GS
715-834-3988
RALPH F HUDSON MD
1030 OAK RIDGE DRIVE
EAU CLAIRE WI 54701
ORS / ORS
CHARLES M IHLE MD
105 E LOWES CREEK ROAD
EAU CLAIRE WI 54701
ORS / ORS
715-834-2701
CHARLES V IHLE MD
836 RICHARD DRIVE
EAU CLAIRE WI 54701
ORS / ORS
PETER M IHLE MD
836 RICHARD DRIVE
EAU CLAIRE WI 54701
OBG / OBG
715-839-5222
DANIEL F JOHNSON MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
FP / FP
715-839-5340
RICHARD A KARK MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
U XU
DAVID J KATZ MD
3203 STEIN BOULEVARD
EAU CLAIRE WI 54701
AN / AN
WALTER M KELLEY MD
351 WEST HEATHER COURT
EAU CLAIRE WI 54701
CD NEP / IM
715-839-5222
DANIEL T KINCAID MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
R / R
715-834-3073
BRUCE C KIRKHAM MD
3737 CLAYMORE LANE
EAU CLAIRE WI 54701
FP / FP
715-839-5175
JOHN R KLUDT MD
807 S FARWELL STREET
EAU CLAIRE WI 54701
OPH
715-834-8471
RONALD H LANGE MD
2302 HENDRICKSON DRIVE
EAU CLAIRE WI 54701-6151
PD / PD
715-839-5201
JOHN P LAYDE MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
FP / FP
7 1 S — '>97— 3 131
ROBERT N LEASUM JR MD
774 EAST NINTH STREET
OSSEO WI 54758
ORS / ORS
JAMES R LEAVITT MD
836 RICHARD DRIVE
EAU CLAIRE WI 54701
DR R / R
715-834-9868
STEVEN S LIEGEL MD
3932 CUMMINGS AVENUE
EAU CLAIRE WI 54701
EAU CLAIRE/DUNN/PEPIN— 31
PTH / PTH
RICHARD P LINDEN MD
125 CANTERBURY ROAD
EAU CLAIRE WI 54701
PD / PD
715-839-5352
RANDALL L LINTON MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
PTH CLP / PTH
KENNETH 0 LOKEN MD
65 TUCKAWAY DRIVE
ASHEVILLE NC 28803
P N / P N
715-834-3171
ALBERT A LORENZ MD
2103 HEIGHTS DRIVE
POST OFFICE BOX 264
EAU CLAIRE WI 54702
GP GS
ROBERT M LOTZ MD
105 SKYLINE DRIVE
EAU CLAIRE WI 54701
IM NEP / IM NEP
715-839-3578
PATRICK D MACKEN MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
GS / GS
715-839-5222
CARL W MANZ MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
GP
WALTON R MANZ MD
430 UNION STREET
EAU CLAIRE WI 54703
OTO HNS MFS / OTO
7 1 5— 839— 3032
JOHN M MARKOVICH MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
CDS / GS
715-839-5204
KEITH E MARTIN MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
GP
WILLIAM T MAUTZ MD
204 SKYLINE DRIVE
EAU CLAIRE WI 54701
FP / FP
7 1 ^ — '^7^— QA7 1
FREDERICK A MELMS JR MD
2211 STOUT ROAD
MENOMONIE WI 54751
GS TS / TS
715-839-5222
JAMES W MERRITT MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
FP / FP
ALLEN F MEYER MD
2119 HEIGHTS DRIVE
EAU CLAIRE WI 54701
OPH / OPH
715-834-2763
DAVID F MILLER MD
745 KINNEY AVENUE
EAU CLAIRE WI 54701
OPH / OPH
GEORGE E MILLER MD
116 CANTERBURY DRIVE L
HAINES CITY
GRENELEFF FL 33844-9732
OS P
715-839-5222
MICHAEL M MILLER MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
R / R
THOMAS D MOBERG MD
401 SKYLINE DRIVE
EAU CLAIRE WI 54703
PD
715-839-5222
NATHAN D MOLLDREM MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
IM GE / IM GE
715-839-3349
JOSEPH D MOTTO MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
NS / NS
715-839-5270
ALFRED MURRLE MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
AN / AN
ALFREDO P NARCISO MD
624 GROVER ROAD
EAU CLAIRE WI 54701
NS / NS
715-839-5270
ROBERT A NAROTZKY MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
GS
ROGER D NATWICK MD
221 1 STOUT ROAD
MENOMONIE WI 54751
PUD
LOUIS G NEZWORSKI MD
2706 IITH STREET
EAU CLAIRE WI 54703
P N / P
614-947-7135
EDWIN 0 NIVER MD
300 VALERIE DRIVE
WAVERLY OH 45690
GE NTR IM / IM GE
715-839-5222
CHARLES R NORDSTROM MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
OTO / OTO
715-834-3448
STANLEY G NORMAN MD
714 W HAMILTON AVENUE
EAU CLAIRE WI 54701
N / N
715-839-5203
DAVID A NYE MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
ORS / ORS
715-839-5206
JAMES J O'CONNOR MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
PD / PD
715-839-5222
MICHAEL J O'HALLORAN MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
OPH / OPH
715-834-3763
ROY A OLSON MD
745 KENNEY AVENUE
EAU CLAIRE WI 54701
OTO / OTO
RICHARD S OSTENSO MD
310 CHESTNUT STREET
EAU CLAIRE WI 54701
IM / IM
715-839-5251
GEORGE E OWEN MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
OBG
SOMRAT PAKPREO MD
116 CANTERBURY ROAD
EAU CLAIRE WI 54701
OPH / OPH
715-835-0075
THOMAS E PEDERSON MD
1030 OAK RIDGE DRIVE
EAU CLAIRE WI 54701
PTH
BERNARD B POESCHEL MD
ROUTE 1 BOX 126A
ELEVA WI 54738
FP / FP
LOU A RAYMOND MD
206 FIFTH AVENUE
EAU CLAIRE WI 54701
PD / PD
715-839-5222
WILLIAM T READ JR MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
FP
715-839-5222
DALE L REID MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
PUD IM / PUD IM
715-839-3566
ROGER K RESAR MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
PS GS
JOSEPH W RUCKER JR MD
310 CHESTNUT STREET
EAU CLAIRE WI 54702
P N / P N
715-839-5369
JAMES A RUGOWSKI MD
3903 STATE STREET ROAD
EAU CLAIRE WI 54701
OPH /OPH
715-235-9046
CARROLL D RUND MD
SUITE 3
2409 STOUT ROAD
MENOMONIE WI 54751
IM ON / IM
715-839-5222
WILLIAM C RUPP MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
FP / FP
DEBRA A S SCHERMAN MD
2211 STOUT ROAD
MENOMONIE WI 54751
OBG / OBG
715-839-5229
JEANNE K SCHROEDER MD
134 CANTERBURY ROAD
EAU CLAIRE WI 54701-7104
D / D
715-839-5222
CARYN I SCHULZ MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
R NM / R NM
715-834-5659
EMIL SCHULZ MD
727 KENNEY AVENUE
EAU CLAIRE WI 54701
PTH / PTH
715-834-7578
WARNER F SHELDON MD
351 COUNTRY CLUB LANE
ALTOONA WI 54720
RHU IM / RHU IM
715-839-5222
TIMOTHY M SHELLEY MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
ORS / ORS
HAROLD E SORENSEN MD
3614 TAMARACK LANE
EAU CLAIRE WI 54701
AN / AN
715-834-8721
VERNE A SPERRY MD
ROOM 207
727 KENNEY AVENUE
EAU CLAIRE WI 54701
IM / IM
715-839-5319
LESLIE M SPITZ MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54701-1510
FP / FP
JOSEPH P SPRINGER MD
1127 OAKWOOD DRIVE
DURAND WI 54736
DR NR R /DR R
JON R STENBERG MD
727 KENNEY AVENUE
EAU CLAIRE WI 54701
OBG
715-839-5222
STEVEN D STENZEL MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
IM GE
715-339-4032
MICHEL N SULTAN MD
900 W CLAIREMONT AVE
EAU CLAIRE WI 54701
AN / AN
715-835-7871
PHILIP A SWANSON MD
415 JEFFERSON STREET
EAU CLAIRE WI 54701
FP / FP
RICHARD A SWENSON MD
807 S FARWELL STREET
EAU CLAIRE WI 54701
AN / AN
HARRY E THIMKE MD
3746 PATTON STREET
EAU CLAIRE WI 54701
IM GP
KHAMNUNG THIRAKOMEN MD
602 MANOR COURT
ALTOONA WI 54720
P N / P N
715-834-2751
JOSEPH M TOBIN MD
2712 STEIN BOULEVARD
POST OFFICE BOX 224
EAU CLAIRE WI 54701-0224
32— EAU CLAIRE/DUNN/PEPIN, FOND DU LAC
R / R
715-834-1505
PETER H ULLRICH MD
737-729 KENNEY AVENUE
EAU CLAIRE WI 54701
AI / PD AI
715-839-5286
MARTIN J VOSS MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
FP
715-835-5379
GEORGE E WAHL MD
127 GILBERT AVENUE
EAU CLAIRE WI 54701
FP / FP
715-235-9671
JAMES A WALKER MD
2211 STOUT ROAD
MENOMONIE WI 54751
FP GS / FP
715-834-2788
KARL E WALTER MD
1620 OHM AVENUE
EAU CLAIRE WI 54701
GS
715-834-3988
WILLIAM H WALTER MD
1030 OAKRIDGE DRIVE
EAU CLAIRE WI 54701
FP
ROBERT F WATSON MD
1252 SOUTH DEWEY
EAU CLAIRE WI 54701
FP OBS
JAMES E WILLARD MD
2211 STOUT ROAD
MENOMONIE WI 54751
FP GER HYP / FP
715-839-5175
LOUIS J WILSON MD
807 S FARWELL STREET
EAU CLAIRE WI 54701
IM CD / IM
JOHN H WISHART MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
ON IM / MON IM
715-839-5222
CHARLES L WOODHOUSE MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
OTO / OTO
715-834-3448
JOHN B YOUNG MD
714 W HAMILTON AVENUE
EAU CLAIRE WI 54701
GP
715-832-8136
F FRANK ZBORALSKE MD
POST OFFICE BOX 459
FALL CREEK WI 54742
FP OM / FP
715-839-5279
TUENIS D ZONDAG MD
733 W CLAIREMONT AVE
POST OFFICE BOX 1510
EAU CLAIRE WI 54702-1510
FOND DU LAC
u
MAURO J AGNELNERI JR MD
80 SHEBOYGAN STREET
FOND DU LAC WI 54935
DR R / DR R
414-921-5546
THOMAS J ANTLFINGER MD
481 E DIVISION STREET
FOND DU LAC WI 54935
OBG / OBG
414-324-5043
EDUARDO G ARELLANO MD
14 BEAVER DAM STREET
WAUPUN WI 53963
GS / GS
JAMES A AVERY MD
ROUTE 2 LOST ARROW RD
FOND DU LAC WI 54935
GP
ARTHUR C BACHUS MD
1005 LA HIGUERA
GREEN VALLEY AZ 85614
GS TS / GS
414-922-3700
NORMAN 0 BECKER MD
505 E DIVISION STREET
FOND DU LAC WI 54935
IM CD / IM CD
414-923-7400
DAVID R BOWMAN MD
80 SHEBOYGAN STREET
FOND DU LAC WI 54935
EM
WILLIAM J BRUSKY MD
708 MEADOWBROOK LANE
FOND DU LAC WI 54935
GS CDS
414-927-7400
THOMAS J CARLSON MD
80 SHEBOYGAN STREET
FOND DU LAC WI 54935
OPH / OPH
414-923-7400
FRANK J CERNY MD
80 SHEBOYGAN STREET
FOND DU LAC WI 54935
IM PUD / IM
414-923-7400
DANIEL F CHAMBERLAIN MD
80 SHEBOYGAN STREET
FOND DU LAC WI 54935
AN / AN
414-923-3009
HENRY T CHANG MD
121 N NATIONAL AVENUE
FOND DU LAC WI 54935
R / R
JOHN E CHARLES MD
214 E DIVISION STREET
FOND DU LAC WI 54935
AN
DON SIK CHOE MD
79 EAST 18TH STREET
FOND DU LAC WI 54935
P / P
414-921-6110
BRIAN C CHRISTENSON MD
SUITE 700
481 E DIVISION STREET
FOND DU LAC WI 54935
IM / IM
414-921-1300
ROBERT E CULLEN MD
481 EAST DIVISION ST
FOND DU LAC WI 54935
GS / GS
414-921-8110
JOSEPH C DEVINE MD
105 SHEBOYGAN STREET
FOND DU LAC WI 54935
FP / FP
414-533-8361
DAVID M FBBEN MD
328 N HELENA STREET
CAMPBELLSPORT WI 53010
U / U
414-923-7400
JOHN T ELLIOTT MD
80 SHEBOYGAN STREET
FOND DU LAC WI 54935
R / R
LOUIS C FISCHER MD
481 E DIVISION STREET
FOND DU LAC WI 54935
OTO / OTO
CLAIR M FLANAGAN MD
P-201 BRINY BREEZES
BOYNTON BEACH FL 33435
FP / FP
414-922-3700
DOUGLAS R FOWNES MD
505 E DIVISION STREET
FOND DU LAC WI 54935
GS / GS
414-923-6413
THOMAS E FREEMAN MD
80 SHEBOYGAN STREET
FOND DU LAC WI 54935
ON IM / IM
414-423-7400
JACOB C FRICK MD
80 SHEBOYGAN STREET
FOND DU LAC WI 54935
GP
414-923-7494
LELAND E FRIEDRICH MD
80 SHEBOYGAN STREET
FOND DU LAC WI 54935
U / U
HARVEY K GUTH MD
80 SHEBOYGAN STREET
FOND DU LAC WI 54935
ORS
BRUCE H HARTMAN MD
73 EAST FIRST STREET
FOND DU LAC WI 54935
D / D
414-923-7400
JAMES F HITSELBERGER MD
80 SHEBOYGAN STREET
FOND DU LAC WI 54935
IM GE / IM GE
4 14-923—5555
ELSA B HORN-DOROIN MD
SUITE 300
481 E DIVISION STREET
FOND DU LAC WI 54935
FP / FP
ROBERT H HOUSE MD
POST OFFICE BOX 96
RIPON WI 54971
AM
414-235-0006
JEWEL S HUEBNER MD
3827 RED OAK COURT
OSHKOSH WI 54901
GP PM
414-748-3370
JOHN M JOHNSON MD
121 W FOND DU LAC ST
POST OFFICE BOX 36
RIPON WI 54971
FP / FP
414-923-7375
PHILIP E KELLER MD
406 MAIN STREET
BROWNSVILLE WI 53006
IM
WILLIAM G KENDELL MD
POST OFFICE BOX 408
THREE LAKES WI 54562-0408
GS / GS
414-748-5368
BURTON C KILBOURNE MD
694 SANDSTONE AVENUE
ROUTE 2
RIPON WI 54971
PD
414-922-2204
JANE H KOLL-FRAZIER MD
27 S RESERVE AVENUE
FOND DU LAC WI 54935
IM / IM
414-923-7420
JOHN F KUGLITSCH MD
80 SHEBOYGAN STREET
FOND DU LAC WI 54935
AN
414-921-7375
TAI HO KWON MD
430 E DIVISION STREET
FOND DU LAC WI 54935
PD / PD
DAVID L LAWRENCE MD
92 E DIVISION STREET
FOND DU LAC WI 54935
CD IM / CD IM
414-923-7400
JOHN E LENT MD
80 SHEBOYGAN STREET
FOND DU LAC WI 54935
OPH / OPH
WILLIAM F MALLATT MD
80 SHEBOYGAN STREET
FOND DU LAC WI 54935
OBG / OBG
414-923-7400
STEPHEN A MASSICK MD
80 SHEBOYGAN STREET
FOND DU LAC WI 54935
R / R
HOWARD MAUTHE MD
258 SMITH ROAD
WATSONVILLE CA 95076
OBG / DBG
414-923-7400
F FULLER MC BRIDE MD
80 SHEBOYGAN STREET
FOND DU LAC WI 54935
GP
JAMES C MC CULLOUGH MD
35 ELM ACRES DRIVE
FOND DU LAC WI 54935
FP GS
414-921-81 10
JACK C MC CULLOUGH MD
105 SHEBOYGAN STREET
FOND DU LAC WI 54935
FP / FP
414-921-81 10
JOHN P MC CULLOUGH MD
105 SHEBOYGAN STREET
FOND DU LAC WI 54935
IM / IM
414-923-1300
HUGH J MC LANE MD
476 E DIVISION STREET
FOND DU LAC WI 54935
FOND DU LAC, FOREST, GRANT— 33
PD / PD
608-251-6440
THOMAS D MEIER MD
SUITE 303
20 SOUTH PARK STREET
MADISON WI 53715
414-921-1506
GEORGE F MEISINGER MD
ROUTE 3 BOX 233C
FOND DU LAC WI 54935
GS CDS / GS
414-921-7000
ROBERT H MIKKELSEN MD
TEN FOREST AUENUE
FOND DU LAC WI 54935
GP
JOSEPH F MILLER MD
ROUTE 1 BOX 242A
MOUNT CALVARY WI 53057
P / P
414-921-6110
CLARENCE E MOORE MD
SUITE 700
481 E DIVISION STREET
FOND DU l.AC WI 54935
FP
414-922-3700
WILBERT E MYERS MD
505 E DIVISION STREET
FOND DU LAC WI 54935
FP / FP
PAUL D NELSEN MD
635 W OSHKOSH STREET
POST OFFICE BOX 96
RIPON WI 54971
GS / GS
414-922-7158
DAVID L NELSON MD
481 E DIVISION STREET
FOND DU LAC WI 54935
GP / AN
414-921-2522
JOSEPHINE N PALLIN MD
2081 TOWER DRIVE
FOND DU LAC WI 54935
R DR NR / R DR NR
414-921-5546
JOHN G PARRISH JR MD
481 EAST DIVISION ST
FOND DU LAC WI 54935
PD
414-921-7776
EWALD H PAWSAT MD
226 SHEBOYGAN STREET
FOND DU LAC WI 54935
FP
414-748-2875
RUSSELL S PELTON MD
317 MOUNT ZION DRIVE
POST OFFICE BOX 187
RIPON WI 54971
PS
414-923-6614
LERTHAI PENGTOVONG MD
1035 MARY HILL PARK
FOND DU LAC WI 54935
ORB / ORS
KARL L PENNAU JR MD
525 E DIVISION STREET
FOND DU LAC WI 54935
FP
414-922-1900
ALFRED G PENNINGS MD
481 E DIVISION STREET
FOND DU I AC WI 54935
FP / FP
414-922-3700
JOHN U PETERS MD
505 E DIVISION STREET
FOND DU LAC WI 54935
PD / PD
CLIFTON R PETERSON MD
92 E DIVISION STREET
FOND DU LAC WI 54935
PD / PD
414-923-7400
WARREN M POST MD
SO SHEBOYGAN STREET
FOND DU LAC WI 54935
GS
414-748-7796
TEODORO M RAMOS MD
POST OFFICE BOX 325
RIPON WI 54971
FP
DAVID B RICH MD
POST OFFICE BOX 96
RIPON WI 54971
OPH / OPH
414-923-7472
JAMES H RUPPLE MD
80 SHEBOYGAN STREET
FOND DU LAC WI 54935
AN
NON I TO M SABLAY MD
954 MEADOW LANE
FOND DU LAC WI 54935
FP / FP
CARL J SAGGIO MD
1990 REINHARDT ROAD
FOND DU LAC WI 54935
DR NR / DR NR
414-921-5676
BRUCE C SALO MD
481 E DIVISION STREET
FOND DU LAC WI 54935
IM / IM
ELIZABEfH T SANFELIPPO MD
80 SHEBOYGAN STREET
FOND DU l.AC WI 54935
PD / PD
ROBERT W SCHROEDER MD
100 MEADOWBROOK BLVD
FOND DU LAC WI 54935
D / D
414-923-1322
JAMES E SCHUSTER MD
333 N PETERS AVENUE
FOND DU LAC WI 54935
OBG
ROBERT J SCHUSTER JR MD
80 SHEBOYGAN STREET
FOND DU LAC WI 54935
OTO / OTO
414-922-9696
DARIUS K SHAHROKH MD
481 E DIVISION STREET
FOND DU LAC WI 54935-3775
GS / GS
HARVEY R SHARPE JR MD
RFD 1 ML BOX 145
GILLETT WI 54124
ORB / ORB
DONALD A SMITH MD
480 E DIVISION STREET
FOND DU LAC WI 54935
GP
414-922-1900
ERNEST V SMITH JR MD
481 E DIVISION STREET
FOND DU LAC WI 54935
PTH / PTH
813-261-1710
RONALD W STEUBE MD
540 PORTS IDE DRIVE
NAPLES FL 33940
PTH / PTH
414-929-1587
K ALAN STORMO MD
430 E DIVISION STREET
FOND DU LAC WI 54935
FP / FP
JEFFREY A STRONG MD
865 AMERICANA DRIVE
FOND DU LAC WI 54935
OPH / OPH
414-923-7400
DAVID F SWEET MD
80 SHEBOYGAN STREET
FOND DU LAC WI 54935
OTO HNS / OTO HNS
414-923-7400
WILLIAM G SYBESMA MD
80 SHEBOYGAN STREET
FOND DU LAC WI 54935
GS / GS
414-921-0560
LYN E TANGEN MD
92 E DIVISION STREET
FOND DU LAC WI 54935
OBG / OBG
414-921-0560
E HOWARD THE IS MD
92 E DIVISION STREET
FOND DU LAC WI 54935
GP / GS
STEPHEN A THE I SEN MD
ROUTE 2 BOX 73
FOND DU LAC WI 54935
P / P
414-929-3502
DAROLD A TREFFERT MD
459 EAST FIRST STREET
FOND DU LAC WI 54935
FP / FP
GAY D TREPANIER MD
481 E DIVISION STREET
FOND DU LAC WI 54935
AN / AN
414-929-1660
SHOGI-TEN TSAI MD
430 E DIVISION STREET
FOND DU LAC WI 54935
GP GS
DAVID J TWOHIG JR MD
232 COTTAGE AVENUE
FOND DU LAC WI 54935
PD / PD
414-923-7400
KIRK A VEIT MD
80 SHEBOYGAN STREET
FOND DU LAC WI 54935
GS
EDWARD W VETTER MD
227 COTTAGE AVENUE
FOND DU LAC WI 54935
IM
414-921-0560
MOJMIR R VRTILEK MD
92 E DIVISION STREET
FOND DU LAC WI 54935
GP GER
414-921-1580
ROBERT L WAFFLE MD
104 SOUTH MAIN STREET
FOND DU LAC WI 54935
R ON / R
HONG CHU WANG MD
45 SHEBOYGAN STREET
POST OFFICE POX 69
FOND DU LAC WI 54935-0069
IM / IM
414-923-7400
DAVID R WEBER MD
80 SHEBOYGAN STREET
FOND DU LAC WI 54935
ORS / ORS
414-923-0641
JOHN A WELSCH MD
73 EAST FIRST STREET
FOND DU LAC WI 54935
PYM
414-922-6622
JOHN SPERRY WIER MD
777 HIGHWAY K
ROUTE 6
FOND DU LAC WI 5493J
PTH / PTH
414-929-1592
HARRY J ZEMEL MD
430 E DIVISION STREET
FOND DU LAC WI 54935
FOREST
FP
ENZO F CASTALDO MD
LAONA WI 54541
GP
BURTON S RATHERT MD
101 W WASHINGTON ST
POST OFFICE BOX 278
CRANDON WI 54520
GRANT
FP GS / FP
608-723-2131
KENNETH L BAUMAN MD
235 N MADISON STREET
LANCASTER WI 53813
FP / FP
608-723-4545
LEO E BECHER MD
815 WEST LINDEN STREET
LANCASTER WI 53813
GP
JOHN J DAVID MD
CASSVILLE WI 53806
GP IM
608-854-2644
MARTIN E FARBSTEIN MD
HAZEL GREEN WI 53811
FP / FP
608-375-4144
WILLIAM P FAST MD
208 PARKER STREET
BOSCOBEL WI 53805
IM PUD / IM
608-739-3192
JAMES M GAITHER MD
525 WISCONSIN AVENUE
MUSCODA WI 53573
FP / FP
608-723-2131
SCOTT M GREEN MD
235 N MADISON STREET
LANCASTER WI 53813
34— GRANT, GREEN
PD PDA / PD
(^08-739-3192
JAMES R HEERSMA MD
525 N WISCONSIN AVENUE
POST OFFICE BOX 5(S5
MUSCODA WI 53573-0565
FP / FP
608-723-2131
GLENN C HILLERY MD
235 N MADISON STREET
LANCASTER WI 53813
FP / FP
WILLARD E KLOCKOW MD
202 N WISCONSIN AVENUE
MUSCODA WI 53573
PD GP / PD
608-348-4677
MEENAKSHI MASK I MD
1370 N WATER STREET
PLATTEVILLE WI 53818
GS CDS / GS
608-348-4677
RAVI KANT MASK I MD
1370 N WATER STREET
PLATTEVILLE WI 53818
FP / FP
JOHN M MC KICHAN MD
1370 N WATER STREET
PLATTEVILLE WI 53818
GP
608-375-4144
JAMES R MC NAMEE MD
208 PARKER STREET
BOSCOBEL WI 53805
ORS
608-233-7162
S MOKROHISKY III MD
4513 GREGG ROAD
MADISON WI 53705
FP / FP
608-375-4144
CAROL E MUELLER MD
208 PARKER STREET
BOSCOBEL WI 53805
FP / FP
608-723-2134
ROBERT M RAILEY MD
235 N MADISON STREET
LANCANSTER WI 53813
GP
EMERY M RANDALL MD
208 PARKER STREET
BOSCOBEL WI 53805
FP
608-723-2131
ROBERT E STADER MD
235 N MADISON STREET
LANCASTER WI 53813
FP 7 FP
608-348-2455
CHARLES L STEI DINGER MD
1370 N WATER STREET
PLATTEVILLE WI 53818
GP A
MILDRED M S STONE MD
ROUTE 1 BOX 111
WAUTOMA WI 54982
GP
608-348-2455
MILTON F STUESSY MD
DOCTORS PARK
POST OFFICE 513
PLATTEVILLE WI 53818
GP
608-744-2115
HAROLD W TAYLOR JR MD
207 EAST SKELLY STREET
CUBA CITY WI 53807
IM A / IM
608-348-2692
CHARLES W YOUNG MD
870 NORTH ELM STREET
PLATTEVILLE WI 53818
GREEN
FP / FP
608-325-601 1
ERIC K ANDERSON MD
2709 SIXTH STREET
MONROE WI 53566
ABS GP
608-938-4972
EDMUNDO C AQUINO MD
145 NORTH MAIN STREET
MDNTICELLO WI 53570
IM RHU OS / IM
608-328-7000
WILLIAM R AUSTAD MD
1515 TENTH STREET
MONROE WI 53566
OPH / DPH
608-328-7000
WILLIAM L BAKER MD
1515 TENTH STREET
MONROE WI 53566
PD / PD
608-328-7216
JOHN D BANCROFT MD
1515 TENTH STREET
MONROE WI 53566
IM CD / IM
GEORGE R BARRY MD
1515 TENTH STREET
MONROE WI 53566
D / D
608-328-7000
ROBERT R BAUMANN MD
1515 TENTH STREET
MONROE WI 53566
GP TRS
608-325-6240
NATHAN E BEAR MD
2260 SIXTH STREET
MONROE WI 53566
CD IM / CD IM
608-328-7224
MELVIN S BLUMENTHAL MD
1515 TENTH STREET
MONROE WI 53566
OTO HNS / OTO
608-328-7378
GEORGE E BREADON MD
1515 TENTH STREET
MONROE WI 53566
IM
JOYCE BREHM MD
2709 SIXTH STREET
MONROE WI 53566
ON IM
ROBERT W BROWNLEE MD
1515 TENTH STREET
MONROE WI 53566
DR / R
ROSS L CLINE III MD
515 22ND AVENUE
MONROE WI 53566
608-328-0331
JAMES A COMBS MD
515 22ND AVENUE
MONROE WI 53566
GS / GS
JAMES T CURRY MD
1515 TENTH STREET
MONROE WI 53566
GE IM / GE IM
608-328-7000
CARLETON B DAVIS JR MD
N3051 YOUTH CABIN ROAD
MONROE WI 53566
PD
608-328-7329
BRUCE K DUEMLER MD
1515 TENTH STREET
MONROE WI 53566
OS / GS
608-325-2559
EUGENE E ECKSTAM MD
2118 20TH AVENUE
MONROE WI 53566
IM / IM
608-328-7000
JAN E ERLANDSON MD
1515 TENTH STREET
MONROE WI 53566
OPH
608-328-7350
JOHN L FELTON MD
1515 TENTH STREET
MONROE WI 53566
GS
608-328-7000
WAYNE J FENCIL MD
1515 TENTH STREET
MONROE WI 53566
IM / IM
JOHN A FRANTZ MD
1515 TENTH STREET
MONROE WI 53566
IM / IM
MARY H FRANTZ MD
1515 TENTH STREET
MONROE WI 53566
PD / PD
WILLIAM B FREY MD
1515 TENTH STREET
MONROE WI 53566
OTO
608-325-5348
JOHN R FULLER MD
2243 SIXTH STREET
MONROE WI 53566
ORS / ORS
608-328-7000
JACOB GEORGE MD
1515 TENTH STREET
MONROE WI 53566
NS / NS
608-328-7290
R ARTHUR GINDIN MD
1515 TENTH STREET
MONROE WI 53566
PTH CLP / PTH CLP
608-328-0430
FRANZ R COSSET MD
515 22ND AVENUE
MONROE WI 53566
FP / FP
TIMOTHY J HAMEL MD
605 EAST FOURTH AVENUE
BRODHEAD WI 53520
EM FP
608-328-7888
WILLIAM E HEIN MD
1515 TENTH STREET
MONROE WI 53566
OBG / OBG
608-328-7000
JOHN E INMAN MD
1515 TENTH STREET
MONROE WI 53566
IM / IM
608-325-601 1
JOHN M IRVIN MD
2709 SIXTH STREET
POST OFFICE BOX 788
MONROE WI 53566-0788
PTH FOP BLB / AP
608-328-0429
CARLOS A JARAMILLO MD
POST OFFICE BOX 786
MONROE WI 53566-0786
DR PDR NR / DR
608-325-7108
JOHN A JERISHA MD
817 15TH AVENUE
POST OFFICE BOX 322
MONROE WI 53566
N
SIK Q JEW MD
1515 TENTH STREET
MONROE WI 53566
FP / FP
608-325-6011
SUSAN K KINAST-PORTER MD
2709 SIXTH STREET
POST OFFICE BOX 788
MONROE WI 53566-0788
CLP DMP PTH / CLP DMP PTH
608-328-7318
GEORGE W KINDSCHI MD
EAST FOREST BOX 10
MONROE WI 53566
IM / IM
608-325-9622
LESLIE G KINDSCHI MD
1770 13TH STREET
MONROE WI 53566
IM END
HANS A KNEUBUHLER MD
1622 16TH STREET
MONROE WI 53566
D / D
608-328-7000
EDWARD L KNUTESON MD
1515 TENTH STREET
MONROE WI 53566
IM
608-328-7000
BILL L MADDIX MD
1515 TENTH STREET
MONROE WI 53566
FP
608-527-5296
PHILIPP H MARTY MD
NEW GLARUS WI 53574
IM CD / IM
CHARLES S MC CAULEY JR MD
1515 TENTH STREET
MONROE WI 53566
FP PD / FP
608-325-3573
CHARLES O MILLER MD
1726 LAKE DRIVE
MONROE WI 53566
OPH / OPH
DWAIN E MINGS MD
POST OFFICE BOX 253
MONROE WI 53566-0253
GS
JACK F MURRAY MD
2709 SIXTH STREET
MONROE WI 53566
GREEN, GREEN LAKE/WAUSHARA, IOWA, JEFFERSON— 35
IM / IM
608-328-7000
BHARATHY V NAIR MD
1515 TENTH STREET
MONROE WI 53566
U / U
608-328-7258
VELAYUDHAN K NAIR MD
1515 TENTH STREET
MONROE WI 53566
ORS / ORS
608-328-7000
HUSHANG NAJAT MD
1515 TENTH STREET
MONROE WI 53566
OBG
608-328-7000
MERLIN J OLSON MD
1515 TENTH STREET
MONROE WI 53566
AN
608-325-7422
VASUDEV M PATEL MD
3015 16TH STREET
MONROE WI 53566
GS CDS / GS
TERRANCE E PETERS MD
1515 TENTH STREET
MONROE WI 53566
IM GE / IM GE
608-328-7187
JAMES C POLLOCK MD
1515 TENTH STREET
MONROE WI 53566
IM PUD
MEHBOOB M QURESHI MD
1515 TENTH STREET
MONROE WI 53566
PD / PD
JAMES A RAETTIG MD
1515 TENTH STREET
MONROE WI 53566
AN / AN
608-325-7540
DAVID C RIESE MD
1421 14TH AVENUE
MONROE WI 53566
OBG FP
608-325-601 1
FERNANDO S SANTIAGO MD
2709 SIXTH STREET
MONROE WI 53566
IM GE / IM GE
HAROLD H SCUDAMORE MD
2612 FOURTH STREET
MONROE WI 53566
CHP P / P
608-328-7321
JANE C SMITH MD
1515 TENTH STREET
MONROE WI 53566
IM / IM
608-328-7000
WILLIAM J STAAB JR MD
1515 TENTH STREET
MONROE WI 53566
PD / PD
FRANK C STILES MD
1515 TENTH STREET
MONROE WI 53566
IM / IM
608-328-7000
JAMES R STORMONT MD
1515 TENTH STREET
MONROE WI 53566
P / P
608-328-7000
R BUCKLAND THOMAS MD
1515 TENTH STREET
MONROE WI 53566
CRS GS / CRS GS
DON G TRAUL MD
1515 TENTH STREET
MONROE WI 53566
IM CD / IM
608-328-7000
GEOFFREY L TULLETT MD
1515 TENTH STREET
MONROE WI 53566
OBG / OBG
608-328-7361
ROBERT L VICKERMAN MD
2106 19TH AVENUE
MONROE WI 53566-3499
IM ON
608-328-7000
ROBERT F WICHSER MD
1515 TENTH STREET
MONROE WI 53566
R / R
DAVID D WISNEFSKE MD
ROUTE 2
W 4634 RICHLAND ROAD
MONROE WI 53566-9802
FP
ROBERT G ZACH MD
ROUTE 2
MONROE WI 53566
PD / PD
608-325-5627
EDWARD ZUPANC MD
2644 22ND AVENUE
POST OFFICE BOX 421
MONROE WI 53566-0421
GREEN LAKE-WAUSHARA
IM / IM
414-361-1838
JEFFREY J CARROLL MD
POST OFFICE BOX 350
BERLIN WI 54923
GP
PEP I TO M EMLANO MD
POST OFFICE BOX 314
WILD ROSE WI 54984
GS
ALONZO R GIMENEZ MD
POST OFFICE BOX 350
BERLIN WI 54923
GP GS
ROY HONG MD
ROUTE 2
WILD ROSE WI 54984
FP / FP
414-622-3254
ROGER A KJENTVET MD
POST OFFICE BOX 142
WILD ROSE WI 54984
AN
414-361-1313
JOHN C KOCH MD
209 east park avenue
BERLIN WI 54923
GP
ALFRED T LEININGER MD
POST OFFICE BOX 277
GREEN LAKE WI 54941
GP
414-622-3219
ERWIN P LUDWIG MD
ROUTE 2 BOX 763
WILD ROSE WI 54984
GS GP
414-622-3254
ENRIQUE W LUY MD
POST OFFICE BOX 141
WILD ROSE WI 54984
FP / FP
414-361-1838
STEVE R OSICKA MD
170 NORTH WISCONSIN
BERLIN WI 54923
FP / FP
414-361-0460
WILLIAM C PIOTROWSKI MD
147 NORTH STATE STREET
BERLIN WI 54923
GS / GS
BARRY L ROGERS MD
POST OFFICE BOX 20
BERLIN WI 54923-0020
IM PUD GP
414-622-3254
TEODORO P ROMANA JR MD
631 COLLIGAN STREET
POST OFFICE BOX 117
WILD ROSE WI 54984-0117
GP GS
LYNN J SEWARD MD
211 E LIBERTY STREET
BERLIN WI 54923
GP
414-361-1838
DAVID J SI EVERS MD
POST OFFICE BOX 350
BERLIN WI 54923
FP / FP
414-361-4366
ALAN L TABER MD
261 MEMORIAL DRIVE
BERLIN WI 54923
GS / GS
414-361-4306
MICHAEL E TIEMAN MD
POST OFFICE BOX 266
BERLIN WI 54923
GP
414-622-3254
RODNEY D WICHMANN MD
POST OFFICE BOX 128
WILD ROSE WI 54984
IOWA
GP
608-943-6308
HARALD P L BREIER MD
POST OFFICE BOX 185
MONTFORT WI 53569
FP / FP
DAVID R DOWNS MD
1169 NORTH BEOUETTE
DODGEVILLE WI 53533
FP / FP
CATHRYN I KAISER MD
HOLLANDALE WI 53544
GS ABS TRS
608-935-9336
YOUNG I KIM MD
829 SOUTH IOWA STREET
DODGEVILLE WI 53533
IM OBG / IM
608-987-2346
EVERETT R LINDSEY MD
104 HIGH STREET
MINERAL POINT WI 53565
GP
STANLEY B MARSHALL MD
4000 24TH STREET NORTH
LOT 609
ST PETERSBURG FL 33714
GP GS
608-935-5382
NATHANIEL G RASMUSSEN MD
308 NORTH MAIN STREET
POST OFFICE BOX 112
DODGEVILLE WI 53533-0112
FP / FP
608-987-3539
JOHN C STRICKLER MD
416 FRONT STREET
MINERAL POINT WI 53565
JEFFERSON
FP / FP
414-563-2404
HAROLD F ANSCHUETZ MD
211 MEMORIAL DRIVE
FORT ATKINSON WI 53538
GP
414-563-2404
HENRY W AUFDERHAAR MD
211 MEMORIAL DRIVE
FORT ATKINSON WI 53538
FP / 99
414-261-4265
ROBERT C BALDWIN MD
1507 DOCTORS COURT
WATERTOWN WI 53094
FP
414-563-5544
DONALD E BATES MD
311 SOUTH MAIN STREET
FORT ATKINSON WI 53538
IM
414-261-1770
JOHN H BECKER MD
123 HOSPITAL DRIVE
WATERTOWN WI 53094
FP
414-563-2404
FRANK V BERAN MD
211 MEMORIAL DRIVE
FORT ATKINSON WI 53538
OPH
EUGENE E BURZYNSKI MD
1501 OCONOMOWOC AVENUE
WATERTOWN WI 53094
PD
BRIGIDO C CALADO MD
123 HOSPITAL DRIVE
WATERTOWN WI 53094
FP / FP
414-261-4265
MOE L CHIN MD
1507 DOCTORS COURT
WATERTOWN WI 53094
AN
ALBERTO C CLAR MD
125 HOSPITAL DRIVE
WATERTOWN WI 53094
36— JEFFERSON, JUNEAU, KENOSHA
FP / FP
414-261-8500
BRUCE J COCHRANE MD
127 HOSPITAL DRIVE
POST OFFICE BOX 49
WATERTOWN WI 53094
IM / IM
414-563-5571
ALAN L DETWILER MD
500 MC MILLEN STREET
FORT ATKINSON WI 53538
FP / FP
MARK C DICKMEYER MD
128 NORTH TRATT STREET
WHITEWATER WI 53190
FP / FP
414-648-2391
MANFRED EFFENHAUSER MD
120 EAST OAK STREET
LAKE MILLS WI 53551
FP / FP
414-478-2141
JOHN S CARMAN MD
144 W MADISON STREET
WATERLOO WI 53594
FP / FP
GEORGE L GAY JR MD
POST OFFICE BOX 28
CAMBRIDGE WI 53523
PTH / PTH
PAUL R GLUNZ MD
130 WARREN STREET
BEAVER DAM WI 53916
FP / FP
414-261-8500
FREDERICK C GREMMELS DO
127 HOSPITAL DRIVE
POST OFFICE BOX 49
WATERTOWN WI 53094
FP / FP
ANNE E GRIFFITHS MD
1173 WEST MAIN STREET
WHITEWATER WI 53190
U / U
414-563-8409
DAVID C GROUT MD
426 MC MILLEN STREET
FORT ATKINSON WI 53538
GS
ROBERT G HANDEYSIDE MD
311 SOUTH MAIN STREET
FORT ATKINSON WI 53538
PD / PD
414-261-8706
JOHN C HEFFELFINGER MD
700 HOFFMANN DRIVE
WATERTOWN WI 53094
FP /■ FP
414-261-8500
RICHARD C HOLDEN MD
127 HOSPITAL DRIVE
POST OFFICE BOX 49
WATERTOWN WI 53094
OPH / OPH
414-261-8225
EDWARD J HOY MD
SUITE 208
123 HOSPITAL DRIVE
WATERTOWN WI 53094
GP
414-563-3212
HUGO N HUNSADER MD
411 MADISON AVENUE
FORT ATKINSON WI 53538
U / U
414-463-8409
EDWARD S KAPUSTKA MD
426 MC MILLEN STREET
FORT ATKINSON WI 53538
FP / FP
414-473-4548
KENNETH R KIDD MD
128 NORTH TRATT
WHITEWATER WI 53190
FP / FP
715-387-5168
RICHARD D LARSON MD
311 SOUTH MAIN STREET
FORT ATKINSON WI 53538
FP / FP
HENDRIK LEERING MD
120 EAST OAK STREET
LAKE MILLS WI 53551
FP GPM / FP GPM
414-648-2686
ROLAND R LIEBENOW MD
309 LAKEVIEW AVENUE
LAKE MILLS WI 53551
FP / FP
414-261-4265
ARTHUR S MARQUIS MD
1507 DOCTORS COURT
WATERTOWN WI 55094
R
PIERCE J MEIER MD
1317 OCTAGON COURT
WATERTOWN WI 53094
GP OBG
EDWARD A MILLER MD
849 COAST BOULEVARD
LA JOLLA CA 92037
ORS / ORS
WALTER D MORITZ MD
POND ROAD
ROUTE 4 BOX 239
FORT ATKINSON WI 53538
GP
414-668-6400
EARL J NETZOW MD
SAUK TRAIL BEACH ROAD
CEDAR GROVE WI 53013
ORS / ORS
FRANK E NICHOLS MD
1520 VERNON STREET
STOUGHTON WI 53589
GP
414-648-5343
MARVIN G PETERSON MD
721 FREMENT STREET
LAKE MILLS WI 53551
ORS HS / ORS
414-563-5558
STANLEY E PETERSON MD
ROUTE 4 BOX 317B
FORT ATKINSON WI
53538-9358
U XU
414-261-1334
DAVID T QUANBECK MD
123 HOSPITAL DRIVE
WATERTOWN WI 53094
GP
414-674-5330
COURTNEY E QUANDT MD
867 HILLSIDE DRIVE
JEFFERSON WI 53549-1805
GP
414-674-4060
RAYMOND W QUANDT MD
529 S FISCHER AVENUE
JEFFERSON WI 53549
GS / GS
414-261-6088
WILLIAM H REED MD
123 HOSPITAL DRIVE
WATERTOWN WI 53094
GP
414-563-2404
JAMES C H RUSSELL MD
211 MEMORIAL DRIVE
FORT ATKINSON WI 53538
FP / FP
414-674-6000
DAVID A RUTLEDGE MD
840 WEST RACINE STREET
JEFFERSON WI 53549
GP
414-261-6586
EUGENE P SCHUH MD
907 CLYMAN STREET
WATERTOWN WI 53094
PH
414-261-4500
RUTH R SCHUH MD
907 CLYMAN STREET
WATERTOWN WI 53094
OBG / OBG
414-261-6162
MOON-WON SONG MD
123 HOSPITAL DRIVE
WATERTOWN WI 53094
OBG
414-262-9717
ANN M TOUSIGNANT MD
SUITE 106
123 HOSPITAL DRIVE
WATERTOWN WI 53094
FP / FP
414-261-8500
TERRY L TURKE MD
127 HOSPITAL DRIVE
POST OFFICE BOX 49
WATERTOWN WI 53094
IM PD / IM PD
414-563-5571
DONALD L WILLIAMS MD
500 MC MILLEN STREET
FORT ATKINSON WI 53538
IM / IM
414-648-2391
JAMES P WISHAU MD
120 EAST OAK STREET
LAKE MILLS WI 53551
GS
414-473-3653
FI LEMON C YAO MD
SAT INWOOD LANE
WHITEWATER WI 53190
JUNEAU
GP
608-464-311 1
HOMER P BAKER MD
POST OFFICE BOX 128
WONEWOC WI 53968
FP / FP
608-462-8414
ROY B BALDER JR MD
1104 ACADEMY STREET
ELROY WI 53929
FP J FP
608-562-31 1 1
JAMES E BURWITZ MD
604 W MILWAUKEE STREET
MAUSTDN WI 53948
GS GP
608-847-5000
REY F FARNE MD
121 MONROE STREET
POST OFFICE BOX 199
MAUSTON WI 53948-0199
GP GS
608-347-5981
VERNON M GRIFFIN MD
767 ELM STREET
MAUSTON WI 53948
FP IM / FP IM
ERIC S HEANEY MD
510 TREMONT STREET
MAUSTON WI 53948
FP / FP
608-562-31 1 1
TIMOTHY R HINTON MD
600 MONROE STREET
NEW LISBON WI 53950
FP / FP
608-847-5000
JAMES J LOGAN MD
1050 DIVISION STREET
MAUSTON WI 53948
FP / FP
D KEITH NESS MD
1040 DIVISION STREET
MAUSTON WI 53948
FP / FP
NANCY E B NESS MD
1040 DIVISION STREET
MAUSTON WI 53948
FP / FP
LEON J RADANT MD
ROUTE 4 BOX 130
MAUSTON WI 53948
GP FP / FP
JACK STRONG MD
1040 DIVISION STREET
MAUSTON WI 53948
KEMOSHA
GS CDS
414-652-2212
ARVIND N ACHARYA MD
6626 SHERIDAN ROAD
KENOSHA WI 53140
IM
414-658-2500
M YUSUF ALI MD
3200 SHERIDAN ROAD
KENOSHA WI 53140
AN GP
414-657-5263
PAUL J AMBRO MD
4314 60TH STREET
KENOSHA WI 53142
ORS / ORS
414-657-3126
AFTAB A ANSAR I MD
3200 SHERIDAN ROAD
KENOSHA WI 53140
R R
GENE F ARMSTRONG MD
6530 SHERIDAN ROAD
KENOSHA WI 53140
OPH OTD / OPH
414-657-3511
RICHARD W ASHLEY MD
POST OFFICE BOX 339
KENOSH/^ WI 53141
OBG / OBG
STEVEN A AZUMA MD
6530 SHERIDAN ROAD
KENOSHA WI 53140
OBG 7 DBG
EDWIN H BARNES III MD
6530 SHERIDAN ROAD
KENOSHA WI 53140
KENOSHA— 37
TS CDS / GB
414-937-5419
JAMES BASS JR MD
6924 HOODS CREEK ROAD
FRANKSVILLE WI 53126
D / D
414-658-2594
A JAMES BENNETT MD
SUITE 2?
3734 SEVENTH AVENUE
KENOSHA WI 53140
GS
414-652-1423
ROMAN BILAK MD
6032 40TH AVENUE
KENOSHA WI 53142
R / R
414-652-7144
HAROLD A BJORK MD
6530 SHERIDAN ROAD
KENOSHA WI 53140
GS
414-652-3776
BLAIR T BONELL MD
7800 SEVENTH AVENUE
KENOSHA WI 53140
IM
414-658-1678
ERNESTO E BUENCAMINO MD
SUITE 11
3734 SEVENTH AVENUE
KENOSHA WI 53140
GS / GS
414-652-2107
A WALID BURHANI MD
6530 SHERIDAN ROAD
KENOSHA WI 53140
IM GP / IM
414-652-6040
A JOHN CAPELLI MD
2701 LINCOLN ROAD
KENOSHA WI 53140
PD / PD
414-652-5115
NICHOLAS M CETTA MD
SUITE a
3618 EIGHTH AVENUE
KENOSHA WI 53140
DR / R
KENNETH E CLARK MD
6530 SHERIDAN ROAD
KENOSHA WI 53140
U / U
414-654-91 18
MEREDITH C CLUBB MD
6215 TENTH AVENUE
KENOSHA WI 53140
PD
414-652-6737
DOROTHY R C0N2ELMAN MD
3618 EIGHTH AVENUE
KENOSHA WI 53140
CDS GS / GS
ROBERT G COOK MD
NO 15
3618 EIGHTH AVENUE
KENOSHA WI 53140
GP
414-652-0840
LOUIS H CREIGHTON MD
7511 26TH AVENUE
KENOSHA WI 53140
PD / PD
414-654-8633
DAVID W DAVIS MD
6213 TENTH AVENUE
KENOSHA WI 53140
PD / PD
414-654-0226
MARIANO F DE GUZMAN MD
3734 SEVENTH AVENUE
KENOSHA WI 53140
GS CDS TS / GS TS
414-552-721 1
WARREN H DE KRAAY MD
SUITE 5
3618 EIGHTH AVENUE
KENOSHA WI 53140
GS / GS
414-657-301 1
DOUGLAS G DEVAN MD
SUITE 26
3734 SEVENTH AVENUE
KENOSHA WI 53140
AI PUD / AI
414-657-9390
KULWANT S DHALIWAL MD
4906 39 TH AVENUE
KENOSHA WI 53142
R / R
WILLIAM S DONNELL MD
6402 THIRD AVENUE
KENOSHA WI 53140
EM
ELIZABETH A DROEGE MD
115 PARK TERRACE
WESTMONT NJ 08108
IM
JAMES T DUNCAN JR MD
5942 SIXTH AVENUE
KENOSHA WI 53140
P
414-652-4832
LESLIE L FAI MD
7744 THIRD AVENUE
KENOSHA WI 53140
OPH / OPH
414-654-0726
JAMES P FERWERDA MD
8020 SHERIDAN ROAD
KENOSHA WI 53140
P
414-656-2721
BERNARD W FREUND JR MD
2106 63RD STREET
KENOSHA WI 53140
IM / IM
WENDEL M FRIEDL MD
1015 65TH STREET
KENOSHA WI 53140
OTO
KISH IN V GANDHI MD
6530 SHERIDAN ROAD
KENOSHA WI 53140
GE IM / IM
MARIO GARRETTO MD
SUITE 16
3734 SEVENTH AVENUE
KENOSHA WI 53140
N NS / NS
414-657-6505
A YALE GEROL MD
SUITE 12
3734 SEVENTH AVENUE
KENOSHA WI 53140
CD PUD
DAVID N GOLDSTEIN MD
2039 19TH AVENUE
KENOSHA WI 53140
OBG
NESIM HALFDN MD
6121 SEVENTH AVENUE
KENOSHA WI 53140
GP
JAMES A HECK MD
6530 SHERIDAN ROAD
KENOSHA WI 53140
OPH OTO
BEN SPALDING HILL MD
6225 SEVENTH AVENUE
KENOSHA WI 53140
IM
414-654-9131
D BOYD HORSLEY MD
SUITE 1
6530 SHERIDAN ROAD
KENOSHA WI 53140
R / R
414-658-1349
LEE H HUBERTY MD
8747 FIRST AVENUE
KENOSHA WI 53140
FP / FP
CHARLES J JANNINGS III MD
POST OFFICE BOX 598
KENOSHA WI 53141
FP / FP
414-658-2516
WILLIAM J JERANEK MD
6530 SHERIDAN ROAD
KENOSHA WI 53140
EM
PREMAL M JOSHIPURA MD
11921 45TH AVENUE
KENOSHA WI 53142
P N
HAROLD C KAPPUS MD
4703 E BRISA DEL NORTE
TUCSON AZ 85718-3601
IM HEM / IM
RAYMOND W KNIGHT MD
1015 65TH STREET
KENOSHA WI 53140
R / R
414-654-6736
EDGAR L KOCH MD
6308 EIGHTH AVENUE
KENOSHA WI 53140
BRET L LA POINTE MD
4617 65TH STREET
KENOSHA WI 53142
GP OS
PAUL J LAWRENCE MD
302 VALLETTE WAY
WEST PALM BEACH FL 33401
IM A / AI
-565-8888
WILLIAM H LIPMAN MD
APT 602
666 UPAS STREET
SAN DIEGO CA 92103
GS
LEIF H LOKVAM MD
7115 THIRD AVENUE
KENOSHA WI 53140
GP
414-652-2710
RODRIGO A MATA JR MD
3734 SEVENTH AVENUE
KENOSHA WI 53140
CRB GS / CR3 GS
414-657-3353
DAVID J MATTEUCCI MD
5004 22ND AVENUE
KENOSHA WI 53140
GS / GS
414-654-8414
JAIRO J MENDIVIL MD
3618 EIGHTH AVENUE
KENOSHA WI 53140
AN
ROGER C MERCADO MD
7540 18TH AVENUE
KENOSHA WI 53140
U
414-654-9118
LYLE D MILLIKEN JR MD
6215 TENTH AVENUE
KENOSHA WI 53140
A
414-694-0757
CECIL A MORROW MD
5405 82ND STREET
KENOSHA WI 53142
IM
414-658-1618
SURESH R NAIK MD
2108 63RD STREET
KENOSHA WI 53140
GP
305-973-1914
MOKTAR NAJAFZADEH MD
APT A-2
1204 BAHAMA BEND
COCONUT CREEK FL 33066
P
414-654-0488
LI GAYA M I NEWMAN MD
SUITE 25
3734 SEVENTH AVENUE
KENOSHA WI 53140-8001
FP / FP
MARVIN L NICE MD
6530 SHERIDAN ROAD
KENOSHA WI 53140
GS / GS
414-658-1618
LOUIS OLSMAN MD
2108 63RD STREET
KENOSHA WI 53140
IM
SIMEON B ORTIZ MD
3200 SHERIDAN ROAD
KENOSHA WI 53140
GS / GS
414-657-9680
ROGER T PACANOWSKI MD
1400 75TH STREET
KENOSHA WI 53140
IM NEP / IM NEP
414-658-1618
DIVAKAR B PAKKALA MD
2106 63RD STREET
KENOSHA WI 53140
IM
414-652-5121
AFET T PAMUKCU MD
7736 THIRD AVENUE
KENOSHA WI 53140
IM GE / IM
414-654-4074
FEVZI S PAMUKCU MD
7736 THIRD AVENUE
KENOSHA WI 53140
ORS / DRS
414-657-5366
ANOO P PATEL MD
5942 SIXTH AVENUE
KENOSHA WI 53140
IM
608-652-8161
PRITI D PATEL MD
7533 22ND AVENUE
KENOSHA WI 53140
GP
JOHN B PEARSON MD
26604 SNEAD DRIVE
SUN LAKE AZ 85224
38— KENOSHA, LA CROSSE
FP / GS
414-654-9127
CHARLES E PECHDUS JR MD
6530 SHERIDAN ROAD
KENOSHA WI 53140
ORS IN / ORS
CLIFTON E PETERSON MD
1400 75TH STREET
KENOSHA WI 53140
D / D
DONNA L POESCH-JERDME MD
322 WEST CENTRAL PARK
DAVENPORT lA 52803
GS / GS
RICHARD A POWELL MD
269 SE STEDBINS TERR
PORT CHARLOTTE FL 33952
FP
ANDREW T PRZLOMSKI MD
6530 SHERIDAN ROAD
KENOSHA WI 53140
OBG / OBG
414-657-5177
HUGH P RAFFERTY MD
6530 SHERIDAN ROAD
KENOSHA WI 53140
IM NEP
414-657-4888
ROSANNA M RANIERI MD
3734 SEVENTH AVENUE
KENOSHA WI 53140
OBG / OBG
414-654-6023
WALTER C RATTAN MD
6530 SHERIDAN ROAD
KENOSHA WI 53140
GP
LEONARD M RAUEN MD
POST OFFICE BOX 596
KENOSHA WI 53141
U / U
JOHN N RICHARDS MD
6215 TENTH AVENUE
KENOSHA WI 53140
FP / FP
414-658-2516
MICHAEL J RIZZO MD
6530 SHERIDAN ROAD
KENOSHA WI 53140
IM HEM
STANLEY R ROSEN MD
6121 SEVENTH AVENUE
KENOSHA WI 53140
CRS / CRS
DAVID D RUEHLMAN MD
APT 485
1220 TASMAN DRIVE
SUNNYVALE CA 94089
FP
414-654-2455
RICARDO M RUSTIA MD
3200 SHERIDAN ROAD
KENOSHA WI 53140
PTH DMP / AP CP DMP
414-656-3216
JOHN G SANSON MD
4206 86TH PLACE
KENOSHA WI 53142
AN / AN
414-658-3706
ISMAEL R SANTA ROMANA MD
APT 14
612 B 15TH PLACE
KENOSHA WI 53140
ORS / ORS
414-654-2245
CHESTER A SATTLER MD
6820 THIRD AVENUE
KENOSHA WI 53140
OPH / OPH
414-657-3636
VINCENT P 3AVAGLI0 MD
6530 SHERIDAN ROAD
KENOSHA WI 53140
OBG
M SCHELLPFEFFER MD
1400 75TH STREET
KENOSHA WI 53140
U / U
414-657-4411
JOHN P SCHMIDT MD
SUITE 105
1244 WISCONSIN AVENUE
RACINE WI 53403
GP
414-657-5218
GEORGE C SCHULTE MD
7221 THIRD AVENUE
KENOSHA WI 53140
GP
HARRY L SCHWARTZ MD
7222 THIRD AVENUE
KENOSHA WI 53140
P / P
414-652-7813
VENKATA K SHARMA MD
SUITE 18
3618 EIGHTH AVENUE
KENOSHA WI 53140
GE IM / GE IM
414-657-6700
FLOYD F SHEWMAKE JR MD
SUITE 16
3734 SEVENTH AVENUE
KENOSHA WI 53140
GP
414-657-7474
MORRIS SIEGEL MD
7008 SECOND AVENUE
KENOSHA WI 53140
GP
WILLIAM C SROKA MD
324 DONALD DRIVE
BURLINGTON WI 53105
N / N
EDWARD T STEVENS MD
SUITE 7
3618 EIGHTH AVENUE
KENOSHA WI 53140
FP / FP
PAUL H SUMNICHT MD
636 TERRY PARKWAY
GRETNA LA 70053
FP / FP
414-553-9500
JOHN H SURRY MD
TALLENT HALL
POST OFFICE BOX 598
KENOSHA WI 53141
R / R
WILLIAM J SWIFT SR MD
ELLISON BAY WI 54210
PTH CLP / PTH
LEELA C THACHENKARY MD
3556 SEVENTH AVENUE
KENOSHA WI 53140
FP / FP
414-763-2485
JOHN D VAN LI ERE MD
POST OFFICE BOX 70
BURLINGTON WI 53105
R / R
GILBERT S WADINA MD
6530 SHERIDAN ROAD
KENOSHA WI 53140
PD / PD
414-652-5261
RAYMOND G WELSCH MD
7728 SECOND AVENUE
KENOSHA WI 53140
GP GS
414-652-8856
FRANK C WILLIAMS JR MD
6334 EIGHTH AVENUE
KENOSHA WI 53140
NS OM
L M WILLIAMSON MD
27041 PIONEER
WIND LAKE WI 53185
OBG / DBG
414-657-5177
RAYMOND W WITT MD
6530 SHERIDAN ROAD
KENOSHA WI 53140
IM
414-654-0231
FREDRICK WOOD JR MD
6530 SHERIDAN ROAD
KENOSHA WI 53140
R / R
414-656-221 1
JOYCE A YEREX MD
5348 WIND POINT ROAD
RACINE WI 53402
IM / IM
MICHAEL ZEIHEN MD
1015 65TH STREET
KENOSHA WI 53140
IM 7 IM
MITCHELL ZIARKO JR MD
1015 65TH STREET
KENOSHA WI 53140
LA CROSSE
PTH / PTH
608-782-7300
R MARIO ABELLERA MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
IM ID / IM ID MMB
608-782-7300
WILLIAM A AGGER MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
OBG / OBG
608-782-9760
UBALDO A ALVAREZ MD
815 SOUTH TENTH STREET
LA CROSSE WI 54601
IM RHU
608-784-3757
ARTHUR G BARBIER MD
SUITE 414
615 SOUTH TENTH STREET
LA CROSSE WI 54601
FP
WILLIAM D BATEMAN MD
134 N LEONARD STREET
WEST SALEM WI 54669
D / D
608-782-7300
JAMES C BAUMGAERTNER MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
PD
608-782-9760
RONALD R BAUMGARTNER MD
815 SOUTH TENTH STREET
LA CROSSE WI 54601
IM EM / IM EM
608-785-0530
JAMES W BAYUK MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
OBG / OBG
608-782-7300
EVERETT A BEGUIN JR MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
FP / FP
MARSHA J BEYER MD
815 SOUTH TENTH STREET
LA CROSSE WI 54601
P
608-784-791 1
DENNIS G BIROS MD
615 SOUTH TENTH STREET
LA CROSSE WI 54601
OPH / OPH
608-784-2420
WILLIAM A BLANK MD
615 SOUTH lOTH STREET
LA CROSSE WI 54601
GS / GS
608-784-8221
ARCHIE G BRITT MD
206 R I VOL I BLDG
LA CROSSE WI 54601
RHU IM / RHU IM
608-782-7300
GARY L BRYANT MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
IM END / IM END
608-792-7300
ROBERT H CAPLAN MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
ORS / ORS
EUGENE J CARLISLE MD
615 SOUTH TENTH STREET
LA CROSSE WI 54601
FP / FP
507-895-6600
BRUCE A CARLSON MD
524 NORTH ELM STREET
LA CRESCENT MN 55947
A PD / AI PD
608-784-1888
KAREL 0 CEJPEK MD
615 S TENTH STREET
LA CROSSE WI 54601
GS / GS
608-788-7808
THOMAS H COGBILL MD
ROUTE 1
FOREST RIDGE
LA CROSSE WI 54601
IM / IM
608-782-9460
DONALD B COMIN MD
815 SOUTH TENTH STREET
LA CROSSE WI 54601
R
608-788-5636
ARNOLD A COOK MD
1134 GRANDAD TERRACE
LA CROSSE WI 54601
PD / PD
608-782-9760
DAVID H CORSER MD
815 SOUTH TENTH STREET
LA CROSSE WI 54601
LA CROSSE— 39
DBG / DBG
608-782-9760
WANIR C DA COSTA MD
815 SOUTH TENTH STREET
LA CROSSE WI 54601
IN NEP / IM NEP
608-782-7300
PHILIP J DAHLBERG MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
PTH CLP / PTH CLP
608-785-0940
RUTH M DALTON MD
700 WEST AVENUE SOUTH
LA CROSSE WI 54601
FP / FP
608-784-6648
WILLIAM E DAVIS MD
630 S TENTH STREET
LA CROSSE WI 54601
CLP PTH / CLP PTH
608-782-4925
PAUL C DIETZ MD
430 NORTH LOSEY BLVD
LA CROSSE WI 54601
TR R / R
PHILIP 0 DOESCHER MD
DEPT/RADIATION THERAPY
1836 SOUTH AVENUE
LA CROSSE WI 54601
FP / FP
DEAN M DREBLOW MD
1212 WELL STREET
ONALASKA WI 54650
OBG / DBG
608-782-9760
JOSEPH B DURST MD
815 SOUTH TENTH STREET
LA CROSSE WI 54601
TR / R
608-732-7300
ROBERT W EDLAND MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
P CHP / PN
608-782-0704
ROBERT M EDWALDS MD
128 SOUTH SIXTH STREET
POST OFFICE BOX 1145
LA CROSSE WI 54601
PD / PD
608-783-6462
GREGORY J EGAN JR MD
419 SAND LAKE ROAD
ONALASKA WI 54650
GEORGE B ELLENZ MD
700 WEST AVENUE SOUTH
LA CROSSE WI 54601
CHARLES H ENGEL MD
436 W FRANKLIN STREET
WEST SALEM WI 54669
GP
608-784-6648
FLOYD W ERNST MD
630 SOUTH TENTH STREET
LA CROSSE WI 54601
OBG / OBG
608-782-7300
PAUL L FELION MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
ORS HS / ORS
608-782-7300
RICHARD A FINK MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
N 7 PN
GREGORY G FISCHER MD
815 SOUTH TENTH STREET
LA CROSSE WI 54601
P N / P N
608-784-8855
ALBERT L FISHER MD
POST OFFICE BOX 816
LA CROSSE WI 54601
IM
FRANK P FURLANO MD
4213 RIVERVIEW DRIVE
LA CROSSE WI 54601
CD IM / IM
ALAN A GABSTER MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
ORS / ORS
RANDALL J GALL MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
CDS GS / GS
608-782-7300
WARREN E GALL MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
FP
FRANK J GALLAGHER MD
1820 NAKOMIS AVENUE
LA CROSSE WI 54601
FP / FP
608-786-0200
GEORGE P GERSCH MD
134 N LEONARD STREET
WEST SALEM WI 54669
IM ID / IM ID
608-782-7300
JAMES E GLASSES MD
2519 HACKBERRY LANE
LA CROSSE WI 54601
p / PN
608-782-7300
T JOSHUA GOLDBLOOM MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
IM CD / IM CD
608-782-7300
CAROLYN C GOREN MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
IM CD / IM CD
608-782-7300
ROBERT M GREEN MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
PM
608-785-0940
MARK D GRIFFITH MD
700 WEST AVENUE SOUTH
LA CROSSE WI 54601
OPH / OPH
608-784-2420
KARL P GRILL MD
SUITE 605
615 SOUTH TENTH STREET
LA CROSSE WI 54601
CD IM / CD IM
608-784-3050
J ROBERT GROVE MD
212 SOUTH IITH STREET
LA CROSSE WI 54601
AN / AN
GRETCHEN GUERNSEY MD
2546 SOUTH 30TH STREET
LA CROSSE WI 54601
TS PDS / GS
A ERIK GUNDERSEN MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
GS / GS
ADOLF L GUNDERSEN MD
3624 EBNER COULEE ROAD
LA CROSSE WI 54601
U / U
ALF H GUNDERSEN MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
R NM / R NM
608-782-7300
GUNNAR A GUNDERSEN MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
GS / GS
608-782-7300
SIGURD B GUNDERSEN JR MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
IM / IM
608-782-7300
THOROLF E GUNDERSEN MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
P / P
608-782-1775
HELEN E HALBERT MD
N3684 SCENIC DRIVE
ROUTE 2
LA CROSSE WI 54601
IM CD / IM
608-782-7300
BRUCE HANDLER MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
ORS / ORS
608-788-5432
STEPHEN L HAUG MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
ORS / ORS
608-782-7300
JOHN W HAYDEN MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
N / N
TIMOTHY K HENKE MD
5694 MONT I CELLO WAY
MADISON WI 53719
IM / IM
608-784-3050
ALOYSIUS W HICKEY MD
212 SOUTH IITH STREET
LA CROSSE WI 54601
U / U
608-782-7300
RICHARD S HOWARD MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
N
KERRY L HRUSKA MD
815 SOUTH TENTH STREET
LA CROSSE WI 54601
P 7 P
608-782-7300
PAULINE M JACKSON MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
PTH DMP 7 PTH DMP
608-782-7300
JOHN F JAN IS MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
AN
ALFHILD I E JENSEN MD
PULI CHRISTIAN HOSP
PULI> TAIWAN R 0. C
CD EM IM 7 IM
608-782-7459
GORDON L JOHNSON MD
504 SOUTH 28TH STREET
LA CROSSE WI 54601
FP 7 FP
608-783-2200
MARK C JUNGCK MD
1212 WELL STREET
ONALASKA WI 54601
U 7 U
608-782-9760
NABIL M A KADER MD
815 SOUTH TENTH STREET
LA CROSSE WI 54601
HEM 7 HEM
608-782-7300
RUDOLPH M KEIMOWITZ MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
P 7 P
608-782-5853
KENT E KELLER MD
615 SOUTH TENTH STREET
LA CROSSE WI 54601
P
LEO V KEMPTON MD
615 SOUTH TENTH STREET
LA CROSSE WI 54601
GS 7 GS
608-782-7300
WILLIAM A KISKEN MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
U 7 U
608-782-7300
A SCOTT KLEIN MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
GS
608-782-9760
GORDON G KOCHSIEK MD
815 SOUTH TENTH STREET
LA CROSSE WI 54601
A IM 7 IM
GEORGE F KROKER MD
2532 EDGEWOOD PLACE
LA CROSSE WI 54601
IM ON 7 IM MON
608-782-7300
ROGER W KWONG MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
IM 7 IM
608-782-7300
THOMAS P LATHROP MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
U 7 U
CLYDE C LAWNICKI MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
EM 7 EM
608-782-7300
EMMA K LEDBETTER MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
IM PUD OM 7 IM PUD
608-782-7300
LARRY A L INDESMITH MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
40— LA CROSSE
R / R
608-782-7300
ROLAND A LOCHER MD
121 SOUTH 13TH STREET
LA CROSSE WI 54601
RHU IM / RHU IM
608-782-7300
JACK N LOCKHART MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
IM HEM / IM HEM
608-782-7300
LAURENCE J LOGAN MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
U / U
608-782-7300
ALMON R MAC EWEN MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
OBG / OBG
608-785-0530
MICHAEL H MADER MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
OPH / OPH
608-784-3050
BERNARD J MANSHEIM MD
212 SOUTH IITH STREET
LA CROSSE WI 54601
ORS / ORS
608-782-7300
RICHARD J MARCHIANDO MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
D / D
608-782-9760
DEAN L MARTALOCK MD
815 SOUTH TENTH STREET
LA CROSSE WI 54601
PS OTO / OTO
608-782-7300
LYNN T MARTIN MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
IM / IM
608-782-2818
ROBERT E MC MAHON MD
N3144 SOUTH VISTA CT
LA CROSSE WI 54601
GS
CHARLES H MILLER III MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
IM / IM
DAVID K MILLER MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
R RIP / R
608-788-4144
GERALD J MILLER MD
2763 HAGEN ROAD
LA CROSSE WI 54601
IM END / IM
608-782-7300
EDWARD B MINER MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
IM ID / IM
608-785-0530
WILLIAM A MORGAN MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
A / AI
DAVID L MORRIS MD
615 S TENTH STREET
LA CROSSE WI 54601
IM / IM
JAMES H MUNN JR MD
ROUTE 1
GREENS ( OULEE ROAD
0NALA3KA WI 54650
GS / GS
608-784-3050
JAMES T MURPHY MD
212 SOUTH IITH STREET
LA CROSSE WI 54601
R NM / R NM
608-788-051 1
DAVID G MUSGJERD MD
2440 HAGEN ROAD
LA CROSSE WI 54601
U / U
608-782-7300
CORNELIUS A NATOLI MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
PD / PD
608-782-9760
DAVID l.EE NELSON MD
815 SOUTH TENTH STREET
LA CROSSE WI 54601
IM / IM
608-785-0530
MICHAEL E NESEMANN MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
IM / IM
608-782-7300
KERMIT L NEWCOMER MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
PTH CLP / PTH CLP
608-785-0940
CHARLES P NICHOLS MD
700 WEST AVENUE SOUTH
LA CROSSE WI 54601
IM / IM
608-782-7300
DAVID D NORENBERG MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
IM ON / IM ON
608-782-9760
JAMES E NOVOTNY MD
212 SOUTH IITH STREET
LA CROSSE WI 54601
CD IM / CD IM
608-782-9760
ROBERT T OBMA MD
212 SOUTH IITH STREET
LA CROSSE WI 54601
OBG / OBG
608-782-9760
WILLIAM J O'LEARY MD
815 SOUTH TENTH STREET
LA CROSSE WI 54601
IM GE / IM
608-782-9760
ASGHAR OLIAI MD
815 SOUTH TENTH STREET
LA CROSSE WI 54601
EM
608-782-7300
JUDSON OMANS MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
GS / GS
608-782-9760
MARK T O'MEARA MD
815 SOUTH TENTH STREET
LA CROSSE WI 54601
ID IM / IM
608-788-5815
EDWIN L OVERHOLT MD
2315 HICKORY LANE
LA CROSSE WI 54601
OTO / OTO
608-782-7300
STEVEN L OVERHOLT MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
IM / IM
STEPHEN L PAVELA MD
2691 HILLCREST DRIVE
LA CROSSE WI 54601
GP
608-783-5238
STEVEN B PEARSON MD
611 OAK AVENUE NORTH
ONALASKA WI 54650
OBG NPM / OBG NPM
608-782-7300
THEODORE M PECK MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
PTH CLP / PTH CLP
608-785-0940
JOHN F PEDERSON MD
W5237 BOMA ROAD
LA CROSSE WI 54601
IM / IM
608-782-7300
EDWARD L PERRY MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
ORS / ORB
608-784-3050
PAUL W PHILLIPS MD
212 SOUTH IITH STREET
LA CROSSE WI 54601
IM A / IM Al
608-782-7300
BRUCE A POLENDER MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
IM / IM
608-788-5939
ROBERT A PRIBEK MD
212 SOUTH IITH STREET
LA CROSSE. WI 54601
IM
608-782-7300
R0BER1 W RAMLOW MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
PD / PD
608-782-7300
LEAH A RE I MANN MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
AN / AN
608-788-0657
DAVID S RHO MD
2905 FARNAM STREET
LA CROSSE WI 54601
FP
JAMES D RICHARDSON MD
520 AMY DRIVE
HOLMEN WI 54636
DR / DR
608-782-7300
CAMERON F ROBERTS MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
OPH / OPH
608-782-7300
DENNIS K RYAN MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
A NPM PD / PD
608-788-1010
VIJAY K SABNIS MD
2738 HAGEN ROAD
LA CROSSE WI 54601
GS / GS
608-782-1041
JOHN J SATORY MD
1404 MAIN STREET
LA CROSSE WI 54601
PD / PD
MARY B SCHEURICH MD
815 SOUTH TENTH STREET
LA CROSSE WI 54601
OPH / OPH
608-782-7300
CARL F SCHMIDT MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
GP
EDWARD J SCHNEEBERGER MD
421 MAIN STREET
LA CROSSE WI 54601
OBG / OBG
608-782-7300
RUDOLF E SCHULDES MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
OTO / OTO
608-782-7300
GLENN M SEAGER MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
NS / NS
608-785-2300
ROY SELBY MD
SUITE A-620
615 SOUTH TENTH STREET
LA CROSSE WI 54601
OTO HNS / OTO
LARRY R SEVEREID MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
PD / PD
608-782-9760
P STEPHEN SHULTZ MD
815 S TENTH STREET
LA CROSSE WI 54601
ORS
608-784-3050
JESUS M SIERRA MD
212 S ELEVENTH STREET
LA CROSSE WI 54601
U / U
CHARLES A SKEMP MD
815 SOUTH TENTH STREET
LA CROSSE WI 54601
GP
608-782-2930
FREDERICK C SKEMP MD
815 SOUTH TENTH STREET
LA CROSSE WI 54601
FP / FP
608-782-9760
FREDERICK SKEMP JR MD
815 SOUTH TENTH STREET
LA CROSSE WI 54601
GP
GEORGE E SKEMP MD
2506 CASS STREET
LA CROSSE WI 54601
OBG / OBG
JOHN T SKEMP MD
218 BURNSIDE
LEHIGH FL 33936
IM / IM
608-782-9760
JOSEPH J SKEMP MD
815 SOUTH TENTH STREET
LA CROSSE WI 54601
LA CROSSE, LAYFAYETTE, LANGLADE, LINCOLN— 41
GS / GS
608-782-9760
JOHN J SMALLEY MD
815 SOUTH TENTH STREET
LA CROSSE WI 54601
IM HEM CLP / IM HEM CLP
608-782-7300
MARTIN J SMITH MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
IM A / IM
608-782-7300
VANEE SONGSIRIDEJ MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
OBG / DBG
608-782-9760
PAUL H STEINGRAEBER MD
815 S TENTH STREET
LA CROSSE WI 54601
R / R
608-788-3580
JOHN D SWINGLE MD
3700 QUEENS AVENUE
LA CROSSE WI 54601
IM GE / IM GE
608-782-7300
DUANE W TAEBEL MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
PM / PM
608-782-7300
NEAL TAYLOR MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
AN
REGALADO A TENDERO MD
308 SHORE ACRES ROAD
LA CRESCENT MN 55947
DR / R
THOMAS R TERHORST MD
700 WEST AVENUE SOUTH
LA CROSSE WI 54601
IM / IM
608-782-7300
JAMES W TERMAN MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
FP / FP
608-785-0940
TEDDY L THOMPSON MD
700 WEST AVENUE SOUTH
LA CROSSE WI 54601
OPH / OPH
608-782-9760
STEVEN T TICHY MD
212 SOUTH IITH STREET
LA CROSSE WI 54601
ORS J ORS
608-782-7300
DOUGLAS G TOMPKINS MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
R / R
608-782-7300
RENATD TRAVELLI MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
IM / IM
JOHN R UJDA MD
212 SOUTH IITH STREET
LA CROSSE WI 54601
FP
608-785-0940
PHILIP H UTZ MD
700 WEST AVENUE SOUTH
LA CROSSE WI 54601
DR NM / DR NM
EUGENE J VALENT INI MD
700 WEST AVENUE SOUTH
LA CROSSE WI 54601
IM
WALTER J VALLEJO MD
212 S IITH STREET
LA CROSSE WI 54601
PTH
RODELINO L VIRATA MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
NM NR NIP / R NM
608-785-0940
DARRYL M WASHA MD
700 WEST AVENUE SOUTH
LA CROSSE WI 54601
GP FP
608-784-4140
MICHAEL J WATUNYA MD
400 HOESCHLER BUILDING
FIFTH AND J STREETS
LA CROSSE WI 54601
D / D
608-782-7300
STEPHEN B WEBSTER MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
IM ON / IM
608-782-7300
JOHN B WEETH MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
PTH / PTH
608-782-7300
SUSAN M WESTER MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
FP / FP
608-782-9760
DAVID E WESTGARD MD
815 S TENTH STREET
LA CROSSE WI 54601
IM / IM
608-785-2570
DEAN E WHITEWAY MD
624 GILLETTE STREET
LA CROSSE WI 54601
OTO / OTO
608-782-9760
RUSTAN J WIERSMA MD
815 SOUTH TENTH STREET
LA CROSSE WI 54601
IM PUD / IM PUD
608-782-7300
EDWARD R WINGA MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
ON IM / ON IM
608-782-7300
ROBERT S WITTE MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
IM NEP / NEP
608-782-7300
WILFRIDO R YUTUC MD
1836 SOUTH AVENUE
LA CROSSE WI 54601
LAFAYETTE
FP
ROBERT J BERNARDONI MD
516 WELLS STREET
DARLINGTON WI 53530
FP
608-523-4262
LOREN A LESHAN MD
309 SOUTH MAIN STREET
BLANCHARDVILLE WI 53516
FP
608-776-2360
NORBERT A MC GREANE MD
ROUTE 2 BOX 187
DARLINGTON WI 53530
FP / FP
608-776-4497
LORI L NEUMANN MD
517 PARK PLACE
DARLINGTON WI 53530
FP
608-776-4497
LYLE L OLSON MD
517 PARK PLACE
DARLINGTON WI 53530
FP / FP
608-776-4497
RICHARD G ROBERTS MD
517 PARK PLACE
DARLINGTON WI 53530
LANGLADE
GP
715-623-4519
BERNARD W BEATTIE MD
614 FIFTH AVENUE
ANT I GO WI 54409
GP
LARRY R BRUN2LICK MD
N621 OLD 26
ANIWA WI 54408
FP
ROBERT W CROMER MD
1 1 1 1 LANGLADE ROAD
ANT I GO WI 54409
GP
715-623-6202
WILLIAM P CURRAN MD
ROUTE 2
DEERBROOK WI 54424
FP / FP
715-623-2351
THEODORE C FOX MD
213 FIFTH AVENUE
ANTIGO WI 54409
GP IM
JOHN E GARRITTY MD
1111 LANGLADE ROAD
ANTIGO WI 54409
FP / FP
715-623-5803
CHARLES A HEUSS MD
N2166 MAPLE ROAD
ANTIGO WI 54409
FP
715-623-3761
ROBERT L KEENER MD
1 1 1 1 LANGLADE ROAD
ANTIGO WI 54409
FP
715-623-2351
JOHN E MC KENNA MD
POST OFFICE BOX 400
ANTIGO WI 54409
FP / FP
JAMES 0 MOERMOND JR MD
N693 HIGHWAY 45S
ANTIGO WI 54409
IM / IM
715-623-3761
JOHN R MYERS MD
1111 LANGLADE
ANTIGO WI 54409
FP / FP
715-623-2351
MICHAEL J REINARDY MD
POST OFFICE BOX 400
ANTIGO WI 54409
GS / GS
715-623-3761
EARL J ROTH MD
1 1 1 1 LANGLADE ROAD
ANTIGO WI 54409
LINCOLN
GS CDS / GS
715-536-2463
MUHAMMAD Y AHMAD MD
716 EAST SECOND STREET
MERRILL WI 54452
IM / IM
715-453-4700
GAIL M AMUNDSON MD
216 N SEVENTH STREET
TOMAHAWK WI 54487
GP GS
715-532-6517
LESTER J BAYER MD
N2715 EAST SHORE DRIVE
MERRILL WI 54452
GP GS
JAMES F BIGALOW MD
1401 HIGHLAND DRIVE
MERRILL WI 54452-1786
ORS
WILLIAM E BRAUN MD
N1585 BLUEBIRD LANE
MERRILL WI 54452
GP GS
715-453-2147
NUNILO L BUGARIN MD
221 E WASHINGTON AVE
TOMAHAWK WI 54487
FP / FP
715-453-2101
JAMES L CARROLL MD
318 N SEVENTH STREET
POST OFFICE BOX 305
TOMAHAWK WI 4487-0305
FP / FP
715-536-951 1
DONALD L EVANS MD
1205 O'DAY STREET
MERRILL WI 54452
GS GP ABS / GS
715-453-2147
MODESTO M FERRER MD
221 E WASHINGTON AVE
TOMAHAWK WI 54487
FP / FP
715-453-2147
ORLANDO M FRANCISCO MD
221 E WASHINGTON AVE
TOMAHAWK WI 54487
N
715-453-2181
CHARLES E GOODELL III MD
216 N SEVENTH STREET
TOMAHAWK WI 54487
42— LINCOLN, MANITOWOC
IM / TM
715-536-551 1
CHAMPALAL GUPTA MD
716 EAST SECOND STREET
MERRILL WI 54452
GP
RAYMOND J HENDERSON MD
327 W WISCONSIN AVENUE
TOMAHAWK WI 54487
FP / FP
715-536-951 1
JAMES S JANOWIAK MD
1205 O'DAY STREET
MERRILL WI 54452
FP / FP
715-536-951 1
GEOFFREY C KLOSTER MD
1205 O'DAY STREET
MERRILL WI 54452
FP / FP
715-536-6322
WALTER I.EWINNEK MD
1205 O'DAY STREET
MERRILL WI 54452
U / U
715-536-6988
JEROME S MAYERSAK MD
717 TEF LANE DRIVE
MERRILL WI 54452
FP / FP
715-536-951 1
MICHAEL K MIKKELSON MD
800 RIVERSIDE AVENUE
MERRILL WI 54452
FP CD GS / FP
715-536-951 1
JACK D MILLENBAH MD
1205 O'DAY STREET
MERRILL WI 54452
OS
715-536-9511
ERLING 0 RAVN JR MD
1205 O'DAY STREET
MERRILL WI 54452
IM / IM
715-453-4700
PETER R ROTHE MD
216 N SEVENTH STREET
TOMAHAWK WI 54487
IM
715-536-951 1
THOMAS P SIMERSON MD
1205 O'DAY STREET
MERRILL WI 54452
MANITOWOC
u / u
414-682-6329
ROBERT J BANKER MD
536 NORTH NINTH STREET
MANITOWOC WI 54220-4016
IM HEM / IM HEM
414-682-8841
EDWARD J BARYLAK MD
601 REED AVENUE
POST OFFICE BOX 3008
MANITOWOC WI 54220
ORS / ORS
414-682-0181
BARRY V BAST MD
600 YORK STREET
MANITOWOC WI 54220
OTO / OTO
414-684-4477
ROGER A BELL MD
300 EAST REED AVENUE
POST OFFICE BOX 277
MANITOWOC WI 54220
IM / IM
414-682-8841
JOHN D BEST MD
601 REED AVENUE
POST OFFICE BOX 3008
MANITOWOC WI 54220
IM / IM
414-682-8841
ROY C BLANK MD
601 REED AVENUE
POST OFFICE BOX 3008
MANITOWOC WI 54220
GP DBG
NELSON A BONNER MD
1112 LINCOLN BOULEVARD
MANITOWOC WI 54220
PD / PD
414-682-8841
ROBERT D BUSH MD
601 REED AVENUE
POST OFFICE BOX 3008
MANITOWOC WI 54220
IM / IM
414-682-8841
DONALD J DE BRUYN MD
601 REED AVENUE
POST OFFICE BOX 3008
MANITOWOC WI 54220
GS / GS
414-682-8841
ROBERT L DERNLAN MD
601 REED AVENUE
POST OFFICE BOX 3008
MANITOWOC WI 54220
ORS / ORS
JOSEPH C DI RAIMONDO MD
1636 MIRIAM ROAD
MANITOWOC WI 54220
FP
STEVEN D DRIGGERS MD
SUITE 7-8
600 YORK STREET
MANITOWOC WI 54220
ORS / ORS
414-682-0181
THOMAS L FINNEGAN MD
600 YORK STREET
MANITOWOC WI 54220
FP / FP
414-793-1105
ROBERT A GAHL MD
2219 GARFIELD STREET
TWO RIVERS WI 54241
GS / GS
414-682-8841
HAROLD L GERNDT JR MD
601 REED AVENUE
POST OFFICE BOX 3008
MANITOWOC WI 54220
DR R / R
JOHN A GOMMERMANN MD
919 LAWTON TERRACE
MANITOWOC WI 54220
FP / FP
MAX H GOODWIN MD
2219 GARFIELD STREET
TWO RIVERS WI 54241
GS / GS
414-682-4646
JOHN T GOSWITZ MD
601 N EIGHTH STREET
MANITOWOC WI 54220
IM / IM
414-682-8841
MARY A GOVIER MD
601 REED AVENUE
POST OFFICE BOX 3008
MANITOWOC WI 54220
GS TB / GS
414-682-0181
TERRY L GUELDNER MD
600 YORK STREET
MANITOWOC WI 54220
IM GE / IM GE
414-682-0181
JAMES W HOFTIEZER MD
600 YORK STREET
MANITOWOC WI 54220
IM
LYNN W HOLDER MD
601 N EIGHTH STREET
MANITOWOC WI 54220
R NM / R NM
414-684-2255
MICHAEL A JACOBI MD
2300 WESTERN AVENUE
MANITOWOC WI 54220
OPH / OPH
JOHN T JIROCH MD
APT 302C
2490 OLD CONCORD ROAD
SMYRNA GA 30080-1612
AI P HYP
414-432-2204
ELEAZAR M KADILE MD
SUITE 3
1901 S WEBSTER AVENUE
GREEN BAY WI 54301
P HYP
414-684-4493
HERMENEGILDO M KADILE MD
021 E WALDO BOULEVARD
MANITOWOC WI 54220
FP / FP
414-793-2281
SEYMOUR L KANER MD
2219 GARFIELD
TWO RIVERS WI 54241
OBG / OBG
414-682-8841
SIVAKAMl KANGAYAPPAN MD
601 REED AVENUE
POST OFFICE BOX 3008
MANITOWOC WI 54220
OBG / OBG
414-682-8841
PAUL L KARRMANN MD
601 REED AVENUE
POST OFFICE BOX 3008
MANITOWOC WI 54220
D / D
414-682-0181
HENRY M KATZ MD
600 YORK STREET
MANITOWOC WI 54220
DR NM / R
THOMAS A KELLER MD
21ST AND WESTERN AVE
MANITOWOC WI 54220
IM CD / IM
414-682-8841
CARL C KOBELT MD
601 REED AVENUE
POST OFFICE BOX 3008
MANITOWOC WI 54220
GS
414-794-7240
DOMINIC A KULJIS MD
3219 ADAMS STREET
TWO RIVERS WI 54241
OTO / OTO
414-684-4477
JOHN R LARSEN MD
300 EAST REED AVENUE
POST OFFICE BOX 277
MANITOWOC WI 54220
U / U
PATRICK F LIMONI MD
1020 MARITIME DRIVE
MANITOWOC WI 54220
IM / IM
414-682-8841
JOHN D LYNCH MD
601 REED AVENUE
POST OFFICE BOX 3008
MANITOWOC WI 54220
IM / IM
414-682-8841
TIMOTHY J MAATMAN MD
601 REED AVENUE
POST OFFICE BOX 3008
MANITOWOC WI 54220
GP
414-794-8723
RICHARD E MARTIN MD
1510 26TH STREET
TWO RIVERS WI 54241
GP
CECILIO T MENDOZA MD
600 YORK STREET
MANITOWOC WI 54220
PD
ALI A MIR MD
2219 GARFIELD STREET
TWO RIVERS WI 54241
OBG
ROBERT E MYERS MD
2219 GARFIELD STREET
TWO RIVERS WI 54241
GP
JOHN E NILLES MD
POST OFFICE BOX 127
MI SHI COT WI 54228
ORS / ORS
414-684-3204
THOMAS K PERRY MD
501 NORTH TENTH STREET
MANITOWOC WI 54220
OPH / OPH
DAVID D PFAFFENBACH MD
1119 MARSHALL STREET
POST OFFICE BOX 705
MANITOWOC WI 54220
OPH / OPH
CYRIL J RADL MD
APT 4
1425 N NINTH STREET
MANITOWOC WI 54220
PD / PD
414-682-8841
SURINDER K RAJPAL MD
601 REED AVENUE
POST OFFICE BOX 3008
MANITOWOC WI 54220
OPH / OPH
ROBERT C RANDOLPH MD
1119 MARSHALL STREET
POST OFFICE BOX 705
MANITOWOC WI 54220
OTO / OTO
414-684-4477
WILLIAM C RANDOLPH MD
300 EAST REED AVENUE
POST OFFICE BOX 277
MANITOWOC WI 54220
FP / FP
414-683-2200
T RAUSCHENBERGER MD
601 BUFFALO
MANITOWOC WI 54220
MANITOWOC, MARATHON— 43
IM / IM
414-682-8841
MARK A SAGER MD
601 REED AVENUE
POST OFFICE BOX 3008
MANITOWOC WI 54220
GS / GS
414-682-0181
DAVID A SATCHELL MD
600 YORK STREET
MANITOWOC WI 54220
OPH / OPH
414-684-4429
D SCHLERNITZAUER MD
POST OFFICE BOX 705
MANITOWOC WI 54220
FP / FP
414-683-2200
GARY A SCHMIDT MD
601 BUFFALO STREET
MANITOWOC WI 54220
FP / FP
414-682-4646
NORMAN C SCHROEDER MD
601 N EIGHTH STREET
MANITOWOC WI 54220
GS / GS
414-682-8841
TIMOTHY J SHAW MD
601 REED AVENUE
POST OFFICE BOX 3008
MANITOWOC WI 54220
CDS GS / GS
PETER J SIPPEL MD
600 YORK STREET
MANITOWOC WI 54220
GS / GS
414-684-5845
WALTER F SMEJKAL MD
208 HURON STREET
MANITOWOC WI 54220
R / R
414-854-5121
GILBERT H STANNARD JR MD
POST OFFICE BOX 288
EPHRAIM WI 54211
FP / FP
414-682-4646
RICHARD S STEIN MD
601 N EIGHTH STREET
MANITOWOC WI 54220
U / U
414-682-6344
JOHN M STERN MD
1020 MARITIME DRIVE
MANITOWOC WI 54220
IM RHU / IM
JOHN L STOUNE MD
600 YORK STREET
MANITOWOC WI 54220
P
414-683-2020
EDGAR C STUNT Z MD
1131 S EIGHTH STREET
MANITOWOC WI 54220
AN / AN
414-683-2074
NINA TEMPLETON MD
615 OAK STREET
MANITOWOC WI 54220
AN / AN
414-683-2074
THOMAS W TEMPLETON MD
615 OAK STREET
MANITOWOC WI 54220
PD
414-682-8841
ROBERT F THORPE MD
601 REED AVENUE
POST OFFICE BOX 3003
MANITOWOC WI 54220
GP
414-775-411 1
JOHN A THRANOW JR MD
106 WILSON STREET
VALDERS WI 54245
ORS / ORS
JOSEPH E TRADER MD
501 NORTH TENTH STREET
MANITOWOC WI 54220
PD / PD
414-682-8841
RICHARD A VAN DREEL MD
601 REED AVENUE
POST OFFICE BOX 3008
MANITOWOC WI 54220
GP
STEPHEN L WELD MD
2219 GARFIELD STREET
TWO RIVERS WI 54241
AN
WAYNE F WHITE MD
2300 WESTERN AVENUE
MANITOWOC WI 54220
GS / GS
414-793-2281
JOHN C ZELDENRUST MD
2219 GARFIELD STREET
TWO RIVERS WI 54241
MARATHON
OBG / OBG
SAMIR L ABADEER MD
2727 PLAZA DRIVE
WAUSAU WI 54401
AN
ROBERT A ALBANI MD
4010 WAKEFIELD DRIVE
COLORADO SPRINGS CD
80906-4325
GS / GS
715-847-3241
CHARLES R ALDEN MD
2727 PLAZA DRIVE
WAUSAU WI 54401
IM
DALE B ANDERSON MD
804 WEST WAUSAU CIRCLE
WAUSAU WI 54401
IM PUD / IM
715-847-3254
DAVID K AUGHENBAUGH MD
2727 PLAZA DRIVE
WAUSAU WI 54401
EM
GREGORY J BACHHUBER MD
W5754 ROBINSON ROAD
TOMAHAWK WI 54487
P
HUGO M BACHHUBER MD
212 NORTH IITH AVENUE
WAUSAU WI 54401
OPH / OPH
715-845-8201
GORDON L BACKER MD
POST OFFICE BOX 689
WAUSAU WI 54401
OPH / OPH
715-845-8201
WILLIAM D BACKER MD
POST OFFICE BOX 689
WAUSAU WI 54401
OBG
GARY M BAKKER MD
1424 STARK STREET
WAUSAU WI 54401
FP / FP
715-847-3281
HALDOR P BARNES MD
2727 PLAZA DRIVE
WAUSAU WI 54401
PTH / PTH
71 5-842-3375
RICHARD D BARTHOLOMEW MD
808 THIRD STREET
WAUSAU WI 54401
IM
715-842-1636
SAILENDRA N BASU MD
1100 LAKE VIEW DRIVE
WAUSAU WI 54401
FP / FP
715-693-6711
JAMES J BEIER MD
607 13TH STREET
MOSINEE WI 54455
PTH CLP / PTH CLP
715-842-3375
KATHY P BELGEA MD
808 THIRD STREET
WAUSAU WI 54401
PD
715-847-3592
JOHN E BOB INSKI MD
2727 PLAZA DRIVE
WAUSAU WI 54401
PTH / PTH
715-847-2130
STEVEN E BODEMER MD
808 THIRD STREET
WAUSAU WI 54401
TR R / TR R
715-845-2866
ADRIAN R BOURQUE MD
333 PINE RIDGE BLVD
WAUSAU WI 54401
OTO OPH / OTO
ENOCH B BRICK MD
912 NINTH STREET
WAUSAU WI 54401
R / R
715-842-0624
G H BRISTER MD
SUITE 209
425 PINE RIDGE BLVD
WAUSAU WI 54401
OTO / OTO
RICHARD H BRODHEAD MD
2305 RIDGE VIEW DRIVE
WAUSAU WI 54401
ORS / ORB
715-842-3202
RICHARD L BUECHEL MD
SUITE 300
425 PINE RIDGE BLVD
WAUSAU WI 54401
FP
715-847-3000
THURL C BURR JR MD
2727 PLAZA DRIVE
WAUSAU WI 54401
FP / FP
715-842-0491
ROBERT E CADWELL MD
212 STURGEON EDDY ROAD
WAUSAU WI 54401
FP
715-748-2121
VINOO CAMERON MD
101 W GIBSON AVENUE
MEDFORD WI 54451
OTO / OTO
715-842-4017
STEPHEN G CHASE MD
SUITE 100
2800 WESTHILL DRIVE
WAUSAU WI 54401
CDS TS / CDS TS GS
715-845-6242
JULIO C DAVILA MD
SUITE 204
425 PINE RIDGE BLVD
WAUSAU WI 54401
U / U
715-847-3351
KENNETH L DAY MD
2727 PLAZA DRIVE
WAUSAU WI 54401
D A / D
715-842-4686
NORMAN F DEFFNER MD
630 FIRST STREET
WAUSAU WI 54401
OBG / OBG
715-847-3284
JOEL R DE KONING MD
2727 PLAZA DRIVE
WAUSAU WI 54401
GE IM
7 1 5—947—
WILLIAM K DERNBACH MD
2727 PLAZA DRIVE
WAUSAU WI 54401
AN
NAM DINH DOAN MD
1612 FOOTHILL AVENUE
SCHOFIELD WI 54476
CD / CD IM
715-845-9282
ELLET H DRAKE MD
SUITE 200
813 SECOND STREET
WAUSAU WI 54401
IM ON / IM ON
715-847-3357
JOHN T A DUELGE MD
1211 PINE STREET
WAUSAU WI 54401
IM
HAROLD H FECHTNER MD
UNIT 351
5200 S TUCKAWAY BLVD
GREENFIELD WI 53221
GP OM
JOHN V FLANNERY SR MD
3409 HORSESHOE SPRING
WAUSAU WI 54401
OTO HNS / OTO
715-845-9634
JOHN V FLANNERY JR MD
SUITE 305
425 PINE RIDGE BLVD
WAUSAU WI 54401
R / R
JAMES M FOERSTER MD
3333 SIXTH STREET
WAUSAU WI 54401
ORS / ORS
715-842-3202
ALEXANDER S FOLTZ MD
SUITE 300
425 PINE RIDGE BLVD
WAUSAU WI 54401
44— MARATHON
CD IM / CD IM
715-845-6242
D JOE FREEMAN MD
SUITE 204
425 PINE RIDGE BLUD
WAUSAU WI 54401
IM
715-845-6242
MARY JO FREEMAN MD
SUITE 204
425 PINE RIDGE BLUD
WAUSAU Wl 54401
NS / NS
715-847-3354
YOUSSEF H GABRIEL MD
2727 PLAZA DRIVE
WAUSAU WI 54401
GS / GS
715-847-3246
BRUCE L GARGAS MD
2727 PLAZA DRIVE
WAUSAU WI 54401
P / P
715-848-1346
CHARLES A GARVEY MD
2422 STEWART SQUARE
WAUSAU Wl 54401
FP / FP
715-847-3379
CURT G GRAUER MD
2727 PLAZA DRIVE
WAUSAU WI 54401
FP / FP
GERALD W GRIM MD
2727 PLAZA DRIVE
WAUSAU WI 54401
FP
BOYD J GROTH MD
607 13TH STREET
MOSINEE WI 54455
GS OM / GS
715-842-6530
WARNER H GUSTAVSON MD
1103 PARCHER STREET
WAUSAU WI 54401
GP OBG
715-848-5244
GEORGE R HAMMES MD
502 MC INDOE STREET
WAUSAU WI 54401
FP / FP
715-842-0671
PAUL Z HAN MD
515 SOUTH 32ND AVENUE
WAUSAU WI 54401
FP / FP
715-675-3391
TERRY L HANKEY MD
995 CAMPUS DRIVE
WAUSAU WI 54401
OPH / OPH
715-845-8201
JOHN M HATTENHAUER MD
POST OFFICE BOX 689
WAUSAU WI 54401
OPH
WILLIAM HENDRICKSON MD
POST OFFICE BOX 548
WOODRUFF WI 54568
OPH / OPH
715-845-8201
STEPHEN J HERMAN MD
POST OFFICE BOX 689
WAUSAU Wl 54401
GP
ARTHUR W HOESSEL MD
POST OFFICE BOX 148
LAKE TOMAHAWK WI
54539-0148
PTH / AP CLP DMP
715-842-3376
GUY W HOLMES MD
808 THIRD STREET
WAUSAU WI 54401
IM HEM
DAVID D JENKINS MD
2005 HEMLOCK AVENUE
SCHOFIELD WI 54476
OBG
715-842-1127
FRANCIS C JOHNSON MD
613 MC INDOE STREET
WAUSAU WI 54401
GS /■ GS
715-847-3241
WILLIAM W JONES MD
2727 PLAZA DRIVE
WAUSAU Wl 54401
CDS TS / TS
PANDURANG V KAMAT MD
4141 BRIARWOOD AVENUE
WAUSAU WI 54401
R DR / R
HENRY H KANEMOTO MD
726 SPRING STREET
WAUSAU WI 54401
FP / FP
715-842-0491
ROBERT C KAUPIE MD
212 STURGEON EDDY ROAD
WAUSAU WI 54401
CLP / CLP
619-743-1065
ORVILLE R KELLEY MD
2305 ROYAL OAK DRIVE
ESCONDIDO CA 92027
OBG / OBG
715-342-0862
TIMOTHY C KLAMMER MD
SUITE 205
2800 WESTHILL DRIVE
WAUSAU WI 54401
EM FP / FP
715-842-9373
FREDERICK A KLEMM MD
2404 HAWTHORNE LANE
WAUSAU WI 54401
GP / PD
715-847-3434
KENNETH R KNUTSON MD
2727 PLAZA DRIVE
WAUSAU WI 54401
AN / AN
715-845-5505
PETER TONG BAK KOH MD
502 E LAKE SHORE DRIVE
WAUSAU WI 54401
FP
715-675-6606
GEORGE KORDIYAK MD
T862 GOETSCH ROAD
WAUSAU WI 54401
DR / DR
715-847-3517
EDGAR B KOSCHMANN MD
2727 PLAZA DRIVE
WAUSAU WI 54401
GS PTH / GS
715-842-0458
JAN GEORGE KOTYNEK MD
SUITE 202
425 PINE RIDGE BLVD
WAUSAU WI 54401
IM
715-847-3254
JAMES D KRAMER MD
2727 PLAZA DRIVE
WAUSAU WI 54401
ORS / ORS
DONALD H KRANENDONK MD
SUITE 300
425 PINE RIDGE BLVD
WAUSAU WI 54401
PTH CLP / PTH CLP
715-842-3375
LEROY A KRUEGER MD
808 THIRD STREET
WAUSAU WI 54401
IM / IM
715-847-3251
JOHN M R KUHN MD
1107 WOODWARD AVENUE
ROTHSCHILD WI 54474
PS GS / GS PS
715-842-0557
JEFFREY A KURTZ MD
SUITE 202
425 PINF RIDGE BLVD
WAUSAU WI 54401
GS OS / GS
715-842-4485
ROY B LARSEN MD
2219 RIDGE VIEW DRIVE
WAUSAU WI 54401
P / P
715-842-1636
DAVID L LARSON MD
1100 LAKE VIEW DRIVE
WAUSAU WI 54401
AN / AN
WOLFRAM G LOCHER MD
3326 NORTH IITH STREET
WAUSAU WI 54401
AN / AN
715-845-5505
SUZANNE G H LOW MD
502 E LAKE SHORE DRIVE
WAUSAU WI 54401
PD ADL / PD
MADHU V I UTHRA MD
SUITE 110
2800 WESTHILL DRIVE
WAUSAU WI 54401
DR R / R
VI NAY D L UTHRA MD
604 STURGEON EDDY ROAD
WAUSAU WI 54401
OPH / OPH
715-845-8201
CHARLES F MAC CARTHY MD
614 FIRST STREET
POST OFFICE BOX 689
WAUSAU WI 54401
CD IM / IM
ROBERT W MACK IE JR MD
2727 PLAZA DRIVE
WAUSAU WI 54401
R
WILLIAM M MAHONY MD
1010 HIGHLAND PARK BLV
WAUSAU WI 54401
OM
OTTO T MALLERY MD
GOVERNOR HARBOR
ELEUTHERA
BAHAMA
TR R / TR
715-847-3506
JACOB H MARTENS MD
2727 PLAZA DRIVE
WAUSAU WI 54401
AN
BARRY A MAXFIELD MD
SUITE 207
425 PINE RIDGE BLVD
WAUSAU WI 54401
ORS / ORS
715-842-3202
THOMAS 0 MILLER MD
SUITE 300
425 PINE RIDGE BLVD
WAUSAU WI 54401
D A / D
715-842-4665
WILLIAM C MILLER MD
808 THIRD STREET
WAUSAU WI 54401
P / PN
RICHARD L MINN I HAN MD
3022 NORTH 12TH STREET
WAUSAU WI 54401
EM / EM
715-847-2160
MARK J MIRICK MD
333 PINE RIDGE BLVD
WAUSAU WI 54401
GS / GS
715-847-3241
ALBERT J MOLINARO MD
2727 PLAZA DRIVE
WAUSAU WI 54401
PD
JOSEPH M MONACO MD
2727 PLAZA DRIVE
WAUSAU WI 54401
FP / FP
715-355-1993
JEFFREY L MOORE MD
APT 14
1924 EVA ROAD
MOSINEE WI 54455
PTH / PTH
RICHARD T MOREHEAD MD
808 THIRD STREET
WAUSAU WI 54401
GS
715-842-3262
ERICH C MUEHLENBECK MD
SUITE 102
2800 WESTHILL DRIVE
WAUSAU WI 54401
FP / FP
715-693-671 1
RICHARD G NASH MD
607 13TH STREET
MOSINEE WI 54455
FP / FP
715-675-3391
RICK A NICOSKI MD
995 CAMPUS DRIVE
WAUSAU WI 54401
FP
715-675-6520
WILLIAM C NIETERT MD
2010 LITTLE RIB CIRCLE
WAUSAU WI 54401
CD IM / CD IM
71 5—847—3335
MAURICE J NORMAN MD
2727 PLAZA DRIVE
WAUSAU WI 54401
FP / FP
715-847-3545
DAVID P NORTH MD
903 HAMILTON STREET
WAUSAU WI 54401
R / R
DONALD M NOW INSKI MD
SUITE 209
425 PINE RIDGE BLVD
WAUSAU WI 54401
PD / PD
715-847-3573
RICHARD C O'CONNOR MD
2727 PLAZA DRIVE
WAUSAU WI 54401
MARATHON, MARINETTE/FLORENCE— 45
NS N /NS
715-845-7326
TEOFILO D ODULIO MD
SUITE 301
425 PINE RIDGE BLVD
WAUSAU WI 54401
D / D
WILLIAM R OWEN MD
2727 PLAZA DRIVE
WAUSAU WI 54401
FP / FP
715-675-3391
THOMAS H PETERSON MD
995 CAMPUS DRIVE
WAUSAU WI 54401
PD
ROBERT R POOLE MD
2727 PLAZA DRIVE
WAUSAU WI 54401
IM / IM
715-848-2811
RICK R REDING MD
SUITE 104
2800 WESTHILL DRIVE
WAUSAU WI 54401
IM / IM
715-842-0974
THOMAS N RENGEL MD
SUITE 205
425 PINE RIDGE BLVD
WAUSAU WI 54401
P / P
715-842-1636
BRUCE C RHOADES MD
1100 LAKEVIEW DRIVE
WAUSAU WI 54401
FP
STEVEN L ROSAS MD
995 CAMPUS DRIVE
WAUSAU WI 54401
OPH / OPH
715-845-8201
LAWRENCE J ROSSMAN MD
POST OFFICE BOX 689
WAUSAU WI 54401
FP / FP
STEPHEN C ROUSH MD
615 PLUMER STREET
WAUSAU WI 54401
PD ADL / PD
715-848-2811
WARREN B RUDY MD
SW104
2800 WESTHILL DRIVE
WAUSAU WI 54401
OTO HNS / OTO
715-845-9635
J GARRY SACK MD
SUITE 305
425 PINE RIDGE BLVD
WAUSAU WI 54401
PD GP
SHELDON A SCHOOLER MD
320 ROSE AVENUE
SCHOFIELD WI 54476
DR N /DR
715-675-9900
LAWRENCE H SCHOTT MD
1818 LENARD STREET
WAUSAU WI 54401
IM / IM
715-848-1495
GERALD H SCHROEDER MD
SUITE 211
425 PINE RIDGE BLVD
WAUSAU WI 54401
PD
ELLEN M SCHUMANN MD
2727 PLAZA DRIVE
WAUSAU WI 54401
GS EM
715-675-6754
RICHARD C SHANNON MD
1819 LENARD STREET
WAUSAU WI 54401
FP / FP
715-842-0491
BURTON K SMITH MD
212 STURGEON EDDY ROAD
WAUSAU WI 54401
GS
STEPHEN M SPELTZ MD
1304 EAST TROY STREET
WAUSAU WI 54401
N / N
715-847-3354
GIZELLE A SPURGEON MD
2727 PLAZA DRIVE
WAUSAU WI 54401
FP OBS GYN / FP OBG
715-845-7231
ALBERT H STAHMER MD
404 SOUTH THIRD AVENUE
WAUSAU WI 54401
GS / GS
KARL H STAHMER MD
404 SOUTH THIRD AVENUE
WAUSAU WI 54401
N
715-847-3354
IVAN STANKO MD
2727 PLAZA DRIVE
WAUSAU WI 54401
OBG / DBG
THOMAS A STARKEY MD
2727 PLAZA DRIVE
WAUSAU WI 54401
ORS / ORS
STEVEN C STODDARD MD
2727 PLAZA DRIVE
WAUSAU WI 54401
N
715-845-7368
RAYMOND J SZMANDA DO
SUITE 301
425 PINE RIDGE BLVD
WAUSAU WI 54401
IM / IM
715-359-9467
DAVID B TANGE MD
1840 HIGHWAY XX
MOSINEE WI 54455
ORS / ORS
GEORGE R TANNER MD
2727 PLAZA DRIVE
WAUSAU WI 54401
AI / AI
715-847-3392
GEOFFREY TAYLOR MD
2727 PLAZA DRIVE
WAUSAU WI 54401
FP / FP
715-847-3541
ARTHUR M WALDMAN MD
2727 PLAZA DRIVE
WAUSAU WI 54401
IM
ROBERT J WARE MD
POST OFFICE BOX 275
MARATHON WI 54448-0275
FP / FP
DENNIS W WESTERN MD
8604 BUTTERCUP ROAD
WAUSAU WI 54401-9344
FP / FP
715-842-0491
DARRELL L WITT MD
212 STURGEON EDDY ROAD
WAUSAU WI 54401
OPH / OPH
GEORGE J WITTEMAN MD
POST OFFICE BOX 689
WAUSAU WI 54401
OTO / OTO
715-845-9634
LEONARD H WURMAN MD
SUITE 305
425 PINE RIDGE BLVD
WAUSAU WI 54401
IM PUD
715-842-4717
CALVIN M YORAN MD
2006 LAMONT STREET
WAUSAU WI 54401
OBG / OBG
715-847-3295
EARL W ZABEL MD
2727 PLAZA DRIVE
WAUSAU WI 54401
U / U
PHILIP M ZICKERMAN MD
2727 PLAZA DRIVE
WAUSAU WI 54401
EM
GARY A ZIMBRIC MD
518 REMINGTON ROAD
MOSINEE WI 54455
MARINETTE-FLORENCE
FP
71 S — SPD — ilSAI
ANTOINE BARRETTE MD
132 NORTH EMERY STREET
PESHTIGO WI 54157
IM / IM
715-735-7421
NEIL C BINKLEY MD
1510 MAIN STREET
MARINETTE WI 54143
IM
715-732-4220
A BOHORFOUSH I I I MD
130 HATTIE STREET
MARINETTE WI 54143
FP
715-735-7421
CLARK H BOREN MD
1510 MAIN STREET
MARINETTE WI 54143
GS / GS
JAMES A BOREN MD
2910 WHITE STREET
MARINETTE WI 54143
PD
STEPHEN C CASELTON MD
2500 HALL AVENUE
MARINETTE WI 54143
OBS / FP
HAROLD P CRISSINGER MD
2500 HALL AVENUE
MARINETTE WI 54143
GP
DAVID D DARCY MD
2500 HALL AVENUE
MARINETTE WI 54143
GS CDS / GS
715-735-7421
J BRYAN FLYNN MD
1510 MAIN STREET
MARINETTE WI 54143
IM PUD / IM PUD
715-735-7421
THOMAS F FOLEY MD
1510 MAIN STREET
MARINETTE WI 54143
OBG
715-735-7112
JOHN W GAY MD
1510 MAIN STREET
MARINETTE WI 54143
OPH / OPH
STEVEN H HDYME MD
801 WELLS STREET
MARINETTE WI 54143
GP
715-735-3356
CHARLES E KOEPP MD
2500 HALL AVENUE
MARINETTE WI 54143
IM NEP / IM
JOHN E KRAUS MD
1510 MAIN STREET
MARINETTE WI 54143
GP
715-856-5131
ALICE M LEE MD
WAUSAUKEE WI 54177
FP
715-854-7477
RANDALL W LEWIS DO
POST OFFICE BOX 339
CRIVITZ WI 54114-0339
GS
DEAN A MAGNIN MD
1510 MAIN STREET
MARINETTE WI 54143
IM / IM
715-735-3356
ELWYN C MANTEI MD
2500 HALL AVENUE
MARINETTE WI 54143
GP
KENNETH J MOSS MD
2500 HALL AVENUE
MARINETTE WI 54143
GP OS
RALPH B PELKEY MD
ROUTE 2 BOX 17
CRIVITZ WI 54114
FP GS
715-735-3356
KENNETH G PINEGAR MD
2500 HALL AVENUE
MARINETTE WI 54143
GS / GS
715-735-3356
JOHN D PINKERTON MD
2500 HALL AVENUE
MARINETTE WI 54143
PTH / PTH
414-834-4745
RAYMOND J ROGERS MD
ROUTE 1 BOX 52
OCONTO WI 54153
IM / IM
715-735-3356
BURNELL n STRIPLING MD
2500 HALL AVENUE
MARINETTE WI 54143
ORS / ORS
JAMES TANDIAS MD
POST OFFICE BOX 435
MARINETTE WI 54143
46— MARINETTE/FLORENCE, MILWAUKEE
PD / PD
JUNG-NAN TSAI MD
1510 MAIN STREET
MARINETTE WI 54143
GER HYP P
715-582-4240
HENRY VEIT MD
ROUTE 1 BOX 81 W
MARINETTE WI 54143
PD
715-735-7421
KEVIN P WONG MD
1510 MAIN STREET
MARINETTE WI 54143
FP DBS / FP
715-735-7421
LEONARD R WORDEN MD
1510 MAIN STREET
MARINETTE WI 54143
ORS HS / ORS
715-732-1745
KENNETH H YUSKA MD
1424 NEWBERRY AVENUE
MARINETTE WI 54143-2498
GP GS
JAMES D ZERATSKY MD
1510 MAIN STRET
MARINETTE WI 54143
MILWAUKEE
OPH / OPH
414-257-5341
THOMAS M AABERG MD
8700 W WISCONSIN AVE
MILWAUKEE WI 53226
IM
WAD IE A ABDALLAH MD
3533 E RAMSEY AVENUE
CUDAHY WI 53110
R / R
414-384-2000
JULIAN E ABRAMS MD
RADIOLOGY DEPT 114
5000 W NATIONAL AVENUE
WOOD WI 53193
IM CD / IM
414-444-1123
RAMON E ACEVEDO MD
SUITE 601
3070 NORTH 51 ST STREET
MILWAUKEE WI 53210
GP
DONALD S ACKERMAN MD
6815 W CAPITOL DRIVE
MILWAUKEE WI 53216
GP
EUGENE J ACKERMAN MD
12335 N COLONY DRIVE
23W MEQUON WI 53092
GS R /DR NS
J ADAMKIEWICZ JR MD
2900 W OKLAHOMA AVENUE
MILWAUKEE WI 53215
IM
ALBERT H ADAMS MD
5757 W OKLAHOMA AVENUE
MILWAUKEE WI 53219
IM PUD
ROBERT T ADLAM MD
5324 N SANTA MONICA BL
MILWAUKEE WI 53217
FP / FP
414-421-8400
SALPI ADROUNY MD
6901 WEST EDGERTON
MILWAUKEE WI 53220
PD
414-873-3440
AVADH B AGARWAL MD
4300 W BURLEIGH STREET
MILWAUKEE WI 53210
R / R
CHARLES H ALBRECHT MD
2201 GENESSEE STREET
UNICA NY 13501
OBG / DBG
414-425-1790
DONALD J ALBRECHT MD
11035 W FOREST HOME AV
HALES CORNERS WI 53130
OPH
414-259-1420
LARKIN N ALLEN DO
9900 W BLUEMDUND ROAD
MILWAUKEE WI 53226
414-259-3925
STEVEN R ALLEN
APT 236
313 NORTH 95TH STREET
MILWAUKEE WI 53226
GS / GS
414-342-0777
S DAVID P ALTMAN MD
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
PTH / PTH
CHARLES H ALTSHULER MD
7929 NORTH REGENT ROAD
MILWAUKEE WI 53217
PD / PD
414-425-5660
JOHN F ALTSTADT MD
11035 W FOREST HOME AV
HALES CORNERS WI 53130
FP / FP
414-444-7788
DAVID E AMOS MD
4823 WEST NORTH AVENUE
MILWAUKEE WI 53208
CHP P / CHP P
4 14—27 1—5555
JOHN T ANDERSEN MD
2350 NORTH LAKE DRIVE
MILWAUKEE WI 53211
EM FP / FP
DENNIS ANDERSON MD
2900 W OKLAHOMA AVENUE
MILWAUKEE WI 53215
U / U
414-258-2640
FRANCIS I ANDRES MD
2500 N MAYFAIR ROAD
MILWAUKEE WI 53226
U / U
414-258-2640
WILLIAM H ANNESLEY JR MD
2500 N MAYFAIR ROAD
WAUWATOSA WI 53226
AN / AN
414-259-9700
SHAMIM A ANSARI MD
2825 NORTH MAYFAIR RD
MILWAUKEE WI 53222
ORS / ORS
305-921-5281
DAVID J ANSFIELD MD
APT 601
1410 SOUTH OCEAN DRIVE
HOLLYWOOD FL 33019
P N
415-493-9120
HERBERT J APFELBERG MD
APT 37
696 TOWLE WAY
PALO ALTO CA 94306
GP
KEITH B APPLEBY MD
APT A212
8949 NORTH 97TH STREET
MILWAUKEE WI 53224
OTO OT MFS / OTO
414-769-9065
SENEKERIM ARMAGAN MD
5820 S PACKARD AVENUE
CUDAHY WI 53110
PD
414-771-0500
HEBATOLLAH S ASHRAF MD
949 GLENVIEW AVENUE
MILWAUKEE WI 53213
PD / PD
414-466-9530
MELVIN M ASKOT MD
3975 N 68TH STREET
MILWAUKEE WI 53216
IM BLB / IM
414-933-5000
RICHARD H ASTER MD
POST OFFICE BOX 10-G
MILWAUKEE WI 53201
OBG / OBG
414-647-8100
YASAR I ATAMDEDE MD
3333 SOUTH 27TH STREET
MILWAUKEE WI 53215
TS CDS GS / TS GS
414-649-3600
JAMES E AUER MD
2901 WEST KINNICKINNIC
RIVER PARKWAY #311
MILWAUKEE WI 53215
IM GER
414-937-5966
DONALD C AUSMAN MD
SUITE W215
940 NORTH 23RD STREET
MILWAUKEE WI 53233
414-964-5922
RENATE AUSTIN
APT 130
2720 N FREDERICK AVE
MILWAUKEE WI 53211
CHP P PD / CHP P
414-332-7333
BRUCE H AXELROD MD
127 E SILVER SPRING DR
MILWAUKEE WI 53217
PD / PD
414-476-4207
SHANTA AYENGAR MD
APT 6
170 NORTH 76TH STREET
MILWAUKEE WI 53213
FP / FP
CESAR S AZCUETA MD
3565 N GREEN BAY AVE
MILWAUKEE WI 53212
OBG
ESTER S AZCUETA MD
SUITE 715
2315 NORTH LAKE DRIVE
MILWAUKEE WI 53211
FP
414-351-2448
RENATO S AZCUETA MD
8120 N MOHAWK AVENUE
FOX POINT WI 53217
PDR R / R
DONALD P BABBITT MD
2701 EAST BEVERLY ROAD
MILWAUKEE WI 53211
OBG / DBG
ALLEN H BABBITZ MD
1218 W KILBOURN AVENUE
MILWAUKEE WI 53233
GP
414-871-5330
LOUIS BABBY MD
6001 W CENTER STREET
MILWAUKEE WI 53210
OBG / OBG
414-442-4800
DONALD J BACCUS MD
3070 NORTH 51ST STREET
MILWAUKEE WI 53210
GS / GS
414-387-2595
EDWARD A BACHHUBER MD
607 RIVER DRIVE
MAYVILLE WI 53050
OBG
IK HAK BAE MD
11035 W FOREST HOME AV
HALES CORNERS WI 53130
OBG / OBG
RAJINDER K BAHAL MD
100 15TH AVENUE
SOUTH MILWAUKEE WI 53172
PM / PM
414-647-5242
SANTOSH K BAHAL MD
3237 SOUTH 16TH STREET
MILWAUKEE WI 53215
R / R
414-546-6452
ROBERT D BAHR MD
8901 W LINCOLN AVENUE
WEST ALLIS WI 53227
IM CD
414-453-5870
ARMIN R BAIER MD
6745 WEST WELLS STREET
WAUWATOSA WI 53213
OBG / OBG
414-321-1 100
WILLIAM W BAIRD MD
8531 W LINCOLN AVENUE
POST OFFICE BOX 27247
WEST ALLIS WI 53227
P N / P N
414-259-0230
DURWARD A BAKER MD
SUITE 1130
2300 N MAYFAIR ROAD
MILWAUKEE WI 53226
GP
VANCE L BAKER MD
4808 WEST LLOYD STREET
MILWAUKEE WI 53208
IM / IM
WILLIAM V BAKER MD
SUITES 308-09
2500 N MAYFAIR ROAD
WAUWATOSA WI 53226
IM PUD
414-272-2985
EDWARD F BANASZAK MD
SUITE 803
2315 NORTH LAKE DRIVE
MILWAUKEE WI 53211
PD A
414-442-6970
PEDRO N BANDA MD
6030 W CAPITOL DRIVE
MILWAUKEE WI 53216
MILWAUKEE— 47
CDS GS / GS
DENNIS F BANDYK MD
DEPT OF SURGERY
8700 W WISCONSIN AVE
MILWAUKEE WI 53226
IM PUD / IM
813-898-5961
ANDREW L BANYAI MD
470 THIRD STREET SOUTH
ST PETERSBURG FL 33701
PTH / PTH
JOHN M BARETA MD
5000 W CHAMBERS STREET
MILWAUKEE WI 53210
D / D
414-342-2232
SHELDON M BARNETT MD
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
OBG
414-425-1790
CARMELA A BARR MD
11035 W FOREST HOME AV
HALES CORNERS WI 53130
414-475-5472
VERONICA BARR
#208
1252 NORTH 68TH
WAUWATOSA WI 53213
D
414-272-4113
JAMES J BARROCK MD
SUITE 317
152 W WISCONSIN AVENUE
MILWAUKEE WI 53203
414-259-0057
LINDA J BARROWS
10416 FISHER PARKWAY
WAUWATOSA WI 53226
CHP P PD / PD P CHF
414-931-4091
RICHARD P BARTHEL MD
1700 W WISCONSIN AVE
POST OFFICE BOX 1997
MILWAUKEE WI 53201
DR GS / R
CARL B BARTHELEMY MD
DEPT OF RADIOLOGY
VA MEDICAL CENTER
WOOD WI 53193
OTO / OTO
414-649-3900
JAMES R BARTON MD
2901 W KINNICKINNIC
RIVER PARKWAY #201
MILWAUKEE WI 53215
OBG
414-464-4227
PATRICIA M BARWIG MD
5539 NORTH 33RD STREET
MILWAUKEE WI 53209
A IG IM / IM
414-425-5750
JOHN E BASICH MD
10950 WEST FOREST HOME
HALES CORNERS WI 53130
PTH OM / PTH
414-931-7600
GEORGE E BATAYIAS MD
500 NORTH 19TH STREET
MILWAUKEE WI 53233
IM
414-444-0869
RICHARD J BATIIOLA MD
2442 NORTH 51ST STREET
MILWAUKEE WI 53210
ORS / OHS
MARK A BAUER MD
11035 W FOREST HOME AV
HALES CORNERS WI 53130
P
414-774-4400
WILLIAM BAUER MD
11803 W NORTH AVENUE
MILWAUKEE WI 53226
GS
RICHARD 0 BAUMAN MD
8332 NORTH LAKE DRIVE
MILWAUKEE WI 53217
OBG GP
414-447-2000
BRIAN J BEAR MD
APT 8B
1633 N PROSPECT AVENUE
MILWAUKEE WI 53202
OM GS ORS
414-671-7000
JAMES M BEARDEN MD
2400 W LINCOLN AVENUE
MILWAUKEE WI 53215
FP / FP
DONALD R BEAVER DO
6901 W EDGERTON AVENUE
POST OFFICE BOX 20928
MILWAUKEE WI 53220
PD / PD
305-562-7324
KARL H BECK MD
APT 202
63 WOODLAND DRIVE
VERO BEACH FL 32962
ORS / ORS
DAVID L PECKER MD
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
GE IM / GE IM
414-276-1906
IRVIN M BECKER MD
SUITE 704
788 N JEFFERSON STREET
MILWAUKEE WI 53202
IM / IM
414-964-0204
JOHN F BECKER MD
1720 E LAKE BLUFF BLVD
MILWAUKEE WI 53211
CD IM
MICHAEL D BECKER MD
APT 1605
4820 WESTGROVE
DALLAS TX 75248-2546
P / P
414-258-2600
ASHOK R BED I MD
1220 DEWEY AVENUE
WAUWATOSA WI 53213
IM
FRANK H BELFUS MD
POST OFFICE BOX 601
MILWAUKEE WI 53201
OBG
414-321-4500
DAVID N BELL IS MD
7635 W OKLAHOMA AVENUE
MILWAUKEE WI 53219
FP / FP
LUCIANO H BELTRAN MD
1834 W WISCONSIN AVE
MILWAUKEE WI 53233
GP OM
BORIS I BENDER MD
5366 N MOHAWK AVENUE
MILWAUKEE WI 53217
GS
414-453-7422
HIRAM B BENJAMIN MD
6168 WASHINGTON CIRCLE
MILWAUKEE WI 53213
A IM / AI IM
414-271-4204
MARSHALL. H BENNER MD
SUITE 900
324 E WISCONSIN AVENUE
MILWAUKEE WI 53202
FP
414-545-7245
AMY K BENNETT MD
6917 W OKLAHOMA AVENUE
MILWAUKEE WI 53219
GP
RICHARDS D BENSHOFF DO
6026 W LISBON AVENUE
MILWAUKEE WI 53210
OS
414-258-2600
DAVID G BENZER DO
1220 DEWEY AVENUE
WAUWATOSA WI 53213
OBG
MICHAEL E BERCEK MD
N85 W15700 RIDGE ROAD
MENOMONEE FALLS WI 53051
OPH / OPH
414-354-2360
EDWIN B BERCOVICI MD
5678 W BROWN DEER ROAD
MILWAUKEE WI 53223
NS N /NS
GEORGE A J BERGLUND MD
SUITE 107
3070 NORTH 51ST STREET
MILWAUKEE WI 53210
FP IM
414-541-6330
GERALD J BERGMANN MD
5232 W OKLAHOMA AVE
MILWAUKEE WI 53219
414-778-0620
STEVEN R BERGQUIST
APT 4
9235 W WISCONSIN AVE
MILWAUKEE WI 53226
D / D
4 t 4—355—2405
ALEXANDER BERMAN MD
7400 W BROWN DEER ROAD
MILWAUKEE WI 53223
GP
LOUIS A BERNHARD MD
1610 N PROSPECT AVENUE
MILWAUKEE WI 53202
GP
HARVEY H BERNSTEIN MD
UNIT 137
2300 W GOOD HOPE ROAD
MILWAUKEE WI 53209
PD / PD
414-352-2620
SUSAN R BERNSTEIN MD
130 W ELLSWORTH LANE
BAYSIDE WI 53217
N /PD
414-536-0800
FERIDOUN BEROUKHIM MD
SUITE 112
2400 SOUTH 90TH STREET
WEST ALLIS WI 53227
GS / GS
FRANK E BERRIDGE JR MD
2050 CLOVER HILL ROAD
ELM GROVE WI 53122
PM / PM
414-649-7709
RAM PARVESH BHALA MD
2900 W OKLAHOMA AVENUE
MILWAUKEE WI 53215
P
414-765-0225
JAYAWANT N BHORE MD
1543 N PROSPECT AVENUE
MILWAUKEE WI 53202
GP FP
ROMEO B BIBOSO MD
100 15TH AVENUE
SOUTH MILWAUKEE WI 53172
GP
JAMES H BILLER MD
101 WEST BERGEN DRIVE
MILWAUKEE WI 53217
OBG
MILTON M BINES MD
606 W WISCONSIN AVE
■MILWAUKEE WI 53203
GE IM / GE IM
414-546-1513
JOHN T BJORK MD
SUITE 206
5757 W OKLAHOMA AVENUE
MILWAUKEE WI 53219
PYA P
DAVID P BLACK MD
2321 E STRATFORD COURT
MILWAUKEE WI 53226
PYA P
414-933-1084
SAMUEL B BLACK MD
SUITE 675
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
P PA / PN
414-289-8620
BARRY BLACKWELL MD
POST OFFICE BOX 342
MILWAUKEE WI 53201
OPH / OPH
4 1 4—933—3795
SAMUEL S BLANKSTEIN MD
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
OTO HNS / OTO
414-543-3100
DONALD S BLATNIK MD
2400 SOUTH 90TH STREET
WEST ALl IS WI 53227
D
414-771-4060
DAVID C BLEIL MD
SUITE 680
2300 N MAYFAIR ROAD
WAUWATOSA WI 53226
P / PN
CRAIN H BLIWAS MD
2200 W KILBOURN AVENUE
MILWAUKEE WI 53233
ORS / ORS
WALTER P BLOUNT MD
2825 N HACKETT AVENUE
MILWAUKEE WI 53211
PS GS / PS GS
414-271-8283
HARVEY M BOCK MD
SUITE 807
2315 NORTH LAKE DRIVE
MILWAUKEE WI 53211
DR / DR
ROBERT M BOEX MD
2820 CAMBRIDGE CIRCLE
BROOKFIELD WI 53005
AN / AN
WARREN C BOGLE SR MD
N27 W27338 WOODLAND DR
PEWAUKEE WI 53072
48— MILWAUKEE
P / FP
BRUCE R BOGOST MD
W303 N5965 SEHLER'S LN
HARTLAND WI 53029
DR / DR
414-546-6440
JEFFREY R BOND MD
8901 W LINCOLN AVENUE
WEST ALLIS WI 53227
OM
JOHN M BOND MD
2012 NAGAWICKA ROAD
HARTLAND WI 53029
P
414-271-5555
JOHN T BOND MD
2350 NORTH LAKE DRIVE
MILWAUKEE WI 5321 1
EM / EM
414-258-8679
LANDY E BONELLI MD
1434 N 122ND STREET
WAUWATOSA WI 53226
IM / IM
MILTON C BORMAN MD
324 E WISCONSIN AVE
MILWAUKEE WI 53202
FP
414-242-1244
SAMUEL L BORNSTEIN MD
2304 W DICKINSON COURT
MEQUON WI 53092
IM / IM
MORTIMER M BORTIN MD
MCOW
POST OFFICE BOX 26509
MILWAUKEE WI 53226
CD IM / CD IM
JAMES T BOTTICELLI MD
SUITE 890
2300 N MAYFAIR ROAD
MILWAUKEE WI 53226
IM / IM
414-453-5870
MICHAEL W BOTTOM MD
6745 WEST WELLS STREET
MILWAUKEE WI 53213
GS / GS
414-961-221 1
WAYNE J BOULANGER MD
2015 E NEWPORT AVENUE
MILWAUKEE WI 53211
U / U
414-352-3100
CHARLES W BOURNE MD
3003 W GOOD HOPE ROAD
POST OFFICE BOX 17300
MILWAUKEE WI 53217
U / U
N WARREN BOURNE MD
SUITE 545
2600 N MAYFAIR ROAD
MILWAUKEE WI 53226
U / U
414-476-0430
RICHARD B BOURNE MD
SUITE 545
2600 N MAYFAIR ROAD
MILWAUKEE WI 53226
GS CDS / GS
414-327-3120
JOHN W BOWMAN MD
5757 W OKLAHOMA AVENUE
MILWAUKEE WI 53219
GP
414-351-0683
LEO M BOXER MD
APT C— 1 1 3
500 WEST BRADLEY ROAD
FOX POINT WI 53217
U GS / U
414-527-3000
RICHARD J BOXER MD
SUITE 301
2350 W VILLARD AVENUE
MILWAUKEE WI 53209
FP
4 14—352—2529
SIDNEY M BOXER MD
8700 NORTH PORT
WASHINGTON ROAD
MILWAUKEE WI 53217
OBG / OBG
414-352-3100
ANDREW BOYD JR MD
3003 W GOOD HOPE ROAD
POST OFFICE BOX 17300
MILWAUKEE WI 53217
PM / PM
ROBERT W BOYLE MD
5000 W NATIONAL AVENUE
WOOD WI 53193
ORB / ORS
EVERETT C BRAGG MD
730 EAST SYLVAN AVENUE
WHITEFISH DAY WI 53217
GS
414-242-9363
WILLIAM A BRAH MD
10008 N HOLMES CT 22W
MEQUON WI 53092
OTO OPH
414-271-5667
WILLIAM D BRAND MD
SUITE 505
238 W WISCONSIN AVENUE
MILWAUKEE WI 53203
IM
414-271-3700
WILLIAM I BRAUNSTEIN MD
2388 NORTH LAKE DRIVE
MILWAUKEE WI 53211
FP GER / AN
414-541-3114
ROBERT R BRAZY MD
6900 W LINCOLN AVENUE
WEST ALLIS WI 53219
OBG / OBG
414-344-3760
JOHN J BRENNAN MD
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
ORS / ORS
414-257-5432
BRUCE J BREWER MD
DEPT OF ORTHO SURGERY
8700 W WISCONSIN AVE
MILWAUKEE WI 53226
GP OPH
CHARLES R BRILLMAN MD
1610 N PROSPECT AVENUE
MILWAUKEE WI 53202
AN / AN
CHARLES BRINDIS MD
2025 NEWPORT AVENUE
MILWAUKEE WI 53211
CHARLES B BRINKLEY III
APT 3
6702 W ST PAUL AVENUE
MILWAUKEE WI 53213
OBG / OBG
FREDRIK F BROEKHUIZEN MD
4830 NORTH WOODBURN
WHITEFISH BAY WI 53217
KATHERINE A BRONER
APT 5
252 CHATTANOOGA STREET
SAN FRANCISCO CA
94114-3424
GS / GS
414-671-3330
JOHN R BROWN MD
SUITE 317
2901 W KK RIVER PKWY
MILWAUKEE WI 53215
ORS / ORS
414-351-3500
DOMENICK S BRUNO MD
7545 NORTH PORT
WASHINGTON ROAD
MILWAUKEE WI 53217
PD PUD / PD
W THEODORE BRUNS MD
10425 W NORTH AVENUE
WAUWATOSA WI 53226
FP
414-258-5235
TIMOTHY G BUCHANAN MD
2562 NORTH BOTH STREET
WAUWATOSA WI 53213
OBG / OBG
414-778-0070
WILLIAM J BUGGY MD
2500 N MAYFAIR ROAD
MILWAUKEE WI 53226
P
414-257-4871
ROBERT S BUJARD JR MD
9201 WATERTOWN PLANK
ROAD
MILWAUKEE WI 53226
GS / GS
FREDERICK BUNKFELDT MD
POST OFFICE BOX V
ELKHART LAKE WI 53020
AN
414-276-1627
SHELDON L BURCHMAN MD
2266 N PROSPECT AVENUE
MILWAUKEE WI 53202
PTH / PTH
414-961-3950
EDWARD A BURG JR MD
2025 E NEWPORT AVENUE
MILWAUKEE WI 53211
P N
JOSEPH J BURGARINO MD
3950 N DOWNER AVENUE
MILWAUKEE WI 53211-2442
GYN / OBG
GORDON F BURGESS JR MD
2015 E NEWPORT AVENUE
MILWAUKEE WI 53211
R / R
HENRY BURKO MD
POST OFFICE BOX 342
MILWAUKEE WI 53201
GP GS
ANTHONY T BUSCAGLIA MD
405 S COUNTRY CLUB DR
ATLANTIS FL 33462
OPH OTO / OPH
414-644-8738
ARTHUR D BUSSEY MD
5572 WEST LAKE DRIVE
ROUTE 5
WEST BEND WI 53095
PD
TED S BUSZKIEWICZ MD
5535 GRANDVIEW DRIVE
GREENDALE WI 53129
R
414-769-4062
RICHARD R BYRNE MD
5900 SOUTH LAKE DRIVE
CUDAHY WI 53110
AN GP
ERNESTO C CABABA MD
18760 YORKSHIRE LANE
BROOKFIELD WI 53005
PTH CLP / PTH
ANTHONY F CAFARD MD
5000 W CHAMBERS STREET
MILWAUKEE WI 53210
PTH / PTH
JOHN R CAFARO MD
5000 W CHAMBERS STREET
MILWAUKEE WI 53210
GP
414-442-3660
DUMITRU I CAIMACAN MD
2700 NORTH 35TH STREET
MILWAUKEE WI 53210
IM
414-671-7000
DONALD CAINE MD
2400 WEST LINCOLN AVE
MILWAUKEE WI 53215
IM / IM
414-671-7000
MARC R CAINE MD
2400 WEST LINCOLN AVE
MILWAUKEE WI 53215
OTO HNS
JEFFERSON N CALIMLIM MD
2388 NORTH LAKE DRIVE
MILWAUKEE WI 53211
FP / FP
414-476-0628
ROBERT E CALLAN MD
668 NORTH 78TH STREET
WAUWATOSA WI 53213
U / U
414-258-5973
DONALD W CALVY MD
950 NORTH 75TH STREET
WAUWATOSA WI 53213
IM CD / IM
THOMAS L CALVY MD
8205 ROCKWAY PLACE
MILWAUKEE WI 53213
IM ON / IM
414-271-1444
SHANKLIN B CANNON MD
720 E WISCONSIN AVENUE
MILWAUKEE WI 53202
KENDALL L CAPECCI
3229 W COLONY DRIVE
GREENFIELD WI 53221
OPH / OPH
EVAN F CARL MD
2500 N MAYFAIR ROAD
MILWAUKEE WI 53226
PTH / PTH
DAVID J CARLSON MD
8220 BROOKSIDE PLACE
WAUWATOSA WI 53213
AN / AN
FREDERICK J CARPENTER MD
620 NORTH 75TH STREET
MILWAUKEE WI 53213
IM
414-332-5873
ALFRED CARTES MD
155 E SILVER SPRING DR
MILWAUKEE WI 53217
FP
JOHN F CARY MD
4183 W COLLEGE AVENUE
MILWAUKEE WI 53221
MILWAUKEE— 49
GS
602-625-2031
WILLIAM T CASPER MD
1889 S ABREGO DRIVE
GREEN VALLEY AZ 85614
OBG
MARCELO G CASTILLO MD
4950 N WDDDBURN STREET
WHITEFISH BAY WI 53217
ANTHONY J CAVAZOS
12301 W DEARBOURN AVE
WAUWATOSA WI 53226
PTH CLP / PTH CLP
414-257-6201
JAMES G CAYA MD
DEPT OF PATHOLOGY
8700 W WISCONSIN AVE
MILWAUKEE WI 53226
EM
JAMES M CERVENANSKY MD
8530 W HAWTHORNE LANE
FRANKLIN WI 53132
OPH / OPH
THOMAS J CESAR Z MD
SUITE 1155
2300 N MAYFAIR ROAD
WAUWATOSA WI 53226
ORS / ORS
414-654-7300
WILLIAM P CHALOS MD
SUITE 2005
3201 SOUTH 16TH STREET
MILWAUKEE WI 53215
IM / IM
414-272-6310
JOHN 0 CHAMBERLAIN MD
324 E WISCONSIN AVENUE
MILWAUKEE WI 53202
OBG / OBG
LAROYCE F CHAMBERS MD
940 NORTH 23RD STREET
MILWAUKEE WI 53233
HS GS / GS
414-453-7418
LEWIS CHAMOY MD
SUITE 100
2300 N MAYFAIR ROAD
MILWAUKEE WI 53226
P / P
414-963-2403
CARLYLE H CHAN MD
3521 N PROSPECT AVENUE
MILWAUKEE WI 53211
GE IM / GE IM
414-276-8499
SEKON CHANG MD
SUITE 10)0
2315 NORTH LAKE DRIVE
MILWAUKEE WI 53211
CDS TS GS / TS GS
414-271-1170
MOHAMMAD A CHEEMA MD
SUITE 911
2315 NORTH LAKE DRIVE
MILWAUKEE WI 53211
CD IM
CARL J CHELIUS MD
3533 EAST RAMSEY AVE
CUDAHY WI 53110
IM
JAGAN M CHINTAMANENI MD
2388 NORTH LAKE DRIVE
MILWAUKEE WI 53211
PD / PD
MEENAKSHI CHINTAPALLI MD
4105 BEAUFORT DRIVE
BROOKFIELD WI 53005
OPH / OPH
DONALD E CHISHOLM MD
10425 WEST NORTH AVE
MILWAUKEE WI 53226
U 7 U
C CHOITHANI MD
2388 NORTH LAKE DRIVE
MILWAUKEE WI 53211
OBG / OBG
HANSA C CHOITHANI MD
4778 N CRAMER STREET
WHITEFISH BAY WI 53211
GP
STEVE L CHOJNACKI MD
2218 S SEVENTH STREET
MILWAUKEE WI 53215
GS
JOHN A CHOPYAK MD
3201 SOUTH 16TH STREET
MILWAUKEE WI 53215
CHP P
CLARENCE P CHOU MD
703 E LEXINGTON BLVD
WHITEFISH BAY WI 53217
DR NR / R
RICHARD H CHRISTENSON MD
3622 N HACKETT AVENUE
MILWAUKEE WI 53211
OTO PS / OTO
JAMES A CHRISTIAN DDS MD
SUITE 520
2266 N PROSPECT AVENUE
MILWAUKEE WI 53202
GS CDS / GS
414-281-9665
THOMAS Y CHUA MD
2745 W LAYTON AVENUE
MILWAUKEE WI 53221
AN
414-259-9700
UI IL CHUNG MD
3335 PARKSIDE DRIVE
BROOKFIELD WI 53005
IM / IM
414-645-4240
WILLIAM W CHUNG MD
3201 SOUTH 16TH STREET
MILWAUKEE WI 53215
IM / IM
MARK J CICCANTELLI MD
1908 FOREST STREET
WAUWATOSA WI 53213
PTH CLP / PTH CLP
414-242-5361
DANN B CLAUDON MD
10121 N LEE COURT 21W
MEQUON WI 53092
GP
414-425-5351
JAMES A CLEMENCE MD
6080 SOUTH 108TH ST
HALES CORNERS WI 53130
CD / CD IM
414-278-7890
EDDY D CO MD
SUITE 610
2266 N PROSPECT AVE
MILWAUKEE WI 53202
PD
ANTHONY 0 COE MD
SUITE 202
756 NORTH 35TH STREET
MILWAUKEE WI 53208
OS / OBG
414-281-4400
JOHN M COFFEY MD
9205 W CENTER STREET
MILWAUKEE WI 53222
IM / IM
WILLIAM L COFFEY JR MD
9625 HARDING BLVD
MILWAUKEE WI 53226-1601
P PYA / P
414-271-1 130
JACK J COHEEN MD
SUITE 4115
161 WEST WISCONSIN AVE
MILWAUKEE WI 53203
PD / PD
414-771-5600
DONALD J COHEN MD
POST OFFICE BOX 601
MILWAUKEE WI 53201
PTH / PTH
414-257-6201
ELSA B COHEN MD
8700 W WISCONSIN AVE
MILWAUKEE WI 53226
PD
GARY A COHEN MD
SUITE 206
8909 N PT WASHINGTON
MILWAUKEE WI 53217-1634
OPH / OPH
414-342-5150
NORMAN E COHEN MD
SUITE 70)
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
PHQ / r'C
ROGER D COHEN MD
9073 N BAYSIDE DRIVE
BAYSIDE WI 53217
AI IM / AI IM
414-546-1 110
STEVEN H COHEN MD
5810 W OKLAHOMA AVENUE
MILWAUKEE WI 53219
ORS / ORS
414-273-7141
ELLIOT L COLES MD
1218 W KILBOURN AVENUE
MILWAUKEE WI 53233
GS / GS
414-271-3700
GEORGE E COLLENTINE MD
2388 NORTH LAKE DRIVE
MILWAUKEE WI 53211
PTH CLP / PTH AP CLP
414-546-6350
DANIEL P COLLINS MD
8901 W LINCOLN AVENUE
WEST ALLIS WI 53227
GP
EUGENE G COLLINS MD
SUITE 114
2400 SOUTH 90TH STREET
WEST ALLIS WI 53227
PTH CLP / PTH CLP
414-649-7338
RICHARD A COLLINS MD
2900 W OKLAHOMA AVENUE
MILWAUKEE WI 53215
ORS / ORS
414-271-6710
MICHAEL C COLLOPY MD
SUITE 4)82
161 W WISCONSIN AVENUE
MILWAUKEE WI 53203
ORS / ORS
PAUL J COLLOPY MD
2608 E MENLO BOULEVARD
MILWAUKEE WI 53211-2648
GS / GS
414-257-5505
ROBERT E CONDON MD
8700 W WISCONSIN AVE
MILWAUKEE WI 53226
KENNETH R CONGER
APT 4
2307 NORTH 80TH STREET
WAUWATOSA WI 53213
GS CDS / GS
414-352-8363
JAMES E CONLEY MD
1406 EAST FOX LANE
MILWAUKEE WI 53217
PTH / PTH
HAROLD J CONLON MD
8901 WEST LINCOLN AVE
MILWAUKEE WI 53227
R
414-937-2131
MICHAEL F CONMY MD
POST OFFICE BOX 1644
MILWAUKEE WI 53201
GS / GS
414-271-3700
JOHN D CONWAY MD
2388 NORTH LAKE DRIVE
MILWAUKEE WI 53211
IM
HAROLD E COOK MD
7431 W WIND LAKE ROAD
WIND LAKE WI 53185
OPH / OPH
414-352-3100
STUART M COOPER MD
9429 NORTH WAVERLY DR
BAYSIDE WI 53217
IM
JOHN E CORDES MD
SUITE 101
5757 W OKLAHOMA AVENUE
MILWAUKEE WI 53219
PD / PD
414-774-4141
VICTOR J CORDES MD
10625 W NORTH AVENUE
WAUWATOSA WI 53226
GP
JOHN W CORNELL MD
3533 EAST RAMSEY AVE
CUDAHY WI 53110
GP
ASHER L CORNFIELD MD
5301 W HAMPTON AVENUE
MILWAUKEE WI 53218
GP
JEROME R CORNFIELD MD
5301 W HAMPTON AVENUE
MILWAUKEE WI 53218
IM / IM
608-753-2206
HOWARD L CORRELL MD
ROUTE 1
ARENA WI 53503
TR / TR
414-257-5636
JAMES D COX MD
8700 W WISCONSIN AVE
MILWAUKEE WI 53226
FP / FP
THOMAS J COX MD
6900 NORTH PORT
WASHINGTON ROAD
MILWAUKEE WI 53217
P CHP
414-344-8226
POLLY H CRAFT MD
POST OFFICE BOX 1997
MILWAUKEE WI 53201
50— MILWAUKEE
DBG FP
414-769-6600
SAMUEL C CRAFT MD
3533 E RAMSEV AVENUE
CUDAHY WI 53110
GP
RICHARD P CRAMER MD
1700 S 60TH STREET
WEST ALLIS WI 53214
IM GE
414-271-3700
CHARLES L CROMWELL MD
2388 NORTH LAKE DRIVE
MILWAUKEE WI 53211
R GP / R
ROBERT P CRONIN MD
4036 N RICHLAND COURT
MILWAUKEE WI 53211
CD IM / CD
414-649-3530
FRANK E CUMMINS MD
2975 SOUTH 29TH STREET
MILWAUKEE WI 53215
GE IM / IM
414-447-6622
JAMES A CUNNINGHAM MD
2602 N 82ND STREET
MILWAUKEE WI 53213-1023
P / P
414-453-1984
GEORGE E CURRIER MD
2445 NORTH 91
WAUWATOSA WI 53226
FP
HARRY M CUTTING MD
5573 W JACKSON PARK DR
MILWAUKEE WI 53219
PD
JOHN J CZAJKA MD
11035 W FOREST HOME AV
HALES CORNERS WI 53130
IM CD / IM CD
414-649-3800
RUSSELL C DABROWSKI MD
2901 WEST KINNICKINNIC
RIVER PARKWAY, #315
MILWAUKEE WI 53215
TR GS R / R
414-289-8290
ALBERTO L DA CONCEICAO MD
950 NORTH 12TH STREET
POST OFFICE BOX 342
MILWAUKEE WI 53201
FP
HENRY L DALE MD
730 SKI LODGE III
BIRMINGHAM AL 35209-3017
GS
414-461-9620
GEORGE M DALEY MD
8430 W CAPITAL DRIVE
MILWAUKEE WI 53222
FP / FP
GLENN A UALL MD
12900 WRAYBURN ROAD
ELM GROVE WI 53122
GP
NICHOLAS F DAMIANO MD
POST OFFICE BOX 100
HALES CORNERS WI 53130
N / N
414-447-6030
R CLARKE DANFORTH MD
SUITE 100
3070 NORTH 51ST STREET
MILWAUKEE WI 53210
CD IM / CD IM
414-277-0327
ALAN DANIEL MD
SUITE 303
788 N JEFFERSON AVENUE
MILWAUKEE WI 53202
IM PUD / IM
EINAR R DANIELS MD
7400 HARWOOD AVENUE
WAUWATOSA WI 53213
P
414-355-6892
LEWIS DANZIGER MD
APT 101
9099 NORTH 75TH STREET
MILWAUKEE WI 53223
IM / IM
414-272-8950
GHOL I G DARIEN MD
SUITE 300
788 N JEFFERSON STREET
MILWAUKEE WI 53202
PD / PD
414-545-4320
GORDON L DATKA MD
8276 FLAGSTONE COURT
GREENDALE WI 53129
OPH / OPH
414-321-8998
RICHARD D DAVENPORT MD
2400 SOUTH 90TH STREET
WEST ALLIS WI 53227
PM / PM
DONNA D DAVIDOFF MD
APT 15
4200 W RIVERS EDGE CIR
MILWAUKEE WI 53209
GP
ISIDORE Z DAVIDOFF MD
C/0 BREMER
535 S CURSON ST #MK
LOS ANGELES CA 90036
GS / GS
414-961-0606
DONALD P DAVIS MD
2015 E NEWPORT AVENUE
MILWAUKEE WI 53211
ON IM / IM MON
414-289-8068
HUGH L DAVIS MD
950 NORTH 12TH STREET
MILWAUKEE WI 53233
N PD / PD
JEAN P DAVIS MD
ROUTE 1 BOX 221 C
WESTFIELD WI 53964
ORS / ORS
RICHARD G DAVITO MD
9400 W LINCOLN AVENUE
WEST ALLIS WI 53227
NS / NS
414-873-7400
JACK H DFCKARD MD
SUITE 107
3070 NORTH 51 ST STREET
MILWAUKEE WI 53210
IM / IM
FRANK L DE GROAT JR MD
1608 W GREEN TREE ROAD
MILWAUKEE WI 53209
DR / DR
414-933-9600
THOMAS G DEHN MD
620 NORTH 19TH STREET
MILWAUKEE WI 53233
PTH / PTH
414-344-8800
ALFONSO B DEIPARINE JR MD
DEPT OF PATHOLOGY
2000 W KILBOURN AVENUE
MILWAUKEE WI 53233
GS
FRANCISCO Y DEL MAR MD
3201 SOUTH 16TH STREET
MILWAUKEE WI 53215
AN / AM
MARTIN J DENIO JR MD
W359 310744 NATURE RD
ROUTE 2 BOX 92
EAGLE WI 53119
GP GS
FABIAN R DERSE MD
4504 W FOND DU LAC AVE
MILWAUKEE WI 53216
IM OS / IM
BERTRAM H DESSEL MD
APT 1
9999 WEST NORTH AVENUE
WAUWATOSA WI 53226
OBG / OBG
414-961-1 191
FREDERICK DETTMANN MD
5589 N DAY RIDGE AVE
MILWAUKEE WI 53217
GP
305-365-4631
NORBERT F DETTMANN MD
1504 FOUNTAIN DRIVE
OVIEDO FL 32765-8688
AN / AN
MARION L DE VAULT MD
14880 W JUNEAU BLVD
ELM GROVE WI 53122
AN
414-964-3723
THOMAS G DEVINE MD
1335 E RANDOLPH COURT
MILWAUKEE WI 53212
IM GE / IM GE
414-671-0121
ALI A DIDA MD
3201 SOUTH 16TH STREET
MILWAUKEE WI 53215
ORS / ORS
414-933-1941
WILLIAM T DICUS MD
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
AN
414-549-1462
MICHAEL A DIDION DO
311 MANDAN DRIVE
WAUKESHA WI 53186
AN
CAROL M DINGES MD
816 NORTH 66TH STREET
WAUWATOSA WI 53213
OBG / OBG
LYNN K DI ULIO MD
SUITE 210
2400 SOUTH 90TH STREET
WEST ALLIS WI 53227
ORS / ORB
414-271-6710
ROBERT A DIULIO MD
SUITE 4182
161 W WISCONSIN AVENUE
MILWAUKEE WI 53203
PS / PS
414-782-8723
CHRISTOPHER R DIX MD
870 BRINSMERE DRIVE
ELM GROVE WI 53122-2101
PS / PS
414-377-2537
JOHN P DOCKTOR, DDS MD
2323 EAST RIVER ROAD
GRAFTON WI 53024
OBG / OBG
JAMES D DOLAN MD
SUITF 210
2400 SOUTH 90TH STREET
WEST ALLIS WI 53227
AN
WILLIAM A DOMANN MD
N86 W 16686 JACOBSON DR
MENOMONEE FALLS WI 53051
D / D
414-321-2300
JEFFREY M DOMNITZ MD
9004 W LINCOLN AVENUE
WEST ALLIS WI 53227
ADL PD OS / PD
414-933-2200
PARNELL DONAHUE MD
940 NORTH 23RD STREET
MILWAUKEE WI 53233
IM
414-332-4808
BARBARA S DONGAS MD
4443 N FREDERICK AVE
SHOREWOOD WI 53211
IM GE / IM
414-447-6622
JOHN E DOOLEY MD
SUITE 507
3070 NORTH 51ST STREET
MILWAUKEE WI 53210
PS / PS
414-476-8855
DAVID K DORMAN MD
2323 N MAYFAIR ROAD
MILWAUKEE WI 53226
OPH
ANTON S DORN MD
3761 NORTH 55TH STREET
MILWAUKEE WI 53216
FP / FP
414-421-8400
MARK A DOROW MD
6901 W EDGERTON AVENUE
MILWAUKEE WI 53220
PD / PD
4 1 4—425—5660
ARTHUR J DORRINGTON MD
11035 W FOREST HOME AV
HALES CORNERS WI 53130
P
JEROME J DOWLING MD
SUITE 205
10425 W NORTH AVENUE
WAUWATOSA WI 53226
IM / IM
CHRISTOPHER J DR AYNA MD
324 E WISCONSIN AVENUE
MILWAUKEE WI 53202
GP
HILBERT N DRICKEN MD
4837 W SUNNYSIDE DRIVE
MILWAUKEE WI 53208
P
414-476-1720
JOSEPH M DRINKA MD
APT 209
12000 W BLUEMOUND ROAD
WAUWATOSA WI 53226
IM / IM
414-771-9870
THOMAS P DRISCOLL MD
10125 W NORTH AVENUE
WAUWATOSA WI 53226
MILWAUKEE— 51
IM GS
MAX F DROZEWSKI MD
1401 A W LINCOLN AVENUE
MILWAUKEE WI 53215
OBG / DBG
414-383-2833
EMIL J DRVARIC MD
3535 W OKLAHOMA AVE
MILWAUKEE WI 53215
IM CD
414-444-1 123
RICHARD A DUCHELLE MD
SUITE 601
3070 NORTH 51 ST STREET
MILWAUKEE WI 53210
GS GP
414-781-0563
EDWARD P DUCKLES DO
15900 CULLEN COURT
BROOKFIELD WI 53005
PM / PM
414-786-8885
PAUL A DUDENHOEFER MD
1030 Pit. GRIM PARKWAY
ELM GROVE WI 53122
PD / PD
THOMAS H DUNIGAN MD
7635 W OKLAHOMA AVENUE
MILWAUKEE WI 53219
PD NS / NS
414-765-0120
DAVID K DUNN MD
324 EAST WISCONSIN AVE
MILWAUKEE WI 53202
ORS
CARL G DUNST MD
7355 NORTH PORT
WASHINGTON ROAD
MILWAUKEE WI 53217
PD / PD
414-272-7009
RUDOLF DUQUESNOY MD
2315 NORTH LAKE DRIVE
MILWAUKEE WI 53211
P / P
414-347-1964
MILO G DURST MD
APT 412
773 N PROSPECT AVENUE
MILWAUKEE WI 53202
IM GER / IM
414-384-2000
EDMUND H DUTHIE JR MD
5000 W NATIONAL AVENUE
MILWAUKEE WI 53193
OBG
414-933-6666
FRANC INE L DVORACEK MD
940 NORTH 23RD STREET
MILWAUKEE WI 53233
OPH / OPH
414-271-7200
HARRY A EASOM MD
SUITE 617
2315 NORTH LAKE DRIVE
MILWAUKEE WI 53211
OTO / OTO
414-273-7833
LEE G EBY MD
324 E WISCONSIN AVENUE
MILWAUKEE WI 53202
FP
PHILIP T ECKSTROM MD
3225 CULLEN DRIVE
BROOKFIELD WI 53005
FP GP
CHARLES R EICHENBERGER
1425 E CAPITOL DRIVE
MILWAUKEE WI 53211
PD PNP / PD
414-352-3100
CARL S L EIBENBERG MD
3003 W GOOD HOPE ROAD
POST OFFICE BOX 17300
MILWAUKEE WI 53217
FP
EDWARD EISENBERG MD
4416 W MEDFORD AVENUE
MILWAUKEE WI 53216
PTH CLP / PTH
414-289-8051
REUBEN EISENSTEIN MD
950 NORTH 12TH STREET
MILWAUKEE WI 53201
CDS GS / GVS GS
414-453-2121
GREGORY A EKBOM MD
SUITE 845
2300 N MAYFAIR ROAD
MILWAUKEE WI 53226
AN
414-786-8711
RAKKI G ELANGOVAN MD
1495 LIBERTY COURT
BROOKFIELD WI 53005
GS FP / GS
414-383-4700
ARNOLD N ELCONIN MD
1672 S NINTH STREET
MILWAUKEE WI 53204-3426
PS / PS
414-961-8890
SHARON L ELIAS MD
SUITE 202
400 W SILVER SPRING DR
MILWAUKEE WI 53217
R NM / R NM
414-546-6440
MATTHEW W ELSON MD
8901 W LINCOLN AVENUE
MILWAUKEE WI 53227
OM
JACK A END MD
1441 E GOODRICH COURT
MILWAUKEE WI 53217
OS / D
414-258-2600
CHARLES J ENGEL MD
5203 ROBERTS DRIVE
GREENDALE WI 53129
PD P /PD
414-272-6297
ELY EPSTEIN MD
924 EAST JUNEAU AVENUE
MILWAUKEE WI 53202
GS OM / GS
414-352-4268
JOHN ERBES MD
8301 NORTH ALLEN LANE
MILWAUKEE WI 53217
PTH CLP / PTH CLP
414-257-5600
CHESLEY P ERWIN MD
PATHOLOGY BUILDING
8700 W WISCONSIN AVE
MILWAUKEE WI 53226
IM
414-273-7994
JOHN H ESSER MD
700 NORTH WATER STREET
MILWAUKEE WI 53202
D / D
414-281-0712
JAMES E ETHINGTON MD
2923 W LAYTON AVENUE
GREENFIELD WI 53221
CDS GS
RICHARD N EVANS JR MD
435 WEST NORTH AVENUE
MILWAUKEE WI 53212
GP
WILLIAM J FABER DO
9235 W CAPITOL DRIVE
MILWAUKEE WI 53222
PTH / PTH
FRANK P FALSETTI MD
2525 SOUTH SHORE DRIVE
MILWAUKEE WI 53207
R / R
GEORGE E FARLEY MD
DEPT OF RADIOLOGY
2400 W VILLARD AVENUE
MILWAUKEE WI 53209
D / D
HUBERT J FARRELL MD
203 W SUBURBAN DRIVE
MILWAUKE WI 53217
IM
414-671-7000
LEWIS M FEIGES MD
2400 W LINCOLN AVENUE
MILWAUKEE WI 53215
P / P
414-257-5989
DONALD L FEINSILVER MD
8700 W WISCONSIN AVE
MILWAUKEE WI 53226
AN
RENATO C FELIZMENA MD
13320 COMMONS DRIVE
LAMPLIGHTER PARK
BROOKFIELD WI 53005
SCOTT A FENGLER
DEPT OF SURGERY
MAD I GAN ARMY MED CTR
TACOMA WA 98431
GP
414-352-0900
JOHN P FETHERSTON JR MD
6900 NORTH PORT
WASHINGTON ROAD
MILWAUKEE WI 53217
FP / FP
414-352-0900
MICHAEL P FETHERSTON MD
6900 NORTH PORT
WASHINGTON ROAD
MILWAUKEE WI 53217
GP
THOMAS J FETHERSTON MD
6900 NORTH PORT
WASHINGTON ROAD
MILWAUKEE WI 53217
OBG / GON
414-225-8175
WILLIAM C FETHERSTON MD
POST OFFICE BOX 339
MILWAUKEE WI 53201
AN
KENNETH R FICK MD
1135 LEGION DRIVE
ELM GROVE WI 53122
TR / TR
414-649-6420
ALAN B F IDLER MD
DEPT OF RAD ONCOLOGY
2900 W OKLAHOMA AVENUE
MILWAUKEE WI 53215
OPH / OPH
414-259-9090
HOWARD W FIEDLER MD
2300 N MAYFAIR ROAD
WAUWATOSA WI 53226
FP / FP
LLOYD L FIFRICK MD
APT 3
4302 N 104TH STREET
MILWAUKEE WI 53222
JACK W FINCH
2555 N 120TH STREET
MILWAUKEE WI 53226
IM
414-744-7768
JACOB M FINE MD
100 15TH AVENUE
SOUTH MILWAUKEE WI 53172
U
STUART W FINE MD
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
AN
414-962-5696
DAVID H FINGARD MD
4870 NORTH LAKE DRIVE
WHITEFISH BAY WI 53217
R / R
WILLIAM A FINGER MD
323 CRESCENT LANE
THIENSVILLE WI 53092
OBG / OBG
WILLIAM E FINLAYSON MD
2003 W CAPITOL DRIVE
MILWAUKEE WI 53206
OTO / OTO
414-241-8000
CHARLES J FINN MD
10520 NORTH PORT
WASHINGTON ROAD
MEQUON WI 53092
P / P
414-258-2600
DONALD C FISCHER MD
36935 HOLLYHOCK WOODS
OCONOMOWOC WI 53066-9460
GER IM / IM
414-289-8059
ALBERT A FISK MD
950 NORTH 12TH STREET
POST OFFICE BOX 342
MILWAUKEE WI 53233
OTO / OTO
LAWRENCE M FLANARY MD
10425 W NORTH AVENUE
MILWAUKEE WI 53226
ORS / ORS
414-933-8158
THOMAS J FLATLEY MD
SUITE 452
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
CDS TS / GS TS
414-649-3990
ROBERT J FLEMMA MD
SUITE 310
2901 W KK RIVER PKY
MILWAUKEE WI 53215
ORS / ORS
414-351-3500
JAMES R FLESCH MD
7545 NORTH PORT
WASHINGTON ROAD
MILWAUKEE WI 53217
FP / FP
ROBERT E FLOOD MD
6900 NORTH PORT
WASHINGTON ROAD
MILWAUKEE WI 53217
IM / IM
JAMES L FLOWERS MD
4887 N GREEN BAY AVE
MILWAUKEE WI 53209
GS / GS
414-961-2226
GEORGE F FLYNN MD
SUITE 305
2015 E NEWPORT AVENUE
MILWAUKEE WI 53211
52— MILWAUKEE
D / D
414-963-1222
HARRY R FOERSTER JR MD
SUITE 240
400 W SILVER SPRING DR
MILWAUKEE WI 53217
OBG
414-476-0306
DAVID V FOLEY MD
2457 N MAYFAIR ROAD
MILWAUKEE WI 53226
R / R
W DENNIS FOLEY MD
2120 LA ROCHELLE COURT
BROOKFIELD WI 53005
OBG / OBG
414-482-2348
JEROME W FONS JR MD
3533 E RAMSEY AVENUE
CUDAHY WI 53110
OPH / OPH
414-271-1580
PETER S FOOTE MD
1684 N PROSPECT AVENUE
MILWAUKEE WI 53202
IM CD / IM
414-771-5300
DANIEL J FORWARD MD
7400 HARWOOD AVENUE
WAUWATOSA WI 53213
PD / PD
414-228-1 140
BETH L FOSTER MD
3437 NORTH 53RD STREET
MILWAUKEE WI 53216
ORS HS / ORS
414-786-2875
LAWRENCE L FOSTER MD
890 ELM GROVE ROAD
POST OFFICE BOX 103
ELM GROVE WI 53122-0103
IM PUD / IM
CURTIS W FOWLER MD
2015 E NEWPORT AVENUE
MILWAUKEE WI 53221
OTO / OTO
414-342-8255
MEYER S FOX MD
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
PS GS / PS GS
803-757-3678
WILLIAM H FRACKELTON MD
98 TOPPIN DRIVE
HILTON HEAD IS SC 29928
AN / AN
414-931-1010
NANCY K FRANCE MD
1700 W WISCONSIN AVE
POST OFFICE BOX 1997
MILWAUKEE WI 53201
AN
MICHAEL C FRANCIS MD
2825 N MAYFAIR ROAD
MILWAUKEE WI 53222
OS / GS
BRUCE P FRANK MD
3970 OAKLAND
MILWAUKEE WI 53215
IM / IM
GLENN H FRANKE MD
SUITE 1330
324 E WISCONSIN AVENUE
MILWAUKEE WI 53202
NS / NS
414-272-3673
LAWRENCE J FRAZIN MD
161 W WISCONSIN AVENUE
MILWAUKEE WI 53203
GS
414-272-5977
MILTON S FREEDMAN MD
SUITE 109
1218 W KILBOURN AVENUE
MILWAUKEE WI 53233
IM
TIMOTHY J FREEMAN MD
2212 NORTH 51ST STREET
MILWAUKEE WI 53208
IM / IM
SALVATORE FRICANO MD
3201 SOUTH 16TH STREET
MILWAUKEE WI 53215
CD IM / IM CD
414-342-8700
BURTON J FRIEDMAN MD
SUITE 707
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
OTO / OTO
414-342-8255
JERRY E FRIEDMAN MD
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
IM PYM
414-453-5870
EDWARD S FRIEDRICHS MD
6745 WEST WELLS STREET
MILWAUKEE WI 53213
U / U
414-271-4331
JOHN G FRISCH MD
5400 N IROQUOIS AVENUE
MILWAUKEE WI 53217-5013
IM CD / IM
414-276-1906
ROBERT A FRISCH MD
788 N JEFFERSON STREET
MILWAUKEE WI 53202
IM / IM
414-272-8950
RICHARD D FRITZ MD
SUITE 300
788 N JEFFERSON STREET
MILWAUKEE WI 53202
OBG / OBG
414-384-1372
ROBERT J FRITZ MD
3535 W OKLAHOMA AVENUE
MILWAUKEE WI 53215
IM
414-466-0600
ROBERT B FRUCHTMAN MD
3975 NORTH 68TH STREET
MILWAUKEE WI 53216
GP
414-543-3539
JAMES W FULTON MD
7714 WEST HONEY CREEK
PARKWAY
MILWAUKEE WI 53219-2739
GP
SAMUEL L GABBY JR MD
821 EAST BUTTLES ROAD
MILWAUKEE WI 53217
GP GS
REYNALDO P GABRIEL MD
4535 WEST LOOMIS ROAD
GREENFIELD WI 53220
ORS / ORS
414-271-1575
FREDERICK G GAENSLEN MD
1031 N ASTOR STREET
MILWAUKEE WI 53202
P / PN
DINSHAH D GAGRAT MD
SUITE 302
2015 E NEWPORT AVENUE
MILWAUKEE WI 53211
IM
414-871-4070
MIGUEL T GALANG JR MD
9000 W BURLEIGH STREET
MILWAUKEE WI 53222
TS GS
4 14-257—5545
TIMOTHY A GALBRAITH MD
8700 W WISCONSIN AVE
MILWAUKEE WI 53266
CD IM / IM
414-649-3530
HENRY H GALE MD
SUITE 300
2901 WFST KK PARKWAY
MILWAUKEE WI 53215
TR R / R
RANJINI GANDHAVADI MD
950 NORTH 12TH STREET
MILWAUKEE WI 53201
OM
THEODORE I GANDY MD
1601 SHASTA
MC ALLEN TX 78501
CD / IM
MUKHTAR A GAN I MD
SUITE 603
2315 NORTH LAKE DRIVE
MILWAUKEE WI 53211
PM
AJIT S GARCHA MD
315 S EASTMOOR AVENUE
BROOKFIELD WI 53005
US
RALPH W GARENS MD
2817 NORTH 71ST STREET
MILWAUKEE WI 53210
FP / FP
414-778-3820
THOMAS F GARLAND MD
1315 NORTH 74TH STREET
MILWAUKEE WI 53213
OPH / OPH
414-459-0807
LAWRENCE L GARNER MD
APT 10-E
939 COAST BOULEVARD
LA JOLLA CA 92037
IM / IM
414-873-3986
MARK W GARRY MD
2718 NORTH 67TH STREET
MILWAUKEE WI 53210
P N PYM / P
LARRY S GARSHA MD
POST OFFICE BOX 189
THIENSVILLE WI 53092-0189
GP OBG
PIERO G GASPARRI MD
1106 E OKLAHOMA AVENUE
MILWAUKEE WI 53207
IM
414-774-7074
MARY PARISH GAV INSKI MD
1819 NORTH 73RD STREET
WAUWATOSA WI 53213-2254
OPH OTO / OPH
IRWIN E GAYNON MD
5067 N WOODBURN STREET
MILWAUKEE WI 53217
PD
ELI A GECHT MD
1672 S NINTH STREET
MILWAUKEE WI 53204
FP / FP
414-463-8900
JAMES E GEIGLER MD
5615 W HAMPTON AVENUE
MILWAUKEE WI 53218
HEM IM / IM
NICHOLAS F GEIMER MD
2420 PASADENA BLVD
WAUWATOSA WI 53226
CHP P / P
414-271-1680
JACK E GEIST MD
2350 NORTH LAKE DRIVE
MILWAUKEE WI 53211
EM FP
414-466-2002
JOAN M GENNRICH MD
10804 W CAPITOL DRIVE
MILWAUKEE WI 53222
ORS / ORS
414-321-2255
KONSTANTTNE S GEORGE MD
9400 W LINCOLN AVENUE
WEST ALLIS WI 53227
IM / IM
JOHN P GERLACH MD
3627A N MORRIS BLVD
SHOREWOOD WI 53211
EM / EM
GARY L GERSCHKE MD
2005 HOLLY HOCK LANE
ELM GROVE WI 53122
PM IM
SYDNEY T GETTELMAN MD
10462 N CIRCLE ROAD
MEQUON WI 53092-5930
GS / GS
PRABHAKAR C GHOSH MD
8410 W CLEVELAND AVE
MILWAUKEE WI 53227
U / U
414-273-3796
JOSEPH GILBERT MD
APT 1106
1610 N PROSPECT AVENUE
MILWAUKEE WI 53202
OPH / OPH
414-933-3795
HERBERT GILLER MD
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
OBG
CALVIN J GILLESPIE MD
11035 W FOREST HOME AV
HALES CORNERS WI 53130
414-463-7715
RICK D GILLIS
3462 NORTH 97TH STREET
MILWAUKEE WI 53222
IM / IM
414-276-1906
IAN H GILSON MD
788 N JEFFERSON STREET
MILWAUKEE WI 53202
PS HNS HS / PS GS
414-476-7240
RUEDI P GINGRASS MD
9800 W BLUEMOUND ROAD
MILWAUKEE WI 53226
OS
414-762-0406
JOHN R GLADIEUX MD
4143 SOUTH 13TH STREET
MILWAUKEE WI 53221
MILWAUKEE— 53
A / AI
414-271-4204
DAVID M GLASSNER MD
SUITE 900
324 E WISCONSIN AVENUE
MILWAUKEE WI 53202
PD
414-671-/000
JOHN S GLASSPIEGEL MD
2400 W LINCOLN AVENUE
MILWAUKEE WI 53215
IM / IM
414-271-1444
ROBERT K GLEESON MD
720 E WISCONSIN AVENUE
MILWAUKEE WI 53202
CHP PD / PN
414-931-4091
LUCILLE B GLICKLICH MD
3431 NORTH LAKE DRIVE
MILWAUKEE WI 53211-2919
PDS / GS
MARVIN GLICKLICH MD
SUITE 316
759 N MILWAUKEE STREET
MILWAUKEE WI 53202
GYN
414-271-3700
CARL F GLIENKE MD
2388 NORTH LAKE DRIVE
MILWAUKEE WI 53211
IM
SIMPLICIO K GO MD
SUITE 214
1218 W KILBOURN AVENUE
MILWAUKEE WI 53233
P
ROBERT F GOERKE MD
1216 N PROSPECT AVENUE
MILWAUKEE WI 53202
MFS BE HNS / OTO
414-241-8000
ROBERT J GOGAN MD
10520 NORTH PORT
WASHINGTON ROAD
MEQUON WI 53092
OM FP / FP
HENRY M GOLDBERG MD
500 NORTH 19TH STREET
MILWAUKEE WI 53233
GP
ESTHER W GOLDBERGER MD
SUITE 802
1610 N PROSPECT AVENUE
MILWAUKEE WI 53202
GS / GS
414-961-1 118
ROBERT J GOLDBERGER MD
2015 E NEWPORT AVENUE
MILWAUKEE WI 53211
GS
JACOB L GOLDING MD
300 EAST CAPITOL DRIVE
MILWAUKEE WI 53212
FP / FP
414-933-3600
STUART L GOLDMAN MD
1834 W WISCONSIN AVE
MILWAUKEE WI 53233
FP / FP
ROBERT W GOLDMANN MD
7270 S 92ND STREET
FRANKLIN WI 53132
OPH / OPH
414-933-3795
PAUL H GOLDSTEIN MD
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
IM
LAWRENCE A GOLOPOL MD
5929 W WASHINGTON BLVD
MILWAUKEE WI 53208
OBG
414-264-8650
JYOTHI GONDI MD
4893 GREEN BAY AVENUE
MILWAUKEE WI 53209
AN GS / AN
414-351-5766
RAO J GONDI MD
1100 EAST DONGES COURT
MILWAUKEE WI 53217
OPH / OPH
414-257-0170
RUSSELL S CONNER I NG MD
SUITE 950
2600 N MAYFAIR ROAD
MILWAUKEE WI 53226
R / R
JAMES E GONYO MD
8700 W WISCONSIN AVE
MILWAUKEE WI 53226
FP
CELERINA GONZALEZ MD
4915 S HOWELL AVENUE
MILWAUKEE WI 53207
FP DR
414-671-5410
RAMON A GONZALEZ MD
1308 SOUTH 16TH STREET
MILWAUKEE WI 53204
IM
JAY S GOODMAN MD
1218 W KILBOURN AVENUE
MILWAUKEE WI 53233
GS CDS / GS
414-462-9555
J JAY GOODMAN MD
SUITE 203
2350 W VILLARD AVENUE
MILWAUKEE WI 53209
PM / PM
KANDAVAR M GOPAL MD
20100 FREEDOM COURT
BROOKFIELD WI 53005
GS
414-781-7627
ARNE C GORDER MD
13900 W BURLEIGH ROAD
BROOKFIELD WI 53005
PM
414-332-9499
JEFFREY B GORELICK MD
1503 E KENSINGTON BLVD
MILWAUKEE WI 53211
PD / PD
414-271-2291
LEONARD GORENSTEIN MD
1218 W KILBOURN AVENUE
MILWAUKEE WI 53233
RICHARD A GORMAN
NO 80
12335 W OKLAHOMA AVE
WEST ALLIS WI 53227
PS HS HNS / GS PS
414-963-1700
GERALD G GOVIN MD
2015 E NEWPORT AVENUE
MILWAUKEE WI 53211
A / Al IM
414-425-5750
TERRY S GRAVES MD
10950 W FOREST HOME AV
HALES CORNERS WI 53130
FP
SAMUEL A GRAZIANO MD
4265 W FOND DU LAC AVE
MILWAUKEE WI 53216
414-476-0124
PAUL J GREBE
747 NORTH 113TH STREET
WAUWATOSA WI 53226
GP
ABRAHAM I GREENBERG MD
C/0 L H GOLD
3023 CENTRAL AVENUE
WILMETTE IL 60091
R TR / TR
MAURICE GREENBERG MD
RADIATION DEPARTMENT
8700 W WISCONSIN AVE
MILWAUKEE WI 53226
OPH / OPH
414-765-9977
JAMES E GREENLEE MD
SUITE 615
2315 NORTH LAKE DRIVE
MILWAUKEE WI 53211
DR
DAVID C GREGG MD
2135 NORTH LAKE DRIVE
MILWAUKEE WI 53202
JAMES S GREGORY MD
3767 NORTH 85TH STREET
MILWAUKEE WI 53222
EM PH
414-765-0849
ROGER A GREMMINGER MD
APT 1608
929 NORTH ASTOR STREET
MILWAUKEE WI 53202
GS CDS / GS
414-327-3120
JOSEPH L GRIESHOP MD
5757 W OKLAHOMA AVENUE
MILWAUKEE WI 53219
OPH OTO
JOSEPH J GRIMM MD
APT 3
1632 CARROLL AVENUE
SOUTH MILWAUKEE WI 53172
ORS / ORS
JAMES A GROH MD
4036 N 51 ST BOULEVARD
MILWAUKEE WI 53216
AN / AN
414-964-8194
JOSETTE B GROSSBERG MD
4608 N WILSHIRE ROAD
MILWAUKEE WI 53211
R / R
414-932-5349
RONALD E GROSSMAN MD
2000 W KILBOURN AVENUE
MILWAUKEE WI 53233
OTO / OTO
414-375-1 577
THOMAS W GROSSMAN MD
11945 W PIONEER ROAD
MEQUON WI 53092
OPH / OPH
ERWIN E GROSSMANN MD
4624 N ARDMORE AVENUE
MILWAUKEE WI 53211
AN
414-258-4360
CLEMENT M GRUM MD
1256 MARTHA WASHINGTON
MILWAUKEE WI 53213
ON HEM
414-289-8014
ESTEBAN GUEVARA MD
5127 WEST DONGES COURT
MILWAUKEE WI 53223-1313
ORS OS / ORS
414-545-3550
JAMES F GUHL MD
5757 W OKLAHOMA AVENUE
MILWAUKEE WI 53219
GP OS
GEORGE J GUMERMAN MD
POST OFFICE BOX E
SUN CITY AZ 85372
GS
414-444-1232
SIGURD B GUNDERSON III MD
2534 NORTH 50TH STREET
MILWAUKEE WI 53210
PD / PD
JAGDISH C GUPTA MD
2388 NORTH LAKE DRIVE
MILWAUKEE WI 53211
ORS
GARY N GUTEN MD
940 NORTH 23RD STREET
MILWAUKEE WI 53233
OBG / OBG
414-271-8558
MILTON F GUTGLASS MD
SUITE 404
1218 W KILBOURN AVENUE
MILWAUKEE WI 53233
PUD IM / IM
PAUL M GUZZETTA MD
SUITE 402
3070 NORTH 51ST STREET
MILWAUKEE WI 53210
AN EM
RICHARD A HAAS MD
11107 N LAKE SHORE LN
MEQUON WI 53092
GYN
414-476-8884
EDGAR A W HABECK MD
7738 GERALAYNE DRIVE
WAUWATOSA WI 53213
EM
GORDON A HALL MD
2025 EAST NEWPORT
MILWAUKEE WI 53211
FP IM / FP
414-350-0900
WILLIAM R HALLORAN MD
6900 NORTH PORT
WASHINGTON ROAD
MILWAUKEE WI 53217
GP
JOSEPH G HALSER JR MD
2445 S KINNICKINNIC AV
MILWAUKEE WI 53207
IM / IM
414-276-2328
H JAMES HAMM MD
SUITE 801
2315 NORTH LAKE DRIVE
MILWAUKEE WI 53211
414-933-9200
MILTON E A HAMMERLY
NO 1
2109 W KILBOURN AVENUE
MILWAUKEE WI 53233
IM
MARGARET M HANAUER MD
N1 W25042 NORTHVIEW RD
WAUKESHA WI 53186
54— MILWAUKEE
IM / IM
414-963-1030
PAUL E HANKWITZ MD
SUITE 208
2015 E NEWPORT AVENUE
MILWAUI^EE WI 53211
NEP IM / IM
414-447-2387
MATTHEW H HANNA MD
3070 NORTH 51ST STREET
MILWAUKEE WI 53210
OM
ARTHUR C HANSEN MD
2565 NORTH 84TH STREET
WAUWATOSA WI 53226
R / R
414-937-5354
RAYMOND A HANSEN MD
RADIOLOGY DEPARTMENT
2000 W KILBOURN AVENUE
MILWAUKEE WI 53233
P / P
414-258-2600
STEVEN V HANSEN MD
1220 DEWEY AVENUE
WAUWATOSA WI 53213
GP
414-352-9390
ERVIN HANSHER MD
APT 313— C
500 WEST BRADLEY ROAD
MILWAUKEE WI 53217-2634
PTH HEM / PTH
GERALD A HANSON MD
DEPT OF PATHOLOGY
8700 W WISCONSIN AVE
MILWAUKEE WI 53226
PUD IM / PUD IM CCM
JAMES COLLOPY HANSON MD
SUITE 516
2901 W KK RIVER PKWY
MILWAUKEE WI 53215
IM GE / IM GE
414-672-1892
JEROME T HANSON MD
SUITE 516
2901 W KK RIVER PARKWY
MILWAUKEE WI 53215-3638
HEM ON
414-672-1892
JOHN P HANSON JR MD
APT 2202
929 NORTH ASTDR STREET
MILWAUKEE WI 53202
OTO / (jTO
KINGE HARA MD
842 INSPIRATION LANE
ESCONDIDO CA 92025
IM / IM
MAURICE A HARDGROVE MD
7659 N LONGVIEW DRIVE
MILWAUKEE WI 53209
PA
HAROLD F HARDMAN PhD MD
DEPT OF PHARMACOLOGY
POST OFFICE BOX 26509
MILWAUKEE WI 53226
U / V
414-463-7170
RAYMOND HARKAVY MD
8430 W CAPITOL DRIVE
MILWAUKEE WI 53222
EM IM
HEIDI J HARKINS MD
7453 N MOHAWK AVENUE
MILWAUKEE WI 53217-3457
AI PD / AI PD
414-463-6640
BERYL A HARRIS MD
9400 NORTH SPRUCE ROAD
MILWAUKEE WI 53217
ON IM / IM
RONALD D HART MD
SUITE 516
2901 W KK RIVER PKWAY
MILWAUKEE WI 53215-3638
GS CDS / GS
414-258-5130
JOHN P HARTWICK MD
ROOM 501
2500 N MAYFAIR ROAD
WAUWATOSA WI 53226
ORS / ORB
414-771-7300
DAVID S HASKELL MD
SUITE 310
2323 N MAYFAIR ROAD
MILWAUKEE WI 53226
GP
JOHN F HAUG MD
2809 NORTH 46TH STREET
MILWAUKEE WI 53210
GS / GVS
JOHN J HAUGH JR MD
SUITE 702
3970 N OAKLAND AVENUE
MILWAUKEE WI 53211
IM
414-258-2600
RICHARD L HAUSER MD
3365 NORTH LAKE DRIVE
MILWAUKEE WI 53211
GP
414-782-7677
LESTER E HAUSHALTER MD
1210 INDJANWOOD DRIVE
BROOKFIELD WI 53005
P N / P N
414-964-9013
DONALD P HAY MD
SUITE 302
2015 E NEWPORT AVENUE
MILWAUKEE WI 53211
PYA P / P
414-782-6480
RAYMOND HEADLEE MD
12505 GREEMOR DRIVE
ELM GROVE WI 53122
GS CDS / GS
414-933-8882
DAVID L HEBER MD
SUITE 422
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
414-475-0171
JIRI HEGER
APT 4
1221 NORTH 70TH STREET
WAUWATOSA WI 53213
414-353-2432
KURT HEGMANN
7115 NORTH 86TH STREET
MILWAUKEE WI 53224
R
JOHN S HEIGHWAY
2825 WEST KK PARKWAY
MILWAUKEE WI 53215
GS / GS
414-25/-1 755
CONRAD M HEINZELMANN MD
12011 W NORTH AVENUE
WAUWATOSA WI 53226
EM / IM
414-257-5634
GAIL E HENDLEY MD
EMERGENCY MEDICINE
8700 W WISCONSIN AVE
MILWAUKEE WI 53226
AN / AN
414-567-3645
ANN BARDEEN-HENSCHEL MD
412 NORTH LAKE ROAD
OCONOMDWOC WI 53066
AN
414-257-3918
G HERNANDEZ-ENGSTRAND MD
NO 202
9102 WEST DIXON
MILWAUKEE WI 53214
GS / GS
JACK K HERRINGTON MD
5631 W LINCOLN AVENUE
POST OFFICE BOX 19B92A
WEST ALLIS WI 53219
OS
ROLAND E HERRINGTON MD
C-250
5200 S TUCKAWAY BLVD
GREENFIELD WI 53221
D / u
414-442-1 177
SIDNEY HERSZENSON MD
SUITE P210
3070 NORTH 51ST STREET
MILWAUKEE WI 53210
CD IM / IM
414-444-1123
TIMOTHY R HESS MD
SUITE 601
3070 NORTH 51ST STREET
MILWAUKEE WI 53210
US
ROSE A KRIZ-HETTWER MD
10 RIDGE ROAD
RUMSON NvI 07760
ORS / ORS
414-351-3500
C HUGH HICKEY JR MD
7545 NORTH PORT
WASHINGTON ROAD
MILWAUKEE WI 53217
AN
ANNE L HIGH MD
5422 N IROQUOIS AVENUE
MILWAUKEE WI 53217
OTO / OTO
HOWARD C HIGH JR MD
5422 N IROQUOIS AVENUE
MILWAUKEE WI 53217
D / D
RICHARD A HIGLEY MD
APT 419
2566 N 124TH STREET
WAUWATOSA WI 53226
OBG / OBG
414-933-6666
NATHAN M HILRICH MD
940 NORTH 23RD STREET
MILWAUKEE WI 53233
AN / AN
414-332-8238
JOSEPH HIMES MD
100 W INDIAN CREEK CT
MILWAUKEE WI 53217
R / R
ROBERT E HINSON MD
9475 N FAIRWAY CIRCLE
MILWAUKEE WI 53217
OBG
414-271-7194
MALCOLM M HIPKE MD
924 EAST JUNEAU AVENUE
MILWAUKEE WI 53202
IM / IM
ERWIN 0 HIRSCH MD
2124 WEST QUINCY COURT
102N MEQUON WI 53092
AI IM / AI IM
414-546-1 110
S ROGER HIRSCH MD
5810 W OKLAHOMA AVENUE
MILWAUKEE WI 53219
IM / IM
414-357-5187
JOHN S HIRSCHBOECK MD
APT 240
9301 NORTH 76TH STREET
MILWAUKEE WI 53223
OPH / OPH
JOHN B HITZ MD
32265 W OAKLAND ROAD
NASHOTAH WI 53058
NA PTH N / NA PTH N
414-257-6210
KHANG-CHENG HO MD
8700 W WISCONSIN AVE
MILWAUKEE WI 53226
AN / AN
414-783-4374
SUN-0 G HO MD
3290 SUNNY VIEW LANE
BROOKFIELD WI 53005
N / N
414-961-7306
RICHARD J HODACH MD
SUITE 408
2015 E NEWPORT AVENUE
MILWAUKEE WI 53211
U / U
414-476-0430
NORMAN B HODGSON MD
SUITE 545
2600 N MAYFAIR ROAD
MILWAUKEE WI 53226
GYN / OBG
414-774-9322
FREDERICK J HOFMEISTER MD
SUITE 226
10425 W NORTH AVENUE
WAUWATOSA WI 53226
PS HS MFS / PS GS
414-259-9000
JOHN P HOGAN MD
SUITE 950
2300 N MAYFAIR ROAD
MILWAUKEE WI 53226
IM / IM
ARTHUR A HOLBROOK MD
3050 E NEWPORT COURT
MILWAUKEE WI 53211-2910
GP
414-353-3808
STANLEY W HOLLENBECK MD
11957 W APPLETON AVE
MILWAUKEE WI 53224
EM / EM
414-784-7655
PETER J HOLZHAUER MD
160 LYNNWOOD LANE
BROOKFIELD WI 53005
PD / PD
414-769-9040
JAMES J HOMSEY MD
5854 SOUTH PACKARD AVE
CUDAHY WI 53110
RUSSELL W HARLAND
2475-A N 68TH STREET
WAUWATOSA WI 53213
MILWAUKEE— 55
RHU IM GER / IM RHU
414-289-8182
BRUCE S HONG MD
950 NORTH 12TH STREET
MILWAUKEE WI 53233
DBG / GON
414-225-8175
DAVID L HOOGERLAND MD
2320 NORTH LAKE DRIVE
POST OFFICE BOX 339
MILWAUKEE WI 53201
OTO / OTO
414-241-8000
S FREDRIC HORWITZ MD
10520 NORTH PORT
WASHINGTON ROAD
MEQUON WI 53092
U / U
414-258-2640
JOHN T HOTTER MD
2500 N MAYFAIR ROAD
MILWAUKEE WI 53226
ORS / ORS
JEROME W HOUSE JR MD
4036 N 51ST BOULEVARD
MILWAUKEE WI 53216
GYN / OBG
414-961-7377
WILLIAM F HOVIS JR MD
2015 E NEWPORT AVENUE
MILWAUKEE WI 53211
AN / AN
LAWRENCE A HOWARDS MD
2305 W WOODBURY LANE
MILWAUKEE WI 53209
PD / PD
JACQUELINE C HOWELL MD
8200 N TEUTONIA AVENUE
MILWAUKEE WI 53209
P
414-257-7261
LENA G HUANG MD
9455 WATERTOWN PL RD
MILWAUKEE WI 53226
CD IM / IM
414-963-1030
GEORGE R HUGHES MD
2015 E NEWPORT AVENUE
MILWAUKEE WI 53211
OPH / OPH
414-259-1930
JACK L HUGHES MD
SUITE 607
2500 N MAYFAIR ROAD
WAUWATOSA WI 53226
ORS / ORS
414-464-8880
BERNARD A HUIZENGA MD
4036 N 51ST BOULEVARD
MILWAUKEE WI 53216
414-782-6352
BARBARA A HUMMEL
14470 W REDWOOD DRIVE
NEW BERLIN WI 53151
P
VICTOR H HUNKEL MD
9009 W CLARKE STREET
MILWAUKEE WI 53226
PD / PD
414-228-1140
SALLY G HUNT MD
8909 NORTH PORT
WASHINGTON RD #203
MILWAUKEE WI 53217-1634
AN / AN
SU-RYONG HUR MD
409 E LEXINGTON BLVD
WHITEFISH BAY WI 53217
P / P
414-784-2719
JAMES R HURLEY MD
13950 ADELAIDE LANE
BROOKFIELD WI 53005
GS HNS ND / GS
414-255-3841
JOHN D HURLEY MD
N106 W16620 OLD FARM
GERMANTOWN WI 53022
CLP / CLP
414-257-6318
CLARA V HUSSEY MD
8700 W WISCONSIN AVE
MILWAUKEE WI 53226
FP
JAMES J HUSSEY MD
2952 N MARYLAND AVENUE
MILWAUKEE WI 53211
ORS / ORS
414-272-0280
JACQUES HUSSUSSIAN MD
SUITE 1019
2315 NORTH LAKE DRIVE
MILWAUKEE WI 53211
OM IM / IM
414-277-2840
ERWIN S HUSTON MD
231 W MICHIGAN STREET
POST OFFICE BOX 2046
MILWAUKEE WI 53201
GS / GS
ELMORE P HUTH MD
1471 LEMON BAY DRIVE
ENGLEWOOD FL 33533
OPH / OPH
414-257-5083
ROBERT A HYNDIUK MD
8700 W WISCONSIN AVE
MILWAUKEE WI 53226
R / R
414-527-8108
HAROLD F IBACH MD
2400 W VILLARD AVENUE
MILWAUKEE WI 53209
P
414-442-8070
JOHN F IMP MD
7632 W LISBON AVENUE
MILWAUKEE WI 53222
GS
RONALD T INDEN MD
14745 WATERTOWN PL RD
ELM GROVE WI 53122
P N
414-962-3333
DONALD G IVES MD
409 E SILVER SPRING DR
MILWAUKEE WI 53217
FP / FP
4 1 4— APS- ‘iTS 1
ROBERT B JACHOWICZ MD
6080 S 108TH STREET
HALES CORNERS WI 53130
ORS / ORS
414-276-6000
PAUL A JACOBS MD
1218 W KILBOURN AVENUE
MILWAUKEE WI 53233
STEVEN J JACOBSEN
APT 4
8327 W CENTER STREET
MILWAUKEE WI 53222
U / U
414-483-8883
HAROLD A JACOBSOHN MD
SUITE 202
5656 S PACKARD AVENUE
CUDAHY WI 53110
OBG / OBG
414-271-2109
FOSTER J JACOBSON MD
1218 W KILBOURN AVENUE
MILWAUKEE WI 53233
IM END / IM
414-276-1906
MITCHELL M JACOBSON MD
788 N JEFFERSON STREET
MILWAUKEE WI 53202
OBG / OBG
414-964-7600
MICHAEL T JAEKELS MD
5631 NORTH MOHAWK ROAD
MILWAUKEE WI 53217
IM PUD / IM
RICHARD P JAHN MD
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
CD IM / CD IM
414-271-3700
DHARAM P JAIN MD
2388 NORTH LAKE DRIVE
MILWAUKEE WI 53211
IM / IM
414-271-6800
ROBERT G JAKUBOWSKI MD
NO 200
525 EAST WELLS STREET
MILWAUKEE WI 53202
GP CDS / GS
414-483-6880
MAZHAR L JAN MD
4379 S HOWELL AVENUE
MILWAUKEE WI 53207-5086
P
414-543-7744
RUTH L KRAMER JANSEN MD
POST OFFICE BOX 27272
MILWAUKEE WI 53227
FP / FP
LEONARD A JAS INSKI MD
POST OFFICE BOX 607
GLENDALE AZ 85311
P N
ROLAND A JEFFERSON MD
105 ALAMEDA
PADRE SERRA
SANTA BARBARA CA 93103
GP
ERWIN J JELENCHICK MD
3810 NORTH 85TH STREET
MILWAUKEE WI 53222
N P / N
414-774-7833
LLOYD F JENK MD
2500 N MAYFAIR ROAD
WAUWATOSA WI 53226
OBG / OBG
THOMAS F JENNINGS MD
1100 PILGRIM PARKWAY
ELM GROVE WI 53122
AN / AN
MARSHALL R JENNISON MD
2545 MAPLE HILL LANE
BROOKFIPXD WI 53005
IM
414-453-5870
LOUIS F JERMAIN MD
6745 WEST WELLS STREET
MILWAUKEE WI 53213
IM CD / IM
WILLIAM M JERMAIN MD
5360 N DIVERSEY BLVD
MILWAUKEE WI 53217
D
414-258-7550
ALFRED JEROFKE MD
SUITE 305
2500 NORTH MAYFAIR RD
WAUWATOSA WI 53226
CRS
HOBART W JOHNSON MD
APT 407
1840 N PROSPECT AVENUE
MILWAUKEE WI 53202
ORS / ORS
J HOWARD JOHNSON MD
10418 BRIGHT ANGEL CIR
SUN CITY AZ 85351
PD / PD
414-771-8228
RAYMOND R JOHNSON MD
12011 WEST NORTH AVE
WAUWATOSA WI 53226
P
ROBERT W JOHNSON MD
10411 NELLIE WHITE LN
FAIRFAX VA 22032
ORS / ORS
ROGER P JOHNSON MD
8700 W WISCONSIN AVE
MILWAUKEE WI 53226
AN
SYDNEY J JOHNSON DO
LAKEVIEW HOSPITAL
10010 W BLUEMOUND RD
MILWAUKEE WI 53226
CDS TS / GS TS
W DUDLEY JOHNSON MD
3112 W HIGHLAND BLVD
MILWAUKEE WI 53208
414-332-4976
MICHAEl. F JOHNSTONE MD
3284 N SHEPARD AVENUE
MILWAUKEE WI 53211
PDS GS / PDS GS
414-271-6303
JUDA Z JONA MD
SUITE 316
759 N MILWAUKEE STREET
MILWAUKEE WI 53202
P / P
414-258-2600
MORTON JOSEPHSON MD
1220 DEWEY AVENUE
WAUWATOSA WI 53213
IM / IM
414-259-3060
CHARLES L JUNKERMAN MD
9200 W WISCONSIN AVE
MILWAUKEE WI 53226
IM
414-442-5528
WILLI G JURCZYK MD
4263 W FOND DU LAC AVE
MILWAUKEE WI 53216
OPH / OPH
414-786-0240
INGRID E JUREVICS MD
17050 W NORTH AVENUE
BROOKFIELD WI 53005
PUD / PUD
414-453-3168
GEORGE H JURGENS MD
2520 NORTH 97TH STREET
WAUWATOSA WI 53226
GS / GS
414-258-7733
AUGUST J JURISHICA MD
9425 W HADLEY STREET
MILWAUKEE WI 53222
56— MILWAUKEE
EM
MAJA A JURISIC MD
3061 NORTH SHEPARD
MILWAUKEE WI 53211
AN
MICHAEL G KAROS MD
2825 N MAYFAIR ROAD
MILWAUKEE WI 53222
R IM / IM
MICHAEL E KEHOE MD
1060 HAWTHORNE RIDGE
WAUKESHA WI 53186
BRIAN T KINDER
1744 S 116TH STREET
WEST ALLIS WI 53214
TS / GS
JOHN F JUST MD
SUITE 795
2300 N MAYFAIR ROAD
WAUWATOSA WI 53226
NS / NS
414-462-9697
ALLAN E KAGEN MD
SUITE 10)
2350 W VILLARD AVENUE
MILWAUKEE WI 53209
ORS / ORS
414-276-6000
LOUIS KAGEN MD
1218 W KILBOURN AVENUE
MILWAUKEE WI 53233
FP / FP
414-367-7377
WILLIAM W KAH MD
W3081 N7021 CLUB
CIRCLE DRIVE EAST
HARTLAND WI 53029
ON HEM / MON
414-278-8290
GERALD J KALLAS MD
NO 1005
2315 NORTH LAKE DRIVE
MILWAUKEE WI 53211
FP GP
414-535-1818
MARYANN M KALMAN MD
APT 13
4224 W VILLARD STREET
MILWAUKEE WI 53209
P CHP / PN
IKAR J KALOGJERA MD
1220 DEWEY AVENUE
MILWAUKEE WI 53213
CDS TS GS / TS GS
414-272-5700
M LAXMAN KAMATH MD
1218 W KILBOURN AVENUE
MILWAUKEE WI 53233
AN / AN
JOHN P KAMPINE MD
5000 W NATIONAL AVENUE
WOOD WI 53193
IM GE / IM GE
414-272-5966
HARRY J KANIN MD
SUITE 217
1218 WEST KILBOURN AVE
MILWAUKEE WI 53233
ORS
414-933-2044
STEVEN J KAPLAN MD
SUITE 560
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
GP / GS
414-671-1500
ROBERT KAREN MD
3501 W GREENFIELD AVE
MILWAUKEE WI 53215
A / AI
414-545-2220
HENRY R KARLIN MD
7635 W OKLAHOMA AVE
MILWAUKEE WI 53219
R / R
414-769-4062
MACK A KARNES MD
5900 SOUTH LAKE DRIVE
CUDAHY WI 531 10
ORS
RICHARD K KARR MD
2388 NORTH LAKE DRIVE
MILWAUKEE WI 53211
N / N
414-963-1115
DAVID M KASHNIG MD
400 W SILVER SPRING DR
MILWAUKEE WI 53217
NM / NM
JOSEPH R KASNER MD
620 NORTH 19TH STREET
MILWAUKEE WI 53233
□PH / OPH
414-645-0344
ROBERT KASTELIC MD
3631 W OKLAHOMA AVENUE
MILWAUKEE WI 53215
EM / EM
414-289-8146
EUGENE H KASTENSON MD
950 NORTH 12TH STREET
MILWAUKEE WI 53233
PUD IM
MICHAEL N KATZOFF MD
2900 W OKLAHOMA AVENUE
MILWAUKEE WI 53215
GS / GS
H MYRON KAUFFMAN MD
14405 JUNEAU BOULEVARD
ELM GROVE WI 53122
GP
LAWRENCE W KAUFMAN MD
3821 S HOWELL AVENUE
MILWAUKEE WI 53207
FP
414-475-0723
CHARLES T KAUFMANN DO
1917 NORTH 56TH STREET
MILWAUKEE WI 53208
P / PN
ROMAN R KAUNAS MD
1725 VILLAGE GREEN CT
ELM GROVE WI 53122
GP GS
EUGENE M KAY MD
73-020 HOMESTEAD ROAD
PALM DESERT CA 92260
OPH / OPH
MARILYN C KAY MD
EYE INSTITUTE
8700 W WISCONSIN AVE
MILWAUKEE WI 53226
ORS
SEAN P KEANE MD
1545 SOUTH LAYTON BLVD
MILWAUKEE WI 53215
U / U
414-961-7323
JOHN W KEARNS MD
SUITE 207
2015 E NEWPORT AVENUE
MILWAUKEE WI 53211
IM
ROBERT A KEBBEKUS MD
811 E WISCONSIN AVENUE
MILWAUKEE WI 53202
AN
THOMAS A KEGEL MD
723 NORTH 79TH STREET
WAUWATOSA WI 53213
AN / AN
414-225-8000
JOHN A KELBLE MD
201 EAST FOX DALE ROAD
MILWAUKEE WI 53217
GS CRS / GS
414-442-1380
WILLIAM B KELLEY MD
6001 W CENTER STREET
MILWAUKEE WI 53210
IM / IM
BRIAN W KENNEDY MD
10425 W NORTH AVENUE
MILWAUKEE WI 53226
PD / PD
414-354-6999
STANLEY N KENWOOD MD
6150 WEST FLORAL LANE
MILWAUKEE WI 53223
P / P
414-332-2727
CHRISTINA C KEPPEL MD
SUITE 307
2015 EAST NEWPORT AVE
MILWAUKEE WI 53211
OPH / OPH
414-383-9390
CHARLES W KESKEY MD
3100 SOUTH 37TH STREET
MILWAUKEE WI 53215
THOMAS S KESKEY
3100 SOUTH 37TH STREET
MILWAUKEE WI 53215
GS / GS
414-871-9000
JAMES P KETTERHAGEN MD
SUITE 402
3070 NORTH 51ST STREET
MILWAUKEE WI 53210
AN
NEVENKA T KEVICH MD
1270 N LAKE SHORE ROAD
GRAFTON WI 53024
OTO HNS / OTO
414-649-3900
THOMAS M KIDDER MD
SUITE 201
2901 W KINNICKINNIC
MILWAUKEE WI 53215
FP
414-527-8000
RANDALL J KIESER MD
APT 112
306 W HAMPTON AVENUE
MILWAUKEE WI 53217
AN / AN
JOSEPH M KIM MD
9997 W GREENWOOD TERR
MILWAUKEE WI 53224
AN / AN
414-527-8000
KUANG S KIM MD
12310 N LAKE SHORE DR
MEQUON WI 53092
P
414-962-8900
S JOHN KIM MD
SUITE 209
5205 N IRONWOOD ROAD
GLENDALE WI 53217
DR / R
YONG W KIM MD
14850 WESTOVER ROAD
ELM GROVE WI 53122
OS DM
414-649-6577
ERIC P KINDWALL MD
2900 W OKLAHOMA AVENUE
MILWAUKEE WI 53215
P / PN
414-291-9674
JOSEF A KINDWALL MD
1840 N PROSPECT AVENUE
MILWAUKEE WI 53202
IM CD
414-649-3505
JAMES F KING MD
SUITE 413
2901 W KK RIVER PKWY
MILWAUKEE WI 53215-3638
R
EDWARD R KINSFOGEL MD
2400 W VILLARD AVENUE
MILWAUKEE WI 53209
GS
414-453-9948
JOHN KISPERT MD
2524 N 124TH STREET
WAUWATOSA WI 53226
OPH / OPH
414-259-9090
ARTHUR C K ISSUING MD
SUITE 630
2300 N MAYFAIR ROAD
WAUWATOSA WI 53226
CRS
414-643-1882
BERNARD J KLAMECKI MD
3201 SOUTH 16TH STREET
MILWAUKEE WI 53215
AN
JAMES G KLAMIK MD
1155 WOODLAND AVENUE
ELM GROVE WI 53122
FP / FP
414-421-8400
DAVID H KLEHM MD
6901 WEST EDGERTON
MILWAUKEE WI 53220
IM / IM
414-962-0200
MORRIS KLEIN MD
330 W SILVER SPRING DR
MILWAUKEE WI 53217
OTO / OTO
414-342-8255
HARVEY KLEINER MD
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
IM
414-671-7000
LEONARD B KLEINERMAN MD
2400 W LINCOLN AVENUE
MILWAUKEE WI 53215
CDS TS GS / TS GS
414-649-3990
LEONARD H KLE INMAN MD
SUITE 310
2901 W KK RIVER PKY
MILWAUKEE WI 53215
GP
WILLIAM J KLEIS MD
9609 RIDGE BOULEVARD
WAUWATOSA WI 53226
OBG / OBG
414-445-7400
JACK A KLIEGER MD
4833 WEST BURLEIGH
MILWAUKEE WI 53210
MILWAUKEE— 57
AN / AN
414-782-7067
ROBERT E KLINGBEIL MD
12750 GREEN MEADOW PL
ELM GROVE WI 53122
IM END / IM
414-962-9454
DOUGLAS D KLINK MD
SUITE 1330
324 E WISCONSIN AVENUE
MILWAUKEE WI 53202
PS MFS HS / PS
414-476-8855
RALPH A KLOEHN MD
ROOM 503
2323 N MAYFAIR ROAD
MILWAUKEE WI 53226
IM
ROGER W KLOEHN MD
2388 NORTH LAKE DRIVE
MILWAUKEE WI 53211
DR R / R
THOMAS E KNECHTGES MD
2900 W OKLAHOMA AVENUE
MILWAUKEE WI 53215
P
ALBERT KNIAZ MD
2240 W GREENWOOD ROAD
MILWAUKEE WI 53209
IM NEP FP / IM
414-643-1530
MAHENDRA S KOCHAR MD
VA HOSPITAL <14A)
WOOD WI 53193
GER GP
414-444-0280
CLARENCE J KOCOVSKY MD
2307 NORTH 49TH STREET
MILWAUKEE WI 53210-2897
IM
414-241-6610
RONALD L KODRAS MD
10945 NORTH PORT
WASHINGTON ROAD
MEQUON WI 53092
PTH / PTH
414-961-3300
ROBERT R KOENIG MD
2025 E NEWPORT AVENUE
MILWAUKEE WI 53211
TS CDS TS / CDS
414-258-0670
DONALD E KOEPKE MD
SUITE 795
2300 N MAYFAIR ROAD
WAUWATOSA WI 53226
OBG / OBG
414-289-9668
CHARLES H KOH MD
2315 NORTH LAKE DRIVE
MILWAUKEE WI 53211
AN
TONG CHUI KOH MD
125 STOCKTON COURT
BROOKFIELD WI 53005
GP
SIDNEY H KOHLER MD
4527 W CENTER STREET
MILWAUKEE WI 53210
PM / PM
414-354-5429
ALKA KOHL I MD
9137 NORTH TROY COURT
BROWN DEER WI 53223
ORS / ORS
414-933-2200
HARVEY S KOHN MD
940 NORTH 23RD STREET
MILWAUKEE WI 53233
ON TR TR
RITSUKO KOMAKI MD
RADIATION ONCOLOGY
8700 W WISCONSIN AVE
MILWAUKEE WI 53226
PTH / PTH
414-257-6201
RICHARD A KOMOROWSKI MD
8700 W WISCONSIN AVE
MILWAUKEE WI 53226
OBG / OBG
414-383-5300
STANLEY A KORDUCKI MD
3201 SOUTH 16TH STREET
MILWAUKEE WI 53215
PS HNS HS / PS
414-259-9000
GEORGE J KORKOS MD
SUITE 950
2300 N MAYFAIR ROAD
MILWAUKEE WI 53226
IM
414-645-4240
MERLIN A KOTTKE MD
3201 SOUTH 16TH STREET
MILWAUKEE WI 53215
AN / AN
VLADIMIR KOVACEVIC MD
9525 NORTH REGENT ROAD
MILWAUKEE WI 53217
PD NPM / PD NPM
414-545-4320
THOMAS H KOWALSKI MD
5757 W OKLAHOMA AVE
MILWAUKEE WI 53219-4392
OBG / OBG
414-647-5115
THOMAS J KOZINA MD
3237 SOUTH 16TH STREET
MILWAUKEE WI 53215
GS
414-778-2394
ERIK J KRAENZLER MD
APT 25
425 SOUTH HAWLEY ROAD
MILWAUKEE WI 53214
GP PTH / PTH
RONALD KRAUTKRAMER MD
1700 SOUTH 60TH STREET
WEST ALLIS WI 53214
FP
KONRAD KRAWCZYK MD
5233 W MORGAN AVENUE
MILWAUKEE WI 53220
GS
LOUIS H KRETCHMAR MD
2821 EAST MENLO BLVD
MILWAUKEE WI 53211
AN / AN
4 1 4-543— S3 1 5
ASHOK K R KRISHNANEY MD
12016 W VERONA COURT
WEST ALLIS WI 53227
P
AUGUST D KROPP MD
SUITE 308
2901 W KK RIVER PKWY
MILWAUKEE WI 53215-3638
FP NM
ARNOLD J KRUBSACK MD
1125 NINTH AVENUE
GRAFTON WI 53024
ORS / ORS
414— 3P1— PP55
ALVIN K KRUG MD
9400 WEST LINCOLN
WEST ALLIS WI 53227
PH GPM / GPM
p i \ o \ so
EDWARD R KRUMBIEGEL MD
3410 GULF SHORE BLVD N
NAPLES FL 33940
IM / IM
414-771-5600
FRED P KRUMENACHER MD
6200 W BLUEMOUNT ROAD
MILWAUKEE WI 53213
ORS / ORB
414-933-8158
MICHAEL C KUBLY MD
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
OBG
MICHAEL J KUHN SR MD
9555 HARDING BOULEVARD
MILWAUKEE WI 53226
FP / FP
414-543-7543
GREGORY J KUHR MD
8117 W OKLAHOMA AVENUE
MILWAUKEE WI 53219
ORS / OHS
414-289-0360
VIJAY V KULKARNI MD
SUITE 71 ]
2315 NORTH LAKE DRIVE
MILWAUKEE WI 53211
GP
ANTHONY B KULT MD
9896 W ARGONNE DRIVE
WAUWATOSA WI 53222
EM
R PRAMOD KUMAR MD
15275 HIDDEN GLEN CT
ELM GROVE WI 53122
IM PUD / IM
414-481-9494
ULLATTIL N KUMAR MD
8842 GARDEN LANE
GREENDALE WI 53129
GP
808-546-8321
JOHN A KUSTERMANN MD
300 ALA MOANA BLVD
POST OFFICE BOX 50266
HONOLULU HI 96850
GP IM
ALOIS F KUSTERMAN MD
C/0 ALEXIAN VILLAGE
7979 W GLENBROOK ROAD
MILWAUKEE WI 53223-1055
IM CD
414-271-7177
URSULA KUTTER MD
SUITE 703
2315 NORTH LAKE DRIVE
MILWAUKEE WI 53211
GP
JAMES R KUZDAS MD
5563 W JACKSON PARK DR
MILWAUKEE WI 53219
PTH CLP / PTH
414-258-1765
JOSEPH F KUZMA MD
1115 HONEY CREEK PKWY
WAUWATOSA WI 53213
OPH / OPH
GREGORY P KWASNY MD
SUITE 1030
2300 N MAYFAIR ROAD
WAUWATOSA WI 53226
IM CD / IM
414-771-1361
PAUL G LA BISSONIERE MD
10425 W NORTH AVENUE
MILWAUKEE WI 53226
414-284 -4705
LARRY E LA CROSSE
212 HIGH STREET
PORT WASHINGTON WI 53074
PTH CLP / PTH CLP
414-937-5255
DAVID J LA FOND MD
DEPT PATH 8< LAD MED
2000 W KILBOURN AVENUE
MILWAUKEE WI 53233
AN / AN
414-281-5950
PETER LAMEKA JR MD
7930 W EDGERTON AVENUE
GREENDALE WI 53129
P / P
4 14—27 1—5555
CHARLES W LANDIS MD
2350 NORTH LAKE DRIVE
MILWAUKEE WI 53211
PTH CLP DLB / AP CLP BLl
414-225-8107
GORDON E LANG MD
2323 NORTH LAKE DRIVE
POST OFFICE BOX 503
MILWAUKEE WI 53201
PTH CLP / PTH CLP
414-963-9951
JEAN L LANG MD
5124 N ARDMORE AVENUE
WHITER ISH BAY WI 53217
IM / IM
414-464-4680
GEORGE M LANGE MD
1200 W GREEN TREE ROAD
MILWAUKEE WI 53217
ORS / ORS
A i A _QOO_P 1
JAMES H LANGENKAMP MD
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
OBG / OBG
414-671-7000
JAY A LARKEY MD
2400 W LINCOLN AVENUE
MILWAUKEE WI 53215
FP EM
414-649-5000
CHARLES A LA ROQUE MD
2900 W OKLAHOMA AVENUE
MILWAUKEE WI 53215
IM NEP / IM NEP
414-352-3100
LAWRENCE S LARSON MD
3003 W GOOD HOPE ROAD
POST OFFICE BOX 17300
MILWAUKEE WI 53217
AN
CAROL W LATORRACA MD
7716 GERALAYNE CIRCLE
MILWAUKEE WI 53213
PTH / PTH
414-774-7345
ROCCO LATORRACA MD
7716 GERALAYNE CIRCLE
MILWAUKEE WI 53213
D / D
414-271-2721
ROGER E LAUBENHEIMER MD
SUITE 925
324 E WISCONSIN AVENUE
MILWAUKEE WI 53202
PD
DAVID A LAUTZ MD
11035 W FOREST AVENUE
HALES CORNERS WI 53130
58— MILWAUKEE
FP / FP
414-649-6729
STEVEN L LAWRENCE MD
1110 SOUTH 24TH STREET
MILWAUKEE WI 53204
IM A / IM AI
414-273-2966
HOWARD J LEE MD
APT 824
924 EAST JUNEAU AVENUE
MILWAUKEE WI 53202
GP
PAUL A LEE MD
131 SPRING STREET
SANTA CRUZ CA 95060
D / D
414-271-2721
WILLIAM P LE FEBER MD
324 E WISCONSIN AVENUE
MILWAUKEE WI 53202
OTO OPH / OTO OPH
414-384-2000
ROGER H LEHMAN MD
5000 W NATIONAL AVENUE
WOOD WI 53193
IM NEP / IM NEP
414-259-3070
JACOB LEMANN JR MD
9200 W WISCONSIN AVE
MILWAUKEE WI 53226
IM / IM
EDWARD J LENNON MD
8701 WATERTOWN
PLANK ROAD
MILWAUKEE WI 53226
PM
414-332-6365
JEROME A LERNER MD
2024 E MARION STREET
SHOREWOOD WI 53211
IM / IM
NEIL A LERNER MD
4372 N ALPINE AVENUE
SHOREWOOD WI 53211
OPH / OPH
4 1 4-933—3795
RICHARD E LERNOR MD
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
FP / FP
GARY N LESKO MD
7878 NORTH 76TH STREET
MILWAUKEE WI 53223
OPH / OPH
414-543-5266
ERNEST LEVENSON MD
12247 W VERONA COURT
WEST ALLIS WI 53227
D / D
414-764-7050
INA G LEVENSON MD
2011 TENTH AVENUE
SOUTH MILWAUKEE WI 53172
AN / AN
RICHARD L LEVERENZ MD
6300 NORTH PORT
WASHINGTON ROAD
MILWAUKEE WI 53217
NS / NR
414-277-0678
JULES D LEVIN MD
SUITE 313
324 E WISCONSIN AVENUE
MILWAUKEE WI 53202
PS 7 PS
414-963-0500
DONALD M LEVY MD
400 W SILVER SPRING DR
MILWAUKEE WI 53217
PUD IM / IM
STUAPT A LEVY MD
9509 N WAKEFIELD COURT
MILWAUKEE WI 53217
R / R
414-961 -3800
JAMES E LICHTY MD
2025 E NEWPORT AVENUE
MILWAUKEE WI 53211
R
CLIFFORD LIDDLE JR MD
3237 SOUTH 16TH STREET
MILWAUKEE WI 53215
IM NM / NM
ALAN S I lEBERTHAL MD
CLINICAL MEDICINE
1218 W KILBOURN AVENUE
MILWAUKEE WI 53233
IM
KARL A LIEFERT MD
5344 S SUTTON PLACE
MILWAUKEE WI 53221
FP
DAVID W LILLICH MD
5346 NORTH SANTA
MONICA BOULEVARD
WHITEFISH BAY WI 53217
GS / GR
RICHARD H LILLIE MD
811 E WISCONSIN AVENUE
MILWAUKEE WI 53202
AN
ROBERT A LIM MD
17510 SIERRA LANE
BROOKFIELD WI 53005
IM GE
414-453-5870
MERLYN C F LINDERT MD
6745 WEST WELLS STREET
MILWAUKEE WI 53213
FP / FP
414-527-831 1
DONALD B LINDORFER MD
2400 W VILLARD AVENUE
MILWAUKEE WI 53209
GS / GS
414-271-3700
ANTHONY J LINN MD
2388 NORTH LAKE DRIVE
MILWAUKEE WI 53211
DBG
414-271-3700
JAMES G LINN MD
2388 NORTH LAKE DRIVE
MILWAUKEE WI 53211
OBG / DBG
414-271-3700
JOHN C LINN MD
2388 NORTH LAKE DRIVE
MILWAUKEE WI 53211
DR R / R
ELLIOT 0 LIPCHIK MD
RADIOLOGY DEPARTMENT
8700 W WISCONSIN AVE
MILWAUKEE WI 53226
PTH / PTH
ROBERT F LIPO MD
DRAWER 11-0
MILWAUKEE WI 53201
R / R
CHARLES R LIPSCOMB MD
1580 HIGHLAND DRIVE
ELM GROVE WI 53122
IM NEP
414-453-5870
JOHN R LITZOW MD
6745 WEST WELLS STREET
MILWAUKEE WI 53213
PD
CHENG-CHI LIU MD
4666 SOUTH 35TH STREET
GREENFIELD WI 53221
AI PD / A PD
414-271 -4204
MARTIN L LOBEL MD
SUITE 900
324 E WISCONSIN AVE
MILWAUKEE WI 53202
PS GS / PS GS
414-259-9000
PAUL W LOEWENSTEIN MD
SUITE 950
2300 N MAYFAIR ROAD
WAUWATOSA WI 53226
IM / IM
414-327-3500
WILLIAM G LONGE MD
SUITE 306
2400 SOUTH 90TH STREET
WEST ALLIS WI 53227
PM / PM
BASIL 10 F LOPEZ MD
2015 E NEWPORT AVENUE
MILWAUKEE WI 53211
CHP P / CHP P
414-258-0755
GUY R LORD MD
1000 NORTH 92ND STREET
MILWAUKEE WI 53226
P / P
414-258-5262
WILLIAM L LORTON MD
1220 DEWEY AVENUE
WAUWATOSA WI 53213
AN
414-476-0668
BENJAMIN W LOUTHAN MD
2828 N 122ND STREET
WAUWATOSA WI 53222
IM
414-272-1393
SIDNEY LUBAR MD
700 NORTH WATER STREET
MILWAUKEE WI 53202
P
ALLAN L UCK MD
6807 REYNARD ROAD
MILWAUKEE WI 53217
CD IM /CD IM
414-273-7368
MISCHA J LUSTOK MD
SUITE 204
1218 W KILBOURN AVENUE
MILWAUKEE WI 53233
PS
JEROME J LUY MD
400 W SILVER SPRING DR
MILWAUKEE WI 53217
PTH / PTH
414-873-2390
BENJAMIN W LYNE MD
3879 NORTH 55TH STREET
MILWAUKEE WI 53216
PD OS / PD
FRANCISCO M MABINI JR MD
5790 GLEN FLORA DRIVE
GREENDALE WI 53129
GS
JESUS D MACACHOR MD
1135 RIDGEWAY ROAD
BROOKFIELD WI 53005
OBG
414-671-7000
JAMES R MACAK MD
2400 WEST LINCOLN AVE
MILWAUKEE WI 53215
U / U
ALEX J MAC GILLIS MD
SUITE 601
2500 N MAYFAIR ROAD
WAUWATOSA WI 53226
P CHP / p CHP
414-271-5555
ANTHONY T MACHI MD
2664 N SUMMIT AVENUE
MILWAUKEE WI 53211
OBG / OBG
4 14—332—3223
STEPHEN MACHINTON MD
SUITE 205
2015 E NEWPORT AVENUE
MILWAUKEE WI 53211
IM PUD / IM
414-461-5355
ROBERT F MADDEN MD
8430 W CAPITOL DRIVE
MILWAUKEE WI 53222
R / R
FRANK E MADDISON MD
RADIOLOGY DEPARTMENT
POST OFFICE BOX 503
MILWAUKEE WI 53201
PTH / PTH
414-257-6201
GONZALO MADIEDO MD
DEPT OF PATHOLOGY
8700 W WISCONSIN AVE
MILWAUKEE WI 53226
IM / IM
414-272-8950
FREDERICK W MADISON MD
SUITE 300
788 N JEFFERSON STREET
MILWAUKEE WI 53202
OBG / OBG
414-271-3700
PREM P MAHATO MD
2388 NORTH LAKE DRIVE
MILWAUKEE WI 53211
NS / NS
414-257-5409
DENNIS J MAIMAN MD
8700 W WISCONSIN AVE
MILWAUKEE WI 53226
ORS / ORS
414-464-8880
MICHAEL R MAJOR MD
4036 NORTH 51 ST BLVD
MILWAUKEE WI 53216
IM CD / IM
MASSOUD MALEKI MD
3201 SOUTH 16TH STREET
MILWAUKEE WI 53215
PTH HEM / PTH HEM
414-649-7336
MOHAMMAD I MALIK MD
PATHOLOGY DEPARTMENT
2900 W OKLAHOMA AVENUE
MILWAUKEE WI 53215
IM END / IM
414-276-1906
SANFORD R MALL IN MD
788 N JEFFERSON STREET
MILWAUKEE WI 53202
OPH / OPH
414-774-2630
DAVID J MALLOY MD
9215 W CENTER STREET
MILWAUKEE WI 53222
GS / GS
414-774-2630
THOMAS G MALLOY MD
9215 W CENTER STREET
MILWAUKEE WI 53222
MILWAUKEE— 59
JOHN A MALONE MD
3201 SOUTH 16TH STREET
MILWAUKEE WI 53215
PM CHP / PM
414-962-7248
BETTY JOAN MALY MD
3835 N MURRAY AVENUE
MILWAUKEE WI 53211
IM / IM
414-541-8425
STEVEN J MAMEROW MD
10243 W NATIONAL AVE
WEST ALLIS WI 53227
DR / DR GS
JOSEPH A MANAGO MD
2900 W OKLAHOMA AVENUE
MILWAUKEE WI 53215
OPH
PAUL D MANDEL MD
SUITE 707
2315 NORTH LAKE DRIVE
MILWAUKEE WI 53211
CD IM / CD IM
414-649-3505
JOHN C MANLEY MD
SUITE 413
2901 W KK RIVER PKWY
MILWAUKEE WI 53215-3638
GS / GS
414-769-6600
ROBERT W MANN MD
3533 E RAMSEY AVENUE
CUDAHY WI 53110
NESTOR MANZANO
7848 W HARWOOD AVENUE
WAUWATOSA WI 53213
AN / AN
ISIDRO L MARANAN MD
6890 N BEECH TREE DR
MILWAUKEE WI 53209
PUD / IM
IRWIN MARGOLIS MD
6500 NORTH ATWAHL
MILWAUKEE WI 53209
DBG / OBG
414-273-1850
RITA M MARINO MD
811 E WISCONSIN AVENUE
MILWAUKEE WI 53202
DR / DR
619-438-781 1
JEROME L MARKS MD
2870 LUCIERNAGA STREET
CARLSBAD CA 92008
P
414-272-4170
JOHN W MARKSON MD
SUITE 601
2266 N PROSPECT AVENUE
MILWAUKEE WI 53202
D / D
414-271-9488
LEONARD S MARKSON MD
SUITE 4052
161 W WISCONSIN AVENUE
MILWAUKEE WI 53203
OBG / OBG
WILLIAM E MARTENS MD
SUITE 226
10425 W NORTH AVENUE
WAUWATOSA WI 53226
GS / GS
813-349-3183
ALBERT G MARTIN MD
5619 CAPE LEYTE DRIVE
SARASOTA EL 34242
GS / GS
414-327-7700
FRANCISCO J MARTINEZ MD
SUITE 104
7635 W OKLAHOMA AVENUE
MILWAUKEE WI 53219
GLORIA MARTINEZ
APT 103
9112 WEST DIXON STREET
MILWAUKEE WI 53214-1358
PTH / PTH
414-784-1495
RONALD R MARTINS MD
1855 HOLLYHOCK LANE
ELM GROVE WI 53122
OBG / OBG
414-442-4800
JOHN J MASSART MD
3070 NORTH 51ST STREET
MILWAUKEE WI 53210
AN / AN
WILLIAM E MATEICKA MD
12605 GREMOOR DRIVE
ELM GROVE WI 53122
FP / FP
414-744-6589
RAUL MATEO MD
3821 S HOWELL AVENUE
MILWAUKEE WI 53207
IM PUD / IM
414-481-9494
GEORGE MATHAI MD
13450 DUNWOODY DRIVE
ELM GROVE WI 53122
OBG / OBG
RICHARD J MATHEWS MD
2388 NORTH LAKE DRIVE
MILWAUKEE WI 53211
PS HS / GS
HAN I S MATLOUB MD
9200 W WISCONSIN AVE
MILWAUKEE WI 53226
OBG / OBG
RICHARD F MATTINGLY MD
8700 W WISCONSIN AVE
MILWAUKEE WI 53226
PTH CLP / PTH CLP
414-961-3917
JAMES E MAY MD
2025 E NEWPORT AVENUE
MILWAUKEE WI 53211
OTO / OTO
414-241-8000
DUANE G MAYHEW MD
10520 NORTH PORT
WASHINGTON ROAD
MEQUON WI 53092
ORS / ORS
JOHN O'D MC CABE MD
10118 NORTH LEE COURT
MEQUON WI 53092
ORS / ORS
414-771 -5080
ROBERT W MC CABE MD
SUITE 310
2323 N MAYFAIR ROAD
MILWAUKEE WI 53226
P
414-964-2003
NANETTE M MC CARTHY MD
SUITE 108
5215 N IRONWOOD ROAD
GLENDALE WI 53217
IM RHU / IM
414-257-5946
DANIEL J MC CARTY MD
8700 W WISCONSIN AVE
MILWAUKEE WI 53226
PTH
601-875-1608
STEPHEN L MC CLELLAN MD
SGHL
USAF MEDICAL CENTER
KEESLER AFB MS 39534
AN / AN
THOMAS F MC CORMICK MD
5049 N PALISADES ROAD
MILWAUKEE WI 53217
PTH / PTH
SAMUEL R MC CREADIE MD
1700 W WISCONSIN AVE
POST OFFICE BOX 1997
MILWAUKEE WI 53201
FP / FP
414-961 -0090
WILLIAM P MC DANIEL MD
4517 NORTH FREDERICK
WHITEFISH BAY WI 53211
PM
JAMES F MC DERMOTT MD
2438 NORTH 95TH STREET
WAUWATOSA WI 53226
ORS / ORS
414-771-5080
WILLIAM P MC DEVITT MD
SUITE 310
2323 N MAYFAIR ROAD
MILWAUKEE WI 53226
FP GP
414-762-3680
WAYNE L MC FADDEN MD
100 15TH AVENUE
SOUTH MILWAUKEE WI 53172
DR / R
EDWARD J MC GUINNIS MD
1761 CHURCH STREET
WAUWATOSA WI 53213
IM
NORVAL W MC KITTRICK MD
170 WEST KRAUSE PLACE
MILWAUKEE WI 53217
GE IM / IM
414-271-6800
PETER J MC NAMARA MD
SUITE 200
525 EAST WELLS STREET
MILWAUKEE WI 53202
N / N
414-259-2881
MICHAEL P MC QUILLEN MD
9200 W WISCONSIN AVE
MILWAUKEE WI 53226
FP
414-645-7006
BRIAN R MC SORLEY MD
1721 W OKLAHOMA AVENUE
MILWAUKEE WI 53215
DR R / R
414-453-5367
PATRICK J MC WEY MD
8028 WARREN AVENUE
WAUWATOSA WI 53213
IM NEP / IM NEP
414-462-2160
JAMES A MEANS III MD
8430 W CAPITOL DRIVE
MILWAUKEE WI 53222
FP / FP
JEANNE M MEDINA MD
4422 NORTH WOODRUFF
SHOREWOOD WI 53211
OTO
414-774-1595
PETER M MEDVED MD
113 NORTH 92ND STREET
MILWAUKEE WI 53226
D / D
414-351-3705
MORRIS M MEISTER MD
777 WEST GLENCOE PLACE
MILWAUKEE WI 53217
GS / GS
414-352-0900
ABDALLAH G MELKONIAN MD
6900 PT WASHINGTON RD
MILWAUKEE WI 53217
ORS / ORS
414-961-0304
DAVID D MELLENCAMP MD
SUITE 501
3970 N OAKLAND AVENUE
MILWAUKEE WI 53211
PD / PD
FRANK J MELLENCAMP MD
6349 N BAY RIDGE AVE
MILWAUKEE WI 53217
PM / PM
414-259-1414
JOHN L MELVIN MD
1000 NORTH 92ND STREET
MILWAUKEE WI 53226
IM / IM
414-444-0680
DARYL J MELZER MD
SUITE 411
3070 NORTH 51ST STREET
MILWAUKEE WI 53210
OM GS
414-351-0190
ELTON MENDELOFF MD
2200 W KILBOURN AVENUE
MILWAUKEE WI 53233
GS / GS
414-961-2505
GALE L MENDELOFF MD
2015 E NEWPORT AVENUE
MILWAUKEE WI 53211
GP
HYMAN MENDELOFF MD
10327 SAVANNAH COURT
21W MEQUON WI 53092
GS CDS
414-281-7883
ROLANDO M MENDIOLA MD
2745 W LAYTON AVENUE
MILWAUKEE WI 53221
BLB HEM IM / BLB HEM IM
414-933-5000
JAY E MENITOVE MD
1701 W WISCONSIN AVE
MILWAUKEE WI 53233
414-962-9207
DAVID C MERRILL
APT 43
2430 W GOOD HOPE ROAD
MILWAUKEE WI 53209-2755
FP / FP
414-672-1353
KIM A MERRIMAN MD
1036 SOUTH 16TH STREET
MILWAUKEE WI 53204
AN / AN
414-782-4832
THEODORE F MEVES MD
18310 BENNINGTON DRIVE
BROOKFIELD WI 53005
NS / NS
414-257-6465
GLENN A MEYER MD
16475 SHORELINE DRIVE
BROOKFIELD WI 53005
GPM PH / GPM
218-326-1174
JULES 0 MEYER MD
1124 E HERMITAGE ROAD
MILWAUKEE WI 53217
60— MILWAUKEE
JEFF M mCHALSKI
4001 W ST PAUL AVENUE
MILWAUKEE WI 53208
GS
NORBERT A MIKOLAJCZAK MD
9309 W HADLEY STREET
MILWAUKEE WI 53222
FP / FP
ILUMINADO M MILLAR MD
5631 W LINCOLN AVENUE
POST OFFICE BOX 19892A
WEST ALLIS WI 53219
ALLEN L MILLARD III
318 PLUMB
MILTON WI 53563
N P / N P
414-276-5474
FRANCIS J MILLEN MD
SUITE 3185
161 W WISCONSIN AVENUE
MILWAUKEE WI 53203
IM
414-771-7857
DEAN D MILLER MD
1945 WAUWATOSA AVENUE
MILWAUKEE WI 53213
D / D
414-332-5856
HAROLD L MILLER MD
1124 E LEXINGTON BLVD
MILWAUKEE WI 53217-5382
FP / FP
414-962-7477
JOHN J MILLER MD
1513 E CAPITOL DRIVE
SHOREWOOD WI 53211
FP
LEE F MILLER MD
8410 W CLEVELAND AVE
WEST ALLIS WI 53227
MICHAEL W MILLER
2122 SOUTH LENNOX
CASPER WY 82601
D / D
414-771-3030
PAMELA PARKE-MILLER MD
2500 N MAYFAIR ROAD
MILWAUKEE WI 53226
PD / PD
414-425-5660
ROBERT JOHN MILLER MD
11035 W FOREST HOME AV
HALES CORNERS WI 53130
NPM PD
GREGORY S MILLEVILLE MD
#309
3070 NORTH 51ST STREET
MILWAUKEE WI 53210
EM
414-363-4264
DELBERT L MINER MD
803 BEULAH PARK ROAD
EAST TROY WI 53120
ORS
414-321-8960
JAMES E MINIKEL MD
5233 W MORGAN AVENUE
MILWAUKEE WI 53220
ORS / ORS
JEFFREY L MINIKEL MD
5233 WEST MORGAN AVE
MILWAUKEE WI 53220
CDS TS / TS
MAHMOOD MIRHOSEINI MD
SUITE 2006
3201 SOUTH 16TH STREET
MILWAUKEE WI 53215
IM
MARSHAL J MIRVISS MD
SUITE 117
1218 W KILBOURN AVENUE
MILWAUKEE WI 53233
PD
LEROY MITCHAM MD
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
AN / AN
SAMIR K MITRA MD
3305 ARROYO ROAD
BROOKFIELD WI 53005
GS CDS / GS
RAM K MITTAL MD
100 15TH AVENUE
SOUTH MIl.WAUKEE WI
53172-1198
PM / PM
414-447-2208
WALIER L MODAFF MD
2545 LAMPLIGHTER LANE
BROOKFIELD WI 53005
R / R
305-972-0037
MORRIS MOEL MD
APT 207
821 CYPRESS BOULEVARD
POMPANO BEACH FL 33060
IM PUD
414-671-7000
HERMES E MONATO MD
2400 W LINCOLN AVENUE
MILWAUKEE WI 53215
D / D
414-352-3100
EUGENE W MONROE MD
3003 W GOOD HOPE ROAD
POST OFFICE BOX 17300
MILWAUKEE WI 53217
GS / GS
JOSE V MONTENEGRO III MD
POST OFFICE BOX 1 1-0
MILWAUKEE WI 53201
ORS / ORB
414-351-1 344
ROBERT P MONTGOMERY MD
7065 N GREEN TREE CT
MILWAUKEE WI 53217
GPM EM
414-421-6724
TIMOTHY J S MOODY MD
3830 W RAWSON AVENUE
FRANKLIN WI 531 SE-
IM A / IM
414-353-6645
M KELLOGG MDOKERJEE MD
9723 W BEECHWODD AVE
MILWAUKEE WI 53224
P / P
217-886-2541
GEORGE E MOORE MD
ROUTE 1
ASHLAND IL 62612
OM
414-671-7000
JOHN S MOORE MD
2400 W LINCOLN AVENUE
MILWAUKEE WI 53215
TS GS / GS
414-351-6119
JOSE M MORENO MD
100 E CHEROKEE CIRCLE
FOX POINT WI 53208
GP
414-463-9700
LLOYD W MOREY DO
4025 NORTH 92ND STREET
WAUWATOSA WI 53222
OTO / OTO
HOWARD V MDRTER MD
ROUTE 3 BOX 3162
BLAIRSVILLE GA 30512-9412
R / R
714-768-8376
SILVANUS A MORTON MD
4025 - 2G CALLE
SONORA ESTE
LAGUNA HILLS CA 92653
414-257-2998
WALTER E MOSCOSO JR
APT 8
11121 W MEINECKE AVE
WAUWATOSA WI 53226
IM
414-671-7000
MARK J MOSKOWITZ MD
2400 W LINCOLN AVENUE
MILWAUKEE WI 53215
GS
414-774-1 255
RICHARD 0 MOSSEY MD
2500 N 108TH STREET
MILWAUKEE WI 53226
GP GS
NAGHI MDTAMEDI MD
SUITE 415
1218 W KILBOURN STREET
MILWAUKEE WI 53233
FP / FP
RAYMOND W MOY MD
6917 W OKLAHOMA AVENUE
MILWAUKEE WI 53219
ORS / ORS
414-453-9800
CARL F MOYER MD
SUITE 608
2600 N MAYFAIR ROAD
MILWAUKEE WI 53226
GP
414-482-2740
CHESTER J MRDCZKOWSKI MD
2352 S KINNICKINNIC AV
MILWAUKEE WI 53207
GS / GS
414-476-9592
JOSEPH J MUELLER MD
SUITE 401
2500 N 108TH STREET
MILWAUKEE WI 53226
PH PUD
800-529-1836
NINA T MUELLER MD
A-210
S77 W12929 MC SHANE RD
HALES CORNERS WI 53130
NS / NS
JOSEPH A MUFSON MD
1610 N PROSPECT AVENUE
MILWAUKEE WI 53202
OBG / OBG
GERALD I MULLANEY JR MD
5631 NORTH MOHAWK ROAD
MILWAUKEE WI 53217
TS CDS GS / TS CD GS
414-649-3990
DONALD C MULLEN MD
2901 W KK RIVER PKY
MILWAUKEE WI 53215
IM
414-463-6350
JOHN P MULLOOLY MD
8430 W CAPITOL DRIVE
MILWAUKEE WI 53222
GS CDS / GS
414-327-3120
GERALD A MUNDSCHAU MD
5757 W OKLAHOMA AVENUE
MILWAUKEE WI 53219
IM / IM
GEORGE A MUNKWITZ MD
NO 801
2315 NORTH LAKE DRIVE
MILWAUKEE WI 53211
GP IM
GEORGE V MURPHY MD
100 15TH AVENUE
SOUTH MILWAUKEE WI 53172
N PD / N PD
414-342-4400
JEROME V MURPHY MD
SUITE 702
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
IM
414-774-7186
DAVID A NAGELHOUT MD
1264 KAVANAUGH PLACE
WAUWATOSA WI 53213
PD END / PD
414-442-8422
B RAMACHANDRAN NAIR MD
3070 NORTH 51 ST STREET
MILWAUKEE WI 53210
GS CDS / GS
BAHRAM NAMDARI MD
6000 SOUTH 27TH STREET
MILWAUKEE WI 53221
TS GS / TS GS
414-962-6300
BENJAMIN G NARODICK MD
6018 NORTH LAKE DRIVE
MILWAUKEE WI 53217
OPH / OPH
414-475-7698
KAMAL F NASSIF MD
SUITE 955
2600 N MAYFAIR ROAD
MILWAUKEE WI 53226
N IM / PN
414-961-4650
PAUL A NAUSIEDA MD
2025 EAST NEWPORT AVE
MILWAUKEE WI 5321 1
AN FP
414-543-7228
GREGORY S NAZE MD
3600 SOUTH 94TH STREET
MILWAUKEE WI 53228
GP
813-535-3544
MICHAEL S NEFCHES MD
#1120 SHADY LANE
15666 49TH STREET N
CLEARWATER FL 33520
R / R
414-421-3347
JAMES R NELLEN MD
6287 PARKVIEW ROAD
GREENDALE WI 53129
ORS / ORS
SAM P NESEMANN MD
9400 W LINCOLN AVENUE
WEST ALLIS WI 53227
GS / GS
414-933-4023
ZEBEDEE J NEVELS MD
2130 W FOND DU LAC AVE
MILWAUKEE WI 53206
FP / FP
414-744-658R
GREGORY M NIERENGARTEN DO
3821 S HOWELL AVENUE
MILWAUKEE WI 53207
GP GS
PAUL J NILAND MD
2570 SOUTH SHORE DRIVE
MILWAUKEE WI 53207
MILWAUKEE— 61
IM
414-476-4630
ROBERT A NIMZ MD
4921 W WISCONSIN AVE
MILWAUKEE WI 53208
P
4 1 4-27 1 —
GILBERT J NOCK JR MD
2350 NORTH LAKE DRIVE
MILWAUKEE WI 53211
OTO / OTO
PATRICK J NOONAN MD
10520 NORTH PORT
WASHINGTON ROAD
MEQUON WI 53092
ORS GS
414-962-1787
STEPHEN L NORD MD
6141 N SANTA MONICA
WHITEFISH BAY WI 53217
P
414-258-2600
ARTHUR G NORRIS MD
1220 DEWEY AVENUE
MILWAUKEE WI 53213
GP
414-463-4550
JOSEPH P NOTHUM MD
4847 N HOPKINS STREET
MILWAUKEE WI 53209
IM CD
ARMANDO N NUNAG MD
3533 E RAMSEY AVENUE
CUDAHY WI 53110
IM
414-769-9760
D'JAHLMA A NUYDA MD
5854 S PACKARD AVENUE
CUDAHY WI 53110
A D
414-962-3824
HAROl D H OBERFELD MD
APT 808
3909 N MURRAY AVENUE
MILWAUKEE WI 53211
IM / IM
JAMES R O'CONNELL MD
3201 SOUTH 16TH STREET
MILWAUKEE WI 53215
FP OB / FP
THOMAS A O'CONNOR MD
1363 N PROSPECT AVENUE
MILWAUKEE WI 53202
TB CD GS / TS GS
414-259-1558
THOMAS M O'CONNOR MD
SUITE 328
10625 W NORTH AVENUE
MILWAUKEE WI 53226
OM
414-671-7000
MICHAEL G 0 'GRADY MD
2400 W LINCOLN AVENUE
MILWAUKEE WI 53215
OPH / OPH
414-933-3795
KENNETH W OLANDER, PhD
SUITE 601
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
GS / GS
VIGGO B OLSEN MD
26642 ALAMO CIRCLE
EL TORO CA 92630
TR / TR
414-225-8085
CARL E OLSON MD
9910 NORTH COREY LANE
MEQUON WI 53092
IM / IM
414-541-5477
CARROLL R OLSON MD
SUITE 202
2400 SOUTH 90TH STREET
WEST ALLIS WI 53227
DAVID C OLSON
8540 GLENCOE CIRCLE
WAUWATOSA WI 53226
HS ORS / ORS
414-453-7418
DAVID WALTER OLSON MD
2300 NORTH MAYFAIR RD
MILWAUKEE WI 53226
EM GS ORS / GS
414-241-3635
DAVID WILLIAM OLSON MD
10208 ASTER LANE, IW
MEQUON WI 53092-6153
IM GE / IM GE
414-271-6800
PHILIP B O'NEILL MD
SUITE 200
525 EAST WELLS STREET
MILWAUKEE WI 53202
IM
GIDEON A OREN MD
3975 NORTH 68TH STREET
MILWAUKEE WI 53216
P / P
414-327-3230
EDNA F OR I GENES MD
7635 W OKLAHOMA AVENUE
MILWAUKEE WI 53219
JOHN M OSTERGAARD
21305 ASTOLAT DRIVE
BROOKFIELD WI 53005
GP
HAROLD H OTTENSTEIN MD
5265 NORTH LAKE DRIVE
MILWAUKEE WI 53217-5371
414-228-7947
MARY F OTTERSON MD
1930 WEST BIRCH COURT
MILWAUKEE WI 53209
U / U
414-344-3700
SAMUEL J OTTO MD
SUITE 40)
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
GS / GS
DAVID W OVITT MD
4648 N WOODBURN STREET
MILWAUKEE WI 53211
IM / IM
414-963-1030
NICHOLAS L OWEN MD
SUITE 208
2015 E NEWPORT AVENUE
MILWAUKEE WI 53211
AN
414-257-6269
RUSSELL H OWEN MD
SUITE 533
8700 W WISCONSIN AVE
MD MILWAUKEE WI 53226
OPH / OPH
ANDREW J OWENS MD
13335 NICOLET AVENUE
ELM GROVE WI 53122
FP GER
305-973-8221
EMANUEL M OXMAN MD
BUILDING D #2B
3304 ARUBA WAY
COCONUT CREEK FL 33066
OBG
ANTHONY C PAGEDAS MD
11035 W FOREST HOME AV
HALES CORNERS WI 53130
ORS / ORS
4 14-321—2255
THOMAS C PAGEDAS MD
9400 W LINCOLN AVENUE
WEST ALLIS WI 53227
FP / FP
414-933-3600
RUTA M PAKALNS MD
7405 W WELLAUER DRIVE
MILWAUKEE WI 53213
GP
JOSE M PALISOC JR MD
3122 SOUTH 13TH STREET
MILWAUKEE WI 53215
GP U
414-351-3350
FRANK J PALLASCH MD
APT 148
425 WEST WILLOW COURT
FOX POINT WI 53217
PTH / PTH
414-527-6407
JAMES T PALOUCEK MD
2400 W VILLARD AVENUE
MILWAUKEE WI 53209
IM / IM
414-278-3521
CONSTANTINE PANAGIS MD
841 NORTH BROADWAY
MILWAUKEE WI 53202
U / U
ANDREW A PANDAZI MD
811 E WISCONSIN AVENUE
MILWAUKEE WI 53202
GS
ANTONIO G PANGILINAN MD
4893 N GREEN BAY AVE
MILWAUKEE WI 53209
DR NM / DR NM
RICHARD M PANISH MD
POST OFFICE BOX 1644
MILWAUKEE WI 53201
OBG
LOUIS J PAQUETTE MD
105 W SILVER SPRING DR
MILWAUKEE WI 53217
OBG / OBG
414-276-3325
JAZMIN D PARCON MD
2315 NORTH LAKE DRIVE
MILWAUKEE WI 53211
IM CD / IM CD
414-453-5870
GERARD T PARENT MD
6745 WEST WELLS STREET
WAUWATOSA WI 53213
N / N
STEVEN H PARK MD
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
OBG
EDWARD C PARKER MD
SUITE 210
2400 SOUTH 90TH STREET
WEST ALLIS WI 53227
IM GE / IM GE
414-447-6622
HARRISON W PARKER MD
SUITE 507
3070 NORTH 51ST STREET
MILWAUKEE WI 53210
OBG
WAYMAN PARKER MD
2003 W CAPITOL DRIVE
MILWAUKEE WI 53206
IM / IM
414-645-281 1
ABBAS PARSA MD
3201 SOUTH 16TH STREET
MILWAUKEE WI 53215
PH FP OM
414-278-3637
PETER J PARTHUM MD
S63 W14899 GARDEN TER
MUSKEGO WI 53150
P CHP
414-289-9560
MUNI H PATEL MD
2350 NORTH LAKE DRIVE
MILWAUKEE WI 53211-4507
P
414-258-2600
JUNE C PATRICK DO
1220 DEWEY AVENUE
WAUWATOSA WI 53213
GS ADS
414-782-8822
THEODORE M PAULBECK MD
14480 WESTOVER ROAD
ELM GROVE WI 53122
OBG / OBG
414-786-6420
ROBERT S PAVLIC MD
17000 W NORTH AVENUE
BROOKFIELD WI 53005
IM
EDUARDO PAZ MD
7205 DORCHESTER LANE
GREENDALE WI 53129
IM RHU / IM RHU
414-785-0777
LARRY C PEARSON MD
6541 N BRAEBURN LANE
GLENDALE WI 53209
CDS TS
414-278-7600
PABLO M PEDRAZA MD
SUITE 901
2315 NORTH LAKE DRIVE
MILWAUKEE WI 53211-4578
OBG / OBG
PHILIP C PELL AND MD
2457 N MAYFAIR ROAD
MILWAUKEE WI 53226
PTH / PTH
JORGE G PELLEGRINI MD
2900 W OKLAHOMA AVENUE
MILWAUKEE WI 53215
GS OS / GS
THOMAS J PENDERGAST MD
2460 NORTH 96TH STREET
WAUWATOSA WI 53226
PD / PD
414-453-3420
ARCHEBALD R PEQUET MD
10425 W NORTH AVENUE
MILWAUKEE WI 53226
LEONEL E PEREZ
APT 1
523 NORTH 26TH STREET
MILWAUKEE WI 53233
OBG / OBG
414-964-9123
SAMUEL G PERLSON MD
4831 N ARDMORE AVENUE
MILWAUKEE WI 53217
62— MILWAUKEE
GS
414-671-7000
NANCY B HETRD MD
2400 WEST LINCOLN AVE
MILWAUKEE WI 53215
R / R
414-453-4919
THEODORE J PFEFFER MD
11725 HOMEWOOD AVENUE
WAUWATOSA WI 53226
GS / GS
WILLIAM M PFEIFER MD
937 WEST SHAKER CIRCLE
98N MEQUON WI 53092
KENNETH J PHILLIPS JR
APT 307
929 NORTH ASTOR STREET
MILWAUKEE WI 53202-3435
PTH CLP / PTH AP CLP
414-937-2166
MICHAEL PHILLIPS MD
POST OFFICE BOX 11-0
MILWAUKEE WI 53201
PTH NM / PTH NM
WILLIAM vl PIER JR MD
2728 NORTH PARK DRIVE
WAUWATOSA WI 53222
IM / IM
414-541-7900
JAMES V PILLIOD MD
2400 SOUTH 90TH STREET
MILWAUKEE WI 53227
D OM / D
414-964-9030
ROBERT B PITTELKOW MD
115 W SILVER SPRING DR
MILWAUKEE WI 53217
DAVID E PITTENGER
4176 SPRUCE HOLLOW NE
GRAND RAPIDS MI
49505-19^8
PS GS / PS GS
414-258-8860
ALAN L POHL MD
SUITE 111
10425 W NORTH AVENUE
MILWAUKEE WI 53226
D / D
414-961-7330
EDWARD L POHLE MD
SUITE 603
3970 N OAKLAND AVENUE
MILWAUKEE WI 53211
IM 7 IM
414-272-8950
HERBERT W POHLE MD
SUITE 300
788 N JEFFERSON STREET
MILWAUKEE WI 53202
IM NM / IM NM
414-961-3300
GUENTHER P POHLMANN MD
2025 E NEWPORT AVENUE
MILWAUKEE WI 53211
IM / IM
GERALD W POINDEXTER MD
4259 EAST OAKWOOD ROAD
OAK CREEK WI 53154
PD / PD
414-964-1 140
LARRY J POLACHECK MD
710 E SILVER SPRING DR
MILWAUKEE WI 53217
PD / PD
414-962-9500
WALTER S POLACHECK MD
2323 E CAPITOL DRIVE
MILWAUKEE WI 53211
GS
414-671-7000
MARVIN POLL MD
2400 W LINCOLN AVENUE
MILWAUKEE WI 53215
P PYA
SAUL K POLLACK MD
700 NORTH WATER STREET
MILWAUKEE WI 53202
U / U
414-344-3360
RANDLE E POLLARD MD
SUITE 508
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
GP GS
4 14-462-4929
ALBERT POPP MD
5272 NORTH 27TH STREET
MILWAUKEE WI 53209
OBG / OBG
414-778-0074
TOD J POREMBKI MD
2500 N MAYFAIR ROAD
WAUWATOSA WI 53226
FP / FP
WILLIAM B POTOS MD
3533 E RANSEY AVENUE
CUDAHY WI 53110
AN
PHILIP F POWONDRA MD
2560 SOUTH 78TH STREET
WEST ALLIS WI 53219
FP EM
PODEROSO G PRADO MD
ROUTE 2, BOX 179
PALMYRA WI 53156
IM NEP / IM NEP
414-276-1007
D RAO PRASAD MD
SUITE 915
2315 NORTH LAKE DRIVE
MILWAUKEE WI 53211
IM RHU / IM
414-276-1007
JAYA C PRASAD MD
2315 NORTH LAKE DRIVE
MILWAUKEE WI 53211
414-476-7774
THOMAS E PREIN
1128 KAVANOUGH PLACE
WAUWATOSA WI 53213
NM NR R / NM NR R
414-527-8103
DANIEL J PRICE MD
2400 W VILLARD AVENUE
MILWAUKEE WI 53209
PD / PD
THOMAS A PRIER MD
3970 LILLY ROAD
BROOKFIELD WI 53005
OTO HNS / OTO
414-447-6700
WILLIAM F PRUDLOW MD
3070 NORTH 51ST STREET
MILWAUKEE WI 53210
CD IM
414-453-4847
THOMAS C PUCHNER MD
SUITE 830
2300 N MAYFAIR ROAD
WAUWATOSA WI 53226
AI PD / AI PD
414-271-3700
JAMES M PUGELY MD
2388 NORTH LAKE DRIVE
MILWAUKEE WI 53211
414-453-5370
XIOMARA PUIG
APT 204
9122 WEST DIXON STREET
MILWAUKEE WI 53214
ORS
414-351-3500
DOMENIC J PULITO MD
7545 NORTH PORT
WASHINGTON ROAD
MILWAUKEE WI 53217
FP PYM
FRANK J PULITO MD
6145 NORTH LAKE DRIVE
MILWAUKEE WI 53217
GP
414-342-4126
ROBERT F PURTELL MD
3316 W WISCONSIN AVE
MILWAUKEE WI 53208
FP / FP
414-342-4126
ROBERT F PURTELL JR MD
3316 W WISCONSIN AVE
MILWAUKEE WI 53208
414-771-8091
KATHY J PURVIS
1314 SOUTH 97TH STREET
WEST ALLIS WI 53214
AN
414-352-1897
ANDRES F QUITZON MD
2245 W BRANTWOOD AVE
MILWAUKEE WI 53209
PTH / AP CLP
414-649-7331
IJAZ N QURESHI MD
2900 W OKLAHOMA AVENUE
MILWAUKEE WI 53215
AN / AN
414-352-8567
WILLIAM B RABENN MD
7607 N LONGVIEW DRIVE
MILWAUKEE WI 53209
GS / GS
414-272-1404
FRED S RACADIO MD
1218 W KILBOURN AVENUE
MILWAUKEE WI 53233
PD
414-671-7000
RUTH M RADEMACHER MD
2400 W LINCOLN AVENUE
MILWAUKEE WI 53215
NPM PD / PD
414-447-2467
STEPHEN C RAGATZ MD
SUITE 309
3070 NORTH 51ST STREET
MILWAUKEE WI 53210
AN / AN
MOHINI K RAISINGHANI MD
12320 WEST OHIO AVENUE
WEST ALLIS WI 53227
P
ROBERT W RAKOW MD
2555-17 N LAKE DRIVE
MILWAUKEE WI 53211
AN / AN
414-351-3159
REUF RAMIC MD
2420 W APPLEWOOD LANE
MILWAUKEE WI 53209
IM
HAROLD RAND MD
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
OPH OTO
RALPH T RANK MD
4620 N BARTLETT AVENUE
MILWAUKEE WI 53211
R / R
JAMES J RANKIN MD
2900 W OKLAHOMA AVENUE
MILWAUKEE WI 53215
PD PHO / PD PHO
414-271-3700
L MOHAN RAO MD
2388 NORTH LAKE DRIVE
MILWAUKEE WI 53211
IM
VELUVOLU K RAO MD
1672 S NINTH STREET
MILWAUKEE WI 53204
R / R
CORNELIUS J RATER MD
5818 NORTH SHORE DRIVE
MILWAUKEE WI 53217
ORS / ORS
EDWARD K RATH MD
5233 W MORGAN AVENUE
MILWAUKEE WI 53220
P / P
DONALD RATKE MD
8080 NORTH BEACH DRIVE
MILWAUKEE WI 53217
PTH / PTH
414-937-5041
HENRY V RAVELO MD
DEPT OF pathology
2200 W KILBOURN AVENUE
MILWAUKEE WI 53233
PD / PD
414-271-3700
LALITHA C RAYAN MD
2388 NORTH LAKE DRIVE
MILWAUKEE WI 53211
R / R
414-527-8108
DOUGLAS A REASA MD
2400 W VILLARD AVENUE
MILWAUKEE WI 53209
PM / PM
414-259-1414
NANJAPPAREDDY M REDDY MD
1000 NORTH 92ND STREET
MILWAUKEE WI 53226
FP
414-481-4897
KENNETH C REDLIN MD
2319 EAST EUCLID AVE
MILWAUKEE WI 53207
GS
RUSSELL R REDLIN MD
52630 EISENHOWER DRIVE
LA QUINTA CA 92253
P
ALAN E REED JR MD
SUITE 260
400 W SILVER SPRING DR
MILWAUKEE WI 53217
OPH / OPH
414-276-4071
FREDERICK H REESER JR MD
SUITE 707
2315 NORTH LAKE DRIVE
MILWAUKEE WI 53211
IM GE / IM GE
414-272-8950
PATRICK T REGAN MD
SUITE 300
788 N JEFFERSON ST
MILWAUKEE WI 53202
MILWAUKEE— 63
CD IM / CD IM
414-344-5442
MICHAEL S REID MD
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
GS / GS
414-774-6130
WILLIAM E REIFENRATH MD
10425 W NORTH AVENUE
MILWAUKEE WI 53226
OBG / OBG
414-774-9322
ROBERT P REIK MD
SUITE 226
10425 W NORTH AVENUE
WAUWATOSA WI 53226
EM / EM
414-961-3508
THOMAS A REM INGA MD
2025 E NEWPORT AVENUE
MILWAUKEE WI 53211
CDS TS GS / TS GS
414-258-0670
CHARLES F REUBEN MD
SUITE 795
2300 N MAYFAIR ROAD
WAUWATOSA WI 53226
AN / AN
414-781-2125
PR I MIT I VO I REYNALDO MD
3835 FRESNO ROAD
BROOKFIELD WI 53005
N / PN
414-289-8099
NORMAN C REYNOLDS JR MD
950 NORTH 12TH STREET
MILWAUKEE WI 53233
OBG / OBG
YONG HEE RHEE MD
8909 NORTH PORT
WASHINGTON ROAD
MILWAUKEE WI 53217
U
IGNATIUS J RICCIARDI MD
1831 NORTH BIST STREET
WAUWATOSA WI 53213
IM CD / IM
414-272-1393
RAYMOND L RICE MD
700 NORTH WATER STREET
MILWAUKEE WI 53202
TR / TR
414-649-6420
MARCIA J S RICHARDS MD
DEPT OF RAD ONCOLOGY
2900 W OKLAHOMA AVENUE
MILWAUKEE WI 53215-0003
GP / GP
HAROLD K RICHES DO
3044 south 92ND STREET
WEST ALLIS WI 53227
OPH / OPH
414-278-7500
JOHN E RIDLEY III MD
SUITE 1001
2315 NORTH LAKE DRIVE
MILWAUKEE WI 53211
GS / GS
414-774-1919
JAN RIECAN MD
2845 NORTH 9BTH STREET
MILWAUKEE WI 53222
IM NEP / IM NEP
414-289-8080
RICHARD E RIESELBACH MD
POST OFFICE BOX 342
MILWAUKEE WI 53201
GS / GS
C SHERRILL RIFE MD
SUITE 795
2300 N MAYFAIR ROAD
MILWAUKEE WI 53226
P
MARC E RITSEMA DO
1220 DEWEY AVENUE
WAUWATOSA WI 53213
IM GE
414-342-1202
JAMES E ROBINSON MD
SUITE 780
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
EM
608-829-3132
JONATHAN ROBINSON MD
201 NORTH WESTFIELD
MADISON WI 53717
IM / IM
PATRICK A ROE MD
360 W NOKOMIS COURT
FOX POINT WI 53217
CD / CD
414-276-8586
JEFFREY ROGERS MD
SUITE 4005
161 W WISCONSIN AVENUE
MILWAUKEE WI 53203
OBG / OBG
JOHN C ROGERS MD
3535 W OKLAHOMA AVENUE
MILWAUKEE WI 53215
OTO GS / OTO
414-281-0602
RUBEN P ROMERO MD
2745 W LAYTON AVENUE
MILWAUKEE WI 53221
OPH / OPH
414-782-5346
GEORGE J RONCKE MD
1650 LINDHURST COURT
ELM GROVE WI 53122-1747
GYN
414-272-0807
MONA ROBE MD
SUITE 204
788 N JEFFERSON STREET
MILWAUKEE WI 53202
DR R / R
414-961-8732
QUENTIN F ROBE MD
3481 NORTH LAKE DRIVE
MILWAUKEE WI 53211
FP / FP
414-449-0404
WILLIAM R ROBE MD
3518 W FOND DU LAC AVE
MILWAUKEE WI 53216
PD /■ PD
414-466-9530
DAVID M ROSENBERG DO
3975 NORTH 68TH STREET
MILWAUKEE WI 53216
FP / FP
414-225-8291
LOUIS R ROSIN MD
3435 PIl.GRIM ROAD
BROOKFIELD WI 53005
GS / GS
414-543-9240
TERENCE V ROTH MD
8410 W CLEVELAND AVE
WEST ALLIS WI 53227
CLP / PTH
DAVID J RDTHWELL MD
2025 E NEWPORT AVENUE
MILWAUKEE WI 53211
GP
EARLE J ROTTER MD
5126 BOETTCHER DRIVE
WEST BEND WI 53095-9148
ORS / ORS
414-351-3500
FRANCIS J ROTTER MD
7545 NORTH PORT
WASHINGTON ROAD
MILWAUKEE WI 53217
AN / AN
WILLIAM C ROUMAN MD
6300 NORTH PORT
WASHINGTON ROAD
MILWAUKEE WI 53217
IM / IM
414-476-9440
OWEN ROYCE JR MD
2222 N MAYFAIR ROAD
MILWAUKEE WI 53226
D / D
414-271-3436
DONALD M RUCH MD
SUITE 1435
111 E WISCONSIN AVENUE
MILWAUKEE WI 53202
IM / IM
414-257-7027
ROGER L RUEHL MD
BUILDING 3
9455 WATERTOWN PLANK
MILWAUKEE WI 53226
IM NM / IM
PHILIP P RUETZ MD
5000 W NATIONAL AVENUE
WOOD WI 53193
IM A
LOUIS L RUFF MD
SUITE 725
2300 N MAYFAIR ROAD
MILWAUKEE WI 53226
GP
414-543-0300
GORDON RUMHOFF MD
8410 W CLEVELAND AVE
WEST ALLIS WI 53227
AN
JAMES R RUSCH MD
2825 NORTH MAYFAIR RD
MILWAUKEE WI 53222
D / D
414-259-1 115
THOMAS J RUSSELL MD
2300 N MAYFAIR ROAD
MILWAUKEE WI 53226
OPH / OPH
414-257-5106
MARK S RUTTUM MD
8700 W WISCONSIN AVE
MILWAUKEE WI 53226
GP OBG
PAUL W RYAN MD
1509 COACHMAN DRIVE
MOUNTAIN HOME AR 72653
ORS / ORS
414-321-8960
JAMES A RYDLEWICZ MD
5233 W MORGAN AVENUE
MILWAUKEE WI 53220
R / R
AUGUST F RYMUT JR MD
633 E LAKE VIEW AVENUE
WHITEFISH BAY WI 53217
P
414-258-2600
KRYSTYNA D RYTEL MD
1220 DEWEY AVENUE
WAUWATOSA WI 53213
OBG / OBG
414-276-4526
MORRIS H SABLE MD
SUITE 301
788 N JEFFERSON STREET
MILWAUKEE WI 53202
ORS
HARRY B SADOFF MD
BUILDING A APT 228
500 WEST BRADLEY ROAD
FOX POINT WI 53217
CD IM / IM
414-271-3740
ALI A SADOUGHIAN MD
SUITE 919
2315 NORTH LAKE DRIVE
MILWAUKEE WI 53211
TS CDS / TS
414-649-3959
SAED F SAEDI MD
SUITE 417
2901 W KK RIVER PKWY
MILWAUKEE WI 53215
IM
ROBERT P SAICHEK MD
NO 314
1218 W KILBOURN STREET
MILWAUKEE WI 53233
GS PDS / GS
414-476-9920
SHIMPEI SAKAGUCHI MD
6551 WASHINGTON CIRCLE
WAUWATOSA WI 53213
PTH / PTH
THOMAS G SAMTER MD
POST OFFICE BOX 342
MILWAUKEE WI 53201
OTO MFS
414-287-0602
MARTIN E SAMUEL DDS MD
2745 W LAYTON AVENUE
MILWAUKEE WI 53221
414-453-0751
JAMES W SANDBERG
APT 7
9131 WEST DIXON STREET
MILWAUKEE WI 53214
GP
414-372-4230
ARTHUR C SANDERS JR MD
2545 N TEUTONIA AVENUE
MILWAUKEE WI 53206
CD PUD / IM
RAYNALDO G SANDOVAL MD
SUITE 754
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
FP / FP
4 14—352—5457
ANTHONY J SANFELIPPO MD
2420 WEST DEAN ROAD
MILWAUKEE WI 53217
PS GS / PS GS
414-259-3094
JAMES R SANGER MD
9200 W WISCONSIN AVE
MILWAUKEE WI 53226
AN
SUSAN L SANTELLE MD
3103 E HAMPSHIRE ST
MILWAUKEE WI 53211
OBG / OBG
414-289-8259
GLORIA E SARTO MD
950 NORTH 12TH STREET
POST OFFICE BOX 342
MILWAUKEE WI 53201-0342
64— MILWAUKEE
GS / GS
414-272-4629
MARVIN E SATTLER MD
SUITE 401
1218 W KILBOURN AVENUE
MILWAUKEE WI 53233
GS / GVS
KENDALL E SAUTER MD
SUITE 501
2500 N MAYFAIR ROAD
MILWAUKEE WI 53226
GS / GS
ALLEN J SAVITT MD
2400 SOUTH 90TH STREET
WEST ALLIS WI 53227
OPH / OPH
414-273-4225
THOMAS R SAWYER MD
811 E WISCONSIN AVENUE
MILWAUKEE WI 53202
GE IM
414-782-7932
WALTER J SCHACHT MD
1320 VICTORIA CIRCLE S
POST OFFICE BOX 671
ELM GROVE WI 53122-0671
AN
414-771-9777
RICHARD M SCHAEFER
6639 WEST LLOYD STREET
MILWAUKEE WI 53213-2024
N P / N
4 1 4—351 —3757
BERNARD S SCHAEFFER MD
APT A-128
500 WEST BRADLEY ROAD
MILWAUKEE WI 53217
R / R
414-225-8160
JAMES A SCHELBLE MD
nil EAST LILAC LANE
MILWAUKEE WI 53217
IM / IM
414-271-3700
FRANCIS G SCHERMAN MD
2388 NORTH LAKE DRIVE
MILWAUKEE WI 53211
IM PUD / IM PUD
414-257-6355
DONALD P SCHLUETER MD
8700 W WISCONSIN AVE
MILWAUKEE WI 53226
AN / AN
414-351—525?
KAREN S SCHMAHL MD
1925 WEST DEAN ROAD
MILWAUKEE WI 53217
CDS TS / TS GS
414-647-1120
TERENCE M SCHMAHL MD
2901 WEST KINNICKINNIC
RIVER PARKWAY
MILWAUKEE WI 53215
ORS
414-771-4755
GREGORY J BCHMELING MD
1513 ST CHARLES STREET
WAUWATOSA WI 53213
AN
414-257-8627
WILLIAM T SCHMELING MD
PHARMACOLOGY ?< TOX
8701 W WATERTOWN PL RD
MILWAUKEE WI 53226
R / R
CHARLES E SCHMIDT MD
7748 MARY ELLEN PLACE
WAUWATOSA WI 53213
OTO
FREDERIC W SCHMIDT MD
8131 GRIDLEY AVENUE
WAUWATOSA WI 53213
OPH / OPH OTO
414-332-7270
HERBERT G SCHMIDT MD
2710 E NEWTON AVENUE
MILWAUKEE WI 53211
IM EM
414-771-0743
RANDALL W SCHMIDT MD
529 NORTH 62ND STREET
WAUWATOSA WI 53213
GS CDS / GS GVS
414-352-3100
ROBERT M SCHMIDT MD
3003 W GOOD HOPE ROAD
POST OFFICE BOX 17300
MILWAUKEE WI 53217
PTH CLP / PTH CLP
414-649-7335
KARL W SCHMITT MD
2900 W OKLAHOMA AVENUE
MILWAUKEE WI 53215
PD / PD
DONNA L SCHMITZ MD
2388 NORTH LAKE DRIVE
MILWAUKEE WI 53211
GYN
JOHN T SCHMITZ MD
2388 NORTH LAKE DRIVE
MILWAUKEE WI 53211
IM / IM
414-546-1 130
GEORGE R SCHNEIDER MD
9330 W LINCOLN AVENUE
WEST ALLIS WI 53227
AI
BERT B SCHOENKERMAN MD
APT 109
6575 N GREEN BAY AVE
MILWAUKEE WI 53209
OPH / OPH
414-453-7171
JEAN H SCHOTT MD
SUITE 508
2500 N MAYFAIR ROAD
MILWAUKEE WI 53226
GS / GS
414-964-4247
CHARLES M SCHROEDER MD
3927 N RIDGEFIELD CIR
SHOREWOOD WI 53211
IM CD / IM
GREGORY H SCHUCHARD MD
5431 N DIVERSEY BLVD
MILWAUKEE WI 53217
FP / FP
414-769-6600
RONALD E SCHULGIT MD
3533 EAST RAMSEY AVE
CUDAHY WI 53110
OPH / OPH
414-257-5082
RICHARD 0 SCHULTZ MD
8700 W WISCONSIN AVE
MILWAUKEE WI 53226
CRS / CRS
414-241-5046
LEONARD J SCHWADE MD
923 CEDAR RIDGE COURT
MEQUQN WI 53092-6003
PD / PD
ABRAHAM B SCHWARTZ MD
SUITE 712
1840 N PROSPECT AVENUE
MILWAUKEE WI 53202
OBG / OBG
414-774-9322
WALTER R SCHWARTZ MD
SUITE 226
10425 W NORTH AVENUE
WAUWATOSA WI 53226
D / D
414-964-3650
RUDOLPH J SCRIMENTI MD
316 E SILVER SPRING DR
MILWAUKEE WI 53217
P
414-242-5143
J ARTHUR SEAHDLM MD
12530 N JACQUELINE CT
MEQUON WI 53092-2314
MERRY E SEBELIK
W203 N10109 LANNON RD
COLGATE WI 53017
GS / GS
PHILIP H SEEFELD MD
8041 BURCHMORE ROAD
THREE LAKES WI 54562-9235
AN
414-786-5572
POLISETTY C SEKHAR MD
20165 FREEDOM COURT
BROOKFIELD WI 53005
OPH / OPH
414-461-7400
JOHN L SELLA MD
8535 W CAPITOL DRIVE
MILWAUKEE WI 53222
OBG
414-462-2272
WILLIAM L SEMLER MD
8430 W CAPITOL DRIVE
MILWAUKEE WI 53222
OBG / OBG
414-933-6666
NEVILLE SENDER MD
940 NORTH 23RD STREET
MILWAUKEE WI 53233
R / R
715-385-2856
GENE W SENGPIEL MD
4541 HARMONY POINT LN
WOODRUFF WI 54568
IM END / IM EM
414-271-2110
JORDAN A SENNETT MD
1218 W KILBOURN AVENUE
MILWAUKEE WI 53233
P / P
4 1 4— A39— 3222
ELVIRA C SENO MD
3606 DYER LAKE ROAD
BURLINGTON WI 53105
FP / FP
LOUIS S SENO JR MD
6900 NORTH PORT
WASHINGTON ROAD
MILWAUKEE WI 53217
IM RHU DIA
414-384-1800
INGEBORG E SEPP MD
1545 SOUTH LAYTON BLVD
MILWAUKEE WI 53215
OBG / OBG
LIONEL T SERVIS MD
7000 NORTH BEACH DRIVE
MILWAUKEE WI 53217-3657
IM / IM
ALBINO L SETTIMI MD
15105 WESTOVER ROAD
ELM GROVE WI 53122
DR / DR
414-257-5200
KATHERINE A H SHAFFER MD
8700 W WISCONSIN AVE
MILWAUKEE WI 53226
OBG / OBG
MOHAMMAD SHAFI MD
BOX 11-0
MILWAUKEE WI 53201
PTH / PIH
414-421-7821
INDU M SHAH MD
5703 ROCHELLE DRIVE
GREENDALE WI 53129
IM PUD / IM
KANAK K SHAH MD
SUITE 200
525 EAST WELLS STREET
MILWAUKEE WI 53202
P
414-276-3244
MILTON SHAPSON MD
700 NORTH WATER STREET
MILWAUKEE WI 53202
R / R
414-962-8477
DONALD K SHAW MD
791 EAST SUMMIT AVENUE
OCONOMOWOC WI 53066
FP
JEROME R SHEFF MD
4915 S HOWELL AVENUE
MILWAUKEE WI 53207
DR / DR
414-961-3800
JAMES J SHERRY MD
2025 E NEWPORT AVENUE
MILWAUKEE WI 53211
AN
414-425-2983
PRAVIN C SHETH MD
9611 W MEADOW PARK DR
HALES CORNERS WI 53130
GP
414-464-31 15
SHAILA R SHIRKE MD
5231 W VILLARD AVENUE
MILWAUKEE WI 53218
ORS HS / ORS
MYSORE S SHIVARAM MD
3201 SOUTH 16TH STREET
MILWAUKEE WI 53215
CDS TS / TS GS
414-272-5893
RICHARD T SHORE MD
SUITE 819
2315 NORTH LAKE DRIVE
MILWAUKEE WI 53211
ORS / ORS
414-545-4646
PHILIP SHOVERS MD
9400 W LINCOLN AVENUE
MILWAUKEE WI 53227
U / U
414-344-3700
JOHN D SILBAR MD
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
PM
414-354-8988
MINDAS V SILIUNAS MD
APT 101
8330 NORTH 46TH STREET
MILWAUKEE WI 53223
FP
414-649-6742
FARROL H SIMS MD
2331 W VIEAU PLACE
MILWAUKEE WI 53204
MILWAUKEE— 65
P OBG / PN
CLIFFORD J SIMSKE MD
10232 WEST NASH STREET
WAUWATOSA WI 53222
AN / AN
414-782-1799
EUGENE P SINCLAIR MD
13185 LEE COURT
ELM GROVE WI 53122
IM HEM ON
UUANITO P SINGSON MD
SUITE 1005
2315 NORTH LAKE DRIVE
MILWAUKEE WI 53211
OBG / OBG
414-778-0070
JOHN E S INSKY MD
2500 N MAYFAIR ROAD
MILWAUKEE WI 53226
OBG / DBG
414-282-3030
KIRIM F SIRIN MD
4768 SOUTH 27TH STREET
MILWAUKEE WI 53221
FP
STEVEN R SIRUS MD
NO 3
3001 SOUTH 56TH STREET
MILWAUKEE WI 53219
GS
LARRY A SISSON MD
1554 S 79TH STREET
WEST ALLIS WI 53214
IM / IM
414-463-251 1
LUCID C SIY MD
3975 NORTH 68TH STREET
MILWAUKEE WI 53216
D / D
CARLA A SKIBBA MD
9033 W GRANGE AVENUE
HALES CORNERS WI 53130
IM NEP / IM
G JON SKULASDN MD
3070 NORTH 51ST STREET
MILWAUKEE WI 53210
GS / GS
DOUGLAS R SLEIGHT MD
3533 E RAMSEY AVENUE
CUDAHY WI 53110
IM GE
414-383-4700
ZACHARY SLOMOVITZ MD
1672 S NINTH STREET
MILWAUKEE WI 53204
IM
JONATHAN SLOMOWITZ MD
1672 S NINTH STREET
MILWAUKEE WI 53204
CD IM / IM
414-271-1633
DAVID A SLOSKY MD
2315 WEST LAKE DRIVE
MILWAUKEE WI 53211
PD / PD
414-425-0525
CATHERINE M SLOTA MD
5631 GATEWOOD LANE
GREENDALE WI 53129
GE IM / GE IM
414-447-2387
THOMAS SLOTA MD
SUITE 606
3070 NORTH 51ST STREET
MILWAUKEE WI 53210
FP
414-332-8817
MAUREEN D SMALL MD
3450 NORTH NEWHALL ST
MILWAUKEE WI 53211-2805
FP
414-383-8487
KENNETH M SMIGIELSKI MD
3615 W OKLAHOMA AVENUE
MILWAUKEE WI 53215
AN / AN
414-784-7787
RICHARD A SMITH MD
13850 WEST WATERTOWN
PLANK ROAD
ELM GROVE WI 53122
DRS / ORS
WILLIAM B SMITH MD
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
P CHP / P CHP
414-332-2450
MARK B SMUCKLER MD
155 E SILVER SPRING DR
MILWAUKEE WI 53217
DR / DR
414-447-2212
WILLIAM A SMULLEN MD
DEPT OF RADIOLOGY
5000 W CHAMBERS STREET
MILWAUKEE WI 53210
PD
414-771-5600
REUBEN J SNARTEMO MD
6200 W BLUEMOUND ROAD
POST OFFICE BOX 601
MILWAUKEE WI 53201
DENNIS A SOBCZAK
APT 3
9636 W OKLAHOMA AVENUE
MILAUKEE WI 53227
D / D IM
414-649-2480
GLENN E SONDAG MD
SUITE 100
2901 WEST KK RIVER PKY
MILWAUKEE WI 53215
PTH CLP / PTH CLP
414-649-7333
PAULA R SONNELAND MD
2900 W OKLAHOMA AVENUE
MILWAUKEE WI 53215
P
K KWANG SOO MD
2025 E NEWPORT AVENUE
MILWAUKEE WI 53211
OBG / OBG
414-425-6464
RALPH F SORTOR MD
10691 W PARNELL AVENUE
HALES CORNERS WI 53130
IM
WALTER C SOUTHCOTT MD
6934 N SENECA AVENUE
MILWAUKEE WI 53217
P N / P N
414-332-9145
DAVID L SOVINE MD
6310 NORTH PORT
WASHINGTON ROAD
GLENDALE WI 53217
ORS / ORS
414-342-4142
JACK D SPANKUS MD
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
IM
414-344-7223
JACK A SPECTOR MD
SUITE 305
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
OS / IM
414-271-1444
ROBERT J SPELLMAN MD
720 E WISCONSIN AVENUE
MILWAUKEE WI 53202
PM / PM
414-527-8442
SALVATORE A SPICUZZA MD
2400 W VILLARD AVENUE
MILWAUKEE WI 53209
R NM / R NM
414-421-4609
DON R SPIEGELHOFF MD
6286 PARKVIEW ROAD
GREENDALE WI 53129
P / PN
HERZL R SPIRO MD
SUITE 304
2015 E NEWPORT AVENUE
MILWAUKEE WI 53211
IM
414-272-5040
MILTON B SPITZ MD
NO 117
1218 W KILBOURN AVENUE
MILWAUKEE WI 53233
OBG / OBG
414-321-4500
DEAN P SPYRES MD
SUITE 115
7635 W OKLAHOMA AVENUE
MILWAUKEE WI 53219
OPH PS
414-476-3580
JAROSLAVA STAFL MD
10425 W NORTH AVENUE
MILWAUKEE WI 53226
CD / CD
414-649-3530
BERNARD J STALLER MD
SUITE 300
2901 WEST KK PARKWAY
MILWAUKEE WI 53215
R PDR DR / R
ROBERT J STARSHAK MD
1700 W WISCONSIN AVE
POST OFFICE BOX 1997
MILWAUKEE WI 53201-1997
ABS
414-643-4900
NICHOLAS P STAVES MD
3238 SOUTH 16TH STREET
MILWAUKEE WI 53215
CHP P / CHP P
414-271-5555
FREDRIC A STEIGER MD
2350 NORTH LAKE DRIVE
MILWAUKEE WI 53211
P N / p N
PAUL G STEIN MD
12320 ST MARTINS ROAD
FRANKLIN WI 53132
P / PN
PHILLIP L STEIN MD
1024 EAST STATE STREET
MILWAUKEE WI 53202
NS
414-271-7227
ROBERT E STEINER MD
SUITE 246
811 E WISCONSIN AVENUE
MILWAUKEE WI 53202
P / P
414-961 -6166
JOHN A STEMPER MD
2216 E EDGEWOOD AVENUE
MILWAUKEE WI 53211
GS / GS
414-691-2414
WALTER P STENBORG MD
W284 N3266 LAKESIDE RD
PEWAUKEE WI 53072-3330
GP
414-962-2363
RUTH S STERN MD
3701 NORTH LAKE DRIVE
MILWAUKEE WI 53211
IM RHU / IM
414-271-3700
RICHARD 0 STERNLIEB MD
2388 NORTH LAKE DRIVE
MILWAUKEE WI 53211
PYA P / p
STEVEN R STEURY MD
4875 NORTH LAKE DRIVE
WHITEFISH BAY WI 53217
OBG / OBG
414-778-0070
WILLIAM C STEWART MD
2500 N MAYFAIR ROAD
MILWAUKEE WI 53226
FP / FP
414-421-8400
SUSAN F STICKELS MD
6901 W EDGERTON AVENUE
MILWAUKEE WI 53220
GS
CHARLES W STIEHL MD
2740 W FOREST HOME AVE
POST OFFICE BOX 15535
MILWAUKEE WI 53215
FP
WILLIAM F STINEMAN MD
4318 SOUTH 20TH STREET
MILWAUKEE WI 53221
GS / GS
414-541-8150
KNUD C STOBBE MD
8410 W CLEVELAND AVE
MILWAUKEE WI 53227
U / U
RICHARD E STOCKINGER MD
POST OFFICE BOX 183
MENOMONEE FALLS WI
53051-0183
R / R
LEO STOCKLAND MD
POST OFFICE BOX 1644
MILWAUKEE WI 53201
IM NEP
414-643-6060
SHERWOOD B STOLP MD
3201 SOUTH 16TH STREET
MILWAUKEE WI 53215
ORS / ORS
414-276-6000
JOSEPH R STONE MD
1218 W KILBOURN AVENUE
MILWAUKEE WI 53233
OPH / OPH
414-961-2020
RICHARD STONE MD
227 E SILVER SPRING DR
MILWAUKEE WI 53217
NS ■■ NS
414-272-3673
RICHARD H STRASSBURGER MD
161 W WISCONSIN AVENUE
MILWAUKEE WI 53203
66— MILWAUKEE
OTO / OTO
GERHARD D STRAUS MD
APT 402
100 WORTH AVENUE
PALM beach FL 33480
DBG / OBG
414-271-3700
ESTIL Y STRAWN MD
2388 NORTH LAKE DRIVE
MILWAUKEE W1 53211
OBG
414-271-3700
ESTIL Y STRAWN JR MD
2388 NORTH LAKE DRIVE
MILWAUKEE WI 53211
FP
SCOTT R STREHLOW MD
4930 SETGN PLACE
GREENDALE WI 53129
OTO FP
MICHAEL A STRIGENZ MD
7802 W LIVINGSTON AVE
WAUWATOSA WI 53213
D / D
414-541-1323
GERALD 0 STUBENRAUCH MD
7635 W OKLAHOMA AVENUE
MILWAUKEE WI 53219
EM
414-28'?-8146
HARLAN A STUEVEN MD
950 NORTH 12TH STREET
MILWAUKEE WI 53233
R NM / R
JOHN R STY MD
9138 N TENNYSON DRIVE
MILWAUKEE WI 53217
FP
RODOLFO P SUAVERDEZ MD
5631 W LINCOLN AVENUE
POST OFFICE BOX 19892A
WEST ALLIS WI 53219
IM / IM
DILIPKUMER B SUBDARAD MD
100 15TH AVENUE
SOUTH MILWAUKEE WI 53172
NS / NS
414-873-7400
P DANIEL SUBERVIDLA MD
SUITE 107
3070 NORTH 51ST STREET
MILWAUKEE WI 53210
ORS / ORS
DENNIS M SULLIVAN MD
1218 W KILBOURN AVENUE
MILWAUKEE WI 53233
414-444-2219
LAWRENCE SULLIVAN MD
2919 NORTH 50TH STREET
MILWAUKEE WI 53210
N PD / PD
414-383-7300
CHARLES SUPAPODOK MD
SUITE 204
2901 W KK RIVER PKWY
MILWAUKEE WI 53215-3660
OPH / OPH
ELIESER B SUSON MD
2300 MAYFAIR ROAD
MILWAUKEE WI 53226
EM
414-933-8333
SUSSAN K SUTPHEN MD
2528 W HIGHLAND BLVD
MILWAUKEE WI 53233
FP / FP
414-352-0888
ABE A SVERDLIN MD
7870 NORTH MOHAWK ROAD
MILWAUKEE WI 53217
GEOFFREY R SWAIN
10636 W GRANTOSA DRIVE
WAUWATOSA WI 53222
CDS TS GS / TS GS
414-258-0670
MICHAEL SWANK MD
SUITE 795
2300 N MAYFAIR ROAD
WAUWATOSA WI 53226
FP / FP
SAMUEL J SWEET MD
606 W WISCONSIN AVENUE
MILWAUKEE WI 53203
IM / IM
JEAN M SWITALA MD
15211 W VERA CRUZ DR
NEW BERLIN WI 53151
PD
414-281-0400
SANTIAGO T SY MD
4666 SOUTH 35TH STREET
MILWAUKEE WI 53221
GP
JOSEPH E SZYMAREK MD
5101 W JACKSON PARK DR
MILWAUKEE WI 53219
IM CD
414-769-6600
ROBERT C TABET MD
3533 E RAMSEY AVENUE
CUDAHY WI 53110
OPH / OPH
414-352-9738
ARTHUR W TACKE MD
777 W GLENCOE PLACE
MILWAUKEE WI 53217
PTH CLP / PTH CLP
414-421-3426
VDSHIRO TAIRA MD
5781 FERN COURT
GREENDALE WI 53129
PTH PD NM / PTH NM
414-931-1010
THOMAS T TANG MD
POST OFFICE BOX 1997
MILWAUKEE WI 53201
OBG / DBG
RUSSELL E TANNER MD
5631 N MOHAWK AVENUE
MILWAUKEE WI 53217
OPH / OPH
PHILIP J TAUGHER MD
2400 SOUTH 90TH STREET
MILWAUKEE WI 53227
GS / GS
ALI TAVAF-MOTAMEN MD
3353 E RAMSEY AVENUE
CUDAHY WI 53110
D / D
414-933-2552
JOEL E TAXMAN MD
1622 W WISCONSIN AVE
MILWAUKEE WI 53233
PS / PS
414-963-0993
JACK L TEASLEY MD
SUITE 401
2015 E NEWPORT AVENUE
MILWAUKEE WI 53211
TS / GS
ALFRED J TECTOR JR MD
2901 WEST KINNICKINNIC
RIVER PARKWAY
MILWAUKEE WI 53215
OS
GAMBER F TEGTMEYER SR MD
APT 520
1840 N PROSPECT AVENUE
MILWAUKEE WI 53202-1963
OPH / OPH
414-271-1 580
RALPH E TEITGEN MD
1684 N PROSPECT AVENUE
MILWAUKEE WI 53202
AN / AN
J WILLIAM TEMPLE MD
2374 N 10 1ST STREET
MILWAUKEE WI 53226
PTH CLP / PTH
JACK R TENGE MD
W221 N2662 LINDENWOOD
WAUKESHA WI 53186
P / P
414-964-2050
ERVIN TEPLIN MD
SUITE 218
400 W SILVER SPRING DR
MILWAUKEE WI 53217
OTO / OTO
414-961-1550
ROBERT W TEPLIN MD
SUITE 309
2015 E NEWPORT AVENUE
MILWAUKEE WI 53211
PTH / PTH
414-527-8404
JOSEPH L TERESI MD
14760 VIRGINIA AVENUE
BROOKFIELD WI 53005
FP / FP
CHARLES E THE I SEN MD
100 1 5TH AVENUE
SOUTH MILWAUKEE WI 53172
GS / GS
414-352-3100
WALTON D THOMAS MD
3003 W GOOD HOPE ROAD
POST OFFICE BOX 17300
MILWAUKEE WI 53217
GP
414-646-8222
RICHARD D THOMPSON MD
1341 MILWAUKEE STREET
DELAFIELD WI 53018
AN
STEPHEN R THOMPSON MD
2729 NORTH SHEPHARD
MILWAUKEE WI 53211
PD
NEIL R THOMSON MD
409 E SILVER SPRING DR
MILWAUKEE WI 53217
PM / PM
EPHREM THOPPIL MD
2900 W OKLAHOMA AVENUE
MILWAUKEE WI 53215
AN / AN
LORON F THURWACHTER JR
621 EAST CEDAR LANE
lOON MEQUON WI 53092
D / D
414-672-8050
PALMER G TIBBETTS MD
3800 SOUTH 27TH STREET
MILWAUKEE WI 53221-1307
IM ON / MON
CHARLES H I TIBER MD
2388 NORTH LAKE DRIVE
MILWAUKEE WI 53211
R / R
EUGENE W TILL MD
2900 W OKLAHOMA AVENUE
MILWAUKEE WI 53215
AN
JAMES J TISONE MD
6070 N ALBERTA LANE
MILWAUKEE WI 53217
CD IM / CD IM
414-321 -8550
ALFONSO L TIU MD
10617 W OKLAHOMA AVE
WEST ALLIS WI 53227
CRS
414-342-7045
MARIO G TOLENTINO MD
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
CRAIG P TOMLINSON
ONE OTIS PLACE
BOSTON MA 02108
D
414-273-7360
SAMUEL W TONKENS MD
925 EAST WELLS STREET
MILWAUKEE WI 53202
EM FP / EM
DENIS J TONSFELDT MD
950 NORTH 12TH STREET
MILWAUKEE WI 53233
OTO / OTO
414-257-5150
ROBERT J TOOHILL MD
8700 W WISCONSIN AVE
MILWAUKEE WI 53226
IM
GREGORY J TOPETZES MD
8430 W CAPITOL DRIVE
MILWAUKEE WI 53222
GS CD / GS GVS
414-257-5516
JONATHAN B TOWNE MD
8700 W WISCONSIN AVE
MILWAUKEE WI 53226
U / U
H AXEL TRANGSRUD MD
7404 PORTLAND AVENUE
MILWAUKEE WI 53213
PUD
HOWARD D TRAVERS MD
SUITE 803
2315 NORTH LAKE DRIVE
MILWAUKEE WI 53211
IM RHU / IM
414-771-9870
WILLIAM L TREACY MD
10125 W NORTH AVENUE
MILWAUKEE WI 53226
SHELLIE A TRENTLAGE
1067 NORTH ROBERTSON
MILWAUKEE WI 53213
GS / GS
MD ROBERT J TRETTIN MD
13240 LEE COURT
ELM GROVE WI 53122
FP
RODOLFO N TREVINO MD
1834 WEST WISCONSIN
MILWAUKEE WI 53233
MILWAUKEE— 67
IM / IM
414-271-3700
C R TRI YAMBAKARAJ MD
2388 NORTH LAKE DRIVE
MILWAUKEE WI 53211
D DMP IM / D DMP IM
414-352-3100
JAMES L IROY MD
3003 W GOOD HOPE ROAD
POST OFFICE BOX 17300
MILWAUKEE WI 53217
IM CD / IM
HERMAN TUCHMAN MD
5215 N IRONWOOD ROAD
MILWAUKEE WI 53217
GS
THOMAS C TUNBERG MD
11121 W WISCONSIN AVE
WAUWATOSA WI 53226
IM
VALERIO 1URGAI MD
908 MILWAUKEE AVENUE
SOUTH MILWAUKEE WI 53172
N / N
414-344-9494
ARTHUR J TURNER MD
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
GS TS / GS
HARVEY A TURNER MD
321 WEST MANOR CIRCLE
MILWAUKEE WI 53217
GS / GS
414-476-9592
HENRY F TWELMEYER MD
SUITE 401
2500 N lOSTH STREET
WAUWATOSA WI 53226
414-797-7912
JOHN M TWELMEYER
1174 PILGRIM PARKWAY
ELM GROVE WI 53122
NS / NS
414-873-7400
DONALD P ULLRICH MD
SUITE 107
3070 NORTH 51ST STREET
MILWAUKEE WI 53210
D / D
414-453-2962
FRANK H URBAN MD
10425 W NORTH AVENUE
WAUWATOSA WI 53226
OBG / DBG
BENJAMIN E URDAN MD
APT 502
1610 N PROSPECT AVENUE
MILWAUKEE WI 53202
OBG / OBG
KENNETH J URLAKIS MD
6001 W CENTER STREET
MILWAUKEE WI 53210
U / U
414-344-3700
BARRY H USOW MD
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
FP
714-768-1282
EUGENE J USOW MD
APT N
5364 ALGARROBO
LAGUNA HILLS CA 92653
FP / FP
414-645-1543
LOUIS B USZLER MD
569 W LINCOLN AVENUE
MILWAUKEE WI 53207
OBG
MARIO L UY MD
756 NORTH 35TH STREET
MILWAUKEE WI 53208
IM / IM
414-645-4240
JORGE T UZQUIANO MD
3201 SOUTH 16TH STREET
MILWAUKEE WI 53215
PD
JOSEPH E VACCARO MD
13425 COMMONS DRIVE
POST OFFICE BOX 443
BROOKFIELD WI 53005-0443
DR / DR
414-289-8015
UR I VAISMAN MD
DEPT OF RADIOLOGY
POST OFFICE BOX 342
MILWAUKEE WI 53201
FP / FP
414-527-B34B
BRUCE L VAN CLEAVE MD
2400 W VILLARD AVENUE
MILWAUKEE WI 53209
AN / AN
414-786-3915
JOHN H VAN GILDER MD
13005 WRAYBURN ROAD
ELM GROVE WI 53122
PTH CLP / PTH
LEANDER J VAN HECKE MD
6055 NORTH KENT AVENUE
WHITEFISH BAY WI 53217
GS / GS
414-461-9620
JAMES A VAN HEEST MD
8430 W CAPITOL DRIVE
MILWAUKEE WI 53222
414-546-3119
ANDRE VAN MOL
8810 W HOWARD AVENUE
MILWAUKEE WI 53228-1752
P
414-258-2600
JAN C VAN SCHAIK MD
1220 DEWEY AVENUE
WAUWATOSA WI 53213
PD
G VATTAKATTCHERRY MD
2388 NORTH LAKE DRIVE
MILWAUKEE WI 53211
FP EM
414-464-2447
ARTURO VELAZQUEZ MD
5408 NORTH 56TH STREET
MILWAUKEE WI 53218
FP / FP
414-762-3680
NICHOLAS A B VENCI MD
100 15TH AVENUE
SOUTH MILWAUKEE WI 53172
FP
LAURENCE J VERLINDEN MD
3155 SOUTH 29TH STREET
MILWAUKEE WI 53215
IM PUD
414-783-5510
PATRICIO F VIERNES MD
13845 W CAPITOL DRIVE
BROOKFIELD WI 53005
GS
ALEJANDRO M VINLUAN MD
ROOM 201
756 NORTH 35TH STREET
MILWAUKEE WI 53208
OBG / OBG
414-769-9220
VITO N VITULLI MD
1100 FAIRVIEW AVENUE
SOUTH MILWAUKEE WI 53172
AN / AN
FERDINAND J VLAZNY MD
447 HORSESHOE LANE
MUKWONAGO WI 53149
P
WESS R VOGT MD
ROOM 515
2350 NORTH LAKE DRIVE
MILWAUKEE WI 53211
MICHAEL A VOLZ
11135 NORTH KENDALL
MIAMI FL 33176
OBG / OBG
BEN F VONDRAK MD
10425 W NORTH AVENUE
WAUWATOSA WI 53226
IM / IM
414-871-9300
W GREGORY VON ROENN MD
2628 N SUMMIT AVENUE
MILWAUKEE WI 53211
OPH / OPH
414-769-6900
GERALD W WADINA MD
12239 W VERONA COURT
WEST ALLIS WI 53227
OBG / OBG
414-271-2109
ALAN M WAGNER MD
SUITE 402
1218 W KILBQURN AVENUE
MILWAUKEE WI 53233
GS CDS / GS
414-462-9955
MARVIN WAGNER MD
SUITE 203
2350 W VILLARD AVENUE
MILWAUKEE WI 53209
OPH / OPH
414-763-7613
PAUL F WAGNER MD
308 MC HENRY STREET
BURLINGTON WI 53105
ID IG IM / IM
414-272-1929
BURTON A WAISBREN MD
SUITE 815
2315 NORTH LAKE DRIVE
MILWAUKEE WI 53211
CD IM / CD IM
414-464-1 167
BURTON A WAISBREN JR MD
8500 W CAPITOL DRIVE
MILWAUKEE WI 53222
ORS PDS / ORS
414-933-2044
RAYMOND C WAISMAN MD
10006 N HOLMES COURT
22W MEQUON WI 53092
IM CD / IM CD
414-271-6800
GEORGE WALCOTT MD
SUITE 200
525 EAST WELLS STREET
MILWAUKEE WI 53202
OBG
HENRY M WALDREN JR MD
SUITE 210
2400 SOUTH 90TH STREET
WEST ALLIS WI 53227
CD / CD
414-649-3530
JOHN A WALKER MD
SUITE 300
2975 SOUTH 29TH STREET
MILWAUKEE WI 53215
NEP IM / NEP IM
JEFFREY I) WALLACH MD
3070 NORTH 51ST STREET
MILWAUKEE WI 53210
OPH
414-352-0280
ERNEST F WALLNER JR MD
777 WEST GLENCOE PLACE
MILWAUKEE WI 53217
U / U
414-258-2640
JOHN P WALSH MD
2500 N MAYFAIR ROAD
MILWAUKEE WI 53226
PD / PD
414-541-9900
STEVEN G WALVISCH MD
10243 W NATIONAL AVE
WEST ALLIS WI 53227
414-377-6443
MARY JO WAMSER
W60 N903 SHEBOYGAN RD
CEDARBURG WI 53012
OBG
MICHAEL WAN MD
2711 WEST WELLS STREET
MILWAUKEE WI 53208
AN / AN
414-529-231 1
JAMES R WARSH MD
5851 GLEN FLORA DRIVE
GREENDALE WI 53129
IM GS
414-962-0006
RICK R WARTGOW MD
4445 N WOODBURN STREET
SHOREWOOD WI 53211-1554
GP FP
414-276-3154
CHESTER G WARTH MD
710 N Pl.ANKINTON AVE
MILWAUKEE WI 53203
ORS
414-276-6000
DANIEL H WART INBEE MD
1218 W KILBOURNE AVE
MILWAUKEE WI 53233
FP
414-933-3600
MASOOD WASIULLAH MD
1834 W WISCONSIN AVE
MILWAUKEE WI 53233
EM / EM
414-453-2824
VICTOR 0 WATERS MD
1234 N 122ND STREET
WAUWATOSA WI 53226
PD
HARRY J WATSON JR MD
8511 W LINCOLN AVENUE
MILWAUKEE WI 53227
IM / IM
414-543-3800
WILLIAM C WEBB MD
8501 W LINCOLN AVENUE
MILWAUKEE WI 53227
GE IM / GE IM
414-546-1513
JEFFREY M WEBER MD
5757 W OKLAHOMA AVENUE
MILWAUKEE WI 53219
68— MILWAUKEE
GP
414-744-6509
MARSHALL L WEBER MD
3821 S HOWELL AVENUE
MILWAUKEE WI 53207
FP / FP
B J WEIUA MD
2508 E BEVERLY ROAD
MILWAUKEE WI 53211
A
HARRY R WEIL MD
3131 E HAMPSHIRE ST
MILWAUKEE WI 53211-3117
AN / AN
4 1 4 — 995 — A 9m
MAXWELL H S WEINGARTEN MD
4720 N CRAMER STREET
MILWAUKEE WI 53211
GS TRS OM
414-271-0373
LEO R WEINSHEL MD
238 W WISCONSIN AVENUE
MILWAUKEE WI 53203
CLP END / CLP CP
HARRY F WEISBERG MD
2574 N TERRACE AVENUE
MILWAUKEE WI 53211
U / U
414-342-7744
CHARLES L WEISENTHAL MD
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
GP
SAMUEL G WEISFELD MD
2388 NORTH LAKE DRIVE
MILWAUKEE WI 53211
IM / IM
CASSANDRA P WELCH MD
2388 NORTH LAKE DRIVE
MILWAUKEE WI 53211
A /PD
ROSS R WELLER MD
SUITE 970
2600 N MAYFAIR ROAD
MILWAUKEE WI 53226
GP
MARVIN WELLS MD
525 CAMINO DE LA
SIERRA NE
ALBUQUERQUE NM 87123
PD / PD
414-786-1160
RONALD K WELLS MD
17030 W NORTH AVENUE
BROOKFIELD WI 53005
PM ./ PM
EDWIN C WELSH MD
13246 DESERT GLEN DR
SUN CITY WEST AZ 85375
PD / PD
414-545-4500
JAMES A WENDERS MD
10202 W HAYES AVENUE
WEST ALLIS WI 53227
ORS
PETER P WENDT MD
161 W WISCONSIN AVENUE
MILWAUKEE WI 53203
OBG / OBG
414-259-0880
WILLIAM P WENDT MD
SUITE 314
10425 W NORTH AVENUE
WAUWATOSA WI 53226
GS / GS
414-321-781 1
HENRY B WENGELEWSKI MD
7689 OVERLOOK DRIVE
GREENDALE WI 53129
DR / DR
JOSEPH F WEPFER MD
2479 NORTH 95TH STREET
MILWAUKEE WI 53226
US
DANIEL R WERBA MD
5538 WEST MONTEROSA
PHOENIX AZ 85031
OBG / OBG
DAVID J WERNER MD
5631 N MOHAWK AVENUE
MILWAUKEE WI 53217
CDS TS GS / TS GS
414-649-3990
PAUL H WERNER MD
SUITE 310
2901 WEST KK PARKWAY
MILWAUKEE WI 53215
NS / NS
414-462-9697
SHELLEY WERNICK MD
SUITE 101
2350 W VILLARD AVENUE
MILWAUKEE WI 53209
PD / PD
WILLIAM WESTLEY JR MD
2722 W OKLAHOMA AVENUE
MILWAUKEE WI 53215
FP
414-358-1491
DAVID E WHITAKER DO
6413 N 105TH STREET
MILWAUKEE WI 53224
EM IM / IM
414-649-7299
JOHN E WHITCOMB MD
2900 W OKLAHOMA AVENUE
MILWAUKEE WI 53215
PS GS / GS
JAMES E WHITE MD
9516 HARDING BOULEVARD
WAUWATOSA WI 53226
ORS / ORB
HARVEY M WICHMAN MD
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
OTO OPH / OTO
414-242-1516
JOSEPH P WILD MD
3033 W BONNIWELL ROAD
136N MEQUON WI 53092
PS HS / PS GS
414-963-1700
TERRENCE J WILKINS MD
2015 E NEWPORT AVENUE
MILWAUKEE WI 53211
IM / IM
DELORE WILLIAMS MD
8501 W LINCOLN AVENUE
WEST ALLIS WI 53227
GS / GS
414-963-1210
D MACLEAN WILLSON MD
2015 E NEWPORT AVENUE
MILWAUKEE WI 53211
IM / IM
414-272-2276
DONALD M WILLSON MD
APT 23
924 EAST JUNEAU AVENUE
MILWAUKEE WI 53202
DONALD J WILSON
APT 21
1129 N MARSHALL STREET
MILWAUKEE WI 53202
TR R / R
J FRANK WILSON MD
DEPT OF RAD THERAPY
8700 W WISCONSIN AVE
MILWAUKEE WI 53226
P N / P N
414-332-0552
JEFFREY W WILSON MD
316 E SILVER SPRING DR
MILWAUKEE WI 53217
D / D IM
414-271-3700
EVONNE M WINSTON MD
2388 NORTH LAKE DRIVE
MILWAUKEE WI 53211
R / R
JOHN C WINTERS MD
POST OFFICE BOX 484
BROOKFIELD WI 53005
IM ID / IM ID
414-272-6310
GERHARD L WITTE MD
324 E WISCONSIN AVENUE
MILWAUKEE WI 53202
PS / PS
414—272—1222
WILBERT WIVIOTT MD
SUITE 409
1218 W KILBOURN AVENUE
MILWAUKEE WI 53233
414-475-9447
DIANE WOLF
1067 ROBERTSON STREET
WAUWATOSA WI 53213
TR PD / PD
SORRELL L WOLFSON MD
2451 EAST VIVA DEL MAR
ST PETERSBURG FL 33706
FP OBS / FP
414-421-8400
MICHAEL S WOLKOMIR MD
3303 N 51 ST BOULEVARD
MILWAUKEE WI 53216
GS / GS
414-257-2441
DONALD A WOLLHEIM MD
SUITE 328
10625 W NORTH AVENUE
MILWAUKEE WI 53226-2380
CDS GS / GS
414-453-2121
JAMES H WOODS MD
SUITE 845
2300 N MAYFAIR ROAD
WAUWATOSA WI 53226
MARY-FRANCES WOODS
1641 E NEWTON AVENUE
SHOREWOOD WI 53211
OBG / OBG
GEORGE S WOODWARD MD
9730 W BLUEMOUND ROAD
MILWAUKEE WI 53226
N
414-961-7305
MARVIN R WOOTEN MD
SUITE 408
2015 E NEWPORT AVENUE
MILWAUKEE WI 53211
GP
GEORGE J WORM MD
7827 W BURLEIGH STREET
MILWAUKEE WI 53222
OBS GYN / OBG MFM
414-447-2674
DENNIS WORTHINGTON MD
5000 W CHAMBERS STREET
MILWAUKEE WI 53210
414-774-8689
HOBART H WRIGHT MD
8026 W WISCONSIN AVE
WAUWATOSA WI 53213
AN / AN
414-782-6432
IRVING V WRIGHT MD
16300 TOMAHAWK TRAIL
BROOKFIELD WI 53005
OBG END
HU I T WU MD
8541 N PELHAM PARKWAY
BAYSIDE WI 53217
P / P
414-645-3531
CHARLES A WUNSCH MD
3201 SOUTH 16TH STREET
MILWAUKEE WI 53215
PM / PM
704-885-2619
JOHN F WYMAN MD
POST OFFICE BOX 94
CEDAR MOUNTAIN NC 28718
PS OTO / PS OTO
414-259-3611
SIDNEY K WYNN MD
9200 W WISCONSIN AVE
MILWAUKEE WI 53226
OTO / OTO
RUSSELL S YALE MD
10520 NORTH PORT
WASHINGTON ROAD
MEQUON WI 53092
DR / R
ALBERT f YARD MD
2900 W OKLAHOMA AVENUE
MILWAUKEE WI 53215
MARK W YEAZEL
11619 DIANE DRIVE
WAUWATOSA WI 53226
EM / EM
414-351-5867
ALBERT S YEE MD
9161 N FIELDING ROAD
BAYSIDE WI 53217
OBG / DBG
414-271-3700
CLYDE W YELLICK MD
2388 NORTH LAKE DRIVE
MILWAUKEE WI 53211
R / R
414-257-6110
JAMES E YOUKER MD
8700 W WISCONSIN AVE
MILWAUKEE WI 53226
PD
414-765-0515
CAROL E YOUNG MD
SUITE 601
2315 NORTH LAKE DRIVE
MILWAUKEE WI 53211
CHP IM / PN
LAURENS D YOUNG MD
GEN HOSP PSYCHIATRY
#175 8700 W WISCONSIN
MILWAUKEE WI 53226
P
MICHAEL M C YOUNG MD
APT 36-A
1910 ALA MOANA BLVD
HONOLULU HI 96815
GS
LOREN J YOUNT MD
SUITE 1015
2315 NORTH LAKE DRIVE
MILWAUKEE WI 53211
MILWAUKEE, MONROE, OCONTO, ONEIDA/VILAS— 69
PS HS
414-259-3095
N JOHN YOUSIF MD
9200 W WISCONSIN AVE
MILWAUKEE WI 53226
OS EM / GS
HAFIZ M YUNUS MD
SUITE 681
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
P
THOMAS E ZADORS MD
316 E SILVER SPRING DR
WHITEFISH BAY WI 53217
GS
ALFREDO P ZAMORA JR MD
1469 SOUTH 70TH STREET
WEST ALLIS WI 53214
P
NORTON L ZAREM MD
1024 EAST STATE STREET
MILWAUKEE WI 53202
P CHP
414-964-4830
DAVID H ZARWELL MD
6405 W WASHINGTON BLVD
WAUWATOSA WI 53213
414-453-9164
JOSEPH F ZASTROW
1351 S lllTH STREET
WEST ALLIS WI 53214
PTH CLP NM / AP CLP NM
414-527-8404
RAYMOND C ZASTROW MD
2400 W VILLARD AVENUE
MILWAUKEE WI 53209
CD / IM
HOWARD J ZEFT MD
2901 WEST KINNICKINNIC
RIVER PARKWAY #315
MILWAUKEE WI 53215
P / P
414-962-8900
CLIFFORD L ZELLER MD
5205 N IRONWOOD ROAD
MILWAUKEE WI 53217-4906
FP / FP
414-462-8250
JAMES H ZELLMER MD
5148 N TEUTONIA AVE
MILWAUKEE WI 53209
OM / GPM
CARL ZENZ MD
2418 ROOT RIVER PKY
WEST ALLIS WI 53227
CHP P IM
414-271-2633
AIVARS A ZEPS MD
SUITE 701
929 N ASTOR STREET
MILWAUKEE WI 53202
IM
608-784-2864
JOHN A ZERNIA MD
2109-B SOUTH SEVENTH
LA CROSSE WI 54601
IM / IM
414-546-0200
ANTHONY P ZIEBERT MD
SUITE 206
2400 SOUTH 90TH STREET
WEST ALLIS WI 53227
PTH IM
414-871-3810
FRANK L ZIEHL MD
3455 N PILGRIM ROAD
BROOKFIELD WI 53005
GS / GS
JAMES f' ZIMMER MD
8410 W CLEVELAND AVE
WEST ALLIS WI 53227
GP
JOSEPH J ZIMMER MD
8410 W CLEVELAND AVE
WEST ALLIS WI 53227
FP / FP
414-272-5040
BURTON M ZIMMERMANN MD
SUITE 117
1218 W KILBOURN AVENUE
MILWAUKEE WI 53233
DR / R
HERBERT J ZIMMERS MD
1620 EAST DEAN ROAD
FOX POINT WI 53217
ORS / ORS
414-933-1941
ROBERT C ZUEGE MD
2040 W WISCONSIN AVE
MILWAUKEE WI 53233
GS / GS
414-272-2250
GERALD R ZUPNIK MD
606 W WISCONSIN AVENUE
MILWAUKEE WI 53203
FP
608-372-411 1
HELEN HAENG-KANG AHN MD
105 W MILWAUKEE STREET
TOM AH WI 54660
FP / FP
608-269-6731
PAUL G ALBRECHT MD
202 SOUTH K STREET
SPARTA WI 54656
FP / FP
608-269-6731
JACK D BROWN MD
POST OFFICE BOX 250
SPARTA WI 54656
FP / FP
JANET S CHESTNUT MD
315 WEST DAK STREET
POST OFFICE BOX 250
SPARTA WI 54656
FP / FP
608-372-411 1
JAMES F GIROLAMI MD
105 W MILWAUKEE STREET
TOM AH WI 54660
FP
KEVIN A JESSEN MD
625 HAYWARD AVENUE
TOMAH WI 54660
GP
CLARENCE E KOZAREK MD
325 BUTTS AVENUE
TOMAH WI 54660
FP / FP
608-372-5951
GUSTAVE A LANDMANN MD
POST OFFICE BOX 729
TOMAH WI 54660-0729
GS / GS
608-269-6731
JUDY K LOTTMANN MD
315 WEST OAK STREET
POST OFFICE BOX 250
SPARTA WI 54656
FP GER / FP
608-269-4765
EDWARD 0 LUKASEK MD
615 PEARL STREET
SPARTA WI 54656
GP
608-272-411 1
JAMEEL S MUBARAK MD
105 W MILWAUKEE STREET
TOMAH WI 54660
GP
PATRICIA R RAFTERY DO
ROUTE 1
SPARTA WI 54656
FP / FP
608-372-5957
MICHAEL J SAUNDERS MD
1200 MC LEAN AVENUE
TOMAH WI 54660
GP
608-269-5066
LOU R SCHMIDT MD
108 WEST MAIN STREET
POST OFFICE BOX 517
SPARTA WI 54656
FP / FP
HUGH H WILLIAMS MD
315 WEST DAK STREET
SPARTA WI 54656
OCONTO
IM
414-846-3092
ROBERT ARTWICH MD
835 SOUTH MAIN STREET
OCONTO FALLS WI 54154
GP / PTH
414-834-4975
KIM Y CHUNG MD
1134 MAIN STREET
POST OFFICE BOX 258
OCONTO WI 54153-0258
GP
414-846-3644
JOHN R CULVER MD
150 NORTH MAIN STREET
OCONTO FALLS WI 54154
PUD DR
DOUGLAS A GUTHEIL MD
145 S WEBSTER AVENUE
DE PERE WI 54115
FP / FP
414-834-2201
GLEN J HEINZL MD
POST OFFICE BOX 170
OCONTO WI 54153-0170
GP
JOHN S HDNISH MD
POST OFFICE BOX 260
OCONTO WI 54153
FP
414-855-6031
METODIO M REYES MD
POST OFFICE BOX 398
GILLETT WI 54124
GP
414-346-3671
CLYDE E SIEFERT MD
164 NORTH MAIN STREET
OCONTO FALLS WI 54154
ONEIDA-VILAS
P N
715-362-4488
DANILO S ABUD MD
1044 KABEL AVENUE
POST OFFICE BOX 1307
RHINELANDER WI 54501-1307
FP
STEPHEN E ANICH MD
HIGHWAY 51
POST OFFICE BOX 470
WOODRUFF WI 54568
D / D
715-369-4500
ROBERT J AYLESWORTH JR MD
TWO EAST OCALA
POST OFFICE BOX 815
RHINELANDER WI 54501
OBG / OBG
OLIVER B BEARDSLEY MD
7734 TROUT ROAD
POST OFFICE BOX 1371
RHINELANDER WI 54501
GS CDS / GS CDS
JAMES P BINDER MD
3006 POLZER DRIVE
WAUSAU WI 54401
GS / GS
JOSEPH A BODENSTEINER MD
1020 KABEL AVENUE
RHINELANDER WI 54501
PD
STUART N BOISMENUE MD
1020 KABEL AVENUE
RHINELANDER WI 54501
IM
715-362-5650
JOHN F BROWN MD
1020 KABEL AVENUE
RHINELANDER WI 54501
IM PUD / IM PUD
715-356-8000
JEROME J CALLAWAY MD
POST OFFICE BOX 549
WOODRUFF WI 54568
PH / GPM
715-362-2836
FRANCES A CLINE MD
123 N STEVENS STREET
RHINELANDER WI 54501
GP
715-479-4171
JOHN J COLGAN MD
321 WALL STREET
POST OFFICE BOX 429
EAGLE RIVER WI 54521
R NM / R
LEON F DE JONGH MD
BOX 26
RHINELANDER WI 54501
GP IM
DOUGLAS K DIEHL MD
POST OFFICE BOX 1023
MINOCQUA WI 54548
ORS HS TRS
715-369-2300
JAMES R DYREBY JR MD
550 TIMBER DRIVE
RHINELANDER WI 54501
PD / PD
LYNN D FGGMAN MD
1020 KABEL AVENUE
RHINELANDER WI 54501
70— ONEIDA/VILAS, OUTAGAMIE
GP GS
715-547-36?6
EVERETT C EICl^HOFF MD
5022 BIRCH ROAD
LAND D'LAKES WI 54540
DBG END / DBG
715-362-6510
PAUL K FIGGE vIR MD
5 W FREDERICK STREET
RHINEl.ANDER WI 54501
OBG / OBG
JAMES M F INNER AN MD
L-2I21 TO TO TOM DRIVE
LAC DU FLAMBEAU WI 5453B
IM CD / IM CD
FRED W FLETCHER MD
1186 CATFISH LAKE ROAD
EAGl.E RIVER WI 54521
ORS
RICHARD N FOLTZ MD
550 TIMBER DRIVE
RHINELANDER WI 54501
IM / IM
715-362-5650
JOHN F FROST MD
1020 KABEL AVENUE
RHINELANDER WI 54501
FP / FP
715-547-3626
JAMES V GREBNER MD
3621 DEERSKIN ROAD
EAGLE RIVER WI 54521-8612
PD / PD
ANTE GRGIC MD
203 SCHIEK PLAZA DRIVE
RHINELANDER WI 54501
R
PAUL W GROTENHUIS MD
4085 NORTH BAY ROAD
RHINELANDER WI 54501
QPH
715-356-3292
GARY A HAUG MD
9637 MANITOU PARK DR
MINOCQUA WI 54548
U / U
715-362-5650
BENN A HAYNES MD
1020 KABEL AVENUE
RHINELANDER WI 54501
IM / IM
715-362-5650
MICHAEL J HENRY MD
1020 KABEL AVENUE
RHINELANDER WI 54501
PTH / PTH
BRUCE F HERTEL MD
1044 KABEL AVENUE
RHINELANDER WI 54501
GP
715-356-8000
JAMES T HOULIHAN MD
240 MAPLE STREET
POST OFFICE BOX 470
WOODRUFF WI 54568
FP
7 1 5—356—3292
LORRAINE F P HOULIHAN MD
WOODRUFF WI 54568
U / U
7 t 5-356—3292
ARTHUR vl JACOBSEN MD
POST OFFICE BOX 549
WOODRUFF WI 54568
FP / FP
715-479-6453
LEWIS L JACOBSON MD
POST OFFICE BOX 1449
EAGLE RIVER WI 54521
FP / FP
715-356-3292
STEVE W JANAK MD
POST OFFICE BOX 549
WOODRUFF WI 54568
IM / IM
DANIEL L JOHNSON MD
2211 STOUT ROAD
MENOMONIE WI 54751-2399
GS / GS
715-356-3292
JAMES R KEUER MD
POST OFFICE BOX 549
WOODRUFF WI 54568
FP PH / FP
715-282-5222
HAROLD J KIEF MD
7231 lake MILDRED ROAD
RHINELANDER WI 54501
IM
715-362-5650
JOHN J KIEF MD
1020 KABEL AVENUE
RHINELANDER WI 54501
ORS / ORS
715-369-2300
ROBERT H KITZMAN MD
550 TIMBER DRIVE
RHINELANDER WI 54501
AN / AN
715-356-5282
DAVID W KOSKI MD
POST OFFICE BOX 744
WOODRUFF WI 54568
I M / I M
BRUCE A KOTILA MD
210 ELM COURT
RHINELANDER WI 54501
OBG / OBG
715-362-6160
PETER L LOES MD
1020 KABEL AVENUE
RHINELANDER WI 54501
FP / FP
CHARLES A LONSDORF MD
POST OFFICE BOX 549
WOODRUFF WI 54568
PD / PD
715-369-5027
STEVEN R MANSON MD
307 RIDGEWAY DRIVE
RHINELANDER WI 54501
N P 7 N
MICHAEL S MAYRON MD
5725 N FOURTH PLACE
PHOENIX AZ 85012
ORS / ORS
715-356-4427
PETER J MELCHER MD
POST OFFICE BOX 109
MINOCQUA WI 54548
FP / FP
7 1 5-356-3292
GEORGE NEMEC JR MD
AVI 1322 WILLIES DRIVE
WOODRUFF WI 54568
IM
715-478-3361
REBECCA CONWAY NIEHAUS MD
313 EAST POLK STREET
CRANDON WI 54520
IM / IM
715-362-5650
LEO G NOR DEN MD
1020 KABEL AVENUE
RHINELANDER WI 54501
OBG / OBG
715-362-5650
JUDITH S PAGANO MD
1020 KABEL AVENUE
RHINELANDER WI 54501
N P / N P
715-369-5051
ELLEN 1 PARRIS MD
1831 STEVENS STREET N
POST OFFICE BOX 615
RHINELANDER WI 54501
IM / IM
STEPHEN R PETERS MD
POST OFFICE BOX 549
WOODRUFF WI 54568
GS / GS
715-356-3292
ANTHONY E POGODZ INSKI MD
POST OFFICE BOX 549
WOODRUFF WI 54568
GS J GS
715-362-5650
GEORGE F PRATT MD
1020 KABEL AVENUE
RHINELANDER WI 54501
PTH
STEVEN R QUACKENBUSH MD
C/0 HYMC
POST OFFICE BOX 470
WOODRUFF WI 54568
FP / FP
715-356-3292
WILLIAM E RADUEGE MD
POST OFFICE BOX 549
WOODRUFF WI 54568
FP
THOMAS K RESAN MD
POST OFFICE BOX 549
WOODRUFF WI 54568
PTH / PTH
CAROL A RITTER MD
1044 KABEL AVENUE
RHINELANDER WI 54501
FP / FP
715-479-2397
E LANNY ROBINS MD
POST OFFICE BOX 129
EAGLE RIVER WI 54521
FP
71 S— T56— 3292
CHARLES A SCHELL MD
POST OFFICE BOX 549
WOODRUFF WI 54568
GP GS / GS
715-362-6061
IRVING F SCHIEK JR MD
203 SCHIEK PLAZA DRIVE
RHINELANDER WI 54501
GS OS
IRVING E SCHIEK III MD
ROUTE 6
RHINELANDER WI 54501
IM OS / IM
904-234-1841
HENRY J C SCHWARTZ MD
3030 LAURIE AVENUE
PANAMA CITY BEACH FL
32407
GS / GS
715-356-3292
BARRY J SEIDEL MD
POST OFFICE BOX 549
WOODRUFF WI 54568
IM / IM
715-362-6303
WARREN K SIMMONS MD
715 LAKE SHORE DRIVE
RHINFLANDER WI 54501
OBG / OBG
715-362-5650
DOROTHY V SKYE MD
1020 KABFL AVENUE
RHINELANDER WI 54501
FP EM / FP
715-356-3292
RAYMOND J SLOAN MD
POST OFFICE BOX 549
WOODRUFF WI 54568
IM / IM
715-362-6160
LEE A SWANK MD
203 SCHIEK PLAZA DRIVE
RHINELANDER WI 54501
AN / AN
715-799-4426
ALLAN E TALBOT MD
ROUTE 1 BOX 371
GILLETT WI 54124-9604
FP GS CDS / GS
QUENTIN M THOMAS MD
EAGLE RIVER WI 54521
GS / GS
715-362-5650
GEORGE R THUERER MD
406 WEST PEARL STREET
RHINELANDER WI 54501
IM / IM
715-356-3292
JAMES K WIESNER MD
POST OFFICE BOX 549
WOODRUFF WI 54568
OUTAGAMIE
DBG
414-739-0114
ERNESTO L ACOSTA MD
506 E LONGVIEW DRIVE
APPLETON WI 54911
FP / FP
414-739-0171
KAREN ADLER-FISCHER MD
401 N ONEIDA STREET
APPLETON WI 54911
I M / I M
414-739-0171
JOHN E ALMQUIST MD
1501 S MADISON STREET
APPLETON WI 54915
IM / IM
414-731-7045
STEPHEN K ALT MD
309 E WASHINGTON ST
APPLETON WI 5491 1
IM / IM
414-734-8062
JACK G ANDERSON MD
900 EAST GRANT STREET
APPLETON WI 54911
OBG
FELICISIMA B BALVERDE MD
715 DEPOT STREET
LITTLE CHUTE WI 54140
FP / FP
JOHN R BARKMEIER MD
1523 S MADISON STREET
APPLETON WI 54911
OUTAGAMIE— 71
AN
TEOFILO EVANGELISTA MD
706 E WISCONSIN AVENUE
APPLETON WI 54911
FP / FP
414-984-3361
MICHAEL S FAUDREE MD
103 SOUTH BEACH
POST OFFICE BOX 257
BLACK CREEK WI 50106-0257
EM
414-738-0563
GEORGE A BEHNKE MD
1406 RIVERVIEW LANE
APPLETON WI 54915
P / PN
ALLAN D BELDEN MD
610 E LONGVIEW DRIVE
APPLETON WI 54911
GP
414-779-4595
JAMES G BERGWALL MD
217 WEST CEDAR
POST OFFICE BOX 100
HORTONVILLE WI 54944
GS / GS
JOSEPH N BONNER MD
106 RIVER DRIVE
APPLETON WI 54911
GS CDS / GS
414-731-8131
CLARK H BOREN JR MD
900 EAST GRANT STREET
APPLETON WI 54911-3494
GP
GEORGE L BOYD MD
605 WISCONSIN AVENUE
KAUKAUNA WI 54130
U / U
DONALD D BRAVICK MD
436 E LONGVIEW DRIVE
APPLETON WI 54911
FP IM / FP
414-733-2949
FREDERICK A BREI MD
601 W PERSHING STREET
APPLETON WI 54911
OBG
414-739-0171
JOHN P BRIODY MD
3100 SHORE DRIVE
MARINETTE WI 54143
R / R
ROBERT G BRUCKER MD
SUITE 103
424 E WISCONSIN AVENUE
APPLETON WI 54911
FP / FP
414-734-4501
KEITH E BUCHANAN MD
620 E LONGVIEW DRIVE
APPLETON WI 54911
A PDA PD / AI PD
414-739-5213
JACK K BURR MD
436 E LONGVIEW DRIVE
APPLETON WI 54911-2192
OTO / OTO
414-734-7181
THOMAS BURROWS MD
626 E LONGVIEW DRIVE
APPLETON WI 54911
IM / IM
414-738-4845
JOHN M BUTITTA MD
1501 S MADISON STREET
APPLETON WI 54915
I M / I M
608-271-6805
GUY W CARLSON MD
APT 806
6209 MINERAL POINT RD
MADISON WI 53705
GS / GS
414-73) -8131
WILLIAM W CHANDLER MD
900 EAST GRANT STREET
APPLETON WI 54911-3494
FP 7 FP
ALAN H CHERKASKY MD
430 BRILL STREET
KAUKAUNA WI 54130
GP OM
SIMON CHERKASKY MD
117 WEST THIRD STREET
KAUKAUNA WI 54130
R TR / TR
HENRY CHESSIN MD
424 E WISCONSIN AVENUE
APPLETON WI 54911
AN
SHAN H CHIEN MD
706 E WISCONSIN AVENUE
APPLETON WI 54911
IM / IM
BLAINE W CLAYPOOL JR MD
424 E LONGVIEW DRIVE
APPLETON WI 54911
OBG / DBG
414-739-0114
RICHARD S CLINE MD
506 E LONGVIEW DRIVE
APPLETON WI 54911
AN
PERFECTO COMPETENTE MD
1751 N RACINE STREET
APPLETON WI 54911
PTH / PTH
ARMENIO C CORDERO MD
DEPT OF PATHOLOGY
1506 S ONEIDA STREET
APPLETON WI 54911
FP
PAUL M CUNNINGHAM MD
320 E GLENDALE AVENUE
APPLETON WI 54911
A / AI
414-734-6614
JAMES C CURRY MD
1 1 1 1 S ONEIDA STREET
APPLETON WI 54915
GS / GS
WILLIAM A DAFOE MD
614 SHERWOOD DRIVE
ALTAMONTE SPRINGS FL
32701
IM / IM
HAROLD G DANFORD MD
900 EAST GRANT STREET
APPLETON WI 54911
OBG
414-739-0171
RAYMON E DARLING MD
1501 S MADISON STREET
APPLETON WI 54915
FP / FP
414-734-4501
D JON DERKSEN MD
620 E LONGVIEW DRIVE
APPLETON WI 54911
OBG / OBG
414-739-01 14
CHARLES F DUNGAR MD
506 E LONGVIEW DRIVE
APPLETON WI 54911
P / P
414-739-9102
DENTON P ENGSTROM MD
610 E LONGVIEW DRIVE
APPLETON WI 54911
PTH CLP / AP CLP RP
414-738-2126
JAMES W ERCHUL MD
DEPT OF PATHOLOGY
1506 S ONEIDA STREET
APPLETON WI 54911
FP / FP
414-735-1200
CHARLES E FENLON MD
229 S MORRISON STREET
APPLETON WI 54911
DR / R
JOHN W FENLON MD
SUITE 103
424 E WISCONSIN AVENUE
APPLETON WI 54911
AN
414-739-3298
PASCUAL B FERNANDEZ MD
706 E WISCONSIN AVENUE
APPLETON WI 54911
HS PS / PS
414-739-3100
DAVID R FINCH MD
1611 S MADISON STREET
APPLETON WI 54915
IM / IM
HENRY A FOLB MD
525 W PARK RIDGE AVE
APPLETON WI 54911-1126
FP / FP
414-734-4501
ROBERT S FOX MD
620 E LONGVIEW DRIVE
APPLETON WI 54911
FP / FP
414-731-4101
C WILLIAM FREEBY MD
1818 N MEADE STREET
APPLETON WI 54911
EM
414-734-3660
GEORGE A FRENCH MD
1827 N RACINE STREET
APPLETON WI 54911
GP
RALPH S GAGE MD
221 MATTHEWS STREET
KIMBERLY WI 54136
GE IM
MICHAEL G GEALL MD
900 EAST GRANT STREET
APPLETON WI 54911
OBG
WALTER S GIFFIN MD
Nil 905 DEER LAKE ROAD
TOMAHAWK WI 54487-9426
ORS
414-731-31 1 1
JAMES E GMEINER MD
1560 PALISADES DRIVE
APPLETON WI 54915
AN
SEVERING G GOMILLA MD
POST OFFICE BOX 384
APPLETON WI 54912
FP / FP
414-738-4840
DOUGLAS H GRANT MD
401 N ONEIDA STREET
APPLETON WI 54911
PD / PD
414-739-0171
MAURY D GRAVES MD
401 N ONEIDA STREET
APPLETON WI 54911
PD / PD
414-739-0171
CHARLES J GREEN MD
401 N ONEIDA STREET
APPLETON WI 54911
R NM / R NR NM
414-739-4213
WILLIAM B GRUBB JR MD
SUITE 103
424 E WISCONSIN AVENUE
APPLETON WI 54911
FP / FP
414-731-9121
DEAN A GRUNER MD
1523 S MADISON STREET
APPLETON WI 54915
ORS / ORS
414-731-661 1
FINN O GUNDERSON MD
900 EAST GRANT STREET
APPLETON WI 54911
ORS / ORS
414-731-311 1
JEROME H HAGENS MD
1260 VALLEY ROAD
APPLETON WI 54911
FP / FP
RICHARD 0 HAIGHT MD
1523 MADISON STREET
APPLETON WI 54911
FP / FP
414-733-3754
WILLIAM H HALE MD
424 E LONGVIEW DRIVE
APPLETON WI 54911
OPH / OPH
414-733-4438
MARVIN L HALL MD
612 E LONGVIEW DRIVE
APPLETON WI 54911
FP / FP
414-722-4123
JILL P HARMAN MD
1830 WEST MEADE STREET
APPLETON WI 54911
OBG / OBG
414-739-0114
JOHN S HARRIS MD
506 E LONGVIEW DRIVE
APPLETON WI 54911
FP
414-733-0202
FRANCIS M HAUCH MD
2207 S KERNAN AVENUE
APPLETON WI 54915
ORS / ORS
414-731-311 1
ROBERT L HAUSSERMAN MD
1260 VALLEY ROAD
APPLETON WI 54911
IM / IM
414-739-0171
BERNARD J HAZA MD
401 N ONEIDA STREET
APPLETON WI 54911
FP / FP
414-738-4846
G MARK HEIFNER MD
1477 KENWOOD CENTER
MIDWAY ROAD
MENASHA WI 54952
FP / FP
DAN L HEYERDAHL MD
620 E LONGVIEW DRIVE
APPLETON WI 54911
72— OUTAGAMIE
P / PN
414-739-9102
BRUCE A HEYL MD
610 E LONGVIEW DRIVE
APPLETON WI 54911
PD / PD
414-739-0171
KURT A HEYRMAN MD
401 N ONEIDA STREET
APPLETON WI 54911
FP / FP
414-739-0171
NANCY U HOMDURG MD
401 N ONEIDA STREET
APPLETON WI 54911
GP CRS
FRANCIS J HUBERTY MD
114 E FRANKLIN STREET
APPLETON WI 5491 1
TR R / R
414-225-3085
MICHAEL T KADEMIAN MD
2315 NORTH LAKE DRIVE
MILWAUKEE WI 53211
D / D
414-733-5138
CHARLES N KAGEN MD
SUITE 409
100 W LAWRENCE STREET
APPLETON WI 54911
D
414-733-5138
MARVIN S KAGEN MD
SUITE 409
100 W LAWRENCE STREET
APPLETON WI 54911
AI IM / AI IM
414-739-9100
STEVEN L KAGEN MD
SUITE 410
100 WEST LAWRENCE
APPLETON WI 54911
P / P
KEITH M KEANE MD
B20 EAST GRANT STREET
APPLETON WI 54911-3478
R / R
414-739-4213
RALPH 0 KENNEDY MD
SUITE 103
424 E WISCONSIN AVENUE
APPLETON WI 54911
DBG / OBG
414-731-51 1 1
JIN SIK KIM MD
1611 S MADISON STREET
APPLETON WI 54911
R / R
ROBERT R KINDE MD
SUITE 103
424 E WISCONSIN AVENUE
APPLETON WI 54911
GS / GS
414-739-0171
EARL B KITZEROW MD
401 N ONEIDA STREET
APPLETON WI 54911
EM / EM
FREDERICK W KNOCH III MD
445 KITTIVER COURT
NEENAH WI 54956
GP
WILLIAM H KNOEDLER MD
314 KIMBERLY AVENUE
KIMBERLY WI 54136
IM CD / IM
414-734-8837
ROBERT C KOBERSTEIN MD
1602 N MEADE STREET
APPLETON WI 54911
ON IM / MON IM
414-731-3135
BRIAN E KOESTER MD
900 EAST GRANT STREET
APPLETON WI 5491 1
IM
414-734-5721
HANNS 0 KRETZSCHMAR MD
4321 N BALLARD ROAD
APPLETON WI 54919
FP / FP
414-739-0171
MICHAEL A KRUEGER MD
401 N ONEIDA STREET
APPLETON WI 54911
OTO / OTO
414-734-7181
MITCHELL F KWATERSKI MD
626 E LONGVIEW DRIVE
APPLETON WI 54911
GP
JAMES W LAIRD MD
APT 3
3001 W FOURTH STREET
APPLETON WI 54914
FP
414-378-0772
CHARLES E LARSON MD
1003 SUPERIOR
APPLETON WI 54911
ORS / ORS
414-731-6611
JOHN R LINDSTROM MD
900 E GRANT STREET
APPLETON WI 54911
EM FP DM / EM FP
414-734-6351
THOMAS M LOESCHER MD
2520 E CRESTVIEW DRIVE
APPLETON WI 54915
D / D
414-734-5967
THOMAS W LUTHER MD
215 SOUTH STATE STREET
APPLETON WI 54911
FP / FP
CHARLES A MC KEE MD
1523 S MADISON STREET
APPLETON WI 54915
PTH BLB / PTH BLB
414-738-2128
DONALD C MC KEE MD
DEPT OF PATHOLOGY
1506 S ONEIDA STREET
APPLETON WI 54915
FP / FP
TERRENCE MEECE MD
522 E PACIFIC STREET
APPLETON WI 54911
PTH / PTH
PEARSE P MEIGHAN MD
ROUTE 6 BOX 1215
WAUPACA WI 54981
IM / IM
414-739-0171
RICHARD A MENET MD
401 NORTH ONEIDA ST
APPLETON WI 54911
PD A I PUD / PD
414-739-0171
JAMES G MERRICK MD
401 N ONEIDA STREET
APPLETON WI 54911
414-734-8481
CHESTER L MEYERS MD
412 E LONGVIEW DRIVE
APPLETON WI 54911
FP / FP
GERALD R MICH MD
1523 S MADISON STREET
APPLETON WI 54915
IM RHU / IM
414-739-0171
RONALD R MOLONY MD
1501 S MADISON STREET
APPLETON WI 54915
PTH CLP / PTH CLP
414-738-6538
BRIAN P MOORE MD
DEPT OF PATHOLOGY
1818 N MEADE STREET
APPLETON WI 54911
GS CD / GS
414-731-8131
GILBERT F MUELLER JR MD
900 EAST GRANT STREET
APPLETON WI 54911-3494
OPH / OPH
414-734-8714
ROSS A MUELLER MD
1620 N MFADE STREET
APPLETON WI 54911
DR / DR
414-739-4213
JAMES E MURPHY MD
SUITE 103
424 EAST WISCONSIN AVE
APPLETON WI 54911
IM DIA / IM
414-734-3865
GEORGE P NICHOLS MD
424 E LONGVIEW DRIVE
APPLETON WI 54911
FP / FP
414-738-4846
N CARTER NOBLE MD
1477 KENWOOD CENTER
MIDWAY ROAD
MENASHA WI 54952
PM / GPM
RAIMUNDS PAVASARS MD
1028 EAST NORTH STREET
APPLETON WI 54911
OBG / OBG
414-739-0114
GEORGE J PETERSEN MD
506 E LONGVIEW DRIVE
APPLETON WI 54911
GS CDS / GS
414-731-8131
PHILIP E PIER MD
900 EAST GRANT STREET
APPLETON WI 54911-3494
R / R
LOUIS T PLOUFF MD
SUITE 103
424 E WISCONSIN AVENUE
APPLETON WI 54911
FP / FP
414-734-4501
DAVID L PRICE MD
620 E LONGVIEW DRIVE
APPLETON WI 54911
FP
414-735-9748
JAMES M QUAYLE MD
2917 NORTH DREW STREET
APPLETON WI 54911
U / U
GABRIEL J QUEROL MD
436 E LONGVIEW DRIVE
APPLETON WI 54911
OBG / OBG
414-735-0811
EUGENE H RANEY MD
900 EAST GRANT STREET
APPLETON WI 5491 1
GP GS
FERDINAND J RANKIN MD
401 N ONEIDA STREET
APPLETON WI 54911
CDS TS / TS GS
414-731-8900
TREVOR A RATTRAY MD
820 EAST GRANT STREET
APPlETON WI 54911-3494
ORS 7 ORS
414-731-661 1
WILLIAM R RICHARDS MD
900 EAST GRANT STREET
APPLETON WI 54911
N / N
414-738-2531
MICHAEL J RIEDER MD
1611 S MADISON STREET
APPLETON WI 54915-1844
OTO / OTO
414-733-4438
JOHN H RUSSELL MD
612 E LONGVIEW DRIVE
APPLETON WI 54911
PUD IM / PUD IM
414-739-3161
JOHN G RUSSO MD
106 HAYES STREET
KAUKAUNA WI 54130
IM ON / IM
414-731-8135
THOMAS A RYAN MD
900 EAST GRANT STREET
APPLETON WI 54911
FP / FP
DOUGLAS D SALMON MD
620 E LONGVIEW DRIVE
APPLETON WI 54911
AN
ANTONIO V SALUD MD
706 E WISCONSIN AVENUE
APPLETON WI 54911
ORS / ORS
414-731-661 1
JAMES M SARGENT MD
900 EAST GRANT STREET
APPLETON WI 54911
GYN
414-739-0114
GEORGE W SAVAGE MD
506 E LONGVIEW DRIVE
APPLETON WI 54911
OBG
414-739-0114
STEPHEN G SAVAGE MD
506 E LONGVIEW DRIVE
APPLETON WI 54911
FP / FP
414-739-0171
THOMAS C SCHELBLE MD
401 N ONEIDA STREET
APPLETON WI 54911
PS HS / PS
414-731-3131
THOMAS J SCHINABECK MD
900 EAST GRANT STREET
APPLETON WI 54911-3494
OBG / OBG
414-731-3341
HASSAN SHAHBANDAR MD
1611 SOUTH MADISON
APPLETON WI 54915
OPH / OPH
414-731 -3237
JOHN A SHILLINGLAW MD
ROOM 305
103 W COLLEGE AVENUE
APPLETON WI 54911
OUTAGAMIE, OZAUKEE, PIERCE/ST CROIX— 73
AN / AN
KENNETH J SIEGRIST MD
POST OFFICE BOX 783
APPLETON WI 54V12
IM ON OS / IM
414-734-5721
FRANKLIN A SMITH MD
4321 N BALLARD ROAD
APPLETON WI 54919
FP / FP
414-734-5721
PATRICK D SNOW MD
4321 N BALLARD ROAD
APPLETON WI 54919
FP / FP
414-735-1200
JAMES V SPRINGROSE MD
229 S MORRISON STREET
APPLETON WI 54911
GS / G5
414-739-0171
GEORGE R STANIS MD
401 N ONEIDA STREET
APPLETON WI 54911
CDS TS GS / GS
414-731-8900
LOUIS A SUAREZ MD
900 EAST GRANT AVENUE
APPLETON WI 54911-3494
OPH / OPH
414-731-0916
ROBERT D SULLIVAN MD
612 E LONGVIEW DRIVE
APPLETON WI 54911
P
THOMAS W TATLOCK MD
610 E LONGVIEW DRIVE
APPLETON WI 54911
GP GS
ARTHUR C TAYLOR MD
303 RIVER DRIVE
APPLETON WI 54915
GP
FRANCIS X VAN LIESHOUT MD
117 EAST NORTH AVENUE
LITTLE CHUTE WI 54140
PD / PD
414-739-0171
JAMES S VEUM MD
401 N ONEIDA STREET
APPLETON WI 54911
FP / FP
414-739-0171
CHARLES C WALLACE MD
401 N ONEIDA STREET
APPLETON WI 54911
OTO HNS / OTO HNS
414-734-7181
RICHARD H ward MD
626 E LONGVIEW DRIVE
APPLETON WI 54911
CDS PYM OS / TS
414-731-8900
DAVID E WARNER MD
820 EAST GRANT STREET
APPLETON WI 54911-3494
OPH / OPH
JEFFREY L WARREN MD
21 PARK PLACE
APPLETON WI 54915
P / P
414-739-9102
JOSEPH B WEISSLER MD
610 E LONGVIEW DRIVE
APPLETON WI 54911
OBG
414-731-3341
MICHAEL E WEST MD
1611 S MADISON STREET
APPLETON WI 54911
IM PUD / IM PUD
414-734-9600
JEFFREY R WHITESIDE MD
820 EAST GRANT STREET
APPLETON WI 54911
AN / AN
414-731-9725
ANTONIO R WICO JR MD
1225 E PAULINE STREET
APPLETON WI 54911
PD / PD
414-739-0171
LLOYD P WILLIAMS MD
401 N ONEIDA STREET
APPLETON WI 54911
FP EM / FP
414-982-4322
JON N WINTHER MD
1410 DIVISION STREET
NEW LONDON WI 54961-1543
AN
KUANG-MIN YANG MD
706 E WISCONSIN AVENUE
APPLETON WI 54911
FP / FP
414-734-3210
JOSEPH J YOUNG MD
1718 N VIOLA STREET
POST OFFICE BOX 85
APPLETON WI 54912
OPH
EDWARD J ZEISS MD
1240 E OPECHEE STREET
APPLETON WI 54911
OPH / OPH
JOHN C ZEISS MD
1620 N MEADE STREET
APPLETON WI 54911
OZAUKEE
R DR / DR
414-282-3355
ISIS A BEBAWY MD
5311 SOUTH 21ST STREET
MILWAUKEE WI 53221
FP / FP
ANN C BEECHER MD
10404 N LARKSPUR LANE
MEQUON WI 53092
ORS
ALLAH W BHATTI MD
326 WEST PIERRE LANE
PORT WASHINGTON WI 53074
I M / I M
414-284-9032
MARK S OOSTWICK MD
223 BARRY AVENUE
PORT WASHINGTON WI 53074
OPH . OPH
M THOMAS CHEMOTTI MD
N94 W6539 FIELDCREST
CEDARBURG WI 53012
PTH CLF / PTH CLP
ARTHUR B CONRAD MD
1301 MILWAUKEE STREET
DELAFIF.LD WI 53018
ORS / ORS
414-284-0884
ANTHONY P DALTON MD
100 WEST MONROE STREET
PORT WASHINGTON WI 53074
GP
414-242-1 120
TED D ELBE MD
143 GREEN BAY ROAD
THIENSVILLE WI 53092
OBS GYN / OBG
414-284-4451
FEMA SO GARAY MD
326 WEST PIERRE LANE
PORT WASHINGTON WI 53074
OPH 7 OPH
414-242-5400
ARTHUR F GARCIA JR MD
214 GREEN BAY ROAD
THIENSVILLE WI 53092
OBG / DBG
414-242-3596
THOMaS a HANDRICH MD
11132 N RIVERLAND CT
MEQUON WI 53092
FP / FP
414-241-6550
JAMES W HARE MD
10945 NORTH PORT
WASHINGTON ROAD
MEQUON WI 53092
GP
414-284-2631
ROBERT F HENKLE MD
100 WEST MONROE STREET
PORT WASHINGTON WI 53074
R / R
AUDREY L HUCKABY MD
W53 N440 PARK CIRCLE
CEDARBURG WI 53012
GP
414-377-0717
HENRY J KATZ MD
N56 W6509 CENTER ST
CEDARBURG WI 53012
FP / FP
414-375-1 580
JOHN R KRUEGER MD
4922 COLUMBIA ROAD
CEDARBURG WI 53012-9103
FP / FP
414-649-7909
HERBERT F LAUFENBURG MD
N70 W6874 BRIDGE ROAD
CEDARBURG WI 53012
PD
OLIVA A LUIB MD
457 WEST GRAND AVENUE
PORT WASHINGTON WI 53074
GS CDS .■ GS
414-375-1 580
AYKARETHU 0 MAMMEN MD
339 W 3EACR0FT COURT
MEQUON WI 53092
OBG
414-241-8506
INDIRA MAMMEN MD
339 W SEACRDFT COURT
MEQUON WT 53092
IM / IM
414-284-345C
DDUGlaS B MC MANUS MD
326 WEST PIERRE LANE
PORT WASHINGTON WI 53074
D
PETER W MESSER MD
3344 WEST GRACE AVENUE
MEQUON wl 53092
GP
414-377-1577
KENNETH F PELANl MD
1240 13TH AVENUE
GRAFTON WI 53024
FP / FP
414-284 -0600
ROBERT A PFEFFER MD
118 EAST GRAND AVENUE
PORT WASHINGTON WI 53074
GP
GEORGE F SAVAGE MD
173 E PROSPECT STREET
PORT WASHINGTON WI 53074
GP OM
414-963-2261
JOSEPH A SEIDL MD
AMERICAN MOTORS
3880 N RICHARDS STREET
MILWAUKEE WI 53212
FP / FP
THOMAS vl SHEWCZYK MD
4922 COLUMBIA ROAD
CEDARBURG WI 53012
GS / GS
414-284-4345
THOMAS WALL MD
326 WEST PIERRE LANE
PORT WASHINGTON WI 53074
P / P
414-375-0055
BRUCE E WEFFENSTETTE MD
POST OFFICE BOX 327
GRAFTON WI 53024-0327
PIERCE-ST CROIX
IM
715-386-4400
MYRON G ANDERSON MD
226 LOCUST STREET
HUDSON WI 54016
FP / FP
ALEX P AVESTRUZ MD
SPRING VALLEY WI 54767
FP / FP
NERISSA L AVESTRUZ MD
SPRING VALLEY WI 5476"'
FP / FP
715-425-6701
JAMES R BEIX MD
409 SPRUCE STREET
RIVER Falls wi 54022
IM
MILTON A CORNWALL MD
327 S SEVENTH STREET
HUDSON WI 540 lo
FP / FP
715-246-6911
JAMES 1. CRAIG MD
821 WEST EIGHT H STREET
NEW RICHMOND Wl 54017
OBG / OBG
EUGENE J DIEFFNBACH MD
226 locust street
HUDSON W! 54016
GP
7 1 5-647-364 1
CHARLES W DOCTER MD
PLUM CITY WI 54761
74— PIERCE/ST CROIX, POLK, PORTAGE
PD / PD
715-28^-5244
JOHN C DOCTE.R MD
ROUTE 1 BOX 108
ARKANSA.W WJ 54721
R DR
715-425-8935
DONAl D W DOHNALEK MD
ROUTE 5 BOX 228
RIVER falls WT 54022
FP / FP
715-386-9381
TERRY G DOMINO MD
220 VINE STREET
HUDSON WI 54016
GS FP / FP
715-246-6041
COLIN J DRURY MD
956 WEST RIVER DRIVE
NEW RICHMOND WI 54017
GP
ERNEST M DRURY MD
911 WEST RIVER DRIVE
NEW RICHMOND WI 54017
GS / GS
715-425-6701
MICHAEL R EVANS MD
409 SPRUCE STREET
RIVER FALLS WI 54022
GS
715-386-231 1
RUBEN E FERMIN MD
226 LOCUST STREET
HUDSON WI 54016
U GS / U
PAUL GLEICH MD
UROLOGY DEPT
640 JACKSON STREET
ST PAUL MN 55101
FP / FP
715-425-6701
ROLAND M HAMMER MD
409 SPRUCE STREET
RIVER FALLS WI 54022
FP / FP
BRUCE G HANSON MD
661 PARKVIEW DRIVE
NEW RICHMOND WI 54017
FP t FP
715-425-6701
PAUL. S HASKINS MD
409 SPRUCE STREET
RIVER FAl.LS WI 54022
FP / FP
715-425-6701
ROBERT B JOHNSON JR MD
409 SPRUCE STREET
RIVER FALLS WI 54022
FP / FP
715-273-4341
EUGENE R JONAS MD
144 SOUTH PLUM STREET
ELLSWORTH WI 54011
ORS / UR5
715-246-2251
A HAMID KHAN MD
ROUTE 4 BOX 312
NEW RICHMOND WI 54017
FP / FP
715-273-5041
FREDERICK B KLAAS MD
144 SOUTH PLUM STREET
ELLSWORTH WI 54011
OBG
715-425-6701
BECKY L K,L EAGER MD
409 SRRUCE STREET
RIVER FALLS WI 54022
R / R
JOSEPH L KOVAR MD
535 HOSPITAL ROAD
NEW RICHMOND WI 54017
FP P
715-262-3286
HOWARD j LANEY MD
119 BROAD STREET
PRESCOTT WI 54021
GP
715-265-4121
ALLEN W I IMBERG MD
144 EAST OAK STREET
POST OFFICE BOX 158
GLENWOOD CITY WI
54013-0158
FP / FP
715-386-9381
VICKI L MAYER MD
220 VINE STREET
HUDSON WI 54016
GS GP / GS
715-246-691 1
NEAL A MELBY MD
645 EAST SECOND STREET
NEW RICHMOND WI 54017
FP / FP
715-684-3326
ROUtRT A NOGLER MD
CURTIS MEDICAL CL INIC
BALDWIN WI 54002
GP GS
715-684-21 19
CLIFFORD A OLSON MD
920 CURTIS STREET
BALDWIN WI 54002
FP / FP
DAVID L OLSON MD
POST OFFICE BOX 68
NEW RICHMOND WI 54017
IM GP FP / IM
715-246-3875
JOSEPH J OSTERBAUER MD
POST OFFICE BOX 68
NEW RICHMOND WI 54017
FP / FP
JAMES C PALMQUIST MD
409 SPRUCE STREET
RIVER FALLS WI 54022
FP / FP
715-425-6701
GEORGE M POPE MD
503 RIVFR HILLS DRIVE
RIVER FALLS WI 54022
FP 7 FP
715-246-6846
JOSEPH E POWELL MD
441 E SEVENTH STREET
NEW RICHMOND WI 54017
FP / FP
715-3FJ6-4400
STEPHEN R SCHMITZ MD
226 LOCUST STREET
HUDSON WI 54016
GP 7 FP
715-639-4151
FRANK A SPRINGER MD
ELMWOOD WI 54740
FP GS 7 FP
715-684-3326
LEONARD B TORKELSDN MD
1380 FRANKLIN STREET
BALDWIN WI 54002
FP 7 FP
LOUIS W WEISBROD MD
POST OFFICE BOX 6939
HAYWARD WI 54843-6939
FP 7 FP
715-425-6701
DAVID M WOESTE MD
409 SPRUCE STREET
RIVER FALLS WI 54022
POLK
GP
715-268-7191
ORRIN N ARNFSON MD
225 SCHOLL
AMEPY WI 54001
FP ' FP
715-483-3221
MARK E BOYKEN MD
208 SOUTH ADAMS STREET
POST OFFICE BOX 739
ST CROIX FALLS WI
54024-0739
GP FP
715-268-7191
WILL 1AM R BYRNE MD
225 SCHOLL STREET
POST OFFICE BOX 106
AMERY WI 54001-0106
GP
715-263-2350
LORNE A CAMPBELL JR MD
165 THIRD STREET
CLEAR LAKE WI 54005
FP 7 FP
HERBERT A DASLER MD
225 SCHOLL STREET
POST OFFICE BOX 106
AMERY WI 54001-0106
FP
PAUL F ELBING MD
225 SCHOLL STREET
POST OFFICE BOX 106
AMERY WI 54001-0106
GP CD
WILLIAM A FISCHER MD
502 BIRCH STREET
FREDERIC WI 54837
FP 7 FP
715-483-3221
ALLEN S HANSON MD
208 SOUTH ADAMS STREET
POST OFFICE BOX 739
ST CROIX FALLS WI
54024-0739
FP 7 FP
715-483-3221
MICHAEL B KOOPMEINERS MD
208 SOUTH ADAMS STREET
POST OFFICE BOX 739
ST CROIX FALLS WI
54024-0739
FP 7 FP
715-483-3221
ARNE T LAGUS MD
208 SOUTH ADAMS STREET
POST OFFICE BOX 739
ST CROIX F'ALLS WI
54024-0739
GP FP
715-268-7596
MICHAEL T G MARRA MD
318 RIVERSIDE BLVD
AMERY WI 54001
FP 7 FP
715-483-3221
LEO K NELSON MD
208 SOUTH ADAMS STREET
POST OFFICE BOX 739
ST CROIX FALLS WI
53024-0739
GS 7 GS
715-483-3221
LLOYD L OLSON MD
219 DAY ROAD
ST CROIX falls WI 54024
FP IM 7 FP
715-483-3221
EVAN H PETERSON MD
208 SOUTH ADAMS STREET
POST OFFICE BOX 739
ST CROIX FALLS WI
54024-0739
GP
715-294-2116
ARNOLD S POTEK MD
301 RIVER STREET
OSCEOLA WI 54020
FP AN 7 FP
715-483-3221
FRED n RIEGEL MD
208 SOUTH ADAMS STREET
POST OFFICE BOX 739
ST CROIX FALLS WI
54024-0739
FP 7 FP
715-483-3221
MICHAEL R SCHMIDT MD
208 SOUTH ADAMS STREET
POST OFFICE BOX 739
ST CROIX FALLS WI
54024-0739
FP 7 FP
DONALD F SCHWAB MD
ROUTE 1 BOX 362 A
HAYESVILl.E NC 28904
GS 7 GS
715-294-2116
JOHN 0 SIMENSTAD MD
301 RIVER STREET
OSCEOLA WI 54020
FP 7 FP
715-483-3221
MARWODD E WEGNER MD
208 SOUTH ADAMS STREET
POST OFFICE BOX 739
ST CROIX FALLS WI
54024-0739
GP
FREDERICK L WHITLARK MD
309 HARR I MAN AVENUE N
AMERY WI 54001
FP 7 FP
715-483-3221
WILLIAM W YOUNG MD
208 SOUTH ADAMS STREET
POST OFFICE BOX 739
ST CROIX FALLS WI
54024-0739
PORTAGE
OTO OPH 7 DTD
715-344-0943
GEORGE H ANDERSON MD
4217 RIDGE COURT
STEVENS POINT WI 54481
FP 7 FP
STEVEN J BAHRKE MD
POST OFFICE BOX 405
PLOVER WI 54467
GP
715-344-3233
VERNARD A BENN MD
615 SUNRISE AVENUE
STEVENS POINT WI 54431
PORTAGE, PRICE/TAYLOR— 75
AN
KASHYAP S BHATl MD
900 ILLINOIS AVENUE
STEVENS POINT WI 54481
IN
ROBERT H BICKFORD MD
STAR ROUTE BOX 34
ROCKPORT TX 78382
AN / AN
715-341-7920
C GARY BODENSTEINER MD
SUITE 331
900 ILLINOIS AVENUE
STEVENS POINT WI 54481
OBG / OBG
715-341-8559
FREDERICK J BOEHM II MD
122 N WILSHIRE DRIVE
STEVENS POINT WI 54481
GS CDS
715-344-4120
RICHARD P BOYER MD
2501 MAIN STREET
STEVENS POINT WI 54481
GP
DANIEL L BRICK MD
2501 MAIN STREET
STEVENS POINT WI 54481
AN
715-346-5345
FONG CHUNG CHANG MD
900 ILLINOIS AVENUE
STEVENS POINT WI 54481
ORS / ORS
715-344-4120
JAMES H DE WEERD JR MD
2501 MAIN STREET
STEVENS POINT WI 54481
OTO / OTO
715-341-8001
ROY J DUNLAP I I MD
508 VINCENT STREET
STEVENS POINT WI 54481
GS T5 / GS TS
715-344-4120
RICHARD A ECKBERG MD
2501 MAIN STREET
STEVENS POINT WI 54481
R
DAVID E ENERSON MD
1201 SOD MARIE AVENUE
STEVENS POINT WI 54481
D
715-344-4573
NYLES R ESKRITT MD
3508 EAST MARIA DRIVE
STEVENS POINT WI 54481
IM / IM
715-344-4637
FRANCIS E GEHIN MD
2009 WEST RIVER DRIVE
STEVENS POINT WI 54481
GP
WALTER A GRAMOWSKI MD
13322 PAINTBRUSH DRIVE
SUN CITY WEST AZ 85375
U / U
715-344-4120
PHILIP K HACKER MD
2501 MAIN STREET
STEVENS POINT WI 54481
EM
DAVID J HENDRICKSON MD
900 ILLINOIS AVENUE
STEVENS POINT WI 54481
GP GS / GS
715-344-3000
FRANK C IBER MD
2402 SPRINGVILLE DRIVE
STEVENS POINT WI 54481
OBG / OBG
715-341-0590
ROBERT J JAEGER MD
3291 THOMPSON COURT
STEVENS POINT WI 54481
IM / IM
JOSEPH F JARABEK MD
2501 MAIN STREET
STEVENS POINT WI 54481
IM GE / IM
ROBERT J JEAN MD
1501 MAIN STREET
STEVENS POINT WI 54481
FP / FP
715-346-7751
DONALD D JOHNSON MD
1800 NORTH POINT DRIVE
STEVENS POINT WI 54481
R / R
715-344-5100
RICHARD A KESSLER MD
900 ILLINOIS AVENUE
STEVENS POINT WI 54481
ORS / ORS
JOHN M KIRSCH MD
3426 EAST MARIA DRIVE
STEVENS POINT WI 54481
ORS HS PS / ORS
715-344-0701
CLARENCE KLASINSKI MD
500 VINCENT STREET
STEVENS POINT WI 54481
R / R
ALBERT M KOHN MD
900 ILLINOIS AVENUE
STEVENS POINT WI 54481
ORS / ORS
715-344-0701
JOHN A KOZISEK MD
500 VINCENT STREET
STEVENS POINT WI 54481
OBG
EDWIN G MAY MD
2501 MAIN STREET
STEVENS POINT WI 54481
GP
715-344-4120
KATHLEEN J MC GINNIS MD
2501 MAIN STREET
STEVENS POINT WI 54481
PTH CLP / PTH
ANGELO MIlANO MD
900 ILLINOIS AVENUE
STEVENS POINT WI 54481
PTH •' PTH
715-346-5050
HERBERT P miller JR MD
900 ILLINOIS AVENUE
STEVENS POINT WI 54481
GP
JAMES D MILLER MD
316 VINCENT STREET
STEVENS POINT WI 54481
GP
715-344-3684
STANLEv R MILLER MD
316 VINCENT STREET
STEVENS POINT WI 54481
GS CDS TS / GS
715-344-4120
BIENVENIDO C PALAGANAS MD
2501 MAIN STREET
STEVENS POINT WI 54481
IM / IM
715-341-8044
JOHN K PAULSON MD
3504 EAST MARIA DRIVE
STEVENS POINT WI 54481
OBG / OBG
JOHN A PICCONATTO MD
122 N WILSHIRE DRIVE
STEVENS POINT WI 54481
ORS / ORS
FRED W REICHARDT MD
1653 NW 19TH CIRCLE
GAINSVILLE FL 32605
U / U
715-341-6181
RICHARD P RE I GEL MD
120 N WILSHIRE DRIVE
STEVENS POINT WI 54481
FP
715-345-0990
PETER A SANDERSON MD
2008 GREEN DRIVE
POST OFFICE BOX 405
PLOVER WI 54467
AN
ANNE M G SCHIERL MD
POST OFFICE BOX 308
STEVENS POINT WI 54481
IM
715-344-4120
E MICHAEL SCHNEEBERGER MD
2501 MAIN STREET
STEVENS POINT WI 54481
PTH / PIH
FRANCESCO SCIARRONE MD
900 ILLINOIS AVENUE
STEVENS POINT WI 54481
GP OBG
715-344-5225
JAMES R SEVEN I CH MD
624 ISADORE STREET
STEVENS POINT WI 54481
GP GS
715-344-6043
W CLIFFORD SHEEHAN MD
1025 SOO MARIE
STEVENS POINT WI 54481
GP
ROBERT H SLATER MD
305 SUNRISE AVENUE
STEVENS POINT WI 54481
GS / GS
715-344-4142
ALB IN J SOWKA MD
1525 MAIN STREET
STEVENS POINT WI 54481
GP
715-344-6908
PAUL N SOWKA MD
3208 alder avenue
STEVENS POINT WI 54481
PRICt-TAYLOR
FP / FP
715-339-2101
PETER N DAHLIE MD
605 PETERSON DRIVE
PHILLIPS WI 54555
IM
715-762-3212
T BAYARD FREDERICK MD
789 S SEVENTH AVENUE
PARK FALLS WI 54552
IM / IM
MICHAEL A HAASE MD
101 N GIBSON AVENUE
MEDFORD WI 54451
PD AN / PD
715-748-2121
MILAN KANCA MD
101 N GIBSON AVENUE
MEDFORD WI 54451
FP / FP
715-762-3212
TIMOTHY J LINDGREN MD
POST OFFICE BOX 190
PARK FALLS WI 54552
FP
LEO J LOFLAND MD
ROUTE 2 BOX 107A
OGEMA WI 54459
U / U
715-748-5324
URQUHARI L MEETER MD
W6922 CENTER AVENUE
MEDFORD WI 54451
GP
715-748-2121
WALTHER W MEYER MD
101 N GIBSON STREET
MEDFORD WI 54451
GS
ROMULO P MOSCOSO MD
101 N GIBSON AVENUE
MEDFORD WI 54451
GP
715-762-4166
JAMES L MURPHY MD
607 THIRD AVENUE SOUTH
PARK FALLS WI 54552
GP
WALTER E NIEBAUER MD
264 NORTH AVON AVENUE
PHILLIPS WI 54555
FP / FP
STEVEN J NOVACHECK MD
POST OFFICE BOX 190
PARK FALLS WI 54552
GP
715-748-2121
DANILO E OLIVEROS MD
101 N GIPSON AVENUE
MEDFORD WI 54451
FP / FP
715-748-3377
JAMES K ROBINSON II DO
105 N GIBSON AVENUE
MEDFORD WI 54451
IM
DINESH H SHAH MD
101 N GIBSON AVENUE
MEDFORD WI 54451
GS / GS
715-762-3212
STEPHEN THORNGATE MD
205 LINDEN STREET
PARK FALLS WI 54552
IM GE
VLADIMIR UHRI MD
107 N GIBSON AVENUE
MEDFORD WI 54451
IM
WILLIAM E YANKE MD
914 S SEVENTH AVENUE
PARK FALLS WI 54552
76— RACINE
RACINE
DBG / DBG
414-637-8314
A CHARLES ALEXANDER MD
1244 WISCONSIN AVENUE
RACINE WI 53403
P
BARRY M ALTENBERG MD
SUITE 201
1244 WISCONSIN AVENUE
RACINE WI 53403
OPH / OPH
414-637-7231
ROBERT G ANDERSON MD
500 WALTON AVENUE
RACINE WI 53402
P N / P N
414-634-8220
GLENN A BACON MD
807 16TH STREET
RACINE WI 53403
GP
414-763-9121
DAVID J BAKER MD
224 N OAKLAND AVENUE
BURLINGTON WI 53105
AN
414-681-2900
HENRY J BARINA MD
3456 N WISCONSIN ST
RACINE WI 53402
IM
DON P BAUMBLATT MD
SUITE 206
1244 WISCONSIN AVENUE
RACINE WI 53403
PTH CLP / PTH CLP
414-636-4212
VICTORIANS A BAYLON MD
3801 SPRING STREET
RACINE WI 53405
PTH CLP / PTH CLP
414-636-2276
HENRY W BDCKELMAN MD
414 ROMAYNE AVENUE
RACINE WI 53402
OPH
414-639-2056
GORDON W BREWER MD
3435 ERIE STREET
RACINE WI 53402
IM / IM
JEROME C BROOKS MD
5625 WASHINGTON AVENUE
RACINE WI 53406
PS HS / PS
RICHARD J C BROWN MD
3315 PATZKE LANE
RACINE WI 53405
GP
JOHN T BRUTON MD
3 SHOREWOOD COURT
RACINE WI 53402
GS / GS
414-632-7521
DONALD R BURKE MD
2405 NORTHWESTERN AVE
RACINE WI 53404
DBG
414-686-8287
MARY I CAMPBELL MD
5625 WASHINGTON AVE
RACINE WI 53406
U / U
414-632-6988
HARK C CHANG MD
SUITE 203
3803 SPRING STREET
RACINE WI 53405
ORS / ORS
414-637-5686
CHARLES W CHRISTENSON MD
500 WALTON AVENUE
RACINE WI 53402
GS CDS / GS
414-632-7521
DONALD F COHILL MD
2405 NORTHWESTERN AVE
RACINE WI 53404
OPH / OPH
KERMIT W COVELL MD
214 WOLFF STREET
RACINE WI 53402
NS / NS GS
S MARSHALL CUSHMAN JR MD
3831 LIGHTHOUSE DRIVE
RACINE WI 53402
IM / IM
414-632-9600
HENRY E DE GROOT MD
SUITE 305
3803 SPRING STREET
RACINE WI 53405
P CHP / P CHP
414-633-2933
ROBERT E DROM MD
211 NINTH STREET
RACINE WI 53403-1510
PD / PD
414-637-4922
STANLEY M ENGLANDER MD
2405 NORTHWESTERN AVE
RACINE WI 53404
FP / FP
LIEF W ERICKSON MD
POST OFFICE BOX 40
BURLINGTON WI 53105
ORS / ORS
414-639-1993
HURON L F.RICSON MD
2405 NORTHWESTERN AVE
RACINE WI 53404
ABS
305-852-3370
LOUIS E FAZEN MD
NO 409
WRENN ST PLANTAT'N KEY
TAVERNIER FL 33070
OTO
DENNIS E FEIDER MD
SUITE 20?
3803 SPRING STREET
RACINE WI 53405
GS PH
813-536-6894
GABRIEL P FERRAZZANO MD
1927 BELLEAIR ROAD
CLEARWATER FL 33546
GYN / OBG
414-886-8213
LOUIS J FLOCH MD
5625 WASHINGTON AVENUE
RACINE WI 53406
PD
STEPHEN T FLOX MD
5625 WASHINGTON AVENUE
RCINE WI 53406
OTO / OTO
414-632-4082
RICHARD J FOGLE MD
SUITE 108
3803 SPRING STREET
RACINE WI 53405
PD / PD
414-637-4922
JOHN W FOREMAN MD
2405 NORTHWESTERN AVE
RACINE WI 53404
OBG / OBG
JOSEPH C FRALICH MD
2405 NORTHWESTERN AVE
RACINE WI 53404
GP
414-763-9121
E PAUL GANDER MD
190 GARDNER AVENUE
BURLINGTON WI 53105
PD / PD
414-637-4922
PETER A GARDETTO MD
2405 NORTHWESTERN AVE
RACINE WI 53404
OBG / OBG
HOWARD I GASS MD
2405 NORTHWESTERN AVE
RACINE WI 53404
GE IM / IM
414-637-7996
JOSEPH E GEENEN MD
1333 COLLEGE AVENUE
RACINE WI 53403
IM / IM
414-632-4455
JAMES P GIERAHN MD
2405 NORTHWESTERN AVE
RACINE WI 53404
GS ABS
414-639-3770
GEORGE N GILLETT MD
416 FOUR MILE ROAD
RACINE WI 53402
PD NPM / PD NPM
414-886-5000
JOHN C GLASPEY MD
5625 WASHINGTON AVENUE
RACINE WI 53406
PD
414-886-8202
ALFRED E GRAF MD
5625 WASHINGTON AVENUE
RACINE WI 53406
GYN / OBG
414-637-7614
ARTHUR B GRANT MD
C/0 C ALEXANDER MD
1244 WISCONSIN AVENUE
RACINE WI 53403
FP / FP
414-634-6679
JUNE L C GRINNEY MD
SUITE 105
3803 SPRING STREET
RACINE WI 53405
GYN / OBG
LEO R GRINNEY MD
SUITE 105
3803 SPRING STREET
RACINE WI 53405
ORS / ORS
JAMES R HAMMES MD
500 WALTON AVENUE
RACINE WI 53402
GS ORS / GS
414-632-7521
WILLIAM C HARRIS MD
2405 NORTHWESTERN AVE
RACINE WI 53404
PD / PD
WILLIAM F HENKEN MD
APT 1 )
700 WATERS EDGE
RACINE WI 53402
IM / IM
414-886-8254
JOHN W HOUSER MD
5625 WASHINGTON AVENUE
RACINE WI 53406
GP
414-632-2252
JOHN G JAMIESON MD
812 MAIN STREET
RACINE WI 53403
IM GE / IM GE
414-637-7996
G KENNETH JOHNSON MD
1333 COLLEGE AVENUE
RACINE WI 53403
AN
OLLI F KAARAKKA MD
1159 N OSBORNE BLVD
RACINE WI 53405
NS
414-634-1909
JOSE KANSHEPOLSKY MD
822 WISCONSIN AVENUE
RACINE WI 53403
TS CDS / TS
SHERALI KHOJA MD
3801 MONARCH DRIVE
RACINE WI 53405
R NM / R NM
414-636-4311
BYUNG HOON KIM MD
468 WIND RIDGE DRIVE
RACINE WI 53402
R NM / R NM
414-639-8504
DAI KAP KIM MD
6600 BROOK ROAD
FRANKSVILLE WI 53126
P / P
414-632-5344
DAVID Y KIM MD
SUITE 203
1244 S WISCONSIN AVE
RACINE WI 53403
PTH
SOO YUN KIM MD
16 STEEPLECHASE DRIVE
RACINE WI 53402
A / AI
414-632-5161
ZAEZEUNG KIM MD
SUITE 103
1300 S GREEN BAY ROAD
RACINE WI 53406
TR / TR
KENNETH A KLEIN MD
8735 WEST MEADOW LANE
FRANKLIN WI 53132
EM / EM
STEVEN J KOENIGSKNECHT MD
3801 SPRING STREET
RACINE WI 53405
GP OBG
WILLIAM F KONNAK MD
3346 NORTH MAIN STREET
RACINE WI 53402
OPH / OPH
414-886-9100
DENNIS J KONTRA MD
5802 WASHINGTON AVENUE
RACINE WI 53406
GP
414-639-9777
RANDOLPH W KREUL MD
40 S VINCENNES CIRCLE
RACINE WI 53402
RACINE— 77
AN / AN
414-632-5119
WILLIAM R KREUL MD
100 12TH STREET
RACINE WI 53403
FP
414-763-3513
GEORGE J K.RISMER MD
POST OFFICE BOX 40
BURLINGTON WI 53105
IM / IM
414-886-8222
JACK T LANE MD
5625 WASHINGTON AVENUE
RACINE WI 53406
OBG / OBG
414-886-8217
DAVID R LE CLOUX MD
5625 WASHINGTON AVENUE
RACINE WI 53406
OPH / OPH
414-637-9615
ROBERT H LEHNER MD
312 SEVENTH STREET
POST OFFICE BOX 1677
RACINE WI 53401
OPH
414-637-9615
ROBERT H LEHNER II MD
POST OFFICE BOX 1677
RACINE WI 53401-1677
GS / GS
414-886-5000
ROBERT B LEITSCHUH MD
5625 WASHINGTON AVENUE
RACINE WI 53406
EM IM
JOHN W LINSTROTH MD
1131 SHERWOOD LANE
CALEDONIA WI 53108
NS N /NS
HARRY H LIPPMAN MD
SUITE 102
3803 SPRING STREET
RACINE WI 53405
IM PUD / IM PUD
414-632-7334
WILLIAM J LITTLE JR MD
SUITE 104
3803 SPRING STREET
RACINE WI 53405
OPH / OPH
414-637-8361
ERNEST L MAC VICAR JR MD
500 WALTON AVENUE
RACINE WI 53402
GYN / OBG
414-632-7521
WILLIAM J MADDEN MD
2405 NORTHWESTERN AVE
RACINE WI 53404
GS CDS HS / GS
414-886-8230
RODNEY W MALINOWSKI MD
5625 WASHINGTON AVENUE
RACINE WI 53406
ORS
414-836-0274
DAVID J MANNING MD
5625 WASHINGTON AVENUE
RACINE WI 53406
CD IM / CD IM
414-652-2260
CARROLL M MARTIN MD
son 14 FH AVENUE
KENOSHA WI 53140
IM / IM
414-886-5000
RICHARD J MAYER MD
5625 WASHINGTON AVENUE
RACINE WI 53406
IM PUD / IM
KEVIN W MC CABE MD
5625 WASHINGTON AVENUE
RACINE WI 53406
IM / IM
JOS I AH A MC HALE MD
315 WOLFF STREET
RACINE WI 53402
OBG / OBG
414-632-6202
DONALD W MILLER JR MD
SUITE 105
1244 WISCONSIN AVENUE
RACINE WI 53403
FP
HUBERT C MILLER MD
421 WILLIAM STREET
RACINE WI 53402
R / R
414-636-231 1
PAUL L MILLER MD
1320 WISCONSIN AVENUE
RACINE WI 53403
IM / IM
RICHARD MINTON MD
2405 NORTHWESTERN AVE
RACINE WI 53404
OBG
414-632-7521
LAURA J MUELLER MD
2405 NORTHWESTERN AVE
RACINE WI 53404
IM PUD / IM PUD
414-632-7521
STEPHEN E MUELLER MD
2405 NORTHWESTERN AVE
RACINE WI 53404
IM ON / IM
CARL F MYERS MD
5625 WASHINGTON AVENUE
RACINE WI 53406
ORS / ORS
414-634-0860
MARVIN W NELSON MD
837 MAIN STREET
RACINE WI 53403
PD / PD
WILLARD H NETTLES JR MD
2405 NORTHWESTERN AVE
RACINE WI 53404
P CHP / PN
JULIAN J NEWMAN MD
500 WALTON AVENUE
RACINE WI 53402
AN
414-681-0543
MEI FONG NGUI MD
5217 WILLOW VIEW ROAD
RACINE WI 53402
US
JOHN R NICKELSEN MD
823 PERRY AVENUE
RACINE WI 53406
PTH / P'l H
414-636-2205
CLAUDE E OBERDORFER MD
1320 S WISCONSIN AVE
RACINE WI 53403
IM ON
414-886-8226
RICHARD N ODDERS MD
5625 WASHINGTON AVENUE
RACINE WI 53406
PD / PD
414-886-5000
ROBERT K ORTWEIN MD
5625 WASHINGTON AVENUE
RACINE WI 53406
U
ROBERT A PALM MD
2405 NORTHWESTERN AVE
RACINE WI 53404
FP / FP
414-878-4424
CAMILLE A PAQUETTE MD
1120 MAIN STREET
UNION GROVE WI 53182
N
414-637-6106
BYUNG H PARK MD
312 SEVENTH STREET
RACINE WI 53403
IM HEM / IM
414-886-5000
MARVIN G PARKER MD
5625 WASHINGTON AVENUE
RACINE WI 53406
D / D
414-632-7535
CHARLES H PATTON MD
2405 NORTHWESTERN AVE
RACINE WI 53404
D GP / D
4 14-632—7535
KENNETH J PECHMAN, PhD MD
2405 NORTHWESTERN AVE
RACINE WI 53404
GP
JAMES J G PETERSEN MD
4222 WASHINGTON AVENUE
RACINE WI 53405
ORS
414-886-8272
GREGORY A PEYER MD
5625 WASHINGTON AVENUE
RACINE WI 53406
GS / GS
414-634-7015
WALTER H PINKUS MD
SUITE 206
1244 WISCONSIN AVENUE
RACINE WI 53403
GP
414-632-3973
JOSEPH D POSTORINO MD
SUITE 107
3803 SPRING STREET
RACINE WI 53405
R NM / R NM
414-681-2343
MOHAMMAD H A QAZI MD
1320 WISCONSIN AVENUE
RACINE WI 53403
IM / IM
414-632-4455
RUSSELL A QUIRK MD
2405 NORTHWESTERN AVE
RACINE WI 53404
NS / NS
414-637-6106
MOHAMMED RAFIULLAH MD
3001 MICHIGAN BLVD
RACINE WI 53402
IM
CHARLES H RAINE MD
2405 NORTHWESTERN AVE
RACINE WI 53404
FP
414-637-5664
JOSE E REYES JR MD
SUITE 205
1244 WISCONSIN AVENUE
RACINE WI 53403
GP
414-634-0422
GLENWAY L ROTHENMAIER MD
1700 C A BECKER DRIVE
RACINE WI 53406
FP / FP
414-886-5000
GERALD J SAMPICA MD
5625 WASHINGTON AVENUE
RACINE WI 53406
PD / PD
414-632-7521
MICHAEL A SATCHIE MD
2405 NORTHWESTERN AVE
RACINE WI 53404
GS
414-639-3496
EDMUND W SCHACHT MD
ONE DEEPWOOD DRIVE
RACINE WI 53402
GP
414-634-1224
FRANK J SCHEIBLE MD
632 HIGH STREET
RACINE WI 53402
GP
ROBERT F SCHELLER MD
1422 DEANE BOULEVARD
RACINE WI 53405
GP IM
414-835-1490
GRACE E SCHENKENBERG MD
POST OFFICE BOX 183
FRANKSVILLE WI 53126
FP / FP
414-886-5000
ALB IN J SCHLEPER MD
5625 WASHINGTON AVENUE
RACINE WI 53406
P / P
414-634-7119
HAROLD T SCHROEDER MD
500 WALTON AVENUE
RACINE WI 53402
CD
GERT J SCHULLER MD
2405 NORTHWESTERN AVE
RACINE WI 53404
PTH CLP / PTH AP CLP
414-636-4212
MYRON SCHUSTER MD
3801 SPRING STREET
RACINE WI 53405
GE 3M / IM
414-886-8500
ROBERT D SHAFFER MD
5625 WASHINGTON AVENUE
RACINE WI 53406
CD IM / CD IM
414-637-7996
HOWARD W SHORT MD
1333 COLLEGE AVENUE
RACINE WI 53403
RHU IM / IM
GREGORY A SHOVE MD
5625 WASHINGTON AVENUE
RACINE WI 53406
IM NEP
414-633-6767
SULTAN H SIDDIQI MD
SUITE 304
3803 SPRING STREET
RACINE WI 53405
GS / GS
414-886-8229
ROBERT F SIEGERT MD
5625 WASHINGTON AVE
RACINE WI 53406
OPH / OPH
414-637-0500
K ANWAR A SINGH MD
3803 SPRING ST STE 301
POST OFFICE BOX 1247
RACINE WI 53405
78— RACINE, RICHLAND, ROCK
PTH
SATNAM SINGH MD
5045 WINDPOINT DRIVE
RACINE Ull 53402
FP /' FP
414-836-8207
RAYMOND E SKUPNIEWICZ MD
5625 WASHINGTON AVENUE
RACINE WI 53406
GS / GS
414-633-0366
LAWRENCE W SMITH MD
904 ORCHARD STREET
RACINE WI 53405
FP
414-763-9128
SHARON A SMITH MD
SUITE 1
425 MILWAUKEE AVENUE
BURLINGTON WI 53105
GS / GS
414-637-6270
WILLIAM U SMOLLEN MD
913 MAIN STREET
RACINE WI 53403
CLP FP
GHONSHAM SOOKNANDAN MD
1618 CENTER STREET
RACINE WI 53403
HELENA P K STEFANOWICZ MD
224 12TH STREET
RACINE WI 53403
OBG / DBG
414-637-831 1
ELIZABETH A STEFFEN MD
734 LAKE AVENUE
RACINE WI 53403
IM PA / IM
RICHARD D STEWART MD
5337 WIND POINT ROAD
RACINE WI 53402
U / U
414-637-5000
EDWARD A STIKA MD
SUITE 103
3803 SPRING STREET
RACINE WI 53405
ON HEM IM / IM
414-886-5000
WILLIAM H STONE MD
5625 WASHINGTON AVENUE
RACINE WI 53406
R NM / R NM
414-886-9000
ARNOLD M STRIMLING MD
3733 SOUTH LANE
FRANKSVILLE WI 53126
CD IM / CD IM
414-637-7996
JAMES F TIERNEY MD
1333 COLLEGE AVENUE
RACINE WI 53403
GS / GS
414-632-1208
JOSEPH C TIFFANY II MD
SUITE 10)
3803 SPRING STREET
RACINE WI 53405
P N
414-637-7239
RALPH E TOMKIEWICZ MD
ROOM 302
312 SEVENTH STREET
RACINE WI 53403
NS / NS
414-637-7777
GORO TSUCHIYA MD
SUITE 307
3803 SPRING STREET
RACINE WI 53405
DR R / R
RICHARD H UDESKY MD
SUITE 207
3803 SPRING STREET
RACINE WI 53405
IM GE / IM
R VENUGOPALAN MD
1333 COLLEGE AVENUE
RACINE WI 53403
OTO / DTO
414-886-9411
JEROME J VERANTH MD
5605 WASHINGTON AVENUE
RACINE WI 53406
U / U
4 14-633—3323
INDUR B WADHWANI MD
SUITE 204
3803 SPRING STREET
RACINE WI 53405
EM IM / IM
RICHARD F WAGNER MD
10614 SEVEN MILE ROAD
FRANKSVILLE WI 53126
FP
414-763-9121
ROBERT C WHEATON MD
190 GARDNER AVENUE
BURLINGTON WI 53105
IM / IM
414-886-8253
CHARLES A WIDEBURG MD
5625 WASHINGTON AVENUE
RACINE WI 53406
OBG
JOSEPH R WILCZYNSKI MD
5625 WASHINGTON AVENUE
RACINE WI 53406
GP
414-633-3070
WARREN H WILLIAMSON MD
500 WAI ION AVENUE
RACINE WI 53402
IM NEP / IM NEP
414-886-5000
DONALD R WILZ MD
5625 WASHINGTON AVENUE
RACINE WI 53406
IM GE / IM GE
414-632-4455
LEWIS E WRIGHT MD
2405 NORTHWESTERN AVE
RACINE WI 53404
AN
414-639-8570
NASIP H YASATAN MD
505 MULBERRY LANE
RACINE WI 53402
FP / FP
414-633-3567
SANTIAGO L YLLAS MD
SUITE 306
3803 SPRING STREET
RACINE WI 53405
ORS
DAVID R ZEMAN MD
837 MAIN STREET
RACINE WI 53403
RICHLAND
FP / FP
608-647-6161
NEIL N BARD MD
1313 W SEMINARY STREET
RICHLAND CENTER WI 53581
FP / FP
608-647-6161
WILLIAM T COOKE MD
1313 W SEMINARY STREET
RICHLAND CENTER WI 53581
FP / FP
608-647-6161
RICHARD W EDWARDS MD
1313 W SEMINARY STREET
RICHLAND CENTER WI 53581
GP
ROY C GLISE JR MD
1313 W SEMINARY ST
RICHLAND CENTER WI 53531
FP / FP
608-647-6161
JOHN C JORDAN MD
1313 W SEMINARY STREET
RICHLAND CENTER WI 53581
GS
608-647-6161
JULIUS H KELERTAS MD
1313 W SEMINARY STREET
RICHLAND CENTER WI 53581
FP
608-647-3262
K ILIAN H MEYER MD
969 N CEDAR STREET
RICHLAND CENTER WI 53581
GP
608-647-4792
L MARAMON PIPPIN MD
1313 W SEMINARY STREET
RICHLAND CENTER WI 53581
FP / FP
608-647-6161
THOMAS L RICHARDSON MD
1313 W SEMINARY STREET
RICHLAND CENTER WI 53581
IM
DALE F SINNETT MD
ROUTE 4
RICHLAND CENTER WI 53581
FP / FP
608-647-6161
ROBERT P SMITH MD
1313 W SEMINARY STREET
RICHLAND CENTER WI 53581
GP
JACK I SPEAR MD
ROUTE 3 BOX 77
RICHLAND CENTER WI 53581
GP
DONALD J TAFT MD
POST OFFICE BOX 649
RICHLAND CENTER WI 53581
FP / FP
608-647-6161
JAMES J TYDRICH MD
1313 W SEMINARY STREET
RICHLAND CENTER WI 53581
IM / IM
608-647-4422
GERALD R WISNIEWSKI MD
1289 W SEMINARY STREET
RICHLAND CENTER WI 53581
ROCK
PD / PD
608-364-2220
GARY B ADAMSKI MD
1905 HUEBBE PARKWAY
BELOIT WI 53511
U / U
608-756-7100
G LEONARD APFELBACH MD
2020 E MILWAUKEE ST
JANESVILLE WI 53545
IM / IM
608-756-5751
JOHN A AUSTIN MD
1200 HOME PARK AVENUE
JANESVILLE WI 53545
R / R
JOHN L BABB MD
2422 RIVERSIDE DRIVE
BELOIT WI 53511
IM
CHARLES S BAKER MD
202 JEFFERSON AVENUE
JANESVILLE WI 53545
ORS
608-362-2438
RAYMOND M BALDWIN MD
2563 RIVERSIDE DRIVE
BELOIT WI 53511
CRS GS / CRS GS
608-364-2230
SUSAN F BEHRENS MD
1905 HUEBBE PARKWAY
BELOIT WI 53511
U / U
608-364-2230
JUAN C BELTRAN MD
1905 HUEBBE PARKWAY
BELOIT WI 53511
OBG / OBG
608-364-2306
PAUL BENNETT I I MD
1905 HUEBBE PARKWAY
BELOIT WI 53511
N / PN
608-755-3500
THOMAS R BERENTSEN MD
580 N WASHINGTON ST
JANESVILLE WI 53545
AN / AN
608-754-3936
DOROTHY W BETLACH MD
2520 LINDEN AVENUE
JANESVILLE WI 53545
R NM / R
608-754-3936
EUGENE H BETLACH MD
2520 LINDEN AVENUE
JANESVILLE WI 53545
D / D
Aoo—
CHARLES R BOARDMAN MD
1905 HUEBBE PARKWAY
BELOIT WI 53511
PD / PD
608-755-3500
K EUGENE BOSTIAN MD
580 N WASHINGTON ST
JANESVILLE WI 53545
FP / FP
RONALD K BOWERS MD
2020 E MILWAUKEE ST
JANESVILLE WI 53545
ROCK— 79
IM GE / IM
608-755-3500
WILLIAM N BRANDT MD
580 N WASHINGTON ST
JANESVILLE WI 53545
GP
608-36^-1 514
LESTER P BRILLMAN MD
2031 RIVERSIDE DRIVE
BELOIT WI 53511
END / IM
608-756-7293
FRANK D BRODKEY MD
2020 E MILWAUKEE ST
JANESVILLE WI 53545
N / PN
608-755-3500
ANDREW M BRUGGER MD
580 N WASHINGTON ST
JANESVILLE WI 53545
PD / PD
608-364-2220
DONALD C BURANDT MD
1905 HUEBBE PARKWAY
BELOIT WI 53511
GP
HARVEY L BURDICK MD
POST OFFICE BOX 66
MILTON WI 53563
FP / FP
608-365-5069
CYRIL M CARNEY MD
2001 EAST RIDGE ROAD
BELOIT WI 53511
GS
KENNETH L CARTER MD
2433 FIELD CREST ROAD
BELOIT WI 53511
IM / IM
608-364-2240
ROBERT L CHANCEY MD
1905 HUEBBE PARKWAY
BELOIT WI 53511
OPH
GEORGE CHARNECKI MD
SUITE 402
101 E MILWAUKEE STREET
JANESVILLE WI 53545
DR R / R
608-364-5266
WOOK-CHIN CHONG MD
1969 WEST HART ROAD
BELOIT WI 53511
AN
STEVEN S CHOUNG MD
2657 AUSTIN PLACE
BELOIT WI 53511
GP
DANIEL M CLARK MD
911 BLACKHAWK BLVD
ROCKTON IL 61072
FP / FP
608-884-3354
DAVID A COHEN MD
1011 NORTH MAIN STREET
EDGERTON WI 53534
DBG / DBG
608-364-2200
DAVID K CRISWELL MD
1905 HUEBBE PARKWAY
BELOIT WI 53511
AN
ROBERTO J DANOCUP MD
3203 ROSE COURT
BELOIT WI 53511
EM GS
RAM DAS MD
1748 OAKLEAF DRIVE
SOUTH BELOIT IL 61080
IM / IM
608-755-3500
ERNEST C DEEDS MD
580 N WASHINGTON ST
JANESVILLE WI 53545
AN / AN
JAY S BE VORE MD
5635 NEWVILLE ROAD
MILTON WI 53563-9441
AN / AN
JOVAN L DJOKOVIC MD
630 WEXFORD DRIVE
JANESVILLE WI 53545
AN / AN
414-752-4380
ROBERT K DODGE MD
526 LOGAN STREET
JANESVILLE WI 53545
OPH
608-755-3500
JOHN J DOWNING MD
580 N WASHINGTON ST
JANESVILLE WI 53545
OPH / OPH
608-364-2204
GERALD R DRUCKREY MD
1905 HUEBBE PARKWAY
BELOIT WI 53511
OM
608-756-7916
PAUL F DURKEE MD
POST OFFICE BOX 629
JANESVILLE WI 53545
PD ID
ANNE E DYSON MD
45 EAST 72ND STREET
NEW YORK NY 10021
OTO HNS / OTO
608-755-3673
WARREN R ELLISON MD
580 N WASHINGTON ST
JANESVILLE WI 53545
GS TS GE / GS
608-756-7261
STEVEN L FALK MD
2020 E MILWAUKEE ST
JANESVILLE WI 53545
GS
608-884-3371
VICTOR S FALK JR MD
5 WEST ROLLIN STREET
EDGERTON WI 53534
IM GE IM GE
608-364-2240
STEVEN J FASS MD
1905 HUEBBE PARKWAY
BELOIT WI 53511
IM
608-364-2200
W FITZGERALD MD
1905 HUEBBE PARKWAY
BELOIT WI 53511
PD / PD
608-364-2200
JANE E FOSSUM MD
1905 HUEBBE PARKWAY
BELOIT WI 53511
PTH CLP / PTH CLP
608-362-5642
JORDON FRANK MD
1969 WEST HART ROAD
BELOIT WI 53511
IM / IM
SAMUEL L FRAZER MD
580 N WASHINGTON ST
JANESVILLE WI 53545
P
608-754-8191
PAUL F FRECHETTE MD
111 NORTH MAIN STREET
JANESVILLE WI 53545
PD / PD
WILLIAM S FREEMAN MD
1905 HUEBBE PARKWAY
BELOIT WI 53511
IM / IM
608-364-2240
LELAND J FROM MD
1905 HUEBBE PARKWAY
BELOIT WI 53511
R IM / R
DAVID L GIBSON MD
POST OFFICE BOX 468
JANESVILLE WI 53547-0468
AN / AN
612-834-2623
ORVIN G GLESNE MD
ROUTE 3 BOX 166
MILTONA MN 56354
PD / PD
608-756-7230
MARK L GOELZER MD
2020 E MILWAUKEE ST
JANESVILLE WI 53545
IM
608-364-2356
KENNETH I GOLD MD
1905 HUEBBE PARKWAY
BELOIT WI 53511
FP / FP
608-882-5170
ROGER S GRAY MD
11 WEST CHURCH STREET
EVANSVILLE WI 53536
DRS / ORS
608-775-3500
GERALD P GREDLER MD
510 NORTH TERRACE
JANESVILLE WI 53545
IM / IM
608-755-3500
STANLEY W GRUHN MD
580 N WASHINGTON ST
JANESVILLE WI 53545
IM
608-755-3500
GEORGE F GUTMANN MD
580 N WASHINGTON ST
JANESVILLE WI 53545
608-754-2002
THOMAS R HANSEN MD
1000 MINERAL POINT AVE
JANESVILLE WI 53545
FP / FP
608-756-7100
EUGENE S HARTLAUB MD
2020 E MILWAUKEE ST
JANESVILLE WI 53545
DR / DR
608-756-0090
JAMES L HATCH MD
1029 PARKRIDGE ROAD
JANESVILLE WI 53545
ORS / ORS
608-364-2308
WILLIAM M HEBBLE MD
1905 HUEBBE PARKWAY
BELOIT WI 53511
OBG / OBG
ROBERT A HOLLAND MD
2326 TRADITION LANE
JANESVILLE WI 53545
FP OTO / FP
JOHN F HOLMES MD
24 HILLTOP DRIVE
MILTON WI 53563
DRS / ORS
608-756-7100
ROBERT N HORSWILL MD
2020 E MILWAUKEE ST
JANESVILLE WI 53545
ORS IM
ROGER E HUIZENGA MD
1905 HUEBBE PARKWAY
BELOIT WI 53511
IM
ANTONIO L JHOCSON MD
1905 HUEBBE PARKWAY
BELOIT WI 53511
OBG / OBG
608-756-7283
EDWARD J JOB MD
2020 E MILWAUKEE ST
JANESVILLE WI 53545
IM / IM
GEORGE T JONES MD
2670 CHATSWORTH DRIVE
BELOIT WI 53511
GS / GS
608-755-3500
RONALD P KARZEL MD
580 N WASHINGTON ST
JANESVILLE WI 53545
GS / GS
MAYER KATZ MD
2677 E CDLLINGSWOOD DR
BELOIT WI 53511
IM GE 7 IM
FRANCIS L KELLER MD
1026 LARAMIE LANE
JANESVILLE WI 53545
OPH
608-364-2200
JAMES L KELLER MD
1905 HUEBBE PARKWAY
BELOIT WI 53511
GS CDS TS / GS
608-756-7261
TRILOK S KHANNA MD
2020 E MILWAUKEE ST
JANESVILLE WI 53545
EM
DONALD KNEPEL MD
EMERGENCY ROOM
1000 MINERAL POINT AVE
JANESVILLE WI 53545
OBG / OBG
608-756-7286
RICHARD L KOCHELL MD
2020 E MILWAUKEE ST
JANESVILLE WI 53545
PD / PD
GORDON E KRONQUIST MD
POST OFFICE BOX 551
JANESVILLE WI 53547
GP
608-755-2500
MICHAEL J LA BRECHE MD
2206 SIMPSON STREET
MADISON WI 53713
OPH
LEO W LAKRITZ MD
POST OFFICE BOX 1058
BELOIT WI 53511-1058
IM
THOMAS J LANG MD
1905 HUEBBE PARKWAY
BELOIT WI 53511
80— ROCK
OTO
60a-3ib4-2200
JONG MAN LEE MD
2211 EAST RIDGE ROAD
BELOIT WI 53511
OTO
PETER U LEE MD
1905 HUEBBE PARKWAY
BELOIT Wl 53511
D / D
813-485-4060
HARLAN M LEVIN MD
1119 KETCH LANE
VENICE FL 33595-1839
CD IM
ROGER G LIM MD
1905 HUEBBE PARKWAY
BELOIT WI 53511
IM RHU / IM
608-755-3500
STEVEN P MACIOLEK MD
580 N WASHINGTON ST
JANESVILLE WI 53545
PD / PD
608-884-3354
NALINI MADAN MD
1011 NORTH MAIN STREET
EDGERTON WI 53534
IM / IM
608-384-3354
SURESH K MADAN MD
1011 NORTH MAIN STREET
EDGERTON WI 53534
R / R
608-756-6743
ROBERT F MATZKE MD
1000 MINERAL POINT AVE
JANESVILLE WI 53545
DRS
THOMAS G MC CALL MD
510 N TERRACE STREET
JANESVILLE WI 53545
GP
EDWARD R MC NAIR MD
120 S CENTER STREET
ORFORDVILLE WI 53576
IM / IM
60B-754-B886
DALE E MILLER MD
1124 BURR OAK COURT
JANESVILLE WI 53545
OBG
608-756-7100
EDWARD C MILLER MD
2020 E MILWAUKEE ST
JANESVILLE WI 53545
IM / IM
JAMES R MILLER MD
1905 HUEBBE PARKWAY
BELOIT WI 53511
OTO HNS GS / OTO
608-755-3500
JOHN C MUNDY MD
580 N WASHINGTON ST
JANESVILLE WI 53545
PD / PD
608-755-3500
BRUCE K NAGLE MD
POST OFFICE BOX 551
580 N WASHINGTON ST
JANESVILLE WI 53547-0551
PD / PD
608-755-3500
KATSUMI NEENO MD
580 N WASHINGTON AVE
JANESVILLE WI 53545
OBG
608-752-0053
HERMAN D NIENHUIS MD
221 WEST COURT STREET
JANESVILLE Wl 53545
PD / PD
608-756-7100
BLAINE B NOWAK MD
2020 E MILWAUKEE ST
JANESVILLE WI 53545
OBG / OBG
608-755-3500
JAMES N 0 BRIEN MD
580 N WASHINGTON ST
JANESVILLE WI 53545
IM / IM
WILLIAM G ODETTE MD
5 WEST ROLLIN
EDGERTON WI 53534
ORS / uRS
608-755-3500
PAUL K ODLAND MD
510 N TERRACE STREET
JANESVILLE WI 53545
R / R
608-364-5266
EDWARD P ONDERAK MD
1969 WEST HART ROAD
BELOIT WI 53511
OBG / OBG
608-754-9323
ERLAND R OTTERHOLT MD
2428 APACHE COURT
JANESVILLE WI 53545
AN PTH / PTH
YON DOO OUGH MD
1969 WEST HART ROAD
BELOI T WI 5351 1
GP
608-754-7925
RICHARD S OVERTON MD
58 SOUTH MAIN STREET
JANESVILLE WI 53545
D / D
608-755-3500
BRUCE R PEARSON MD
580 N WASHINGTON ST
JANESVILLE WI 53545
OPH / OPH
608-754-7781
JOHN F PEMBER MD
60 WATER STREET
POST OFFICE BOX 429
JANESVILLE WI 53547-0429
ORS / ORS
608-755-3555
MARK S PERPICH MD
510 N TERRACE STREET
JANESVILLE WI 53545
IM CD / IM
DANIEL 'I PETERSON MD
580 NORTH WASHINGTON
JANESVILLE WI 53545
U / U
608-755-3500
ARTHUR C PLAUTZ JR MD
580 N WASHINGTON ST
JANESVILLE WI 53545
GS / GS
608-362-2545
WILLIAM H POLLARD JR MD
803 LILAC ROAD
BELOIT WI 5351 1
FP / FP
608-362-4146
WILLIAM A PRUETT MD
2031 RIVERSIDE DRIVE
BELOIT WI 53511
IM
608-752-4904
MARSHALL F PURDY MD
23 W MU WAUKEF STREET
JANESVILLE WI 53545
AN
608-362-4444
FELIPE 1. QUI MD
2151 CRITTENDEN DRIVE
BELOIT WI 53511
FP / FP
608-884-3371
PEDRO 0 RANOLA MD
FIVE W ROLLIN STREET
EDGERTON WI 53534
IM NEP / IM
608-756-7100
RAMACHANDRA RAO MD
2020 E MILWAUKEE ST
JANESVILLE WI 53545
GP AN
608-752-4439
ESTHER L RAU MD
1317 BENNETT STREET
JANESVILLE WI 53545
GP
60S- 388-2032
ARTHUR I REINARDY MD
705 FIRST STREET
KEWAUNEE WI 54216
GS ABS ND / GS
813-639-6080
EVERETT W REINARDY MD
14-A BANYAN POINT
PUNTA GORDA FL 33950
OTO / OTO
608-756-7100
DAVID S ROWE MD
2020 E MILWAUKEE ST
JANESVILLE WI 53545
GS TS / GS
608-755-3500
FRANCIS R RUSSO MD
580 N WASHINGTON ST
JANESVILLE WI 53545
GP GS
RAFAEL S SALADAR MD
2031 RIVERSIDE DRIVE
BELOIT WI 5351 1
GP
608-362-9221
FERNANDO E SALVADOR MD
2031 RIVERSIDE DRIVE
BELOIT WI 53511
OBG / OBG
501-525-2337
RICHARD J SANDERSON MD
ROUTE 3 BOX 151
HOT SPRINGS AR 71901
IM
THOMAS S SARGEANT MD
580 N WASHINGTON ST
JANESVILLE WI 53545
OBG / OBG
WALTER A SCHOLTEN JR MD
1905 HUEBBE PARKWAY
BELOIT WI 53511
GP
608-876-6371
JACK D SCHROEDER MD
ROUTE 5
JANESVILLE WI 53545
GS GP / GS
CHARLES E SHEARER MD
1011 NORTH MAIN STREET
EDGERTON WI 53534
GS FP / GS
608-884-3354
THOMAS M SHEARER MD
1011 NORTH MAIN STREET
EDGERTON WI 53534
GS / GS
608-755-3626
P RICHARD SHOLL MD
580 north WASHINGTON
POST OFFICE BOX 551
JANESVILI E WI 53545-0551
IM / IM
DAVID A, SMITH MD
580 N WASHINGTON ST
JANESVILLE WI 53545
IM / IM
608-754-9088
HERBERT M SNODGRASS MD
5031 KNOLLWOOD
ROUTE 6
JANESVILLE WI 53545
OBG / OBG
608-364-2342
MYRON G SPOONER MD
1905 HUEBBE PARKWAY
BELOIT WI 5351 1
GP PH
JOSEPH C SPRINGBERG MD
POST OFFICE BOX 687
BELOIT WI 5351 1
CDS GS / GS
WILLIAM H SQUIRES MD
580 N WASHINGTON AVE
JANESVILLE WI 53545
PTH CLP / PTH CLP
608-362-5642
SERAFIN B TERUEL MD
1969 WEST HART ROAD
BELOI T WI 5351 1
ORS / OPS
608-756-7206
JEFFREY C THOMAS MD
2020 E MILWAUKEE ST
JANESVILLE WI 53545
GP
608-756-7100
PAUL C TREGONING MD
2020 E MILWAUKEE ST
JANESVILLE WI 53545
ORS /■ ORS
608-364-2230
ALLEN 0 TUFTEE MD
1905 HUEBBE PARKWAY
BELOI r WI 5351 1
OTO
ALLEN H rWYMAN MD
1905 HUEBBE PARKWAY
BELOIT Wl 53511
OBG / OBG
608-755-3630
JAMES G VOGEL MD
580 N WASHINGTON ST
JANESVII^LE WI 53545
PD / PD
608-756-7100
STEPHEN C WERNER MD
2020 E MILWAUKEE ST
JANESVILLE WI 53545
FP / FP
608-756-7100
WILLIAM P WEST MD
2020 E MILWAUKEE ST
JANESVILLE WI 53545
A IM
608- 755-3500
TERRANCE L WISEMAN MD
580 N WASHINGTON ST
JANESVILLE WI 53545
ROCK, RUSK. SAUK, SAWYER, SHAWANO— 81
GS TS / GS
608-364-2230
GEORGE F WOODINGTON MD
1905 HUEBBE PARKWAY
BELOIT W1 53511
IM / Irt
608-754-6017
DOROTHY J ZAJaC MD
60 SOUTH RIVER STREET
JANESVILLE WI 53545
RUSK
GS
JOSEPH S BACHIR MD
906 COLLEGE AVENUE W
LADYSMITH WI 54848
GP
715-532-6073
WILLIAM B A J BAUER MD
417 W FOURTH ST NORTH
LADYSMITH WI 54848
FP / FP
RALPH P BENNETT MD
906 W COLLEGE AVENUE
LADYSMITH WI 54848
IM / IM
715-532-6615
RON M CHARIPAR MD
1216 EAST RIVER
LADYSMITH WI 54848
FP / FP
715-532-6651
HOWARD T CHATTERTON MD
906 COLLEGE AVE WEST
LADYSMITH WI 54848
IM / IM
715-532-6651
DOUGLAS M DE LONG MD
906 COLLEGE AVE WEST
LADYSMITH WI 54848
DR / R
715-532-3727
DAVID P ELLIS MD
1011 SHADY LANE
LADYSMITH WI 54848
IM / IM
715-532-6651
RICHARD J ROME IS MD
906 college AVENUE W
LADYSMITH WI 54848
FP
ROBERI D SHEELER MD
906 COLLEGE AVENUE
LADYSMITH WI 54848
FP / FP
715-532-0651
EMIL B STIENKE MD
906 COLLEGE AVENUE
LADYSMITH WI 54848
GP GS
715-868-2421
MAURICE I WHALEN MD
POST OFFICE BOX 217
BRUCE WI 54819
FP / FF-
715-532-6651'
JOHN L 2IEMER MD
906 college AVE WEST
LADYSMITH WI 54848
SAUK
FP / FP
608-524-6477
DAVID E BURNETT MD
1900 N DEWEY AVENUE
REEDSBURG WI 53959
FP / FP
608-643-3351
HAAKON P CARLSON MD
55 PRAIRIE AVENUE
PRAIRIE DU SAC WI 53578
GS / GS
608-524-2349
JAMES W CLAY MD
1900 N DEWEY AVENUE
REEDSBURG WI 53959
FP / FP
608-524-6477
JAMES R DAMOS MD
1900 N DEWEY AVENUE
REEDSBURG WI 53959
GS / GS
JOHN A DE GIOVANNI MD
75 PRAIRIE AVENUE
PRAIRIE DU SAC WI 53578
FP
608-592-3296
DALE P FANNEY MD
601 CLARK STREET
LODI WI 53555
IM / IM
608-356-2145
THOMAS R FLYGT MD
1902 JEFFERSON STREET
BARABOO WI 53913-1543
FP / FP
608-546-421 1
IHQR A GALARNYK MD
PLAIN WI 53577
GS
608-356-6656
EDWIN J HAMMER MD
703 14TH STREET
BARABOO WI 53913
GP
ROBERI G hansel MD
131 MONROE STREET
BARABOO WI 53913
FP
GERALD J HOLMEN MD
703 14TH STREET
BARABOO WI 53913
GP
608-356-4777
MELVIN F HUTH MD
203 FOURTH STREET
BARABOO WI 53913
FP / FP
608-643-3351
STEVEN J JOHNSON MD
55 PRAIRIE AVENUE
PRAIRIE DU SAC WI 53578
FP FP
608-588-2502
GERALD C KEMPTHORNE MD
153 E JEFFERSON STREET
SPRING GREEN WI 53588
FP
608-524-6477
ROBERT G KNIGHT MD
1900 N DEWEY AVENUE
REEDSBURG WI 53959
FP / PP
606-643-3351
JOHN KOCH MD
55 PRAIRIE AVENUE
PRAIRIE DU SAC WI 5357B
FP 7 FP
608-524-6477
ROBERT J KOONTZ MD
1900 N DEWEY AVENUE
REEDSBURG WI 53959
ORS GS / ORS
608-643-2471
DIANA L. KRUSE MD
75 PRAIRIE AVENUE
PRAIRIE DU SAC WI 53578
FP / FP
608—356—6656
DAVID P KUTER MD
703 14TH STREET
BARABOO WI 53913
FP / FP
608-356-6656
JAMES M LEWIS MB
703 14TH STREET
BARABOO WI 53913
FP / FP
608-fc,43-3351
JOHN A MC AULIFFE MD
55 PRAIRIE AVENUE
PRAIRIE DU SAC WI 53578
FP / FP
THOMAS T MIDTHUN MD
703 14TH STREET
BARABOO WI 53913
FP / FP
608-253-1171
MAUREEN MURPHY MD
POST OFFICE BOX 325
WISCONSIN DELLS, WI 53965
EM GS NS
GUY A O'CONNOR MD
130 tenth avenue
BARABOO WI 53913-1660
GP
OTTO V PAWLISCH MD
531 EAST MAIN STREET
REEDSBURG WI 53959
GP
608-356-3984
CARLYLE R PEARSON MD
POST OFFICE BOX 169
BARABOO WI 53913
ORS / ORS
608-356-3942
MICHAEL D PLOOSTER MD
1070 ROSEMARY CIRCLE
BARABOO WI 53913
R NM / R NM
608-546-5891
ROBERT E POLCYN MD
ROUTE 1 BOX 128
PLAIN WI 53577
ORS / ORS
ARNOLD N ROSENTHAL MD
75 PRAIRIE AVENUE
PRAIRIE DU SAC WI 53578
I M I M
608-356-2145
DANNY R SESSLER MD
407 OAK street
POST OFFICE BOX 187
BARABOO WI 53913-0187
FP / FP
60S - 35 1'— 6656
JOHN T SI EBERT MD
703 14TH STREET
BARABOO WI 53913
GS
608-524-6451
RODOlFC G SIMEON MD
lie main street
REEDSBURG WI 53959
FP / FP
608-643-3351
THOMAS P SULLIVAN MD
55 PRAIRIE AVENUE
PRAIRIE DU SAC WI 53578
FP / FP
608-356-6656
DONALD W VANGOR MD
703 14TH STREET
BARABOO WI 53913
GS GP
608-524-6441
VICTOR G VERGARA JR MD
1900 N DEWEY STREET
REEDSBURG 53959
P CHP
BETH WAl.TERS- JONES MD
547 NORTH PARK STREET
REEDSBURG WI 53959
FP / FP
608-643-3065
GIBBS W ZAUFT MD
257 WATER STREET
PRAIRIE DU SAC WI 53578
SAWYER
GP
LLOYD M BAERTSCH MD
ROUTE 3 BOX 3998
HAYWARD WI 54843
GP
JOHN F HUSSA MD
ROUTE 3 BOX 3998
HAYWARD WI 54843
N
715-634-2622
MARTIN H SAHS MD
116 WEST SECOND STREET
POST OFFICE BOX 72
HAYWARD WI 54843
GP
GUNNAR A SMARS JR MD
2216 LEXINGTON DRIVE
MANITOWOC WI 54220
GP
PAUL STRAPON III MD
ROUTE 3 BOX 3998
HAYWARD WI 54843
SHAWANIJ
GP
715-52fa-3137
JOHN J ALBRIGHT MD
610 WEST GREEN BAY
SHAWANO WI 54166
GP
715-524-2161
DAVID S ARVOlD MD
117 E GREEN BAY STREET
SHAWANO WI s41o6
GP
715-526-3137
FRANK L VN T BERG MANN MD
610 W GREEN BAY STREET
SHAWANO WI 54166
GS / GS
7 1 5-524-2 1 ol
ARTHUR A CANTWELL JR MD
117 E GREEN BAY STREET
SHAWANO WI 54166,
82— SHAWANO, SHEBOYGAN
GP
715-5£'6-3137
WILLIAM A, COAN MD
610 W GREPN BAV STREET
SHAWANO WI 54166
FP / FP
715-524-2161
RONALD L HARMS MD
117 r GREEN DAY STREET
SHAWANO WI 54166
FP / FP
715-524-0161
JOHN D HART MD
117 E GREEN BAY STREET
SHAWANO WI 54166
GP GS
715-524-2161
DONALD A JEFFRIES MD
117 E GREEN BAY AVENUE
SHAWANO WI 54166
R / R
715-524-2161
MIGUEL-ANGEL JIMENEZ MD
117 E GREEN BAY STREET
SHAWANO WI 54166
GP
FLOYD L LITZEN MD
GRESHAM WI 54128
FP / FP
715-524-2161
RONALD L LOGEMANN MD
117 E GREEN BAY STREET
SHAWANO WI 54166
FP / FP
715-524-2161
RALPH D PETTY MD
117 E GREEN BAY STPET
SHAWANO WI 54166
GP GS
715-526-3137
DONALD W SCHULZ MD
610 W GREEN BAY STRET
SHAWANO WI 54166
GP
715-526-3313
ALOIS J SEBESTA MD
126 1/2 S MAIN STREET
POST OFFICE BOX 360
SHAWANO WI 54166
P N
JOHN C SHIELDS MD
W 3456 RIVER HEIGHTS
SHAWANO WI 54166
FP / FP
715-524-2161
RICHARD R STOUGHTON MD
117 E GREEN BAY STREET
SHAWANO WI 54166
GP
715-758-2167
PATRICIA J STUFF MD
POST OFFICE BOX 366
BONDUEL WI 54107
GP
RALPH E TAUKE MD
TIGERTON WI 54486
FP / FP
715-524-2161
THOMAS J THOMAS MD
117 E GREEN DAY STREET
SHAWANO WI 54166
SHEBOYGAN
OBG / DBG
414-457-4461
ARVED 0 ASHBY MD
1011 N FIIGHTH STREET
SHEBOYGAN WI 53081
OPH / OPH
DAVID KING AYMOND MD
1953 N SIXTH STREET
SHEBOYGAN WI 53081-2958
OBG / OBG
414-458-3713
DAVID J BATZNER MD
POST OFFICE BOX 944
SHEBOYGAN WI 53082-0944
IM HEM ON / IM
414-457-4461
PETER A BEATTY MD
1011 N EIGHTH STREET
SHEBOYGAN WI 53081
FP / FP
414-457-4461
RIECK W BEIERSDORF MD
1011 N EIGHTH STREET
SHEBOYGAN WI 53081
AI IM / AI IM
414-457-4616
VIJAY K BERI MD
904 NORTH NINTH STREET
SHEBOYGAN WI 53081
FP / FP
WARREN A BRAVER MD
528 EVERGREEN PARKWAY
SHEBOYGAN WI 53031
GP
414-892-7021
ARTHUR J BRICKBAUER MD
315 FORREST AVENUE
PLYMOUTH WI 53073-1221
D A 7 D
JAMES W BRINGE MD
2708 N SEVENTH STREET
SHEBOYGAN WI 53081
DR R / R
RICHARD L CAMPBELL MD
649 UPPER ROAD
KOHLER WI 53044
DR / DR
414-459-4671
THOMAS R CONNELL MD
RADIOl OGY DEPARTMENT
1601 NORTH TAYLOR DR
SHEBOYGAN WI 53081
FP OBG
414-894-2636
KAREN K COWAN MD
635 PAINE STREET
KIEL WI 53042
IM
MANUEL C DELEON III MD
708 ST CLAIR AVENUE
SHEBOYGAN WI 53081
ORS / ORS
414-457-4461
JAN P DE RODS MD
1011 N EIGHTH STREET
SHEBOYGAN WI 53081
PTH CLP / PTH CLP
602-886-2676
HERMAN J DICK MD
APT 245
5666 E HAMPTON STREET
TUCSON AZ 85712
IM
BURNFl.L F ECKARDT MD
1226 N EIGHTH STREET
SHEBOYGAN WI 53081
IM PUD
414-892-6386
RAYMOND H EVERS MD
913 RIVEPVIEW DRIVE
PLYMOUTH WI 53073
OBG / OBG
414-457-4461
PEDRO B FERNANDEZ MD
1011 N EIGHTH STREET
SHEBOYGAN WI 53081
U
414-457-4461
DIRK T FISHER MD
1011 N EIGHTH STREET
SHEBOYGAN WI 53081
OTO 7 OTO
PAUL M FLEMING MD
101 1 N eighth street
SHEBOYGAN WI 53081
DR / R
JACOB M GEREND MD
705 OAK TREE ROAD
SHEBOYGAN WI 53081
ORS / ORS
DONALD R GORE MD
1226 N EIGHTH STREET
SHEBOYGAN WI 53081
U 7 LI
414-457-4858
CHRISTOPHER A GRAF MD
1720 N EIGHTH STREET
SHEBOYGAN WI 53081
OPH
414-452-1810
KATHRYN A GREEN MD
1442 NORTH 315T STREET
SHEBOYGAN WI 53081
IM / IM
414-457-4461
CURTIS W HANCOCK MD
101 1 N EIGHTH STREET
SHEBOYGAN WI 53081
FP
414-467-3477
HORACE J HANSEN MD
ROUTE 2 MILL ROAD
SHEBOYGAN FALLS WI 53085
AN / AN
414-458-1727
DONALD J HARVEY MD
3415 RIVER BLUFF DRIVE
SHEBOYGAN WI 53081
FP / FP
HAROLD N HEINZ MD
1030 LEISURE WORLD
MESA AZ 85206
IM / IM
414-457-4461
ROBERT A HELMINIAK MD
1011 N EIGHTH STREET
SHEBOYGAN WI 53081
U 7 U
414-457-4461
JOHN P HERMANN MD
101 1 N EIGHTH STREET
SHEBOYGAN WI 53081
AN / AN
414-459-4728
GEORGE L HESS vlR MD
907 ASPEN ROAD
KOHLER WI 53044
GS
414-457-7972
FREDERICK G HIDDE MD
714 NORTH AVENUE
SHEBOYGAN WI 53081
D IM / D IM
414-457-4461
JAMES F HILDEBRAND MD
1011 N EIGHTH STREET
SHEBOYGAN WI 53081
P
414-458-4361
JOSEF INA L HIZON MD
1415 NORTH 13TH STREET
SHEBOYGAN WI 53081
P N / PN
EDWARD E HOUFEK MD
237 SW FIFTH AVENUE
BOYNTON BEACH FL 33435
P / P
414-457-4461
EARL H JOCHIMSEN MD
101 1 N EIGHTH STREET
SHEBOYGAN WI 53081
AN
MARVIN G JUME3 MD
ROUTE 1
SHEBOYGAN WI 53081
IM
CHANDA KAPUR MD
HIGHWAY 23 EAST
PLYMOUTH WI 53073
FP / FP
414-457-4461
ROBERT A KELLER MD
1011 N EIGHTH STREET
SHEBOYGAN WI 53081
IM / IM
414-452-6000
VYTAS K KERPE MD
1226 N EIGHTH STREET
SHEBOYGAN WI 53081
PTH / PTH
ROGER G KLETTKE MD
PATHOLOGY DEPARTMENT
1601 N TAYLOR DRIVE
SHEBOYGAN WI 53081
D / D
414-457-4461
MARK R KNABEL MD
1011 N EIGHTH STREET
SHEBOYGAN WI 53081
IM
JAMES B KUPLIC MD
1226 N EIGHTH STREET
SHEBOYGAN WI 53081
U / U
414-457-4858
TIMOTHY A KURTEN MD
1720 N EIGHTH STREET
SHEBOYGAN WI 53081
OPH / OPH
414-452-5400
CHRISTOPHER L LARSON MD
1442 NORTH 31ST STREET
SHEBOYGAN WI 53081
GS / GS
414-452-491 1
KENNETH J LISBERG MD
1226 N EIGHTH STREET
SHEBOYGAN WI 53081
OTO PS / OTO
414-457-2100
RICHARD K LOUDEN MD
1720 N EIGHTH STREET
SHEBOYGAN WI 53081
GP
LARRY J MALEWISKI MD
1930 N EIGHTH STREET
SHEBOYGAN WI 53081
SHEBOYGAN, TREMPEALEAU/JACKSON/BUFFALO— 83
IM PUD / IM PUD
414-457-4461
ROBtRT T WILLIS MD
1011 N EIGHTH STREET
SHEBOYGAN WI 53081
GS / GB
414-457-4461
RICHARD B WINDSOR MD
1011 N EIGHTH STREET
SHEBOYGAN WI 53081
PTH / PTH
414-457-5033
DENNIS A WOOD MD
233 HURON AVENUE
SHEBOYGAN WI 53081
N / N
414-457-3737
THOMAS J ZWEIFEL DO
1720 N EIGHTH STREET
SHEBOYGAN WI 53081
TREfIPEALEAU-JACKSON-BUFFALO
GP
608-685-3534
MAX 0 HACHHUBER MD
POST OFFICE BOX 365
ALMA WI 54610
FP / FP
414-457-4438
DEAN A MANCHESKI MD
904 NORTH NINTH STREET
SHEBOYGAN WI 53081
FP
414-457-4438
BERNARD S MARSHO MD
904 NORTH NINTH STREET
SHEBOYGAN WI 53081
FP
414-457-4438
PATRICK R MARSHO MD
904 NORTH NINTH STREET
SHEBOYGAN WI 53081
IM / IM
414-457-4461
JAMES D MICHAEL MD
101 1 N EIGHTH STREET
SHEBOYGAN WI 53081
R
ALLEN MISCH MD
3111 N KONING DRIVE
SHEBOYGAN WI 53081
IM
414-458-0044
THOMAS MOCKER T JR MD
1720 N EIGHTH STREET
SHEBOYGAN WI 53081
PD HEM / PD
GHULAM MOHAMMAD MD
1011 N EIGHTH STREET
SHEBOYGAN WI 53081
AN
JANE M MOIR MD
ROUTE 1
OOSTBURG WI 53070
AN / AN
414—4 58—4652
CVNTHIANE j'^MDRGENWECK MD
1953 N STXTH STREET
SHEBOYGAN WI 53081-2958
IM GE / IM
414-457-4461
JONATHAN V MOULTON MD
1011 N EIGHTH STREET
SHEBOYGAN WI 53081
D / D
414-457-9100
KEVIN S MYERS MD
904 NORTH NINTH STREET
SHEBOYGAN WI 53081
GS TS / GS
FREDERICK P NAUSE MD
1720 N EIGHTH STREET
SHEBOYGAN WI 53081
ORS / ORS
414-457-4461
COLE S NORTHUP MD
1011 N EIGHTH STREET
SHEBOYGAN WI 53081
FP FP
414-457-4461
CYNTHIA P NORTHUP MD
1011 N EIGHTH STREET
SHEBOvGAN WI 53081
GS / GS
414-457-4461
DONALD D DHME MD
1011 N EIGHTH street
SHEBOYGAN WI 53081
PD PDA • PD
414-457-4461
D DOUGLAS OPEL MD
1011 N EIGHTH STREET
SHEBOYGAN WI 53081
FP / FP
JAMES R PAWLAK MD
904 NORTH NINTH STREET
SHEBOYGAN WI 53081
GP
414-893-0524
PABLO M PEREZ MD
133 EAST MILL STREET
PLYMOUTH WI 53073
OPH
414-458-3782
ROBERT W POINTER MD
1442 NORTH 313T STREET
SHEBOYGAN WI 53081
GS / GS
414-457-4461
DEAN B PRATT MD
332 PARK AVENUE
SHEBOYGAN WI 53081
PD / PD
414-457-4461
SARAH J PRATT MD
332 PARK AVENUE
SHEBOYGAN WI 53081
OBG / DBG
414-457-4461
GARRY A QUINN MD
1011 N EIGHTH STREET
SHEBOYGAN WI 53081
FP GS / FP
414-457-5016
MARTIN A RAMMER JR MD
1930 N EIGHTH STREET
SHEBOYGAN WI 53081
PD
JOHN M REINEMANN MD
101 1 N EIGHTH STREET
SHEBOYGAN WI 53081
OBG
414-457-4461
THOMAS RIES MD
1011 NORTH EIGHTH ST
SHEBOYGAN WI 53081
DM
414-457-4441
DONALD M ROWE MD
110 SUGAR BUSH LANE
ELKHART LAKE WI 53020
ORS HS / ORS
414-452-5320
WENDELIN W SCHAEFER MD
904 NORTH NINTH STREET
SHEBOYGAN WI 53081
AN
CHARLES A SCHMITT MD
707 MAYFLOWER STREET
SHEBOYGAN WI 53081
OPH / OPH
414-457-4461
EDWARD G SCHOTT MD
101 1 N EIGHTH STREET
SHEBOYGAN WI 53081
GP CRS / GS
414-893-0558
IRVIN L SCHROEDER MD
210 SELMA STREET
PLYMOUTH WI 53073
IM CD / IM
JOHN F SCHWALBACH MD
1011 N EIGHTH STREET
SHEBOYGAN WI 53081
OTO 7 OTO
414-457-4461
PASCHAl A SCIAPRA MD
ion N EIGHTH STREET
SHEBOYGAN WI 53081
DR / DR
414-458-8903
ROBERT J SCOTT MD
2809 N SEVENTH STREET
SHEBOYGAN WI 53081
ORS / ORS
414-458-3791
D SCOTT SELLINGER MD
1226 N EIGHTH STREET
SHEBOYGAN WI 53081
P N / P
414-457-4461
ASGHAR A SHAH MD
1011 N EIGHTH STREET
SHEBOYGAN WI 53081
FP / FP
414-893-141 1
MARK W SHARON MD
1000 EASTERN AVENUE
PLYMOUTH WI 53073
PD 7 PD
414-457-4461
ROLF L SIMONSON MD
101 1 N EIGHTH STREET
SHEBOYGAN WI 53081
FP
414-893-1411
LLOYD J STEFFAN MD
1000 EASTERN AVENUE
PLYMOUTH WI 53073
ORS HS / ORS
414-458-3791
OTTO K STEWART MD
1226 N EIGHTH STREET
SHEBOYGAN WI 53081
GP
414-894-3322
ALVIN C THEILER MD
500 FREMONT STREET
KIEL WI 53042
ADS FP
JOSE Q TOLENTINO MD
202 TOWER ROAD
ADELL WI 53001
ORS / uRS
414-458-3820
JOHN J VAN DRIEST MD
408 NOR PH AVENUE
SHEBOYGAN WI 53081
FP / FP
timothy j van LI ERE MD
712 RANDOM LAKE ROAD
RANDOM l-AKE WI 53075
OQ f'riC, / pc
WILLIAM G WAGNER MD
1226 N EIGHTH STREET
SHEBOYGAN WI 53081
IM
414-458-2197
PHILIP H WALKER MD
1226 N EIGHTH STREET
SHEBOYGAN WI 53081
FP / FP
414-457-4461
W GREGORY WEISSHAAR MD
1011 N EIGHTH STREET
SHEBOYGAN WI 53081
IM 7 IM
STEPHEN C WESTCOTT MD
1011 N EIGHTH STREET
SHEBOYGAN WI 53081
GP OM
414-457-4441
JAMES 1, WEYGANDT MD
MEDICAL DEPARTMENT
KOHLER company
KOHLER WI 53044
GS / GS
715-284-431 1
STEPHEN J DELVENTHAL MD
610 WEST ADAMS STREET
BLACK RIVER FALLS WI
54615
FP GER 7 FP
JAMES J DICKMAN II MD
610 WEST ADAMS STREET
BLACK RIVER FALLS WI
5461 5
FP / FP
RICHARD L HOLDER MD
610 WEST ADAMS STREET
BLACK RIVER FALLS WI
54615
GP
DAVID B JOHNSON MD
405 N EAU CLAIRE ST
MONDOVI WI 54755-1114
FP 7 FP
715-284-431 1
EUGENE KROHN MD
610 WEST ADAMS STREET
BLACK RIVER FALLS WI
5461 5
ABS
608-323-3301
FLORENTINO E LLEVA MD
POST OFFICE BOX 106
ARCADIA WI 54612
GS FP
W BRADFORD MARTIN MD
1933 PARK STREET
WHITEHALL WI 54773
GP
608-532-4200
CLARENCE B MOEN MD
133 WEST GALE AVENUE
GALESVILLE WI 54630
GP GS
ROBERT KROHN MD
POST OFFICE BOX 70
BLACK RIVER FALLS WI
54615-0070
P
carol A LARSON MD
ROUTE 3 BOX 90
DURAND WI 54736
84— TREMPEALEAU/JACKSON/BUFFALO. VERNON, WALWORTH
FP / FP
715--284-431 1
JOHN H NOBLE MD
110S> HARRISON STREET
BLACK RIVER FALLS WI
54615
FP / FP
715-284-4311
GaRV K PETERSEN MD
610 WEST ADAMS STREET
BLACK RIVER FALLS WI
54615
FP / FP
715-284-431 1
JEFFREY K POLZIN MD
610 WEST ADAMS STREET
BLACK RIVER FALLS WI
54615
FP
608-582-2422
ELMER P ROHDE MD
POST OFFICE BOX 369
GALESVILLE WI 54630-0369
PD / PD
JOANNE A SELKURT MD
1933 PARK STREET
WHITEHALL WI 54773
FP / FP
715-976-3883
WILLIAM E WRIGHT MD
LOCK BOX 90
MONDOVI WI 54755
GP
608-323-3354
RIZALINO N YRAY MD
POST OFFICE BOX 146
ARCADIA WI 54612
FP / FP
608-637-3175
THOMAS M AMBELANG MD
POST OFFICE BOX 467
VIROQUA WI 54665
GP
608-634-3126
PHILLIPS T BLAND MD
100 MELBY STREET
WE3TBY WI 54667
GS FP
901-286-2929
THOMAS E BOSTON MD
FORCUM DAKS BLDG
2455 NICHOLS AVE
DYER5BURG TN 38024
FP / FP
608-625-2494
JAMES M DE LINE MD
POST OFFICE BOX 35
LA FARGE WI 54639
FP / FP
TIMOTHY J DEV ITT MD
RFD 1
SOLDIERS GROVE WI 54655
FP
608-648-2066
CARL A FNDER MD
POST OPFICE BOX 65
DE SOTO WI 54624
GS TS
ROLANDO A MACASAET MD
318 WEST DECKER STREET
VIROQUA WI 54665
PD / PD
JEFFREY F MENN MD
31S WEST DECKER STREET
VIROQUA WI 54665
GP
608-637-3175
HAROLD E OPPERT MD
318 W DECKER STREET
VIROQUA WI 54665
FP / FP
608-637-3174
ROBERT A STARR MD
318 W DECKER STREET
VIROQUA WI 54665
GP
608-637-3195
DAVID E VIG MD
POST OFFICE BOX 72
VIROQUA WI 54665
GP
608-637-3195
DE VFRNE W VIG MD
POST OFFICE BOX 72
VIROQUA WI 54665
GS / GS
EDWARD N VIG MD
521 EAST TERHUNE
VIROQUA WI 54665
WALWORTH
IM PUD / IM
414-248-8527
NESTOR C ALABARCA MD
255 HAVENWOOD DRIVE
LAKE GENEVA WI 53147
GP
HENRY F BISCHOF MD
1024 S I AKE SHORE DR
LAKE GENEVA WI 53147
EM / EM
JOHN L BOWMAN MD
719 PADDOCK LANE
LIVERTYVILLE IL 60048
EM
CAROL M BROWN DO
3205 ANN LOUISE DRIVE
NEW BERLIN WI 53151
FP
414-275-2101
IRWIN J BRUHN MD
ROUTE 1 BOX 64-A
LAKEVILLE ROAD
WALWORTH WI 53184
R IM / R
414-275-6624
ERNEST L BURNELL MD
ROUTE 3 BOX 85-C
FONTANA WI 53125
FP / FP
414-723-3100
EDWARD E CARLSON MD
100 SOUTH WASHINGTON
ELKHORN WI 53121
OPH / OPH
414-248-2278
THOMAS H F CHALKLEY MD
GENEVA OFFICE MALL
HIGHWAY H AT NN
LAKE GENFIVA WI 53147
PH GPM / GPM
414-473-6683
RUTH E CHURCH MD
APT 316C
435 STAR IN ROAD
WHITEWATER WI 53190
IM NEP / IM
414-248-8527
EDSEL G DOREZA MD
255 HAVENWOOD STREET
LAKE GENEVA WI 53147
FP PD
JOHN FONMIN MD
255 HAVENWOOD STREET
LAKE GENEVA WI 53147
FP / FP
ROCCD S GALGAND MD
130 BROOK LANE
DELAVAN WI 53115
FP DBG PD / FP
414-248-221 1
GREGORY J GERBER MD
1119 MADISON STREET
LAKE GENEVA WI 53147
OBS
414-728-4252
ELENA NGO GRAC I OSA MD
124 SOUTH THIRD STREET
DELAVAN WI 53115
PD
414-728-4252
JOSEPH D GRAC I OSA MD
124 SOUTH THIRD STREET
DELAVAN WI 53115
FP IM
414-275-2101
DANIEL R HANSEN MD
POST OFFICE BOX G
WALWORTH WI 53184
ORS / ORS
414-248-4467
CLARENCE R HART MD
TEN PELl ER ROAD
POST OFFICE BOX B
LAKE GENEVA WI 53147
FP / FP
414-275-2101
DALE G JACOBSON MD
POST OFFICE BOX G
WALWORTH WI 53184
ORS / ORS
414-248-4467
JAMES L KNAVEL MD
TEN PELLER ROAD
POST OFFICE BOX B
LAKE GENEVA WI 53147
FP / FP
414-248-221 1
BRITTON W KOLAR MD
717 GENEVA STREET
LAKE GENEVA WI 53147
FP / FP
414-723-3100
JANET C LINDEMANN MD
100 SOUTH WASHINGTON
POST OFFICE BOX 547
ELKHORN WI 53121
FP / FP
414-728-3443
JOHN E MARTIN JR MD
517 WALWORTH AVENUE
DELAVAN WI 53115
FP / FP
414-723-3100
HENRY R MOL MD
100 S WASHINGTON ST
POST OFFICE BOX 547
ELKHORN WI 53121
PTH CLP / PTH
MARK D MOLOT MD
2038 LAWLER ROAD
EAST TROY WI 53120
GP
414-723-3100
RICHARD J ROGERS MD
100 S WASHINGTON ST
ELKHORN WI 53121
GS CDS / GS
414-72B-8205
ARTURO C SAP I DA MD
1232 PHOENIX STREET
DELAVAN WT 53115
FP IM / FP IM
414-248-221 1
GARTH R SCHNEIDER MD
717 GENEVA STREET
LAKE GENEVA WI 53147
FP / FP
414-723-3100
JOSEPH B SCHROCK JR MD
100 S WASHINGTON ST
POST OFFICE BOX 577
ELKHORN WI 53121
GS / GS
414-723-6666
JAMES V SEEGERS MD
104 S WISCONSIN STREET
ELKHORN WI 53121
GS ON / GS
414-248-8527
JUANILITO N SELDERA MD
ROUTE 1 BOX 396-F
FONTANA WI 53125
AN EM
MY I NT T SINGH MD
POST OFFICE BOX 1002
ELKHORN WI 53121
GP
414-728-3441
GLENN A SMILEY MD
107 NORTH THIRD STREET
DELAVAN WI 53115
AN
MENANDRO V TAVERA JR MD
ROUTE 4 BOX 246
LAKE GENEVA WI 53147
OPH / OPH
414-248-3577
NICHOLAS W VEITH MD
ROUTE 3 HIGHWAY 50E
LAKE GENEVA WI 53147
IM / IM
HAROLD J WERBEL MD
1839 CHAISE DRIVE
CARSON CITY NV 89701
FP / FP
414-728-2651
WILLIAM C WOODS MD
915 GENEVA STREET
DELAVAN WI 53115
OBG / OBG
414-248-8527
GEORGE L YAO MD
255 HAVENWOOD DRIVE
LAKE GENEVA WI 53147
OBG
414-248-8527
JOY ZERRUDO-SELDERA MD
ROUTE 1 BOX 396-F
FONTANA WI 53127
WASHINGTON— 85
WASHINGTON
GP AN
JAMES E ALBRECHT MD
2487 PLEASANT VALLEY
JACKSON WI 53037
IM / IM
414-673-5745
JAMES L ALGIERS MD
1004 E SUMNER STREET
HARTFORD WI 53027
GS / GS
414-673-5050
SALEEM BAKHTIAR MD
1113 E SUMNER STREET
HARTFORD WI 53027
IM / IM
414-673-5745
JAMES R BARGENQUAST MD
1004 E SUMNER STREET
HARTFORD WI 53027
GS OM / GS
CARROLL A BAUER MD
HCR4 BOX 117
PHILLIPS WI 54555
FP
414-338-1 123
JAMES F BAUMGARTNER MD
APT 101 N
151 UNIVERSITY DRIVE
WEST BEND WI 53075
PD / PD
414-338-1123
JEROLD J BEERENDS MD
279 SOUTH 17TH AVENUE
WEST BEND WI 53095
FP / FP
414-338-1 123
ROBERT T BODENSTEINER MD
279 SOUTH 17TH AVENUE
WEST BEND WI 53095
PTH NM / PTH NM
414-334-8285
ROLAND C BROWN MD
551 SILVERBROOK DRIVE
WEST BEND WI 53095
FP / FP
414-677-3661
SANDRA K BYERLY MD
N168 W20060 MAIN ST
POST OFFICE BOX 26
JACKSON WI 53037
GP
FLORIZEL F CASTRO MD
1040 FOND DU LAC AVE
POST OFFICE BOX 428
KEWASKUM WI 53040-0428
OTO HNS MFS / OTO
JAMES A CHERMAK MD
623 ELM STREET
WEST BEND WI 53095
PD
414-334-1265
TIMOTHY J CHYBOWSKI MD
643 S EIGHTH AVENUE
WEST BEND WI 53095
R DR / R
WILLIAM M CLAYBAUGH MD
SUITE 201
2500 N M^Yl-AIR ROAD
MILWAUKEE WI 53226
GP
414-626-2666
RICHARD G EDWARDS MD
1121 S FOND DU LAC AVE
POST OFFICE BOX 7
KEWASKUM WI 53040-0007
FP / FP
AURORA M ESTRELLA MD
1713 NORTH MAIN STREET
WEST BEND WI 53095
OBG / OBG
414-334-4300
RENATO S ESTRELLA MD
1713 NORTH MAIN STREET
POST OFFICE BOX 454
WEST BEND WI 53095-0454
FP
4 1 4-334-5263
RAYMOND 0 FRANKOW MD
606 HIGHLAND VIEW DR
WEST BEND WI 53095
N P / PN
ROBERT H FRIEDMAN MD
N89 W16840 APPLETON AV
MENOMONEE FALLS WI 53051
FP / FP
JAMES D FROEHLICH MD
7066 N TRENTON ROAD
WEST BEND WI 53095
GS TS > GS TS
414-334-2622
ROBERT J GARDNER MD
844 WEST BADGER LANE
WEST BEND WI 53095
IM / IM
414-338-1 123
CHARLES S GEIGER JR MD
279 SOUTH 17TH AVENUE
WEST BEND WI 53095
GP GS
414-334-4076
RICHARD D GIBSON MD
321 HAWTHORNE DRIVE
WEST BEND WI 53095
FP
LAWRENCE A GILL MD
1201 OAK STREET
WEST BEND WI 53095
FP
BRUCE G GRISWOLD MD
615 ARTHUR PLACE
WEST BEND WI 53095
PD / PD
RONALD G GRITT MD
1004 E SUMNER STREET
HARTFORD WI 53027
FP / FP
414-334-3481
ALVIN T GRUNDAHL MD
1201 OAK STREET
WEST BEND WI 53095
IM GE / IM GE
414-673-5050
UDAY V GUPTE MD
1113 E SUMNER STREET
HARTFORD WI 53027
U / U
414-961-1 1 1 1
DANIEL B GUTE MD
6290 NORTH PORT
WASHINGTON ROAD
MILWAUKEE WI 53217
FP / FP
414-334-3451
TODD J HAMMER MD
1201 OAK STREET
WEST BEND WI 53095
FP / FP
GARY M HERDRICH MD
5484 ROAD FOUR
WEST BEND WI 53095
FP
414-673-5050
WILLIAM C HOFFMANN MD
1113 E SUMNER STREET
HARTFORD WI 53027
GP
414-673-9373
THEODORE J KERN MD
617 SOUTH MAIN STREET
HARTFORD WI 53027
PD PDC / PD
CHUNGKl LEE MD
1113 E SUMNER STREET
HARTFORD WI 53027
GS / GS
414-338-1 123
J DAVID LEWIS MD
279 SOUTH 17TH AVENUE
WEST BEND WI 53095
IM / IM
414-338-1123
WILLIAM J LISTWAN MD
279 SOUTH 17TH AVENUE
WEST BEND WI 53095
R / R
WILLIAM J MALLORY MD
2500 N MAYFAIR ROAD
MILWAUKEE WI 53226
IM / IM
414-673-5745
MICHAEL J MALLY MD
1004 E SUMNER STREET
HARTFORD WI 53027
OBG / OBG
ANTONIO Z MARASIGAN MD
1004 E SUMNER STREET
HARTFORD WI 53027
DR R / DR R
414-352-0530
ABRAHAM MELAMED MD
1107 EAST LILAC LANE
MILWAUKEE WI 53217
DR R / DR R
414-476-4242
ROBERT W MOTHS MD
2500 N MAYFAIR ROAD
MILWAUKEE WI 53226
IM
414-338-1 123
DONALD M MUTH MD
279 SOUTH 17TH AVENUE
WEST BEND WI 53095
OPH / OPH
EARL W NEPPLE MD
614 WESTRIDGE DRIVE
WEST BEND WI 53095
GS / GS
414-673-5745
ROBERT J NICKELS MD
1004 SUMNER STREET
HARTFORD WI 53027
FP
414-333-1 123
WILLIAM A NIELSEN MD
279 SOUTH 17TH AVENUE
WEST BEND WI 53095
IM / IM
414-338-1 123
ROBERT W NINNEMAN MD
279 S 1 7TH AVENUE
WEST BEND WI 53095
ORS / UR5
414-338-6641
MARK T O'MEARA JR MD
1201 OAK STREET
WEST BEND WI 53095
GP
414-673-5050
VALERIUS V QUANDT MD
1113 E SUMNER STREET
HARTFORD WI 53027
IM FP / FP
414-673-8248
EMILIO B REGALA JR MD
1004 E SUMNAR STREET
HARTFORD WI 53027
ORS / ORS
414-333-6641
MICHAEl. C REINECK MD
1201 OAK STREET
WEST BEND WI 53095
OPH
PAUL R RICE MD
731 PINE DRIVE
WEST BEND WI 53095
OPH
WALLACE E SCHEUNEMANN MD
824 WEST BADGER LANE
WEST BEND WI 53095
ORS / ORS
414-338-6641
PAUL R SCHNEIDER MD
1201 OAK STREET
WEST BEND WI 53095
DR NM / DR
414-476-4242
LARRY H SHERKOW MD
5644 COLLEEN LANE
WEST BEND WI 53095
AN
AURORA A SI SON MD
1040 FOND DU LAC AVE
POST OFFICE BOX 428
KEWASKUM WI 53040-0428
GS
CESAR V SISON MD
1040 FOND DU LAC AVE
POST OFFICE BOX 428
KEWASKUM WI 53040-0428
U / U
ARTHUR M SONNELAND III MD
271 GREEN BAY ROAD
CEDARBURG WI 53012
FP
414-338-1 123
RICHARD F SORENSEN MD
279 SOUTH 17TH AVENUE
WEST BEND WI 53095
OBG / OBG
414-673-5050
TETSUO TAGAWA MD
1113 E SUMNER STREET
HARTFORD WI 53027
PD / PD
414-338-1123
SIMON T TAN MD
279 SOUTH 17TH AVENUE
WEST BEND WI 53095
IM IM
JAMES C TURNER MD
300 KETTLE MORAINE DR
SLINGER WI 53086
AN
JESSE O VEGAFRIA MD
768 EASTERN AVENUE
WEST BEND Wl 53095
IM
424-fc73-5745
ERIC F WEBER MD
1004 r SUMNER STREET
HARTFORD WI 53027
86— WASHINGTON, WAUKESHA
FP / FP
414-338-1 J,?3
THOMAS t WEX MD
279 SOUTH 1 7TH AVENUE
WEST BEND WI 53095
R ' R
414-476-4242
RICHARD E ZELLMER MD
2500 N 108TH STREET
MILWAUKEE WI 53226
OS / GPM
ARTHUR P ZINTEK MD
2372 HILLSIDE ROAD
RICHPIELD WI 53076
WAUKESHA
IM
JOSE S AGPOON MD
S5 W22449 E MORELAND
WAUKESHA WI 53186
R /■’ P
John' B alderti md
15250 WOODDRIDGE ROAD
BROOKFIELD WI 53005
P / P
414-547-9384
JAMES A ALSTON MD
210 MC CALL STREET
WAUKESHA WI 53186
FP / FP
414-367-2128
KEVIN J ARNOLD DO
123 LAWN STREET
HARTLAND WI 53029
FP PTH
PARAMJIT K BAMRAH MD
915 E SUMMIT AVENUE
OCONOMOWOC WI 53066
IM END / IM END
414-782-4270
MICHAEL F BANASIAK MD
POST OFFICE BOX 544
BROOKFIELD WI 53005
DR NM / NM
VINCENT p BANKER MD
7310 WELLAUEP DRIVE
WAUWATOSA WI 53213
AN / AN
402-371-3338
JERGEN L BARBER MD
117 NOR rH 18TH STREET
NORFOLK NE 68701
NS / NS
414-542-9503
GEORGE R BARTL MD
1111 DELAFIELD STREET
WAUKESHA WI 53186
IM
414-547-1811
JOSEPH A BARTOS MD
403 NORTH GRAND AVENUE
WAUKESHA WI 53186
GS / GS
414-542-3312
ROBERT E BARTOS MD
210 EAST WABASH AVENUE
WAUKESHA WI 53186
GERALD C BELLEHUMEUR MD
8185 N GREEN DAY AVE
MILWAUKEE WI 53209
OTO / oro
414-547-1614
THOMAS P BELSON MD
nil DEL afield STREET
WAUKESHA WI 53186
P OS / P
414-542-0123
KATHRYN M C BEMMANN MD
412 NORTH WEST AVENUE
WAUKESHA WI 53186
IM
GERALD N BERMAN MD
1 1 1 1 DEI AFIELD STREET
WAUKESHA WI 53186
OTO
414-255-2500
DAVID J DESTE MD
W180 N7950 TOWN HALL
MENOMONEE FALLS WI 53051
DBG
DHUN N BHATHENA MD
nil DELAFIELD STREET
WAUKESHA WI 53186
PD
414-736-7720
JUAN T BIAGTAN MD
17000 WEST NORTH AVE
BROOKFIELD WI 53005
PD / PD
414-255-2500
RICHARD H BIDLER MD
WiaO N7850 TOWN HALL
POST OFFICE BOX 427
MENOMONEE FALLS WI 53051
P / PN
MARK D BIEHL MD
nil DELAFIELD STREET
WAUKESHA WI 53186
IM IM
414-782-4270
STEPHEN R BIELKE MD
POST OFFICE BOX 544
BROOKFIELD WI 53005-0544
PD
JEROME R BISCHEL MD
1535 E PACINE AVENUE
WAUKESHA WI 53186
GS CDS / GS
414-786-3722
JOHN S BLACKWOOD MD
17050 W NORTH AVENUE
BROOKFIFLD WI 53005
IM HEM / IM
DAVID G BLAKE MD
W180 N7950 TOWN HALL
MENOMONEE FALLS WI 53051
ORS
414-255-7030
STEVEN Bl-ATNIK MD
WiaO N7950 TOWN HALL
POST OFFICE BOX 427
MENOMONEE FALLS WI 53051
I M / I M
414-782-4270
MICHAEL J BLICK MD
17050 W NORTH AVENUE
POST OFFICE BOX 544
BROOKFIELD WI 53005
DR / DR
ROBERT A BOEDECKER MD
2760 CLEARWATER DRIVE
BROOKFIELD WI 53005
ORS HS / ORS
414-544-531 1
JOHN T BOLGER MD
223 WISCONSIN AVENUE
WAUKESHA WI 53136
ORS / ORS
414 544-531 1
RICHARD H BOLT MD
223 WISCONSIN AVENUE
Waukesha wi 531 86
PD / PD
414-255-7030
CHARLES H BRANNEN MD
W180 N7950 TOWN HALL
POST OFFICE BOX 427
MENOMONEE FALLS WI 53051
IM
414-255-2500
WILLIAM M BRENNAN MD
W180 N7950 TOWN HALL
POST OFFICE BOX 427
MENOMONEE FALLS WI 53051
IM
414-646-399?
J THOMAS BREYER MD
34304 SUNSET DRIVE
OCONOMOWOC WI 53066
I M 7 I M
414-251-7500
PATRICK J BRODY MD
NB4 W 16889 MENOMONEE
MENOMONEE FALLS WI 53051
OPH / OPH
DWIGHT H BROWN MD
17000 W NORTH AVENUE
BROOKFIELD WI 53005
FP IM / FP
414-569-2300
CHARLES D BRUMMITT MD
915 EAST SUMMIT AVENUE
OCONOMOWOC WI 53066
OBG / OBG
414-544-4411
EDWARD J BUERGER MD
nil DELAFIELD STREET
WAUKESHA WI 53186
FP
414-549-0737
JOHN L BUHL MD
336 WISCONSIN AVENUE
WAUKESHA WI 53186
GYN OBS / OBG
414-255-7090
KIM R BURCH MD
W180 N7950 TOWN HALL
POST OFFICE BOX 427
MENOMONEE FALLS WI 53051
DR / P
414-647-5132
RODOLFO G BURGOS MD
N9 W29304 THAMES ROAD
WAUKESHA WI 53186
IM
414-774-8388
EUGENE P BURKE MD
10625 W NORTH AVENUE
WAUWATOSA WI 53226
IM HEM / IM
LAWRENCE B BURKERT MD
POST OFFICE BOX 544
BROOKFIELD WI 53005
P X P
414-425-7593
C BUSCAGLIA MD
5310 S MAGELLAN DRIVE
NEW BERLIN WI 53151
ORS / ORS
414-786-2875
ROBERT 0 BUSS MD
890 ELM GROVE ROAD
POST OFFICE BOX 103
ELM GROVE WI 53122
I M / I M
414-422-0720
JAMES J BUTH MD
S69 W 15636 JANESVILLE
MUSKEGO WI 53150
AN
PAUL E CAMPBELL MD
1307 EAST BROADWAY
POST OFFICE BOX 884
WAUKESHA WI 53137
D / 0
414-784-7820
JOHN S CANT I ER I MD
17030 W NORTH AVENUE
BROOKFIELD WI 53005
FP
414-771-2239
VERNETTE M CARLSON MD
APT 301
2542 N 124TH STREET
WAUWATOSA WI 53226
FP
PAUL R CHAMBERS MD
123 LAWN STREET
HARTLAND WI 53029
FP OBG / FP
414-367-2128
RICHARD K CHAMBERS MD
123 LAWN STREET
HARTLAND WI 53029
N
414-542-9503
BRIAN A CHAPMAN MD
nil DELAFIELD STREET
WAUKESHA WI 53186
AN / AN
414-782-5905
RICHARD W CHERWENKA MD
1100 WESTBROOKE PKWY
WAUKESHA WI 53186
DBG / DBG
414-255-7090
CLYDE M CHUMBLEY II MD
POST OFFICE BOX 427
MENOMONEE FALLS WI 53051
OBG / OBG
414-255-2500
DOUGLAS 0 CLARK MD
W180 N7950 TOWN HALL
POST OFFICE BOX 427
MENOMONEE FALLS WI 53051
DBG 7 OBG
414-569-2300
JOHN L CLAUDE MD
915 EAST SUMMIT AVENUE
OCONOMOWOC WI 53066
IM / IM
414-567-0227
DAN T CLEARY MD
1030 KEATS CIRCLE
OCONOMOWOC WI 53066
IM / IM
DANIEL M CLINE MD
1023 SOUTH FREMONT
SPRINGFIELD MO 65804
FP / FP
414-544-6333
W CLOTHIER JR MD
413 NORTH EAST AVENUE
WAUKESHA WI 53186
OPH / OPH
414-786-0240
JANE M COLLIS-GEERS MD
17050 W NORTH AVENUE
BROOKFIELD WI 53005
WAUKESHA— 87
FP / FP
414-968-2560
MICHAEL L. CUMMENS MD
S47 W30757 HWY 83
POST OFFICE BOX 35
GENESEE DEPOT WI 53127
ORS / ORS
414-786-3090
PATRICK W CUMMINGS JR MD
17050 W NORTH AVENUE
BROOKFIFLD WI 53005
IM ID / IM ID
414-255-7020
MICHAEL P DAILEY MD
W130 N7950 TOWN HALL
MENOMONEE FALLS WI 53051
DBG / OBG
414-544-441 1
JAMES P DALE I DEN MD
nil DELAFIELD STREET
WAUKESHA WI 53186
FP / FP
JAMES E HALL MD
nil DELAFIELD STREET
WAUKESHA WI 53186
DPH
LEE L DANNENBERG MD
N88 W 16624 APPLETON AV
MENOMONEE FALLS WI 53051
OTO / OTO
414-547-1614
RONALD J DARLING MD
nil DELAFIELD STREET
WAUKESHA WI 53186
OTO HNb / OTO
414-547-] 614
WILLIAM A DARLING MD
nil DELAFIELD STREET
WAUKESHA WI 53186
IM
414-251-9260
HALIL DAVASLIGIL MD
W178 N9736 RIVERSBEND
CIRCLE WEST
GERMANTOWN WI 53022
CDS Gb / GS
414-542-0444
WILLIAM B DAVIES MD
nil DELAFIELD STREET
WAUKESHA WI 53186
kD hD
414-257-3063
ALAN A DF ANGEL I S MD
W34 Nlbb89
MENOMONEE AVENUE
MENOMONEE FALLS WI 53051
AN
ELEUTERIO A DE GUZMAN MD
W180 NS 170 DESTINY DR
MENOMONEE FALLS WI 53051
ORS / ORS
414-5d9-2276
STEPHEN P DELAHUNT MD
915 EAST SUMMIT AVENUE
OCONOMOWOC WI 53066
D
414-334 -0826
KENNETH J DEMPSEY MD
2419 W WASHINGTON ST
WEST BEND WI 53095
ORS / OHfa
414-544-531 1
CHARLES A DESCH MD
223 WISCONSIN AVENUE
WAUKESHA WI 53186
IM / IM
414-255-2500
PHILIP J DOUGHERTY MD
W180 N7950 TOWNHALL RD
MENOMONEE FALLS WI 53051
IM / IM
414-542-9531
THOMAS J DOUGHERTY MD
11 11 DELAF I ELD STREET
WAUKESHA WI 53186
IM
TERESA A DOWDY MD
1717 PARAMOUNT DRIVE
WAUKESHA WI 53186
PD
HENRY D DRAYER MD
W180 N7950 TOWN HALL
POST OFFICE BOX 427
MENOMONEE FALLS WI 53051
GE IM / IM
MARK W DREYER MD
W180 N7950 TOWN HALL
MENOMONEE FALLS WI 53051
FP / FP
414-542-/977
THOMAS F DUGAN MD
336 W WISCONSIN AVENUE
WAUKESHA WI 53136
PTH / PTH
ARNOLD A EFFRON MD
791 EAST SUMMIT AVENUE
OCONOMOWOC WI 53066
IM CD / IM CD
414-255-2500
DAVID E ENGLE MD
WISO N7950 TOWN HALL
MENOMONEE FALLS WI 53051
AN / AN
STANLEY A ENGLUND MD
725 AMERICAN AVENUE
WAUKESHA WI 53186
IM / IM
414-255-7030
HOWARD A EVERT MD
W180 N7950 TOWN HALL
MENOMONEE FALLS WI 53051
PS ■■ PS
414-646-2221
LIU A BREYER FEINBERG MD
1053 LAKE WATERVILLE
OCONOMOWOC WI 53066
U / u
414-547-3600
THOMAS A FERBER MD
nil ntLAFIELD STREET
WAUKESHA WI 53 IBS
R NM / R NM
414-544-2431
ROBE.RT C FEULNER MD
611 WESTMINSTER DRIVE
WAUKESHA WI 53186
IM
JOHN T F 1 Bh MD
5247 N HOLLYWOOD AVE
MILWAUKEE WI 53217
OM / OM
414-7B2-14b5
CHARLES W hISHDURN MD
17125 W CLEVELAND AVE
NEW BERLIN WI 53151
DBG / DBG
JOHN H FLANAR-t MD
10125 W NORTH AVENUE
WAUWATOSA WI 53226
OPH / OPH
41 4-54*’- 3352
R FLICKINGER JR MD
102 EAST MAIN STREET
WAUKESHA WI 53186
GS / GS
414-255-2500
JOHN J FOLEY MD
W180 N7950 TOWN HALL
POST OFFICE BOX 427
MENOMONEE FALLS WI
53051-0427
GS / GS
414-542-0444
PAUL S FOX MD
nil DELAFIELD STREET
WAUKESHA WI 53186
P
414-367-5237
ROBERT J FRANCIS MD
W307 N6992 CLUB CIR E
HARTLAND WI 53029
P
EUGENE B P FRANK MD
114 EIGHTH ST SOUTH
BRADENTON BEACH FL 33510
GS / GS
414-542- 9466
RICHARD G FRANTZ MD
nil DELAFIELD STREET
WAUKESHA WI 53186
P N / P N
414-255-2500
MARK L FREEMAN MD
W180 N7950 TOWN HALL
MENOMONEE FALLS WI 53051
AN
414-786-2828
RUDY P FROESCHLE MD
830 BRIAR RIDGE DRIVE
WAUKESHA WI 53186
A IM / IM A1
414-54 /-3444
MARTIN Z FRUCHTMAN MD
217 WISCONSIN AVENUE
WAUKESHA WI 53186
OPH OS / OPH
414-547-3352
WALTER E GAGER MD
102 EAST MAIN STREET
WAUKESHA WI 53186
IM ^ IM
THOMAS I GALLAGHER MD
2778 NORTH 70TH STREET
MILWAUKEE WI 53210
AN / AN
414-547-9043
GREGORY L GALLO MD
S33 W26856 HAWTHORNE
HOLLOW DRIVE
WAUKESHA WI 53186
GP HYP
HYMAN A GANTZ MD
W223 S3885 GUTHRIE RD
WAUKESHA WI 53186
IM / IM
414-422-0720
PETER T GEISS MD
S69 W I 5636 JANESVILLE
MUSKEGO WI 53150
I M / I M
414-255-/030
ROBERT N GERBHAN MD
W180 N7950 TOWN HALL
MENOMONEE FALLS WI 53051
IM GE . IM GE
414-255-7020
GARY L GERSTNER MD
WISO N7950 TOWN HALL
MENOMONEE FALLS WI 53051
FP
414-544-0281
SARAH L GOOGE MD
338 LEMIRA AVENUE
WAUKESHA WI 53186
P IM
THOMAS J GORAL MD
34810 PABST ROAD
OCONOMOWOC WI 53066
FP / FP
414-782-8272
JOHN 0 GRADE MD
1050 LEGION DRIVE
ELM GROVE WI 53122
OTO / OTO
414-251-7500
RICHARD J GRUNKE MD
N84 W 16889 MENOMONEE
MENOMONEE FALLS WI 53051
OBG / DBG
MICHAEl. GRYNIEWICZ MD
3275 APPl EGATE LANE
BROOKFIELD WI 53005
IM
GUNNAR GUNDERSEN I I MD
APT 724
12650 W BLUEMOUND ROAD
ELM GROVE WI 53122
PD / PD
JOHN R GUY MD
nil DELAFIELD STREET
WAUKESHA WI 53186
GS / GS
414-784-1778
PHILIP C GUZZETTA JR MD
19015 T ANAL A DRIVE
BROOKFIFLD WI 53005-4841
ORS / ORS
414-251-7500
JAMES G HACKETT MD
N84 W 16839 MENOMONEE
MENOMONEE FALLS WI 53051
OBG / OBG
GLORIA M HALVERSON MD
18590 ANITA DRIVE
BRDOKFIF.LD WI 53005
FP
414-544-5959
STEVEN G HAMMER MD
434 MADISON STREET
WAUKESHA WI 53188
AN / AN
414-786-8205
PETER T HANSEN MD
18625 LF chateau DRIVE
BROOKFIELD WI 53005
N . N
414-542-9503
JAMES C HANSON MD
nil DELAFIELD STREET
WAUKESHA WI 53186
ORS / ORS
414-544-531 1
GERALD L HARNED MD
223 WISCONSIN AVENUE
WAUKESHA WI 53186
FP / FP
414-251-7500
KENNETH J HARRINGTON MD
W154 N8083 ELM LANE
MENOMONEE FALLS WI 53051
IM GE / IM
JOHN A HARRIS MD
nil DELAFIELD STREET
WAUKESHA WI 53186
OBG
TIMOTHY W HARSTAD MD
N84 W 16889 MENOMONEE A
MENOMONEE FALLS WI 53051
IM
TERRF.NCE N HART MD
POST OFFICE BOX 544
BROOKFIFLD WI 53005
88— WAUKESHA
p / p
414-544-2396
GARY C HAUSER MD
725 AMERICAN AVENUE
WAUKESHA WI 53186
TS OS / T5 GS
414-342-2003
PAUL. F HAUSMANN MD
BOX 36
DELAFIEL.D WI 53018-0036
PD
414-786-8199
NANCY R HAWORTH MD
3075 SAUK IRAIL
BROOKFIELD WI 53005
GS / GS
414-569-2275
RICHARD F HEARN MD
915 EAST SUMMIT AVENUE
OCONOMOWGC WI 53066
U / U
414-547-3600
RICHARD ( HEIN MD
124 OXFORD ROAD
WAUKESHA WI 53186
DR / DP
R DAVID HELLING MD
S23 W26149 CANTERBURY
WAUKESHA WI 53186
I M / I M
414-251-5945
DONALD J HENNESSY JR MD
W180 N7950 TOWN HALL
MENOMONEE FALLS WI 53051
NS
414-542-7767
LA VFRN H HERMAN MD
1143 DOWNING DRIVE
WAUKESHA WI 53186
IM PUD / IM PUD
414-255-7020
DANIEL W HERRELL MD
W180 N7950 TOWN HALL
POST OFFICE BOX 427
MENOMONEE FALLS WI 53051
U / U
414-782-5012
RICHARD A HERRMANN MD
17030 W NORTH AVENUE
BROOKFIELD WI 53005
FP / FP
414-251-7500
DONALD J HEYRMAN MD
W137 N7657 NORTH HILLS
MENOMONEE FALLS WI 53051
RHU IM DM / RHU IM
414-255-2500
ALAN C HILGEMAN MD
W180 N/950 TOWN HALL
MENOMONEE FALLS WI 53051
PD
414-542-2536
DONALD D HILLAN MD
nil DEI AFIELD STREET
WAUKESHA WI 53186
DBG / DBG
THOMAS A HOFBAUER MD
POST OFFICE BOX 427
MENOMONEE FALLS WI 53051
IM
414-255-2500
JACK R HOFFMAN MD
W180 N7950 TOWN HALL
POST OFFICE BOX 427
MENOMONEE FALLS WI 53051
P
THOMAS L HOLBROOK MD
POST OFFICE BOX 7
DELAFIELD WI 53018
GP IM / IM
414-255-2500
CHARLES E HOLMBURG MD
W180 N7950 TOWN HALL
MENDMONFE FALLS WI 53051
AN / AN
ROBERT E HOLZGRAFE MD
W226 N1509 NORTH AVE
WAUKESHA WI 53186
OPH AM / OPH
414-255-7070
JOHN C HOVEY MD
WIBO W7V50 TOWN HALL
POST OFFICE BOX 427
MENOMONEE FALLS WI 53051
FP / FP
414-367-2128
DAVID P IMSE MD
123 LAWN STREET
HARTLAND WI 53029
PD / PD
KATHRYN D lORIO MD
1 1 1 1 DEL AFIELD STREET
WAUKESHA WI 53186
OTO MFS A. / OTD
414-567-0505
MICHAEL C JANOWAK MD
888 THACKERAY TRAIL
OCONOMOWOC WI 53066
A
WILLIAM C JANSSEN MD
425 E WISCONSIN AVENUE
MILWAUKEE WI 53202
AN
PALMIRA A JANUSONIS MD
W347 S494B HIGHWAY G
DOUSMAN WI 53118
FP / FP
414-363-7142
DOROTHY J JAYNE MD
225 EAGLE LAKE AVENUE
MUKWONAGO WI 53149
FP / FP
414-786-4080
THOMAS R JENSEN MD
485 CLAREMONT COURT
WAUKESHA WI 53186
PTH / PTH
414-544-2134
COLLIN B JOHNSON MD
725 AMERICAN AVENUE
WAUKESHA WI 53186
FP / FP
DALE A JOHNSON MD
819 EAST SUMMIT AVENUE
OCONOMOWOC WI 53066
GS ABS TRS / GS
414-542-3117
JAMES L JOLIN MD
POST OFFICE BOX 1538
WAUKESHA WI 53187
IM PUD / IM PUD
414-344-5450
CLARENCE W JQRDAHL JR MD
POST OFFICE BOX 11-0
MILWAUKEE WI 53201
AN
414-785-1025
DANIEL G JUDGE MD
1245 INDIANWOOD DRIVE
BROOKFIELD WI 53005
PTH CLP / PTH CLP
414-544-2284
ROBERT L KASCHT MD
W288 S5161 ROCKWOOD TR
WAUKESHA WI 53186
DBG END / DBG END
414-544-2801
K PAUL KATAYAMA MD
725 AMERICAN AVENUE
WAUKESHA WI 53186
GS / GS
414-251-7500
PATRICK K KEANE MD
N84 W16889 MENOMONEE
MENOMONFTE FALLS WI 53051
R NM / R
414-255-2500
THEODORE A KELLER MD
W180 N7950 TOWN HALL
POST OFFICE BOX 427
MENOMONEE FALLS WI 53051
FP / FP
414-646-8269
JOHN E KELLY MD
4648 N LAKE CLUB CIR
OCONOMOWOC WI 53066
HNS OTO / OTO
414-475-9300
JOHN J KELLY MD
SUITE 505
2500 N MAYFAIR ROAD
MILWAUKEE WI 53226
GE
414-225-8812
JAN IS J KENGIS MD
nil DELAFIELD STREET
WAUKESHA WI 53186
GP
ELMER F KERN MD
314 MAIN STREET
MUKWONAGO WI 53149
IM / IM
MARTIN W KERN MD
nil DELAFIELD STREET
WAUKESHA WI 53186
TR / TR
414-447-2221
DOUGLAS KING MD
5000 W CHAMBERS STREET
MILWAUKEE WI 53210
FP
HOWARD M KLOPF MD
569 W VISTA HERMOSA DR
GREEN VALLEY AZ 85614
FP / FP
MARGARET M KNIGHT MD
7434 W GARFIELD AVENUE
WAUWATOSA WI 53213
FP / FP
414-363-7142
THOMAS J KOEWLER MD
225 EAGl E LAKE AVENUE
MUKWONAGO WI 53149
A IM
414-547-3055
WAYNE H KDNETZKI MD
403 NORTH GRAND AVENUE
WAUKESHA WI 53186
ORS / ORS
414-255-5559
JOHN K KONKEL MD
N84 W 16889 MENOMONEE
MENOMONEE FALLS WI 53051
ORS / ORS
414-251-7500
KURT F KONKEL MD
N84 W 16889 MENOMONEE
MENOMONEE FALLS WI 53051
PD / PD
414--569-2300
ROBERT W KRIEGER MD
915 E SUMMIT AVENUE
OCONOMOWOC WI 53066
ORB / ORS
414-544-531 1
ALFRED E KRITTER MD
223 WISCONSIN AVENUE
WAUKESHA WI 53186
AI PDA / AI PD
414-255-7060
S PAUL KUWAYAMA MD
WiaO N7950 TOWN HALL
POST OFFICE BOX 427
MENOMONEE FALLS WI 53051
PM / PM
414-548-1932
WILLIAM J LA JOIE MD
S32 W27641 DALEVIEW DR
WAUKESHA WI 53188
R DR NM / DR NM
414-785-2161
JOHN P LAMMERS MD
19333 W NORTH AVENUE
BROOKFIELD WI 53005
EM / EM
414-782-1548
MARK G LANGENFELD MD
1645 LEGION DRIVE
ELM GROVE WI 53122
FP
JULIE. N LARSEN MD
400 FAIRVIEW AVENUE
WAUKESHA WI 53186
AN / AN
414-251-1000
RUDOLFO S LASTRILLA MD
W180 N8085 TOWN HALL
MENOMONEE FALLS WI 53051
AN
KENNETH C LEENHOUTS MD
W250 56475 CENTER ROAD
WAUKESHA WI 53186
FP / FP
414-548-6903
RICHARD n LEWAN JR MD
434 MADISON STREET
WAUKESHA WI 53188
GS / GS
URIEL R LIMJOCO MD
W213 N5349 ADAMDALF DR
MENOMONEE FALLS WI 53051
OPH / OPH
41 4-547—3352
GREGORY R LOCHEN MD
102 EAST MAIN STREET
WAUKESHA WI 53186
P / PN
414-542-7404
MICHAEL J LOGAN MD
3610 HICKORY LANE
OCONOMOWOC WI 53066
DR P / R PN
WILLIAM T LUCKEY MD
1545 WEST SPRUCE COURT
RIVER HILLS WI 53217
IM
DONALD M LUEDKE MD
POST OLFICE BOX 544
BROOKFIELD WI 53005
PTH
GARY J MADAY MD
1105 TERRACE DRIVE
ELM GROVE WI 53122-2039
DR / DR
414-785-2161
PETER N MADDEN MD
19333 W NORTH AVENUE
BROOKFIELD WI 53005
WAUKESHA— 89
PD
DALE H MANN MD
16040 SIESTA LANE
BROOKFIELD WI 53005
FP NM / NM
414-453-6565
RAJASHRI S MANOLI MD
10425 W NORTH AVENUE
MILWAUKEE WI 53226
D / D
414-255-7040
ROBERT W MAREK MD
WIBO N7950 TOWN HALL
POST OFFICE BOX 427
MENOMONEE FALLS WI 53051
OTO / OTO
DEAN L MART I NELL I MD
888 THACKERAY TRAIL
OCONOMOWOC WI 53066
IM EM / IM
414-547-0000
TIMOTHY G MC AVOY MD
148 WISCONSIN AVENUE
WAUKESHA WI 53186
OPH
602-895-9594
GLEN E MC CORMICK MD
26422 S CEDAR CREST DR
SUN LAKES AZ 85224
OPH / OPH
414-547-3352
MICHAEl R MC CORMICK MD
102 EAST MAIN STREET
WAUKESHA WI 53186
U / U
414-547-3600
TIMOTHY H MC DONELL MD
nil DEL AFIELD STREET
WAUKESHA WI 53188
ORS / ORB
414-255-7855
ROBERT E MC WHIRTER MD
N8S W 166 16 MAIN STREET
MENOMONEE FALLS WI 53051
GS / GS
414-542-2581
WILLIAM MERKOW MD
324 WEST MAIN STREET
WAUKESHA WI 53186
IM CD / IM
414-251-7500
STEVEN L MERRY MD
N84 W 16889 MENOMONEE
MENOMONEE FALLS WI 53051
OBG
MATTHEW A MEYER MD
W290 N 3159 HILLCREST
PEWAUKEE WI 53072
AN / AN
414-567-7151
G DANIEL MILLER MD
37880 FOREST DRIVE
OCONOMOWOC WI 53066
PTH / AP CLP
414-546-6350
MARVIN D MILLER MD
8901 W LINCOLN AVENUE
WEST ALLIS WI 53227
ORS / ORB
OWEN E MILLER MD
1405 l.DOKOUT DRIVE
WAUKESHA WI 53186
FP / f P
414-786-5534
JOHN P MODRZYNSKI MD
17400 WEST NORTH AVE
BROOKFIELD WI 53005
EM / EM
414-544-2267
CLAUD E MORGAN MD
6245 N WOODS IDE ROAD
NASHOTAH WI 53058
FP EM
414-784-1249
BETH ANNE MORSTAD MD
2400 DECARLIN DRIVE
BROOKFIELD WI 53005-3922
GS / GS
414-542-9466
ALBERT J MOTZEL JR MD
nil DELAFIELD STREET
WAUKESHA WI 53186
ORS / ORS
KARL H MUELLER MD
2015 HOLLYHOCK LANE
ELM GROVE WI 53122
OPH
JAMES H NAGEL MD
nil DELAFIELD STREET
WAUKESHA WI 53186
D IM / D IM
414-567-0247
RICHARD E NEILS MD
888 THACKERAY TRAIL
OCONOMOWOC WI 53066
R / R
414-782-2488
ALBERT A NEMCEK MD
2970 SANTA MARIA DRIVE
BROOKFIELD WI 53005
FP OM
414-547-6699
JAMES L NOLAN JR MD
235 HARRISON AVENUE
WAUKESHA WI 53186
CLP
THOMAS C NOLASCO JR MD
19333 W NORTH AVENUE
BROOKFIELD WI 53005
AN / AN
PAUL J NOVACEK MD
16730 RIDGEVIEW DRIVE
BROOKFIELD WI 53005
OM / GS
414-544-1300
STANLEY J NULAND MD
W228 N683 WESTMOUND DR
WAUKESHA WI 53186
PD
414-549-5624
JOSEPH P 0' GRADY JR MD
nil DELAFIELD STREET
WAUKESHA WI 53186
IM / IM
MICHAEL G O'MARA MD
888 THACKERAY TRAIL
OCONOMOWOC WI 53066
N / PN
OWEN OTTO MD
34810 PABST ROAD
OCONOMOWOC WI 5306O
OTO HNS A / OTO
414-784-7150
JOHN R PARK MD
17050 W north avenue
BROOKFIELD WI 53005
DR / R
JAN D PEARCE MD
12778 W NORTH AVENUE
BROOKFIELD WI 53005
GP
MIODRAG B PECARSKI MD
171 WOLF DRIVE
DOUSMAN WI 53118
OTO / OTO
414-255-7045
KENNETH R PETERS MD
W180 N7950 TOWN HALL
POST OFFICE BOX 427
MENOMONEE FALLS WI 53051
GYN OBG
414-547-3434
JACK A PETERSON MD
SUITE 434
217 WISCONSIN AVENUE
WAUKESHA WI 53186
ORS / ORS
414-786-2875
JOHN R PHILLIPS MD
890 ELM GROVE ROAD
POST OFFICE BOX 103
ELM GROVE WI 53122
ORB / ORS
CALMAN S PRUSCHA II MD
888 THACKERAY TRAIL
OCONOMOWOC WI 53066
AN
414-547-8410
ROBERT V PURTOCK MD
2907 FARMVIEW COURT
WAUKESHA WI 53186
CD IM
414-251-7500
ALBERTO S QUERIMIT MD
N84 W 16889 MENOMONEE
MENOMONEE FALLS WI 53051
FP / FP
JOHN L RASCHBACHER MD
434 MADISON STREET
WAUKESHA WI 53186
U / U
414-542-1001
ROBERT J RASMUSSEN MD
nil DELAFIELD STREET
WAUKESHA WI 53186
FP FP
414-549-9100
ROBERT 1 REICHLE MD
W228 N683 WESTMOUND DR
WAUKESHA WI 53186
FP
414-548-6903
HOPE M RICE MD
434 MADISON STREET
WAUKESHA WI 53188
R / H
ALPHONSE M RICHTER MD
725 AMERICAN AVENUE
WAUKESHA WI 53186
OBG / OBG
414-544-2801
ANNE M RIENDL MD
POST OFFICE BOX 1907
WAUKESHA WI 53187-1907
GS CDS / GS
414-255-2500
JOHN D RIESCH MD
POST OFFICE BOX 427
MENOMONEE FALLS WI
53051-0427
IM CD
414-569-2300
MICHAEL J RIETBROCK MD
915 EAST SUMMIT AVENUE
OCONOMOWOC WI 53066
GS •' GS
414-255-2500
THOMAS H ROBERTS MD
W180 N7950 TOWN HALL
POST OFFICE BOX 427
MENOMONEE FALLS WI 53051
GP
414-567-3232
ALBERT F ROGERS MD
POST OFFICE BOX 26
OCONOMOWOC WI 53066
FP / FP
414-363-7142
WILBUR E ROSENKRANZ MD
225 EAGLE LAKE AVENUE
MUKWONAGO WI 53149
EM
608-255-5043
JOHN W ROWE MD
201 BRAM STREET
MADISON WI 53713
PTH
PAUL J RYKWALDER MD
885 TANGLEWOOD DRIVE
BROOKFIELD WI 53005
EM / IM
414-351-3122
HENRY I SAPERSTEIN MD
7370 NORTH SENECA ROAD
FOX POINT WI 53217
PD
DENNIS J SARAN MD
1717 PARAMOUNT
WAUKESHA WI 53186
AN
414-781-3467
KENT C SCHAEFER MD
4720 LINCREST DRIVE
BROOKFIELD WI 53005
OPH /• OPH
EDWIN H SCHALMO JR MD
POST OFFICE BOX 203
MUKWONAGO WI 53149
PTH CLP / PTH
JAY F SCHAMBERG MD
S47 W22060 LAWNSDALE
WAUKESHA WI 53186
D
414-251-7500
BETH A SCHENCK MD
N84 W 16889 MENOMONEE
MENOMONEE FALLS WI 53051
R ON TR
414-781-5057
KEVIN L 5CHEWE MD
16430 TIA COURT
BROOKFIELD WI 53005
OBG / OBG
414-542-2531
CLAUDE W SCHMIDT MD
217 WISCONSIN AVENUE
WAUKESHA WI 53186
OBG OBG
414-255-2500
ROBERT D SCHMIDT MD
W180 N7950 TOWN HALL
POST OFFICE BOX 427
MENOMONEE FALLS WI 53051
AN ' AN
ROBERT H SCHOENEMAN MD
2420 N 94TH STREET
WAUWATOSA WI 53226
OBG -• OBG
THOMAS A SCHROEDER MD
915 EAST SUMMIT AVENUE
OCONOMOWOC W! 53066
I M . I M
414-569-2300
BERNHARD J SCHUMACHER MD
915 SUMMIT AVENUE
OCONOMOWOC WI 53066
90—WAUKESHA, WAUPACA
FF FP
414-251-7500
ROBFRT L SCHWARZ MD
NB4 W168B9 MFNOMDNEE
MENOMONEE FAU.S WI 53051
GS
414-542-4980
LINDA L SELL MD
3235 S JOHNSON ROAD
NEW BERLIN WI 53151
GS / GS
414-786-3722
ROBERT H SEWELL MD
17050 W NORTH AVENUE
BROOKFIELD WI 53005
N
414-255-7020
MICHAEL J SHAENBOEN DO
W180 N7950 TOWN HALL
MENOMONEE FALLS WI 53051
PD / PD
414-542-2536
LAWRENCE K SIEGEL MD
nil DELAFIELD STREET
WAUKESHA WI 53186
AN / AN
414-542-0028
JAMES T SMALL JR MD
904 TENNY AVENUE
WAUKESHA WI 53186
GP GS
WARRFN G SMIRL MD
723 CLINTON STREET
WAUKESHA WI 53186
D / D
414-542-9241
WILLIAM D SMITH MD
217 WISCONSIN AVENUE
WAUKESHA WI 53186
OBG / OBG
414-786-6420
JAMES A STADLER II MD
17000 W NORTH AVENUE
BROOKFIELD WI 53005
FP / FP
414-251-7500
JERREL I. STANLEY MD
N84 W 16889 MENOMONEE
MENOMONEE FALLS WI 53051
AN / AN
414-691-3962
RONALD W STEIN MD
W272 N2141 FIELDHACK
PEWAUKEE WI 53072
FP / FP
414-628-3859
THOMAS E STEINMETZ MD
W202 N11S51 MERKEL DR
GERMANTOWN WI 53022
IM
414-542-2581
AARON SWEED MD
324 WEST MAIN STREET
WAUKESHA WI 53186
FP
414-544-5791
GWENDOLYN TANEL MD
482 ORCHARD AVENUE
WAUKESHA WI 53186
OPH / QPH
THOMAS F TAYLOR MD
888 THACKERY TRAIL
OCDNOMOWOC WI 53066
AN
414-255-1 393
ROBERT L TEMPLE MD
N85 W 15702 MENOMONEE
RIVER PARKWAY
MENOMONEE FALLS WI 53051
FP
DAVID C THIES MD
100 SOUTH WASHINGTON
POST OFFICE BOX 547
ELKHDRN WI 53121-0547
PTH / PTH
THOR M THORGERSEN MD
20840 BROOK PARK DRIVE
WAUKESHA WI 53186
P / P
414-255-7020
PAUL C TODD MD
W18C N7750 TOWN HALL
MENOMONEE FALLS WI 53051
HS ORS / ORS
414-786-30P0
LEE M TYNE MD
17050 W NORTH AVENUE
BROOKFIELD WI 53005
PD / PD
DAVID 0 ULERY MD
915 EAST SUMMIT AVENUE
OCDNOMOWOC WI 53066
R NM / R NM
414-544-2431
JOHN T UNDERBERG MD
725 AMERICAN AVENUE
WAUKESHA WI 53186
IM
MICHAEl J UNGER MD
W180 N7950 TOWN HALL
MENOMONEE FALLS WI 53051
N / N
SCOTT D VAN STEEN MD
W180 N7950 TOWN HALL
MENOMONEE FALLS WI 53051
PTH CLP / PTH CLP
414-544-2286
SOM D VARMA MD
3471 1 FAIRVIEW ROAD
DCONDMOWDC WI 53066
FP
414-547-4490
NED F VASQUEZ MD
1133 SUMMIT AVENUE
WAUKESHA WI 53186
PM / PM
414-259-1414
SRIDHAR V VASUDEVAN MD
1000 NORTH 92ND STREET
MILWAUKEE WI 53226
FP
GERALD R VERSTOPPEN MD
940 S ST AUGUSTINE ST
PULASKI WI 54162
FP / FP
414-786-6520
ROBERT S VIEL MD
18735 PLEASANT STREET
BROOKFIELD WI 53005
GP / FP
MARCIANO C VISAYA MD
146 PARK AVENUE
PEWAUKEE WI 53072
AN / AN
JOHN J VONDRELL MD
2025 BURNWOOD COURT
BROOKFIELD WI 53005
IM GE / IM
ROBERT S WAGNER MD
915 EAST SUMMIT AVENUE
OCDNOMOWOC WI 53066
CDS IM / IM
RICHARD J WAKEFIELD MD
1622 NORTH HAWLEY ROAD
MILWAUKEE WI 53208
I M / I M
414-547-6240
JOHN W WAKELY MD
403 NORTH GRAND AVENUE
WAUKESHA WI 53186
PD / PD
414-784-1597
FRANK A WALKER MD
HAMAD general HOSPITAL
P 0 BOX 3050 DOHA
QATAR. ARABIAN GULF
OBG
414-544-441 1
ROBERT L WARTH MD
nil DELAFIELD STREET
WAUKESHA WI 53186
P CHP / P
WILLIAM N WATSON MD
888 THACKERAY TRAIL
OCDNOMOWOC WI 53066
FP / FP
MARVIN WIENER MD
12500 W BLUEMOUND RD
ELM GROVE WI 53122
PD / PD
414-569-2231
MARK P WE SSL I NG MD
915 EAST SUMMIT AVENUE
OCDNOMOWOC WI 53066
FP / FP
HERBERT C WHITE DO
W312 S4272 HIGHWAY 83
POST OFFICE BOX 188
GENESEE DEPOT WI 53127
OPH / OPH
OTTO A WIEGMANN MD
17050 W NORTH AVENUE
BROOKFIELD WI 53005
GP
JAMES F WILKINSON MD
915 SUMMIT AVENUE
OCDNOMOWOC WI 53066
OPH OTO
PHILIP M WILKINSON MD
915 SUMMIT AVENUE
OCDNOMOWOC WI 53066
FP
414-363-7142
THOMAS H WILLIAMS MD
225 EAGLE LAKE AVENUE
MUKWONAGO WI 53149
FP / FP
THOMAS F WINTERS MD
2814 N UNIVERSITY DR
WAUKESHA WI 53188
AN
414-352-6275
SUNG-KYUN WOO MD
1840 W WOODBURY LANE
GLENDALE WI 53209
FP / FP
DONALD L WOOD MD
17400 W NORTH AVENUE
BROOKFIELD WI 53005
ORS / ORS
414-786-3090
JAMES P WOOD MD
17050 W NORTH AVENUE
BROOKFIELD WI 53005
PTH FOP / PTH FOP
414-548-7575
HELEN M COOPER -YOUNG MD
OFC OF THE MED EXAM'R
515 W MORELAND BLVD
WAUKESHA WI 53186
FP . FP
414 662- 3331
FLOrC M 2ARB0CK MD
S88 W22915 MAPLE ST
DIG BEND WI 53103
CHP P , CHP P
414-964-4830
RICHARD C ZIMMERMAN MD
N89 W16785 APPLETON AV
MENOMONEE FALLS WI 53051
WAUPACA
GS / GS
71 5 3 ~^>25 1
PAUlINO g’^BELGADO MD
61 ANNE STREET
CLINTONVILLE WI 54929
GS / GS
BARTON J BLUM MD
710 RIVERSIDE DRIVE
POST OFFICE BOX 387
WAUPACA WI 54931
FP / FP
715-253-2909
MARSHALL 0 BOUDRY MD
122 WEST UNION STREET
WAUPACA WI 54981
FP / FP
ROY R BUCHHOLZ MD
POST OFFICE BOX 26
WEYAUWEGA WI 54983
FP / FP
715-258-1160
GILBERT C DURGSTEDE MD
710 RIVERSIDE DRIVE
POST OFFICE BOX 387
WAUPACA WI 54981
GP OBG
715-823-651 1
HARRY S CASKEY MD
61 ANNE STREET
CLINTONVILLE WI 54929
FP / FP
715-258-1160
ROBERT A DENT MD
POST OFFICE BOX 387
WAUPACA WI 54981-0387
FP / FP
715-823-5161
CYNTHIA A EGAN MD
32 HUGHES STREEET
CLINTONVILLE WI 54929
FP / FP
414-982-3606
DONN D FUHRMANN MD
1420 ALGOMA STREET
NEW LONDON WI 54961
GP GS
LUIS L GALANG MD
POST OFFICE BOX 282
NEW LONDON WI 54961
FP / FP
414-596-3435
CESAR A GARVIDA MD
425 SECOND STREET
MANAWA WI 54949
FP
LESLIE H GRAY MD
32 HUGHES STREET
CLINTONVILLE WI 54929
PTH CLP / PTH CLP
715-258-9001
PETER C HAMEL MD
ROUTE 4 BOX 191
WAUPACA WI 54981
WAUPACA, WINNEBAGO— 91
R
414-98P-3769
DAVID A HAMMES MD
1405 MILL STREET
NEW LONDON WI 54961
FP / FP
715-754-5267
ROBERT D HEINEN MD
725 WEST RAMSDELL
POST OFFICE BOX 474
MARION WI 54950
GP
LAWRENCE F HEISE MD
61 ANNE STREET
CLINTONVILLE WI 54929
GP
NUMERIANO J HOLLERO MD
POST OFFICE BOX 291
lOLA WI 54945
FP / FP
71 5-258-1 193
D MARK LOCHNER MD
710 RIVERSIDE DRIVE
POST OFFICE BOX 387
WAUPACA WI 54981
FP / FP
414-867-3141
LLOVD P MAASCH MD
206 SOUTH MILL STREET
POST OFFICE BOX 250
WEYAUWEGA WI 54983
GP
715-258-8667
HOWARD J MC GINN IS MD
323 S WASHINGTON ST
WAUPACA WI 54981
FP / PP
715-258-1 187
ROBERT L PETERSON MD
710 RIVERSIDE DRIVE
POST OFFICE BOX 387
WAUPACA WI 54981
FP GER / FP
715-258-4240
PAUL A PFARR MD
POST OFFICE BOX 146
KING WI 54946-0146
PTH FP / FP
GENEROSD N RODRIGUEZ MD
FAIRVIEW DRIVE
NEW LONDON WI 54961
FP / FP
715-258-1173
JERRY R SALAN MD
710 RIVERSIDE DRIVE
POST OFFICE BOX 387
WAUPACA WI 54981
GP
HERMAN C SCHMALLENBERG MD
502 WF;ST DEACON AVENUE
NEW LONDON WI 54961
GP
715-258-3434
JOHN H STEINER MD
208 EAST UNION STREET
POST OFFICE BOX 369
WAUPACA WI 54981
FP / FP
414-982-3606
ALAN D STROBUSCH MD
1420 ALGOMA STREET
NEW l.ONDON WI 54961
GP
CLARENCE A TOPP MD
95 north MAIN STREET
CLINTONVILLE WI 54929
FP / FP
414-982-3421
JOSEPH W WEBER MD
525 HIGH STREET
NEW LONDON WI 54961
GS / GS
414-982-3606
CARLOS C YU MD
1420 ALGOMA STREET
NEW LONDON WI 54961
WINNEBAGG
p
HERBERT M ALLEN MD
111 E WISCONSIN AVENUE
NEENAH WI 54956
CD IM / IM
MAMQUN B AL-NOURI MD
515 DOCTORS COURT
OSHKOSH WI 54901
ORS PYM / ORB
GAY R ANDERSON MD
111 E NORTH WATER ST
NEENAH WI 54956
GP
GERHARD R C ANDERSON MD
APT 702
1101 CRYSTAL LAKE DR
POMPANO BEACH FL 33064
P / P
414-725-1810
GEORGE W ARNDT MD
706 EAST FOREST AVENUE
NEENAH WI 54956
U / U
414-722-7747
SAFOUH A ATASSI MD
169 E NORTH WATER ST
NEENAH WI 54956
DR NM / DR NM
414-233-8060
JOHN F AUFDERHEIDE MD
261 6A FOND DU LAC ROAD
OSHKOSH WI 54901
IM GE .■ IM
414-727-4200
JOSEPH F BACHMAN MD
411 LINCOLN STREET
NEENAH WI 54956
P / P
414-233-4557
RALPH K BAKER MD
418 JEFFERSON STREET
OSHKOSH WI 54901
I M / 1 M
CURT IS C BALTZ MD
POST OFFICE BOX 1009
NEENAH WI 54956
AN / AN
414-233-7455
JAMES H FHARBOUR MD
1322 MENOMINEE DRIVE
OSHKOSH WI 54901
DBG / OBG
F BARTIZAL JR MD
1370 S COMMERCIAL ST
NEENAH WI 54956
IM
414-233-4270
JAMES L BASILIERE MD
414 DOCTORS COURT
OSHKOSH WI 54901
AN / AN
DEEDRIC W BAUER MD
POST OFFICE BOX 504
NEENAH WI 54956
DR / DR
414-725-1 141
LAWRENCE L BAUER MD
2437 FOREST MANOR CT
NEENAH WI 54956
IM / IM
414-231-5855
DEAN B BECKER JR MD
ROOM 407
404 NORTH MAIN STREET
OSHKOSH WI 54901
AN
414-729-9239
SCOTT A BEHRENS MD
459 EMERSON
NEENAH WI 54956
GP
414-622-3950
REUBEN H BITTER MD
ROUTE 2 BOX 947
WILD ROSE WI 54984
PTH CLP / PTH CLP
CHARLES I BOWERMAN MD
631 HAZEL STREET
OSHKOSH WI 54901
EM FP / FP
TIMOTHY L BOWERS MD
1375 LAKE BREEZE ROAD
OSHKOSH WI 54901
ORS / ORS
JOHN S BOYLE MD
510 DOCTORS COURT
OSHKOSH WI 54901
ORB / ORS
414-236-3257
DAVID G BRYANT MD
400 CEAPE AVENUE
OSHKOSH WI 54901
ORS / ORS
414-233-6000
ROY E BUCK MD
POST OFFICE BOX 165
OSHKOSH WI 54902-0165
IM / IM
JAMES R BURNS MD
508 QUARRY LANE
NEENAH WI 54956
U / U
414-727-4200
JOHN T CAMPBELL MD
411 LINCOLN STREET
NEENAH WI 54956
CDS TS GS / TS GS
ROBERT G CARLSON MD
DEPT OF SURGERY
VA MEDICAL CENTER
BIG SPRING TX 79720
A PD / AI PD
414-727-4200
CHI AW C CHARaVEJASARN MD
411 LINCOLN STREET
NEENAH WI 54956
AN
MAN Y CHOI MD
612 CHATHAM COURT
NEENAH WI 54956
FP / FP
414-727-4213
DAVID L CHRISTOPHERSON MD
411 LINCOLN STREET
NEENAH WI 54956
GS HS / GS
414-236-3240
DAVID D CLARK MD
400 CEAPE AVENUE
OSHKOSH WI 54901
GS
414-231-1767
WILLIAM E CLARK MD
4060 WINDERMERE LANE
OSHKOSH WI 54901
OPH / OPH
414-235-3303
GERALD P CLARKE MD
509 S WASHBURN AVENUE
POST OFFICE BOX 2623
OSHKOSH WI 54903-2623
P / P
414-722-1033
HARRY J COLGAN MD
1215 DOCTORS DRIVE
NEENAH WI 54956
OPH OTO / OPH
414-733-6137
JOHN E CONWAY MD
1203 NICOLET CIRCLE
APPLETON WI 54915
DTD / OTO
414-236-3280
WILLIAM A CRAWFORD MD
400 CEAPE AVENUE
OSHKOSH WI 54901
GS
414-727-4200
JOHN M CROWE MD
411 LINCOLN STREET
NEENAH WI 54956
U / U
EARL F CUMMINGS MD
1 1 1 1 EVANS ST
OSHKOSH WI 54901
PTH / PTH
VINCENT H DAHL MD
631 HAZEL STREET
OSHKOSH WI 54901
EM GP
414-235-4607
HAROLD J DANFORTH MD
1424 CONRAD STREET
OSHKOSH WI 54904
IM OM / IM
414-721-5881
ROBERT E DEDMON MD
2100 WINCHESTER ROAD
NEENAH WI 54956
P
JULITA M DE GUZMAN MD
APT 128
571 WEST ARNDT STREET
FOND DU LAC WI 54935
FP FM
414-725-1269
HUGH F DE MOREST JR MD
502 SURREY LANE
NEENAH WI 54956
R / R
414-727-4200
CHARLES P DILIBERTI MD
W4878 ESCARPMENT TERR
MENASHA WI 54952
DR / DR
414-725-0235
JERRY C DOSS MD
724 YORKSHIRE ROAD
NEENAH WI 54956
R NR / R
414-722-1 582
ROBERT F DOUGLAS MD
155 POPLAR COURT
NEENAH WI 54956
92— WINNEBAGO
OPH / OPH
414-235-0066
EDWTN L UOWNING t>1D
719 DOCTORS COURT
OSHKOSH HI 54901
GP
414-582-79S7
LORFN J DRISCOLL MD
226 north ninth AOENUE
KlINNECONNE HI 54986
OPH '■ OPH
414-235-5151
STEPHEN S DUDLEY HD
503 DOCTORS COURT
OSHKOSH WI 54901
I M / I H
HICHAEL A DUEFY HD
650 DOCTORS COURT
OSHKOSH WI 54901
OPH UTO / OPH UTQ
PAUL S EHRICh HD
3880 IRUNWOOD LANE
BRADENTON FL 33529
D > D
414-725-565P
JOHN W F'ADLR HD
1424 S COHHERCIAl ST
NEENAH WI 54956
PTH CLP > PTH CLP
414-729-JOOl
OWEN L HELTON MD
130 SECOND STREET
NEENAH WI 54956
R NH R Nh
414-722--! 582
TIMOTHY r FEaHERTY MD
547 E WISCONSIN AVENUE
NEENAH WI 54956
IM END / IH end
414-727-4352
THOMAS P FOX MD
411 LINCOLN STREET
NEENAH WI 54950
FP / HP
414-275-5167
WOJCIECH A GADOWSKI MD
402 EDGEWODD DRIVE
NEENAH WI 54950
P
414-725-8285
GERAl.D a GEHL MD
1215 DOCTORS DRIVE
NEENAH WI 54956
PD / PP
414-727-4430
NATAL. IF L GEHRIMGER MD
878 AIRPORT ROAD
MENAbHA WI 54952
PD '■ PD
414-727-4201
ROBERT E GEHRINGER JR MD
411 LINCOLN STREET
NEENAH WI 54956
OPH
414-725-3204
BARBARA GELDNER MD
240 FIRST STREET
NEENAH WI 54956
NS / NS
414-727-4210
MICHAEL M GEl-DNER MD
POST OLFICE BOX 1009
NEENAH WI 54956
CD IM / IM CD
KENNETH A GELLER MD
POST OFFICE BOX 1009
NEENAH WI 54956
CLP / PTH
PAUL N GDHDES MD
130 SECOND STREET
NEENAH WI 54956
GS
LOUIS n GRABER MD
1400 BROOKS LANE
OSHKOSH WI 54901
U / U
813-799-6457
ALBERT P GRAHAM MD
APT 54
2072 AUSTRALIA WAV W
CLEARWATER FL 33575-3699
RHU IM ' RHU IM
414-727- 4200
JOHN T GRANDONE MD
411 LINCOL.N STREET
NEENAH WI 54956
GS / gS
414-727-4232
JOHN H GRAV MD
411 LINCOLN STREET
NEENAH WI 54956
GP IM
414-235 1383
BENJAMIN S GREENWOOD MD
400 CEAPF AVENUE
OSHKOSH WI 54901
OTO ■' OTO
414-727-4200
REX C GHOMER MD
411 LINCOLN STREET
NEENAH WI 54956
I M / I M
414-231 -0703
VERNON G GUENTHER MD
1003 EVANS STREET
OSHKOSH WI 54901
IM
414-725-8228
ERDAL Y GURSOY MD
1416 S commercial ST
NEENAH WI 54956
GP
414-725-3191
GLENN E GUSTAFSON MD
POST OFFICE BOX 420
MENASHA WI 54952
N / N
414-233-5580
AHMAD Y HAFFAR MD
2023 N POINT STREET
OSHKOSH WT 54901
GP
414-231 -6338
WARREN V HAHN MD
1220 WEST NEW YORK
OSHKOSH WI 54901
DBG / OBG
414-727-4304
CHARLES HAMMOND MD
411 LINCOLN STREET
NEENAH WI 54956
I M / I M
414-231 -3737
JAMES J HANUSA MD
650 DOCTORS COURT
OSHKOSH WI 54901
CDS TS
414-725-7060
HAROLD W HARDING MD
240 FIRST STREET
NEENAH WI 54956
GPM OS OS
JOHN R HASELDW MD
no W NORTH water ST
NEENAH WI 54956
IM NEP
414-727-4200
DAVID S HATHAWAY MD
411 LINCOLN STREET
NEENAH WI 54°56
R / R
414-727-4200
SUE A HAUSSERMAN DUGAN MD
411 LINCOLN STREET
NEENAH W) 54956
GP FP
414-685-6403
DARRELL F M HAY MD
323 JEFFERSON AVENUE
OMRO WI 54963
PTH CLP /■ PTH CLP
414-729-3009
H CULLEN HENSHAW MD
130 SECOND STREET
NEENAH WI 54956
IM PUD / IM
414-/27-4250
FREDRIC L HILDEBRAND MD
411 LINCOLN STREET
NEENAH WI 54956
P
414-235-4910
KURT A HOEHNE MD
1841 NORTHPOINT STREET
OSHKOSH WI 54901
PD PD
JOHN E HOGGATT MD
111 E NORTH WATER ST
NEENAH WI 54956
OBG / OBG
414-231 -0710
ROBERT J HOLLY MD
712 DOCTORS COURT
OSHKOSH WI 54901
CDS TS GS / GS
414-725-7060
JOHN F HUBERT JR MD
995 BRIGHTON DRIVE
MENASHA WI 54952
PD / PU
414-231-1680
JOHN B HUGHES MD
645 DOCTORS COURT
OSHKOSH WI 54901
I M / I M
414-231-3737
RICHARD C HUGHES MD
650 DOCTORS COURT
OSHKOSH WI 54901
GS / GS
414-236-3240
ROBERT G ISOM MD
400 CEAPE AVENUE
OSHKOSH WI 54901
GP
RICHARD A JENSEN MD
POST OFFICE BOX 656
MENASHA WI 54952
NEP TM / NEP IM
414-727-4262
RICHARD H KAMMENZIND MD
411 L INCOLN STREET
NEENAH WI 54956
PD / PD
LARRY P KAMMHOLZ MD
645 DOCTORS COURT
OSHKOSH WI 54901
IM / IM
414-725-2070
JOHN R KEEGAN MD
222 S WASHINGTON ST
POST OFFICE BOX 657
MENASHA WI 54952-0657
P / P
414-235-5100
THOMAS J KELLEY MD
POST OFFICE BOX 266
BUTTE DES MORTS WI 54927
ORS / ORS
414-727-4283
WILLIAM F KENNEDY MD
411 LINCOLN STREET
NEENAH WI 54956
PD NPM / PD
414-727-4276
HOWARD L KIDD MD
411 LINCOLN STREET
NEENAH WJ 54956
OPH / OPH
CLEMENS G KIRCHGEDRG MD
148 PALO VERDE DRIVE
LEESBURG FL 32748
GP
414-236-3221
THOMAS M K IVLIN MD
400 CEAPP: AVENUE
OSHKOSH WI 54901
FP / FP
414-727-4410
RICHARD D KLAMM MD
411 LINCOLN STREET
NEENAH WI 54956
R NM NR / R
414-722-1 532
FRED E KLEIN MD
1209 S COMMERCIAL ST
NEENAH WI 54956
FP / FP
MICHAEl S KNIEP MD
1194 SAWTELL COURT
OSHKOSH WI 54901
I M ON / I M
414-727-4239
JOHN P KONSEK MD
411 LINCOLN STREET
NEENAH WI 54956
GP OM
414-721 -5901
MARY K KING-KUBIAK MD
2100 WINCHESTER ROAD
NEENAH WI 54956
GP GS
414-231-5014
RAYMOND V KUHN MD
1830 LAKE BREEZE ROAD
OSHKOSH WI 54901
D JM / D IM
414-727-4200
GARY M l.AMPS MD
411 LINCOLN STREET
NEENAH WI 54956
AN
414-725-9121
OWEN E LARSON MD
POST OFFICE BOX 1027
NEENAH WI 54956
AN / AN
414-231-4337
JOHN A lLSCHKE MD
1536 WHITE SWAN DRIVE
OSHKOSH WI 54901
NS NS
414-231-9052
MARC A LETELLIER MD
4085 WINNEGAMMIE ROAD
NEENAH WJ 54956
IM
EDWARD R LOFTUS MD
1416 S COMMERCIAL ST
NEENAH WI 54956
WINNEBAGO— 93
EM KP / FP
THOMAS J LUETZOW MD
5157 NORTH LOOP ROAD
LARSEN WI 54747
P
BARBARA M MOUNTS MD
130 SECOND STREET
NEENAH WI 54756
FP EM / FP
PAUL M PLUEDDEMAN MD
ROUTE 3 BOX 727
WAUTOMA WI 54792
OBG / OBG
FREDERICK 1. SCHAEFER MD
1416 COMMERCIAL STREET
NEENAH WI 54756
ORS / ORS
414-725-5611
KIM H 1 ULLOFF MD
111 E NORTH WATER ST
NEENAH WI 54756
OBG / UBG
RICHARD C: MURRAY MD
712 DOCTORS COURT
OSHKOSH WI 54701
FP
414-730-0021
GEORGE N PRATT JR MD
150 RIUERVIEW COURT
APPLETON WI 54715-1007
GP
414-236-3270
NYAL M SCHEUERMANN MD
400 CEAPE AVENUE
OSHKOSH WI 54701
PD NPM / PD
414-727-4200
C MAC DONALD II MD
411 L INCOLN STREET
NEENAH WI 54756
N / N
414-725-7073
H A ABDUL MAJID MD
240 FIRST STREET
NEENAH WI 54756
GS / GS
414-235-6760
JOHAN A MATH I SDN MD
712 DOCTORS COURT
OSHKOSH WI 54701
P / P
414-233-1773
JOHN B MC ANDREW MD
2136 WHITE SWAN DRIVE
OSHKOSH WI 54701
IM / IM
414-727-4276
PAUL B MC AVOY MD
411 LINCOLN STREET
NEENAH WI 54756
FP / FP
THOMAS J MC COOL MD
400 ceape avenue
OSHKOSH WI 54701
FP
DONALD H MC DONALD MD
17 SOUTH THIRD AVENUE
WINNECONNE WI 54786
GS TS / GS TS
813-367-4725
JOHN J MC GLOIN MD
735 126TH AVENUE
TREASURE ISLAND FL 33706
AN / AN
813-367-4725
MARY T MC GLOIN MD
735 126TH AVENUE
TREASURE ISLAND FL 33706
R NM / R
414-235-1754
JOHN R MC KENZIE MD
415 S MEADOW STREET
OSHKOSH WI 54701
GP
81 3-263-2783
JAMES V MELI MD
4741 WEST BOULEVARD
NAPLES FL 33740
P IM / P IM
414-233-3715
EDWARD D MEYER MD
2107 DOTY STREET
OSHKOSH WI 54701
FP ■ FP
HARVEY MONDAY MD
5354 RIMWOOD LANE
OSHKOSH WI 54701
I M / I M
HAROLD C MORK MD
2034 N POINT STREET
OSHKOSH WI 54701
PTH / PTH
ROBERT D NEUBECKER MD
2346 HICKORY LANE
OSHKOSH WI 54701
OPH •• OPH
414-727-4286
KENNETH G NEWBY MD
411 LINCOLN STREET
NEENAH WI 54756
ORS / ORS
414-233-8550
PAUL C O'CONNOR MD
510 DOCTORS COURT
OSHKOSH WI 54701
AN . AN
THOMAS J 0 'REGAN MD
256 NORTH PARK STREET
NEENAH WI 54756
OTO / OTO
414-727-4285
DAVID M OSTROWSKI MD
411 L.INCOLN STREET
NEENAH WI 54756
OBG / OBG
414-727-4200
DONALD J PANSCH MD
411 LINCOLN STREET
NEENAH WI 54756
OBG / OBG
FRANK N PANSCH MD
APT 1002
4575 COVE CIRCLE
MADEIRA BEACH FL 33708
PM / PM
TAI J PARK MD
130 SECOND STREET
NEENAH WI 54756
P
LED B PERSSION MD
APT G
2771 DUDLEY DRIVE EAST
WEST PALM BEACH FL 33415
DM
GORDON W PETERSEN MD
APT 274
7300 WEST DEAN ROAD
MILWAUKEE WI 53223
P
414-23to-3223
JOHN T PETERSIK MD
400 CEAPE AVENUE
OSHKOSH WI 54701-5271
ORS / QR5
41 A-727-7300
JOSEPH E PI LON MD
POST OFFICE BOX 466
MENASHA WI 54752
P .' P
414-233-1773
ER CHANG PING JR MD
1627 HICKORY STREET
OSHKOSH WI 54701
OBG / OBG
414-231-0710
JAMES R PLDS MD
712 DOCTORS COURT
OSHKOSH WI 54701
GS / GP
414-727-4200
KEVIN F QUINN MD
411 LINCOLN STREET
NEENAH WI 54756
IM
CURTIS S RADFORD MD
17 SOUTH THIRD STREET
WINNECONNE WI 54786
PD / PD
414-727-4200
ROGER A RATHERT MD
411 LINCOLN STREET
NEENAH WI 54756
OTO HNS MFS / OTO
414-233-2400
JAMES R RAYMOND MD
515 DOCTORS COURT
OSHKOSH WI 54701
PD / PI)
414-727-4200
G DOUGLAS REILLY MD
411 LINCOLN STREET
NEENAH WI 54756
IM PD / IM
KIRTIDA N RINGWALA MD
1650 CLIFFVIEW COURT
OSHKOSH WI 54701
U / U
414-236-3238
RICHARD W ROBERTS MD
400 CEAPF AVENUE
OSHKOSH WI 54701
ORS / URS
414-233-8550
DAVID H ROMOND MD
510 DOCTORS COURT
OSHKOSH WI 54701
N / N
414-727-431 1
GIZELL M ROSETTI MD
411 LINCOLN street
NEENAH WI 54756
D / D
L THOMAS ROZUM MD
84 COUNTRY CLUB LANE
OSHKOSH WI 54701
R /■’ R
DONALD J RYAN MD
1207 S COMMERCIAL ST
NEENAH WI 54756
DR / DR
414-722- 1 582
MICHAiEL A SAN DRETTO MD
1207 5 COMMERCIAL ST
NEENAH WI 54756
ORS / ORS
414-722-7700
JAN C PAR NECK I MD
1416 S COMMERCIAL ST
NEENAH WI 54756
IM CD - IM CD
414-727-4355
EDWARD S SCANLAN MD
411 LINCOLN STREET
NEENAH WI 54756
ORS / OHS
PETER W SCHMITZ MD
2441 FORESTMANOR COURT
NEENAH WI 54756
GP PTH
316-663-8004
ROBERT L SCHWAB MD
807 LOCK LOMMOND
HUTCHINSON KS 67502
P
MARGARET J SEAY MD
1135 ELMWOOD AVENUE
OSHKOSH WI 54701
I M / I M
414-727-4200
WILLIAM F SICKELS MD
411 LINCOLN STREET
NEENAH WI
GS
FREDERICK
235 GRANT
NEENAH WI
P / PN
RICHARD B
102 SALLY
NEENAH WI
54756
H SMITH MD
STREET
54756
STAFFORD MD
LANE
54756
GS
MARVIN H STEEN MD
POST OFFICE BOX 1171
CAREFREE AZ 85331
ORS GS / ORS
414-727-4200
LYALL C STILP I I MD
41 1 LINCOLN STREET
NEENAH WI 54756
GS / GS
414-235-6360
LESLIE H STONE MD
1835 LAKE BREEZE ROAD
ROUTE 4
OSHKOSH WI 54704
OBG / OBG
RONALD L STREBEL MD
1370 S COMMERCIAL ST
NEENAH WI 54756
NS / NS
414-725-7071
RALPH I SUECHTING MD
240 FIRST STREET
NEENAH WI 54756
PD / PD
414-727-4200
JOHN D SWANSON MD
411 LINCOLN STREET
NEENAH Wi 54756
EM FP
414-727-2060
E ROBERT TAAKE MD
POST OFFICE BOX 444
NEENAH WI 54756
AN
414-725-0114
ANTONIO C TAlENS MD
106 WOODS IDE COURT
NEENAH WI 54756
R R
GRACE L I ARRAN! MD
W4878 ESCARPMENT TERR
MENASHA WI 54752
94— WINNEBAGO, WOOD
GS TS CDS / GS TS
414-725 4527
DANltL. S THEAHLE MD
169 E NORTH WATER ST
NEENAH WI 54956
R NM / R
DONALD C TURNER MD
411 KIlTlVER COURT
NEENAH WI 54956
P
414-235-4910
ALEX USPENSKY MD
POST OEFICE BOX 9
WINNEBAGO WI 54985
ORS / ORS
WALDO R VARBERG MD
1416 S COMMERCIAL ST
NEENAH WI 54956
DR NM / R
414-722-1582
ROBERT A VINCENT MD
1209 S COMMERCIAL ST
NEENAH WI 54956
N / N
414-233-5580
KENNETH M VISTE JR MD
631 HAZEL STREET
OSHKOSH WI 54901
IM IM
414-233-4270
WILLIAM G WEBER MD
414 DOCTORS COURT
OSHKOSH WI 54901
PD / PD
414-231-1680
CHARLES E WERNBERG MD
645 DOCTORS COURT
OSHKOSH WI 54901
IM / IM
414-233-4270
ROBERT L WESTON MD
414 DOCTORS COURT
OSHKOSH WI 54901
AN / AN
414-233-8118
TIMOTHY G WEX MD
1110 EVANS STREET
OSHKOSH WI 54901
GP
EARl B WILLIAMS MD
POST OFFICE BOX 740
OSHKOSH WI 54902
I M / I M
414-727-4200
EDWIN E WILSON MD
411 L INCOLN STREET
NEENAH WI 54956
R NM •• R
414-233-6241
ERIC B WILSON MD
4397 COUNTRY CLUB ROAD
OSHKOSH WI 54901
DBG / DBG
414-231-0710
RICHARD C WOLFGRAM MD
4596 BELL HAVEN LANE
OSHKOSH WI 54904
IM / IM
414-231-3737
ROLAND N WOODRUFF MD
650 DOCTORS PARK
OSHKOSH WI 54901
OBG
EUGENE N WRIGHT MD
12 ANCHORAGE
ROUTE 2
SALEM SC 29676
FP / FP
414-231-4164
LANCE E ZERNZACH MD
4466 FOND DU LAC ROAD
OSHKOSH WI 54901
GS / GS
414-235-6960
ERNEST J ZMOLEK MD
712 DOCTORS COURT
OSHKOSH WI 54901
OTO / OTO
715-387-5245
RUBEN T AGUAS MD
1000 NORTH OAK AVENUE
MARSHFIEID WI 54449
IM
MICHAEL G ALDRICH MD
1000 north oak avenue
MARSHFIELD WI 54449
IM
715-387-0376
JON W ALLEN MD
CLINIC 3F
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
IM
715-423-1300
william ALLEN MD
400 DEWEY STREET
WISCONSIN RAPIDS WI 54494
IM
715-421-0890
RICARDO A ALMONTE MD
THIRD FLOOR
400 DEWEY STREET
WISCONSIN RAPIDS WI 54494
GP IM
715-423-0122
NORBERT W ARENDT MD
1041 HILL STREET
WISCONSIN RAPIDS WI 54494
CRS GS / CRS GS
715-387-5321
CONSTANTS S AVECILLA MD
1000 north OAK AVENUP
MARSHFIELD WI 54449
PTH IP BLB / PTH IP
MARY C BALDAUF MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
IM FjN / IM MON
715-387-5134
TARIT K SANER JEE MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
PTH / PTH
EFSTATHIOS BELTAOS MD
1000 NORTH OAF AVENUE
MARSHFIELD WI 54449
OTO HNS / OTO
715-387-5245
FERNANDO B BERSAlONA MD
1000 NORTH DAK AVENUE
MARSHFIELD WI 54449
R DR X R
715-387-5261
KENNETH J BILLINGS MD
lOOO NORTH OAK AVENUE
MARSHFIELD WI 54449
RHU IM / RHU IM
715-387-5190
DAVID F BJARNASON MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
PD PNP / PD PNP
715-387-5154
EDWARD U BLAU MD
1000 NORTH DAK AVENUE
MARSHFIELD WI 54449
FP
WILBUR J BOULET MD
1000 NORTH DAK AVENUE
MARSHFIELD WI 54449
PD
414-739-0171
MONA S BOULOS MD
401 N ONEIDA STREET
APPLETON WI 54911
AN
715-387-7179
PHIL IP F BOYLE MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
IM CD
JOHN N BR DWELL JR MD
700 SOUTH DRAKE AVENUE
MARSHFIELD WI 54449
AN
JOHN L BURNS JR MD
600 MARYKNOLL AVENUE
MARSHFIEl.D WI 54449
OBG / OBG
715-397-5161
RAYMOND E BURR ILL MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
GS
JOSEFIND B CABALTICA MD
315 FIRST STREET
NEKOOSA WI 54457
IM PUD / IM PUD
715-387-5319
JOHN A CAMPBELL MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
:"P / FP
7 1 5-387-51 68
PHILLIP R CANFIELD MD
1000 NORTH DAK AVENUE
MARSHFIELD WI 54449
R R
ROBERT D CARLSON MD
1000 NORTH DAK AVENUE
MARSHFIELD WI 54449
PTH / PTH
715-387-7654
SHENG-HSIUNG CHANG MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
PD
715-387-2939
DDOl.EY YAT-SEN CHEN MD
1416 NORTH WOOD STREET
MARSHFIELD WI 54449
ORS
715-387-5202
HONG MO CHEN MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
PM / PM
DOMINIC S CHU MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
IN ■■ IM
RICHaRD w ClASEN MD
315 FIRST STREET
NEKOOSa WI 54457
FP / FP
715-423-1300
CHARLES CONGER MD
400 DEWEY STREET
WISCONSIN RAPIDS WI 54494
IM
JAMES P CONTERATD MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
END IM / IM END
GUERDON J COOMBS MD
1000 NORTH DAK AVENUE
MARSHFIELD WI 54449
IM GE
GLENN S CUSTER JR MD
1908 S PALMETTO AVENUE
MARSHFIELD WI 54449
IM NEP / IM NEP
715-387-5345
RICHARD A DART MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
IM
MICHAEL J DAWSON MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
P
WARWICK R DEAN MD
1403 N BROADWAY AVENUE
MARSHFIELD WI 54449
IM FP / IM FP
715-387-5471
NORMAN A DESBIENS MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
ORS / ORS
WOLFGANG 0 DIETSCHE MD
POST OFFICE BOX 1265
WISCONSIN RAPIDS WI 54494
IM RHU / IM RHU
715-387-5190
ANDREA DLESK MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
IM PUD / IM PUD
715-387-5319
WILLIAM V DDVENBARGER MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
NEP / NEP IM
715-387-5292
DOUGLAS P DUFFY MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
IM
715-423-0122
PAUL R EGGE MD
1041 HILL STREET
WISCONSIN RAPIDS WI 54494
OTO / OTO
715-387-5245
VICTOR S EJERCITO MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
715-387-6596
DAVID C ELMEER MD
422 bluebird LANE
MARSHFIELD WI 54449
IM CD / IM
715-387-9375
DEAN A EMANUEL MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
IM / IM
715-387-5434
SCOTT S ERICKSON MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
WOOD— 95
OPH / QPH
715-387-5236
CHARLES A ERR ICO MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
PM / PMR
HERBERT K FISCHER MD
1000 north OAK AVENUE
MARSHFIELD WI 54449
FP / FP
STEVEN M FONTANNINI DO
510 MARA I HON
MARSHFIELD WI 54449
PD N / PD
DAVID B FRENS MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
IM HEM / IM
WILLIAM R FRIEDENBERG MD
1000 north oak avenue
MARSHFIELD WI 54449
CD IM / IM
W BRUCF FYE MD
1000 north oak avenue
MARSHFIELD WI 54449
PTH / PTH
715-387-7654
KOSASIH S GANI MD
812 N COLUMBUS AVENUE
MARSHFIELD WI 54449
P CHP /• P CHP
715-389-5424
W WARREN GAR IT AND MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
D
BRVON GAUL MD
laiO BRITTANY PLACE
MADISON WI 53711
ON HEM / IM
JANE A GEHL5EN MP
710 SOUTH BIRCH AVENUE
MARSHFIELD WI 54449
GS
715-387-4441
STEVEN A GIUBEFFI MD
2809 W fifth STREET
MARSHFIELD WI 54449
IM RHU / IM RHU
JERRY W GOLDBERG MD
1000 north oak avenue
MARSHFIELD WI 54449
N / N
715-337-5352
PAUL G GOTTSCHALK MD
1000 north dak avenue
MARSHFIELD WI 54449
IM CD / IM CD
FRANK J GDUZE MD
10105 WILLOWCREEK CIR
SUN CITY AZ 85373
TR / TR R
715-387-7637
ROBERT H GREENLAW MD
1000 NORTH DAK AVENUE
MARSHFIELD WI 54449
PD CD / PD
715-387-5251
GEORGE G GRIESE JR MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
PD NPM / PD NPM
715-387-5251
JODY R GROSS MD
1000 NORTH oak AVENUE
MARSHFIELD WI 54449
IM / IM
FRANK S GUZOWSKI MD
1000 north oak avenue
MARSHFIELD WI 54449
PS HS / PS
715-387-5457
LOUIS C HACKER MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449-5777
U
715-387-5234
ROBERT P HAIGHT JR MD
1000 NORTH OAK AVENUE
MARSHFIELD Wl 54449
IM GER PYM
715-387-5437
GURDON H HAMILTON MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
PD AI / PD AI
715-387-5186
RAYMOND L HANSEN MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
IM FP
JEFFREY W HANSON MD
411 ST JOSEPH AVENUE
MARSHFIELD WI 54449
N OS / PN
715-387-5351
PHIROZE L HANSOTIA MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
GS / GS
715-387-5419
JERRY M HARDACRE MD
1000 NORTH OAK AVENUE
MARSHFIELD Wl 54449
DBG
715-387-5206
PAUL G HARKINS MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
GS / GS
715-423-1300
WILLIAM J HENRY MD
400 DEWEY STREET
WISCONSIN RAPIDS Wl 54494
AN / AN
715-423-9487
DENNIS A HENZIG MD
4458 BURR OAKS TRAIL
WISCONSIN RAPIDS WI 54494
DR R / R
715-387-8330
TIMOTHY G HERBERT MD
2300 MANN STREET
MARSHFIELD WI 54449
AI JM / AI
715-387-5186
ROBERi M HEYWOOD MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
P / PS
WILLIAM H HEYWOOD MD
600 NORTH WOOD AVENUE
MARSHFIELD WI 54449
OBG / DBG
715-387-5161
GEORGE L HILL MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
R OS / R
715-384-5618
DAYTON H HINKE MD
W221 TURTLE RIDGE ROAD
MARSHFIELD WI 54449
R / R
715-337-5262
MARVIN L HINKE MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
R
THOMAS n HINKE MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
IM HEM ON / IM HEM MON
715-387-5426
WILLIAM G HOCKING MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
GS / GS
715-397-5507
JAMES L HOEHN MD
1000 north OAK AVENUE
MARSHFIELD WI 54449
OTO / OTO
715-387-5245
JAMES J HOLT MP
1000 WORTH OAK AVENUE
MARSHFIELD WI 54449
AN / AN
WARREN J HOLTEY MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
JAMES A HOLZBERGER MD
APT 302
1350 W BETHUNE AVENUE
DETROIT MI 48202
IM CD NM / IM CD MM
715-387-5301
P DANIEL HORTON MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
OM IM /' IM OM
715-387-5523
EDWARD P HORVATH JR MD
1000 WE3TVTEW DRIVE
MARSHFIELD WI 54449
GS
715-387-01 17
BRUCE C HUBERT MD
1201 ADI ER ROAD
MARSHFIELD WI 54449
FP / FP
715 -423-0122
TIMOTHY K HUEBNER MD
1041 HILL STREET
WISCONSIN RAPIDS WI 54494
PD
715-423-1300
ANDREW W HULME MD
400 DEWEY STREET
WISCONSIN RAPIDS WI 54494
PM / PM
715-387-5328
SAMUEL IDARRAGA MD
1000 NORTH DAK AVENUE
MARSHFIELD WI 54449
ORS
715-424-1881
JAMES A JOHNSON MD
420 DEWEY STREET
POST OIF ICE BOY 1265
WISCONSIN RAPIDS WI 54494
FP / FP
715-423-0122
ROBERT L JOHNSON MD
1041 HILL STREET
WISCONSIN RAPIDS WI 54494
IM GE / IM GE
715-387-5253
SIDNEY E JOHNSON MD
1000 NORTH OAK AVENUE
MARSHFIELD Wl 54449
OTO / 010
JAMES K JONES MD
400 DEWEY STREET
WISCONSIN RAPIDS WI 54494
N / N
PERCY N KARANJIA MD
1000 north OAK AVENUE
MARSHFIELD WI 54449
NS / NS
715-387-5297
DONALD B KELMAN MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
D
715-387-6677
DAVID N KINGSLEY MD
APT 207
1603 SOUTH LOCUST
MARSHFIELD WI 54449
OTD HNS / OTO
715-387-5245
ALBERT M KINKELLA MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
GE IM / IM
JOHN P KIRCHNER MD
402 PARK STREET
MARSHFIELD WI 54449
IM
715-307-0162
ROGER S KNUTSON MD
10945 ROBIN ROAD
MARSHFIELD Wl 54449
GS
715 -387-5221
ROBER'^ L KQLTS MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
DR PDR / R
KEN‘1 A KRETCHMAR MD
1136 W BLODGETT STREET
MARSHFIELD WI 54449
ROBERT A KRUGfcR MD
1000 NORTH OAK AVENUE
MARSHFIELD Wi 54449
N c N
715-387-5351
FRANCIS KRUSE JR MD
1005 WEST FIFTH STREET
MARSHFIELD WI 54449
IM PUD / IM PUD
715-387-5319
MICHAEL J KRYDA MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
GS CDS / GS GV5
715-387-5610
MARVIN t KUEHNER MD
1000 NORTH OAK AVENUE
MARSHFIELD Wl 54449
P '..HP
715 -384-3942
INDRANl 1 KUMARAPERU MD
1 126 ONSTAD
MARSHFIELD Wl 54449
OPH / OPH
715-387-5236
JAMES A KUNKEL MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
FP / FP
RICHARD D LARSON MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
96— WOOD
GB T9 / GB TS
715-387-1)275
BEN R LAWTON MD
1000 NORTH OAK AVENUE
MARBHFIELD WI 54449
I M ID / I M
J DOUGLAS LEE MD
1000 N OAK AVENUE
MARSHFIELD WI 54449
IM RHU / IM
MARTHA L LEE MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
FP / FP
RICHARD A LEER MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
OBG / DBG
715-387-5161
RUSSELL F LEWIS MD
1000 NORTH OAK AVENUE
MARSHFIFLD WI 54449
IM / IM
715-387-5435
PAUL L LISS MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
PD PDF / PD PDE
715-387-5185
SHARON I MABY MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
IM / IM
715-387-5434
SANFORD D MAC DONALD MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
IM / IM
715-384-5513
GEORGE E MAGNIN MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
CD IM / CD IM
715-387-5460
PATRICK M MALONEY MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
DR /DR IM
WILLIAM F MANOR DO
1000 NORTH DAK AVENUE
MARSHFIELD WI 54449
IM / IM
715-387-5349
WILLIAM J MAURER MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
ORS / ORB
715-387-5202
PHILIP J MAYER MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
IM HEM
JOSEPH J MAZ2A MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
ORS / ORS
715-421-5257
JOHN W MC DONOUGH DO
4540 CHURCH AVENUE
WISCONSIN RAPIDS WI 54494
IM END / IM END
715-387-5481
ALAN K MC KENZIE MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
N IM / IM
JAMES C MC VEETY MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
IM / IM
715-387-5853
MICHAEL P MEHR MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
D / D I M
715-387-531 1
JOHN W MELSKI MD
1000 NORTH OAK AVENUE
MARSHFIFLD WI 54449
PD
206-632-9369
JAMES A MEYER MD
APT 103
4468 LINDEN AVENUE N
SEATTLE WA 98103
GS
BRYAN D MEYERS MD
1000 NORTH OAK AVENUE
MARBHFIELD WI 54449
D DMP / D DMP
715-387-5311
DONALD J MIECH MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
ORS / ORS
JOHN P MILBAUER MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
OPH / OPH
715-424-4141
KEVIN B MILLER MD
400 DEWEY STREET
POST OFFICE BOX 309
WISCONSIN RAPIDS WI 54494
IM NM / NM
RICHARD W MILLER MD
1000 NORTH OAK AVENUE
MARSHFIFLD WI 54449
FP / FP
715-387-5168
E GRADY MILLS MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
AN / AN
WARREN 1. MIRANDA MD
1024 W BLODGETT STREET
MARSHFIELD WI 54449
U / U
715-387-5233
NELSON A MOFFAT MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
PS HS NFS / PS
715-387-5457
RAMA D MUKHERJEE MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
DR / DR
715-387-5261
GERALD M MULLIGAN MD
904 STATE STREET
MARSHFIELD WI 54449
P
715-384-5479
JOHN J MULVANEY MD
806 EAST 19TH STREET
MARSHFIELD WI 54449
GS TS CDS / GS TB
715-387-5275
WILLIAM 0 MYERS MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
PD PHD / PD PHO
715-387-5251
H JAMES NICKERSON MD
1000 NORTH OAK AVENUE
MARBHFIELD WI 54449
IM END / IM END
715-387-5481
THOMAS F NIKOLAI MD
1000 NORTH OAK AVENUE
MARSHFIFLD WI 54449
IM GE / IM GE
715-387-5471
ROBERT G NORFLEET MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
IM GE
715-387-5471
JESUS F NUNEZ-GORNEB MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
R / R
THOMAS G OLSEN MD
305 DRAKE COURT
MARSHFIELD WI 54449
PD NPM / PD NPM
715-387-5016
JAMES C OPITZ MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
IM ON / IM MON
715-387-5134
JOSEPH L OUSLEY MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
N / PN
ROBERT W PAGE MD
1610 FELKER AVENUE
MARSHFIELD WI 54449
I M / I M
GEORGE A PAGELS MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
IM GE / IM GE
715-387-5471
KEVIN PARENT MD
1000 NORTH OAK AVENUE
MARBHFIELD WI 54449
PTH / PTH
715-421-7434
JUNG KYUN PARK MD
DEPT OF PATHOLOGY
410 DEWEY STREET
WISCONSIN RAPIDS WI 54494
IM NEP / IM NEP
715-387-5292
JOHN P PARKER MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
AN / AN
715-387-7179
FREDERIC L PAULSEN MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
AN / AN
715-387-7179
DONALD P PEDERSON MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
FP / FP
FREDRICK A PERRYMAN MD
1041 HILL STREET
WISCONSIN RAPIDS WI 54494
IM
DOUGLAS B PETERSON MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
GP
715-886-3175
LOUIS R PFEIFFER MD
315 FIRST STREET
NEKOOSA WI 54457
IM GER / IM
715-387-5852
ROBERT E PHILLIPS MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
GS
715-423-3911
LELAND C POMAINVILLE MD
351 MADISON STREET
WISCONSIN RAPIDS WI 54494
GS / GS
MARIO V PONCE MD
1041 HILL STREET
WISCONSIN RAPIDS WI 54494
IM / IM
715-423-0122
MINERVA N PONCE MD
1041 HILL STREET
WISCONSIN RAPIDS WI 54494
PD / PD
715-387-5251
GERALD E PORTER MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
IM
THEODORE A PRAXEL MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
IM
JOHN PRZYBYLINSKI MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
PD N /PD
715-387-5868
LOUIS J PTACEK MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
PUD IM / PUD IM
715-387-5319
DANIEL L QUINN MD
PULMONARY MED SECTION
1000 NORTH OAK AVENUE
MARBHFIELD WI 54449
CDS TB / TS
715-387-5275
JEFFERSON F RAY III MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
IM CD / IM CD
715-387-5301
RICHARD A REINHART MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
PTH / PTH
715-387-7654
CESAR N REYES JR MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
GE IM / IM GE
715-387-5471
ROSS A RHODES MD
1001 WEST UPHAM STREET
MARSHFIELD WI 54449
OBG / OBG
715-387-5511
THOMAS J RICE MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
IM NTR / IM
715-387-5435
PETER M RIES MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
WOOD— 97
R
JUSTO RODRIGUEZ MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
D / D
RICHARD U ROWE MD
BOfc SOUTH OAK AVENUE
MARSHFIELD WI 54449
U / U
715-387-5232
MICHEL Y ROY MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
OBG / OBG
715-387-5161
JOHN W RUPEL MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
IM ON / IM MON
715-387-5416
DANIEL A RUSHING MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
TR R / TR
715-387-7637
HOMER H RUBS MD
611 SAINT JOSEPH AVE
MARSHFIELD WI 54449
GE IM / GE IM
715-387-5471
MICHAEL E RYAN MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
PTH / AP CLP
SYED MIR SAJJAD MD
1601 NORTH WOOD AVENUE
MARSHFIELD WI 54449
NS / NS
715-387-5297
DAHIJ S SAL I Ell MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
GS CDS TS / GB TS
715-387-5107
RICHARD D SAUTTER MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
FP / FP
715-423-0122
JOHN W SCHALLER MD
1041 HIU STREET
WISCONSIN RAPIDS WI 54494
IM HEM / IM HEM
715-387-5426
LEE L SCHLOEBSER MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
D / D DI
715-387-5312
WILLIAM F SCHORR MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
IM
715-384-2505
NEAL J SCHROETER MD
801 WEST FOURTH STREET
MARSHFIELD WI 54449
D / D
JOSEPH F SEBER JR MD
14202 MaRGINADI COURT
MIAMI LAKES FL 33103
U
MICHAEL C SEELEN MD
1000 tJURTH OAK AVENUE
MARSHFIELD WI 54449
R / R
JOHN R BHEFLIN MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
OBG
715-387-5161
NAGLAA M SHEHAB MD
1000 NURTH OAK AVENUE
MARSHFIELD WI 54449
PTH
RICHARD M SHUFFSTALL MD
410 DEWEY STREET
WISCONSIN RAPIDS WI 54494
AN
715-387-7179
SENEN V SIASOCO MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
IM
ROSS F SIEMERS MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
PD PHO / PD
TERESA SILBERMAN MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
U / U
715-421-1151
CHARLES C SORENSEN MD
400 DEWEY STREET
WISCONSIN RAPIDS WI 54494
OPH / OPH
715-387-5236
GEORGE M SPARKS MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
GS OM / GS
715-422-3977
CLIFFORD H STARR MD
231 FIRST avenue NORTH
WISCONSIN RAPIDS WI 54494
OBG / OBG
715-387-5161
MICHAEL L STEVENS MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
OPH / OPH
715-387-523t.
THOMAS W STRAM MD
1000 NORTH OAK AVENUE
MARSHFIElD WI 54449
IM / IM
JAMES L 5TRUTHERS MD
8349 E SGUAW LAKE ROAD
LAC DU FLAMBEAU WI 54538
IM EM / IM
715-387-5497
DEAN T STUELAND MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
ADi- PD / PD
JOHN J SUITS MD
mow FOURTH STREET
MARSHFIELD WI 54449
PD / PD
715-387-5251
BRADLEY J SULLIVAN MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
PD PDC ' PD PDC
715- 387-5570
THOMAS M SUTTON MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
AN
715-387-7179
PANDY G SWAMY MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
GS / GS
MARK K SWANSON MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
FP / FP
715-886-3175
JOHN E THOMPSON MD
315 FIRST STREET
NEKOOSA WI 54457
IM ON / IM MON
715-387-5134
STUART v) TIPPING MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
ORS HS
ERIK O TORKELSON MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
GS PDS / GS PDS
715-387-5469
WILLIAM M TOYAMA MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
ORB RHU / ORS
715-387-5202
PAUL S TREUHAFT MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
I M 7 I M
715-387-5434
SUSAN L TURNEY MD
lOOO NORTH OAK AVENUE
MARSHFIELD WI 54449
PD AI / PD AI
715-387-5186
JOHN T TWIGGS MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
IM CD / IM
715-387-5301
RICHARD H ULMER MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
NS / NS
715-387-5297
HANS G VANDERSPEK MD
1000 NORTH OAK AVENUE
MARSHFIF.LD WI 54449
PM / PM
PANNA V VAR I A MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
P
VIRENDRA j VAR I a MD
1000 north oak avenue
MARSHFIELD WI 54449
GS
CHARLES A VEDDER MD
900 SAWYER DRIVE
MARSHFIELD WI 54449
PD '■ PD
715-334-5883
JAMES S VEDDER MD
lOOO WEST FIFTH STREET
MARSHFIELD WI 54449
GS / GS
715-423-0122
RENE S VICENTE MD
1041 HILL STREET
WISCONSIN RaPIDS WI 54494
FP / FP
715-423-1 300
MARVIN A VOS MD
400 DEWEY STREET
WISCONSIN RAPIDS WI 54494
CD JM
715-387- 5301
DIETER M VOSS MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
PD OS 7 PD
715-387-5251
STEPHEN F WAGNER MD
1000 NORTH OAK AVENUE
MARSHFIFLD WI 54449
IM ID
715-387-5193
EDWARD W WALTERS MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
IM RHU 7 IM RHU
715-387-5190
WILLIAM L. WASHINGTON MD
1000 NORTH DAK AVENUE
MARSHFIELD WI 54449
NM I M / NM I M
715-387-7787
G JOHN WEIR JR MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
IM 7 IM
715-387-5434
FREDERIC P WESBROOK MD
ROUTE 3 BOX 167A
MARSHFIELD WI 54449
GS 7 GS
715-387-5609
GAIL H WILLIAMS MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
IM 7 IM
715-423-1 300
JANET A WILSON MD
400 DEWEY STREET
WISCONSIN RAPIDS WI 54494
DR NR 7 DR
715-421-7430
THOMAS R WINCH MD
410 DEWEY STREET
WISCONSIN RAPIDS WI 54494
OBG 7 OBG
715-387-5046
BRUCE A W I NEMAN DO
1000 north oak avenue
MARSHFIELD WI 54449
IM NEP
715-387-5292
ROBERT H WINEMILLER MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
ORS
MARK D WISNEFSKE MD
1000 NORTH OAK AVENUE
MARSHFIELD WI 54449
IM
WILLIAM J WITTMAN MD
ROUTE 2 BOX 119
OLIVIA MN 56277
GP OBG
CHARLES F WOOD MD
1041 hill STREET
WISCONSIN RAPIDS WI 54494
P ■ P
715-387-5441
MICHAEL T WOOD MD
lOOO NORTH OAK AVENUE
MARSHFIELD WI 54449
RICHARD W SHALLMAN MD
1703B E FILLMORE ST
MARSHFIEl-D WI 54449
98— WCX5D
IM GE / IM GE IM
715-387-5471 THOMAS W ZOCH MD
JOHN B WYMAN MD 1306-B WALNUT STREET
1000 NORTH OAK AVENUE MARSHFIELD WI 54449
MARSHFIELD WI 54449
IM
DIANNE L ZWICKE MD
4261 W HIGHLAND BLVD
MILWAUKEE WI 53208
house of
BIDWELL, inc.
7954 West Harwood
and Watertown Plank Road
Milwaukee, Wisconsin 53213
ORTHOTIC
AND
PROSTHETIC
SERVICES
1-414 744 6250
Radio
dispatched
truck fleet
for
INDUSTRY, INSTITUTIONS,
SCHOOLS, ETC.
AUTHORIZED PARTS
AND SERVICE FOR
CLEAVER-BROOKS
Throughout Wisconsin
and Upper Michigan
SALES
Boiler room accessories
O2 trims
Cleveland controls
and Car automatic bottom
blowdown systems
SERVICE-CLEANING
ON ALL MAKES
Complete Mobile Boiler Room
Rentals
Stevens Point— 715/344-7310
Green Bay-414/494-3675
Madison —608 / 249-6604
PBBS EQUIPMENT CORP.
5401 N Park Dr
PO Box 365
Butler, WI 53007
Phone: 414/781-9620
HEALTH PROFESSIOHALS!
The Army Medical Department
represents the largest comprehensive
system ot health care in the United
States and offers unique advantages
to the student, resident, and practi
tioner in the following professions:
• Neurosurgery
• General Surgery
• Orthopedic Surgery
•Obstetrics & Gynecology
• Otolaryngology
• Anesthesiology
• Psychiatry
• Child Psychiatry
• Family Practice
• Emergency Medicine
• General Medicine
• Pediatrics
As an Army Officer, you will receive
substantial compensation, an annual
paid vacation, and participate in a
remarkable non-contributory retire
ment plan.
For more information just fill out
the attached form and mail. Or
call: (312) 926-2040/2147. (Collect
calls accepted.)
PLEASE SEND MORE INFORMATION ABOUT OPPORTUNITIES
IN THE ARMY MEDICAL DEPARTMENT
MAIL OR CALL:
ARMY MEDICAL DEPARTMENT, BLDG 142, ROOM 345
FT SHERIDAN, IL 60037 (312) 926-2040/2147
NAME AGE
ADDRESS
ZIP PHONE (AC)
SCHOOL ATTENDED/ATTENDING
GRADUATION DATE DEGREE
SPECIALTY AREA OF INTEREST
Medical School Scholarships are Available
1 14
WISCONSIN MEDICAL JOURNAL, JULY 1985: VOL. 86
ORGANIZATIONAL
COUNTY MEDICAL SOCIETIES
President (P) and Secretary (S); Executive Secretary (ES), Treasurer (T); Executive Vice President (EVP);
Executive Assistant (EA); Assistant Secretary (AS); and telephone numbers
ASHLAND BAYFIELD IRON
P— Mark K Belknap, MD
922 Second Avenue, West
Ashland, WI 54806
(715) 682-6651
S— David M Saarinen, MD
2101 Beaser Avenue, #2
Ashland, Wl 54806
BARRON WASHBURN
BURNETT
P— Donald E Riemer, MD
PO Box 127
Cumberland, Wl 54829
(715) 822-2231
S— Roger F Macy, MD
PO Box 127
Cumberland, Wl 54829
(715) 822-2231
BROWN
P— James R Mattson, MD
501 S Military Avenue
Green Bay, Wl 54303
S— Stephen D Hathway, MD
PO Box 1700
Green Bay, WI 54305
(414) 433-3653
T— Roger C Wargin, MD
613 Ridgeview Court
Green Bay, WI 54303
(414) 499-8859
CALUMET
P— Randy T Theiler, MD
451 East Brooklyn Street
Chilton, WI 53014
S— William E Hannan, MD
614 Memorial Drive
Chilton, WI 53014
CHIPPEWA
P— Richard C Sazama, MD
3203 Stein Blvd
Eau Claire, WI 54701
(715) 835-6548
S— Robert S Lea, MD
1 102 Dover Street
Chippewa Falls, WI 54729
CLARK
P— Vangala J Reddy, MD
216 Sunset Place
Neillsville, WI 54456
(715) 743-3101
S— Rupa Chennamaneni, MD
216 Sunset Place
Neillsville, WI 54456
(715) 743-3231
COLUMBIA MARQUETTE
ADAMS
P— Donald J Taylor, MD
1015 West Pleasant Street
PO Box 387
Portage, WI 53901
(608) 742-8389
S— Paul j Slavik, MD
916 Silver Lake Drive
Portage, WI 53901
ES— Mrs Elayne Hanson
PO Box 352
Portage, WI 53901
(608) 742-2410
CRAWFORD
P— Eli M Dessloch, MD
780 South Beaumont Road
PO Box 89
Prairie du Chien, WI 53821
(608) 326-6978
S— Michael S Garrity, MD
610 East Taylor Street
Prairie du Chien, Wl 53821
(608) 326-6466
DANE
P— Sigurd E Sivertson, MD
1300 University Ave, Rm 1245A
Madison, WI 53706
S— Donald A Bukstein, MD
1313 Fish Hatchery Road
Madison, Wl 53715
DODGE
P— Gerald H Klomberg, MD
130 Warren Street
Beaver Dam, WI 53916
(414) 887-1711
S— Daniel R Erickson, MD
Route 1, Highway 28
Horicon, WI 53032
(414) 485-4341
EA— Ms Shirley Dinsch
1008 West Burnett Street
Beaver Dam, WI 53916
(414) 885-4726
DOOR KEWAUNEE
P— Alfonso G Tamayo, MD
1623 Rhode Island
PO Box 107
Sturgeon Bay, WI 54235
(414) 743-3383
S— William Faller, MD
330 South 16th Place
PO Box 466
Sturgeon Bay, WI 54235
DOUGLAS
P— Robert R Mataczynski, MD
1514 Ogden Avenue
Superior, WI 54880
(715) 394-5557
S— Alfred E Lounsbury, MD
3600 Tower Avenue
Superior, WI 54880
(715) 392-8111
EAU CLAIRE DUNN PEPIN
P— Patrick W Connerly, MD
807 South Farwell Street
Eau Claire, WI 54701
(715) 839-5175
S— Stanley G Norman, MD
714 South Hamilton Avenue
Eau Claire, WI 54701
(715) 834-3448
FOND DU LAC
P— William G Sybesma, MD
80 Sheboygan Street
Fond du Lac, Wl 54935
(414) 923-7400
S— Elizabeth T Sanfelippo, MD
80 Sheboygan Street
Fond du Lac, WI 54935
T— Robert H House, MD
PO Box 96
Ripon, WI 54971
(414) 748-6400
FOREST
P— Enzo F Castaldo, MD
Laona, WI 54541
(715) 674-3131
S— Burton S Rathert, MD
101 West Washington
PO Box 278
Crandon, WI 54520
(715) 478-2413
GRANT
P— John M McKichan, MD
1370 North Water Street
Platteville, WI 53818
(608) 348-2455
Robert E Stader, MD
235 North Madison Street
Lancaster, Wl 53813
(608) 723-2131
GREEN
P— Carlos A Jaramillo, MD
PO Box 786
Monroe, WI 53566
(608) 328-0429
S— Jacob George, MD
1515 10th Street
Monroe, WI 53566
(608) 328-7000
GREEN LAKE WAUSHARA
P— John C Koch, MD
209 East Park Avenue
Berlin, Wl 54923
(414) 361-1313
S— Michael E Tieman, MD
PO Box 266
Berlin, WI 54923
(414) 361-4306
IOWA
P— Timothy A Correll, MD
227 Commerce Street
Mineral Point, WI 53565
(608) 935-9331
S— Harold P L Breier, MD
PO Box 185
Montfort, WI 53569
(608) 943-6308
JEFFERSON
P— Alan L Detwiler, MD
500 McMillen Street
Fort Atkinson, WI 53538
(414) 563-5571
S— Edward J Hoy, MD
123 Hospital Drive, #208
Watertown, WI 53094
JUNEAU
P— D Keith Ness, MD
1040 Division Street
Mauston, WI 53948
(608) 847-5000
S— Nancy E B Ness, MD
1040 Division Street
Mauston, WI 53948
(608) 847-5000
WISCONSIN MEDICAL JOURNAL, JULY 1985: VOL, 86
115
ORGANIZATIONAL
KENOSHA
P— Andrew T Przlomski, MD
6530 Sheridan Road
Kenosha, WI 53140
(414) 658-2516
S— Aftab A Ansari, MD
3200 Sheridan Road
Kenosha, WI 53140
ES— Mr James Splitek
4109-67th Street
Kenosha, WI 53142
(414) 654-9166
LA CROSSE
P— Pauline M Jackson, MD
1836 South Avenue
La Crosse, WI 54601
(608) 782-7300
S— Thomas P Lathrop, MD
1836 South Avenue
La Crosse, WI 54601
(608) 782-7300
LAFAYETTE
P— Lyle L Olson, MD
517 Park Place
Darlington, WI 53530
(608) 776-4497
S— Richard G Roberts, MD
517 Park Place
Darlington, WI 53530
(608) 776-4497
LANGLADE
P— Theodore C Fox, MD
213 5th Avenue
Antigo, WI 54409
(715) 623-2351
S— John R Myers, MD
nil Langlade Road
Antigo, WI 54409
(715) 623-3761
LINCOLN
P— Muhammad Y Ahmad, MD
716 East 2nd Street
Merrill, WI 54452
(715) 536-2463
S— Gail M Amundson, MD
216 North 7th Street
Tomahawk, WI 54487
(715) 453-4700
MANITOWOC
P— John C Zeldenrust, MD
2219 Garfield Street
Two Rivers, WI 54241
(414) 293-2281
S— Henry M Katz, MD
600 York Street
Manitowoc, WI 54220
(414) 682-7124
MARATHON
P— Curt G Grauer, MD
2727 Plaza Drive
Wausau, WI 54401
(715) 847-3379
S— Leonard H Wurman, MD
425 Pine Ridge Blvd, #305
Wausau, WI 54401
(715) 845-9634
ES— Ms Lorraine W Kordas
PO Box 569
Wausau, WI 54401
(715) 845-6231
MARINETTE-FLORENCE
P— James Tandias, MD
PO Box 435
Marinette, WI 54143
S— Leonard R Worden, MD
1510 Main Street
Marinette, WI 54143
(715) 735-7421
MILWAUKEE
P— Lucille B Glicklich, MD
1610 N Prospect Ave, #1202
Milwaukee, WI 53202
S— Donald P Davis, MD
2015 East Newport Avenue
Milwaukee, WI 53211
EVP— Mr William B Harlan
1020 North Broadway, #200
Milwaukee, WI 53202
MONROE
P— Jameel S Mubarak, MD
105 West Milwaukee Street
Tomah, WI 54660
(608) 372-41 1 1
S— Jack D Brown, MD
PO Box 250
Sparta, WI 54656
(608) 269-6731
OCONTO
P— John S Honish, MD
PO Box 260
Oconto, WI 54153
S— Clyde E Siefert, MD
164 North Main Street
Oconto Falls, WI 54154
(414) 846-3671
ONEIDA-VILAS
P— Stephen R Peters, MD
PO Box 549
Woodruff, WI 54568
S— Robert J Aylesworth Jr, MD
1020 Kabel Avenue
Rhinelander, WI 54501
(715) 362-5650
ES— Mrs Sally Christoffersen
1020 Kabel Avenue
Rhinelander, WI 54501
(715) 362-5650
OUTAGAMIE
P — Marvin L Hall, MD
612 East Longview Drive
Appleton, WI 54911
(414) 743-4438
S— David R Finch, MD
1611 South Madison Street
Appleton, WI 54911
(414) 739-3100
AS— Ms Dolores A Ebben
211 East Franklin Street
Appleton, WI 54911
(414) 734-5951
OZAUKEE
P— Thomas Wall, MD
326 West Pierre Lane
Port Washington, WI 53074
S— Peter W Messer, MD
3344 West Grace Avenue
Mequon, WI 53092
FIERCE ST CROIX
P— Terry G Domino, MD
280 Vine Street
Hudson, WI 54016
(715) 386-9381
S— Joseph E Powell, MD
441 East 7th Street
New Richmond, WI 54017
(715) 246-6846
POLK
P— William W Young, MD
104 Adams Street South
St Croix Falls, WI 54024
(715) 483-3221
S— Vacancy
PORTAGE
P— Joseph F Jarabek, MD
2501 Main Street
Stevens Point, WI 54481
(715) 344-4120
S — Roy J Dunlap II, MD
508 Vincent Street
Stevens Point, WI 54481
(715) 341-8001
PRICE-TAYLOR
P— T Bayard Frederick, MD
789 South 7th Avenue
Park Falls, WI 54552
(715) 762-3212
S— Walther W Meyer, MD
101 North Gibson Avenue
Medford, WI 54451
(715) 748-2121
RACINE
P— Richard N Odders, MD
5625 Washington Avenue
Racine, WI 53406
(414) 886-8226
S— Dennis J Kontra, MD
5802 Washington Avenue
Racine, WI 53406
T— Kenneth J Pechman, MD
2405 Northwestern Avenue
Racine, WI 53404
ES— Mr John M Bjelajac
PO Box 592
Racine, WI 53401
(414) 634-0702
RICHLAND
P— Thomas L Richardson, MD
1313 West Seminary Street
Richland Center, WI 53581
(608) 647-6161
S— Robert P Smith, MD
1313 West Seminary Street
Richland Center, WI 53581
(608) 647-6161
ROCK
P— Jovan L Djokovic, MD
630 Wexford Drive
Janesville, WI 53545
S— Daniel T Peterson, MD
580 North Washington Street
Janesville, WI 53545
(608) 755-3500
RUSK
P— Joseph S Bachir, MD
906 College Avenue West
Ladysmith, WI 54848
(715) 532-6651
S— Ron M Charipar, MD
1216 East River
Ladysmith, WI 54848
(715) 532-5561
SAUK
P— David E Burnett, MD
1900 North Dewey Avenue
Reedsburg, WI 53959
S— James W Clay, MD
1900 North Dewey Avenue
Reedsburg, WI 53959
SAWYER
P— Lloyd M Baertsch, MD
Rte 3, Box 3998
Hayward, WI 54843
S— Paul Strapon III, MD
Rte 3, Box 3998
Hayward, WI 54843
lie
WISCONSIN MEDICAL JOURNAL, JULY 1985: VOL. 86
ORGANIZATIONAL
SHAWANO
P— William A Coan, MD
610 West Green Bay Street
Shawano, WI 54166
(715) 526-3137
S— Alois J Sebesta, MD
126‘/2 South Main Street
PO Box 360
Shawano, WI 54166
(715) 526-3313
SHEBOYGAN
P— Robert A Helminiak, MD
1011 North 8th Street
Sheboygan, WI 53081
S— Robert J Scott, MD
2809 North 7th Street
Sheboygan, WI 53081
(414) 457-5033
TREMPEALEAU-JACKSON-
BUFFALO
P-John H Noble, MD
1105 Harrison Street
Black River Falls, WI 54615
S— James J Dickman II, MD
610 West Adams Street
Black River Falls, WI 54615
(715) 284-4311
VERNON
P— David A Van Dyke, MD
PO Box 149
Viroqua, WI 54665
(608) 637-7052
VP— Thomas M Ambelang, MD
PO Box 467
Viroqua, WI 54665
S— Deverne W Vig, MD
PO Box 72
Viroqua, WI 54665
(608) 637-3195
WALWORTH
P— James L Knavel, MD
PO Box B
Ten Peller Road
Lake Geneva, WI 53147
(414) 248-4467
S— James V Seegers, MD
104 South Wisconsin Street
Elkhorn, WI 53121
(414) 723-6666
WASHINGTON
P— James D Froehlich, MD
7066 North Trenton Road
West Bend, WI 53095
(414) 673-5745
S— Emilio B Regala, MD
1004 East Sumner Street
Hartford, WI 53027
(414) 673-5745
WAUKESHA
P— Thomas J Dougherty, MD
1 1 1 1 Delafield Street
Waukesha, WI 53186
(414) 542-9531
S— Robert L Warth, MD
1 1 1 1 Delafield Street
Waukesha, WI 53186
(414) 544-4411
T— Gerald L Harned, MD
223 Wisconsin Avenue
Waukesha, WI 53186
(414) 544-5311
ES— Mr Robert Herzog
850 Elm Grove Road, #1
Elm Grove, WI 53122
(414) 784-3747
WAUPACA
P— Leslie H Gray, MD
46 North Main Street
Clintonville, WI 54929
S— Donn D Fuhrmann, MD
1420 Algoma Street
New London, WI 54961
(414) 982-3606
WINNEBAGO
P— John B McAndrew, MD
600 S Main St
Oshkosh, WI 54901
414/233-1773
S— Roy E Buck, MD
PO Box 165
Oshkosh, WI 54902
(414) 233-6000
WOOD
P— Richard H Ulmer, MD
1000 North Oak Avenue
Marshfield, WI 54449
S— Michael J Kryda, MD
1000 North Oak Avenue
Marshfield, WI 54449
(715) 387-5319B
CLASSICAL ITALIAN
RESTAURANT
5518 UNIVERSITY AVENUE
MADISON (608) 233-2200
ELEGANT DINING • FINE WINES • INTIMATE
COCKTAIL LOUNGE • OPEN DAILY AT 5:00 PM
"For an elegant night of Italian dining. ” — Prof Herbert Kubly, Milwaukee Journal writer
WISCONSIN MEDICAL JOURNAL, JULY 1985: VOL. 86
117
ORGANIZATIONAL
Membership facts
Whether you’re just starting medical school, maintaining a
full-time practice, or retiring, SMS has a membership classi-
fication to fit your individual needs. Election to membership
by the County Medical Society in which your principal place
of practice is located carries with it membership in the State
Medical Society of Wisconsin and, if you wish, the American
Medical Association. If you qualify for resident membership
at the time of your election, your membership dues are
greatly reduced. This may also qualify you for reduced dues
the first two years of your practice. In addition, two-physician
families may be eligible for a $50 discount on total SMS
membership dues. Dues for regular membership in 1 985 are
$455 for SMS, $330 for AMA, and county society dues vary.
A more detailed listing of SMS membership classifications and
their corresponding dues follows:
State Medical Society of Wisconsin
DESCRIPTION OF MEMBERSHIP
CLASSIFICATIONS
Regular Member in active practice. Some are regular mem-
bers that have reduced SMS and/or AMA dues because they
are new practitioners (first year or two out of residency).
Resident; Physician who at January 1 of dues year is in an
approved training program as a hospital resident or research
fellow who is licensed to practice medicine and surgery in
Wisconsin.
Military Service; Members who are serving in the U S. armed
forces (generally not to exceed five years).
Associate: Member whose dues are waived because of fi-
nancial hardship due to illness or disability. This classifica-
tion is temporary and is reviewed on an annual basis.
Life; Member who has held membership in a state medical
society for 50 years or is a Past President of the State Med-
ical Society of Wisconsin.
Honorary: Member who was named by the Board of Direc-
tors in recognition of long and distinguished service to the
cause of medicine.
Your membership in organized medicine will help Insure
the continued "safety" of your practice and quality care
for all patients. Your voice will be heard through par-
ticipation. Membership in the State Medical Society of Wiscon-
sin also requires membership in the county medical society
(AMA membership is optional but encouraged). For Regular,
Part-time Practice, or Over Age 70 membership classifi-
cations, dues may be paid in one lump sum or in two
equal installments; one-half of the total payable by Jan-
uary 1, the other half not later than May 15, 1985 which is
the removal date for those members who have not com-
pleted payment. You are urged to renew your membership.
Retired; Member who has completely retired from practice
(works less than 240 hours per year). All dues are waived
unless county society indicates they wish to charge county
dues.
Part-time Practice; Physician, regardless of age, who prac-
tices 1,000 hours or less during the calendar year but does
not qualify for retired membership.
Over Age 70: Member in active practice who is over 70 years
of age as of January 1.
Candidate: Member attending a medical school in Wiscon-
sin or fulfilling a postgraduate obligation prior to eligibility
for licensure.
Scientific Fellow: The Board of Directors may by invitation
and unanimous consent confer upon any person engaged in
teaching of or research in one or more of the basic sciences
at an accredited college or university, and not holding the
degree of Doctor of Medicine or Osteopathy, the status of
Scientific Fellow.
Emeritus: Retired members who have chosen not to renew
their license.
1985 DUES AMOUNTS FOR THESE
CLASSIFICATIONS
SMS
AMA
COUNTY
Regular
$455
$330
Normal County Dues
Resident
45.50
45
Varies
Military Service
-0-
220 or 45
-0-
Associate
-0-
-0-
-0-
Life
-0-
-0-"
-0-
Honorary
-0-
-0-"
-0-
Retired
-0-
-0-'
-0-
Part-time Practice
227.50
330"
Normal County Dues
Over Age 70
227.50
-0-"
Normal County Dues
Scientific Fellow
-0-
.-0-
Emeritus
-0-
-0-*
Candidate —
Freshman Year
Medical Student
-0-
20
Varies
Sophomore and
Succeeding Medical
Student Years
10
20
Varies
Postgraduate— One
10
45
Varies
"Physicians in the following categories may be eligible for exemption from
paying AMA dues; (1) Financial hardship and/or disability, (2) Age 65-69 and
retired from the practice of medicine, (3) Over age 70 regardless of retirement
status.
State Society dues are prorated on a monthly basis for
those elected to membership July 1 through September 30.
Those elected after September 30 have no dues payable for
the balance of the year in which they are elected. AMA dues
follow the same pattern except prorating is on a semiannual
basis rather than monthly basis.
To begin the membership process, if your practice is or will
be located in Wisconsin, or you have any questions, you may
contact your local county society or call the Membership
and Communications Division of the State Medical Society,
if in Wisconsin: 1-800-362-9080 (Madison area number:
257-6781).H
WISCONSIN MEDICAL JOURNAL, JULY 1985: VOL. 86
For professional liability insurance, the stakes are too
high to depend on anyone else.
That's why the State Pledical Society has endorsed a
professional liability plan which has been developed
especially for Wisconsin physicians.
Available only to members of the SMS— and offered
through Sl'IS Services, Inc.— this medical malpractice policy
has superior features including:
• Consent of the physician is required before settlement of
any claim.
• Availability of legal counsel, experienced in defendant
medical liability.
• All members of claims and underwriting committees are
Wisconsin physicians.
• Occurrence coverage provided for claims arising during
the policy period, even if claim is reported at a later
time.
for the best in professional liability coverage, contact
SMS Services, Inc. at (608) 257-6781 or toll-free 1-800-362-9080
know how vital it is to safeguard the present...
and to protect the future.
Endorsed by the
State Medical Society
of Wisconsin
Underwritten by: ROFESSIONALS
INbUkANCE COMPANY
A respected leader in coverage for preferred markets.
jT
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Centralized
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Systems
^ INCORPORATED
SEGMENTATION
Your solution to profitable patient and insurance
billing management.
Centralized Billing Systems can provide the
complete picture, or just the part that your
practice is missing . . . from efficient and
professional billing management systems to
complete PC software or hardware.
• Stand Alone (PC)
Systems & Software
• Statement Processing
• Insurance Processing
• On-Line Inquiry
• Patient Recall
• Appointment Scheduling
• Batch (mail-in) Systems
For further information or no-obligotion
consultation please coll
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Milwaukee, Wl 53222 Kenosha, Wl 53142
(414) 535-0100 (414) 658-8603
TRY AIR FORCE
EXPERIENCE
Experience Air Force Medicine. It can be just
what you’d like your rriedical practice to be.
More time to practice medicine. More time
with your family. Even more time for your
hobbies. It’s all part of Air Force EXPERIENCE.
Talk to a member of our medical placement
team today. Find out how you can experience
the perfect medical practice as an AIR FORCE
PHYSICIAN.
FOR INFORMATION CALL:
414-258-2430
Outside area call collect
On the leading edge of technology
BLUE BOOK UPDATE
r
L
Transposition of pages
In the June Blue Book issue, under Commissions
and Committees, pages 123 and 124 were inadver-
tently transposed.
Also in this same issue the Physicians Alliance
Commission, recently merged as indicated on page
124 (corrected to page 123), is as follows:
Physicians Alliance Commission
This Commission shall plan, organize, and implement programs
to protect and preserve the legislative, socioeconomic, and
political interests of the members of the State Medical Society of
Wisconsin. The Commission shall analyze state and federal legisla-
tion and administrative rules and policies, and recommend to the
Board of Directors specific actions and positions designed to carry
out this responsibility. The Commission shall also inform the
membership of the Society regarding proposed legislation and
other public policy initiatives, seek the enactment of legislation
for the best interests of the public, scientific medicine, and the
medical profession, and promote and encourage Society members
to be politically active individually and collectively. This Com-
mission shall act to protect the socioeconomic interests of the
Society membership in public and private health care delivery
systems and recommend to the Board of Directors specific
strategies and efforts to achieve this purpose. This Commission
shall consist of members appointed by the Board of Directors in
a number deemed sufficient to execute the responsibilities dele-
gated to the Commission. Membership on the Commission shall
also include a representative from each of the specialty sections
of the Society, subject to approval by the Board of Directors.
These representatives shall be appointed by the sections annually,
and shall have the right to vote on all matters before the Com-
mission. The President, President-elect, Immediate Past Presi-
dent, and Chairman of the Board of the Society shall serve as ex-
officio members of the Commission with vote.
Robert F Purtell Jr, MD, Milwaukee, Chairman, 1986
Charles E Pechous, MD, Kenosha, Vice Chairman, 1986
Joseph C DiRaimondo, MD, Manitowoc, 1987
Vernon Dodson, MD, Madison, 1987
Carl S L Eisenberg, MD, Milwaukee, 1986
Jordon Frank, MD, Beloit, 1986
Gerald A Gehl, MD, Neenah, 1987
Ronald L Harms, MD, Shawano, 1987
C Robert Jackson, MD, Madison, 1987
H Myron Kauffman, MD, Wauwatosa, 1987
Geoffrey C Kloster, MD, Merrill, 1988
Dennis J Kontra, MD, Racine, 1987
Jack M Lockhart, MD, La Crosse, 1986
Michael P Mehr, MD, Marshfield, 1986
John C Oujiri, MD, Ashland, 1988
Peter J Parthum, MD, MPH, Muskego, 1988
Michael C Reineck, MD, West Bend, 1988
John O Simenstad, MD, Osceola, 1 988
Charles L Steidinger, MD, Platteville, 1988
Joseph L Teresi, MD, Brookfield, 1988
John E Thompson, MD, Nekoosa, 1988
W Gregory Von Roenn, MD, Milwaukee, 1986
DeLore Williams, MD, West Allis, 1987
Raymond C Zastrow, MD, Milwaukee, 1986
Ex OFFICIO VOTING MEMBERS:
President: John K Scott, MD, Madison
President-elect: Charles W Landis, MD, Milwaukee
Immediate Past President: Timothy T Flaherty, MD, Neenah
Chairman of the Board: Darold A Treffert, MD, Fond du Lac
continued next column
Section Representatives:
Anesthesiology Section: John F Kreul, MD, Madison
Family Physicians Section: Terry L Hankey, MD, Wausau
Internal Medicine Section: Susan L Turney, MD, Marshfield
Ophthalmology Section: M Thomas Chemotti, MD, Cedarburg
Otolaryngology Section: William W Finch, MD, Madison
Pathology Section: Harry J Zemel, MD, Fond du Lac
Pediatrics Section: Ferrin C Holmes, MD, Sturgeon Bay
Radiology Section: George F Roggensack, MD, Madison
(Other Section Representatives to be appointed)
* * *
Two newly created task forces, to follow the
commissions and committees (pages 122-125) are:
Task Force on Medical Liability
The purpose of this task force shall be to monitor current
liability developments and to examine a series of options and alter-
natives relative to a long-range solution of the medical liability
problem, reporting to the Board of Directors.
William J Listwan, MD, West Bend, Chairman
Vaughn Demergian, MD, Madison
Jerome W Fons Jr, MD, Cudahy
C Robert Jackson, MD, Madison
Paul A Jacobs, MD, Milwaukee
Sidney E Johnson, MD, Marshfield
Thomas M Kidder, MD, Milwaukee
Frederick C Kriss, MD, Madison
Walter D Moritz, MD, Fort Atkinson
Russell A Quirk, MD, Racine
Michael C Reineck, MD, West Bend
Richard G Roberts, MD, Darlington
Paul H Steingraeber, MD, La Crosse
W Stuart Sykes, BM, Madison
William L Treacy, MD, Milwaukee
Robert F Purtell Jr, MD, Milwaukee
Kenneth M Viste Jr, MD, Oshkosh
(Members to be added from certain specialties)
Task Force on Physician Review and Discipline
The purpose of this task force shall be to evaluate and make
recommendations for the improvement of physician review and
discipline in the State of Wisconsin. Its findings and recommen-
dations shall be made to the Board of Directors as they are
developed, and a final report to the Board and the House should
be available no later than March 1, 1986.
Peter L Eichman, MD, Madison, Chairman
C William Freeby, MD, Appleton
Richard D Fritz, MD, Milwaukee
Lucille B Glicklich, MD, Milwaukee
Cyril M Hetsko, MD, Madison
John J Kief, MD, Rhinelander
Timothy T Flaherty, MD, Neenah
William L Treacy, MD, Milwaukee
Russell F Lewis, MD, Marshfield
Gerald C Kempthorne, MD, Spring Green
Robert E Johnston, MD, Green Bay
Charles S Geiger, MD, West Bend
D Mark Lochner, MD, Waupaca
George F Flynn, MD, Milwaukee
William L Baker, MD, Monroe
Adolf L Gundersen, MD, La Crosse
Rudolf W Link, MD, Madison
Edwin L Overholt, MD, La Crosse
Philip H Utz, MD, La Crosse
Barry Blackwell, MD, MilwaukeeH
WISCONSIN MEniCAI, JOURNAL, JULY 1985: VOL. 86
121
American Physicians Life's comprehensive and competi-
tively priced line of insurance products is now being
offered exclusively through SMS Services Inc., to State
Medical Society members.
APL is a majority-owned subsidiary of Physicians
Insurance Company of Ohio (PICO) and a sister com-
pany of The Professionals Insurance Company, the
carrier of the SMS-endorsed Professional Liability
Insurance Plan.
APL coverages available to you through SMS Services
Inc., and its authorized insurance representatives
include;
• Innovative Universal Life coverages
• Low Cost Graded Premium Whole Life plan
• Yearly Renewable and Convertible Term Life protection
• Non-cancellable Disability Income programs
• Single and Flexible Premium Annuities
• Comprehensive Office Overhead Expense protection
Why not contact SMS Services Inc., today to find out
how American Physicians Life can solve all your life
insurance needs.
CONTACT:
SMS SERVICES INC.
330 EAST LAKESIDE STREET
P.O. BOX 1109
MADISON, WISCONSIN 53701
(608) 257-6781 OR TOLL FREE
1-800-362-9080
PHYSICIANS EXCHANGE
Family Practitioner. Marshfield Clinic
Department of Family Medicine is seek-
ing a BE/BC Family Practitioner for a
new position. The physician joining the
Clinic's expanding 5-member department
will enjoy the support of one of the na-
tion's largest multispecialty groups, share
the philosophy of family-oriented care
with a preventive focus, and enjoy full
hospital privileges but without the dis-
tractions of OB or surgical responsibili-
ties. Marshfield Clinic offers an excellent
salary plus extensive fringe benefits.
Please send curriculum vitae and the
names of several references to: E Grady
Mills, MD, Family Medicine Department
Chairman, Marshfield Clinic, Marshfield,
WI 54449 or call collect at 715/387-
5168. p6-8/85
Primary care physician. Dodge Correc-
tional Institution, Waupun, Wisconsin—
Bureau of Correctional Health Services,
Division of Health. $23.80 per hour plus
add-on depending on experience or train-
ing. Starting pay is currently being re-
viewed and may be adjusted after July.
Physician with background in general or
family practice or internal medicine
sought for a part-time position (50%| with
Department of Health and Social Services
at Dodge Correctional Institution (DCI).
DCI is the male reception center for the
state prison system. The physician will
be engaged in coordinating the assess-
ment and evaluation of medical needs for
new prisoners, providing direct medical
care in an ambulatory setting, and super-
vising the Physician Assistant. Inquiries
should be made to Barbara J Whitmore,
Box 309, Madison, Wisconsin 53701;
tel: 608/267-7170. Equal Opportunity
Employer. 7/85
Family Practice physician MD or DO
Board eligible or certified. Contact Leon
Gilman, 4957 West Fond du Lac Ave,
Milwaukee, WI 53216 or call 414/871-
7900. 6-8/85
RATES: 50t per word, with a minimum
charge of $20.00 per ad. BOXED AD
RATES: $25.00 per column inch.
DEADLINE: Copy must be received by the
15th of the month preceding month of issue;
e.g., copy for the August issue is due July 15.
Send copy to: Wisconsin Medical Journal,
Box 1109, Madison, Wisconsin 53701; or
phone (area code 608) 257-6781 ; or toll-free
in Wisconsin: 800/362-9080.
MEDICAL YELLOW PAGES
West Bend, Wisconsin, General Clin-
ic, a (18) physician multispecialty group,
is seeking physicians in the specialties of
Internal Medicine, Family Practice, OB/
GYN, and Pediatrics. First-year salary
guaranteed. Corporate membership pos-
sible after one year. Excellent fringe
benefits. Located in scenic, recreational
area with close proximity to Milwaukee.
Please contact Hans W Schmelzling, Ad-
ministrator, General Clinic, 279 S 17th
Ave, West Bend, WI 53095; ph 414/338-
1123. 6tfn/85
Versatile Surgeon wanted to comple-
ment aggressive family practice group in
rural northeastern Minnesota resort com-
munity. Well-equipped 40-bed hospital
with proven surgical practice volume.
Outstanding outdoor recreational op-
portunities with time off to enjoy it.
Reply with CV to E Johnson, Ely Medical
Center, Ltd, 224 East Chapman Street,
Ely, Mn 55731; ph 218/365-3151. 6tfn/85
Psychiatrist. Full-time adult staff posi-
tion in well-established HMO serving
over 210,000 people in one of the leading
metropolitan areas of the Midwest. Join
excellent staff of 35 psychotherapists and
seven psychiatrists. Outstanding bene-
fits, competitive salaries and a flexible
work week providing time for teaching
and other professional pursuits. Send cur-
riculum vitae to: Paul J Brat, MD, Med-
ical Director, Group Health, Inc, 2829
University Avenue Southeast, Min-
neapolis, Minnesota 55414. 6-7/85
Attractive opportunity for a Board
certified/eligible family physician to es-
tablish a new community practice. The
family practitioner will be eligible for
full-hospital privileges at Beloit Memorial
Hospital, a medium-sized acute care
facility. This opportunity offers a guaran-
teed financial and start-up package. In-
quiries or CV should be directed to
Gregory K Britton, Administrative Direc-
tor, Beloit Memorial Hospital, 1969 West
Hart Road, Beloit, Wisconsin 53511; ph
608/364-5104. p6-8;g9/85
Excellent opportunity for a Board cer-
tified or eligible internist to practice
in conjunction with an 8-member Inter-
nal Medicine Department of a 26-mem-
ber multispecialty group. The group is
located in southeastern Wisconsin, in a
city of 100,000 between two major
metropolitan areas of greater than one
million. If interested, please send CV to:
Stephen L Wagner, Kurten Medical
Group, 2405 Northwestern Ave, Racine,
WI 53404. All inquiries will be kept
confidential. 6tfn/85
Family Practice. Third Family Practice
physician needed to join multispecialty
group of 17 in Hartford, WI. Two branch
locations. All facilities modern and well
equipped. Guaranteed first year negoti-
able salary; usual fringe benefits. Con-
tact: Murlin Bernd, Clinic Manager,
1004 E Sumner St, Hartford, WI 53027;
ph 414/673-5745 p7-8/85
Internal Medicine. Hospital-based pri-
vate practice; rural community near Eau
Claire, Wisconsin; part-time satellite
available. Call sharing and guarantees
provided. Critical care management.
Two hours to Minneapolis. Charles Nel-
son, Fox Hill Associates, 250 Regency Ct,
Waukesha, WI 53186; ph 414/785-6500.
p7/85
Internist to join satellite of multi-
specialty clinic in Madison, Wisconsin.
Satellite is located ten miles from Mad-
ison and has one internist already prac-
ticing. Support from all departments anti-
cipated from multispecialty clinic. Fringe
benefits and salary attractive plus ex-
cellent working conditions, environment
and associates. New satellite is growing
and additional physician is needed to give
our patients quality care. Send resume to
Dept 556 in care of the Journal. p6-8/85
Obstetrician/Gynecologist, Board eli-
gible/certified, for Green Bay metropoli-
tan area. Large multispecialty clinic with
excellent salary and benefits. Call or
write: W J Mommaerts, Administrator,
West Side Clinic, sc, 1551 Dousman St,
Green Bay, WI 53403; ph 414/494-
561 1 p6-9/85
Internist-Infectious Disease Phy-
sician. The Racine Medical Clinic, a pro-
gressive cluster corporation of 32 phy-
sicians, is currently seeking an Internist-
Infectious Disease physician. Full bene-
fits, unlimited earnings and a full and
exciting practice are offered. Please con-
tact: Roger D Lacock, Administrator,
Racine Medical Clinic, 5625 Washington
Ave, Racine, WI 53406; ph 414/886-
5000. 6tfn/85
Full-time physician wanted for es-
tablished Urgent Care center affiliated
with regional hospital. Board eligibility
or certification in primary specialty re-
quired. Competitive salary. 45-hours per
week. Benefit package. Paid malpractice.
Incentives, medium-sized city. Family-
oriented progressive community. Quality
school system, cultural advantages. Uni-
versity, abundant outside recreational op-
portunities. Send CV to Dept 558 in care
of the Journal. p6-8/85
WISCONSIN MEDICAL JOURNAL, JULY 1985: VOL. 86
123
MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
continued
Wanted Board Certified Otolaryngol-
ogist. Head and neck surgeon. Join active
one-man practice. General otolaryngol-
ogy, head and neck surgery, facial plastic
surgery, nasal allergy. Computerized of-
fice with x-ray, audiologist, and hearing
aid dispensing. Northern Wisconsin near
Apostle Islands National Lakeshore. Con-
tact James A Hamp, MD, ENT Profes-
sional Associates, SC, 2101 Beaser Ave,
Suite 1, Ashland, WI 54806; ph 715/682-
9311. 4-9/85
Family Physicians, Ophthalmologist,
Orthopedist needed to join 30 physicians
of the Olmsted Medical Group of Roches-
ter. Opportunities available in main office
and satellites. Exceptional salary and
benefit package provided in a choice pro-
fessional and cultural community. Contact
James E Hartfield, MD, Medical Director,
210 Ninth Street SE, Rochester, MN
55903: ph 507/288-3443. 5-7/85
Internist. BC/BE to join Internal Medi-
cine Department of multispecialty group.
Excellent benefits and competitive salary.
Call or write: W J Mommaerts, Admini-
strator, West Side Clinic, sc, 1551 Dous-
man St. Green Bay, WI 53403;
ph 414/494-5611 p6-9/85
Family Practitioner needed to join
established Family Practice group in East
Central Wisconsin city of 50,000 on
beautiful Lake Winnebago. Competitive
salary, fringes, excellent recreation area.
Send CV to MS Knier, MD, 555 S Wash-
burn, Oshkosh, Wis 54901; 414/426-0265.
lOtfn/84
FAMILY PRACTITIONERS
INTERNISTS, OB/GYN
The UW Office of Rural Health is seek-
ing primary care specialists for more
than 50 communities throughout Wis-
consin. Opportunities are available
throughout Wisconsin for Board certi-
fied physicians trained in US medical
schools and residencies.
CONTACT:
Laurie Glowac or Fred Moskol
New Physicians for Wisconsin
University of Wisconsin
Department of Family Medicine
777 S Mills St, Madison, WI 53715
Phone 608/263-4095 7/85-6/86
Board Eligible Orthopedic Surgeon to
join established orthopedic practice in
East Central Wisconsin. Contact Dept 553
in care of the Journal. 2tfn/85
Otolaryngologist. BC/BE to join busy
ENT Department within 23-member
multispecialty group. Excellent benefits
and competitive salary. Call or write: W J
Mommaerts, Administrator, West Side
Clinic, sc, 1551 Dousman St, Green
Bay, WI 53403; ph 414/494-5611.
6-9/85
Family Practice physician needed
to join five family practitioners and a
general surgeon. Immediate oppor-
tunity in west central Wisconsin near
La Crosse. $45,000 first year guarantee
plus incentive. Excellent recreational
area. Community hospital. Send CV
to William L Simpson, Administrator,
PO Box 250, Sparta, WI 54656; or phone
608/269-6731. p5-7/85
Madison, Wisconsin. Experienced phy-
sician for ambulatory care center. Medic-
East, first and only independent ACC in
Madison. Now well established. Located
in heart of Eastside of Madison. Appli-
cants BC/BE demonstrated experience in
primary care, well-developed com-
munication skills. Competitive salary, ex-
cellent benefits, attractive practice setting.
Contact David A Goodman, MD, Medic-
East, 2810 E Washington, Madison, WI
53704; ph 608/244-1213. ltfn/85
Physicians needed full or part-time to
perform light physicals. Milwaukee area.
Professional liability provided. Phone
414/344-2100, Ms Jenkins. lOtfn/84
MD positions nationwide. No
fee. Advanced Medical Place-
ments, Inc. 6414 Copps Avenue,
Madison, WI 53716. Tel: 608/222-
5556. p7/85
Walk-In Clinic Physician. Po-
sition available July 1. Regular
hours, no call, no inpatient re-
sponsibilities, guaranteed salary,
generous benefits. Prefer general-
ist physician comfortable with ur-
gent care situation. Part of 50
physician multispecialty group in
beautiful La Crosse, WI; popula-
tion 50,000. If interested, please
call or write P S Shultz, MD, Medi-
cal Director, Skemp-Grandview-
La Crosse Clinic, 815 S 10th St, La
Crosse, WI 54601; ph 608/782-
9760. 7/85
Wanted— Board qualified— board cer-
tified obstetrician-gynecologist as an
associate. Modern well equipped facility.
Excellent starting salary and benefits in-
cluding profit sharing plan. Please contact
Elizabeth Allen Steffen, MD, 734 Lake
Ave, Racine, Wis 54303. 9tfn/83
Second Family Practitioner needed to
staff a satellite of a 38-physician multi-
specialty group in Kiel, a beautiful small
community in East Central Wisconsin. At-
tractive income arrangements, association
membership possible after one year, pen-
sion and profit sharing, extensive fringe
benefits. Contact R B Windsor, MD, 1011
North 8 St, Sheboygan, WI 53081; ph 414/
457-4461. c2tfn/85
Internist with or without subspecialty
interest. Board Certified or eligible, to
join six other internists in a well-estab-
lished, 23-man expanding multispecialty
group in prosperous lakeside south-
eastern Wisconsin city of 36,000. The
Internal Medicine Department currently
has subspecialties in cardiology, pul-
monary medicine, and medical on-
cology. Liberal fringe benefits. Initial
salary plus percentage as associate.
Full status in service corporation, with
incentive-oriented formula after first
year. Contact J F Kuglitsch, MD, Fond du
Lac Clinic, SC, 80 Sheboygan St, Fond
du Lac, Wis 54935; ph 414/923-7420
collect. 5tfn/85
Family Practice opportunity to join a
four-physician family practice group in
south central Wisconsin city of 15,000.
Pleasant community atmosphere within
T1V2 hours of Madison and Milwaukee.
Excellent recreational area. First year
guaranteed salary. Contact: Chad
Burchardt, Business Manager, Medical
Associates of Beaver Dam, Wis 53916; ph
414/887-7101. 5tfn/85
US Air Force Medical Corps Cur-
rently has opportunities for specialty
physicians. Excellent benefits and
attractive practice settings world-
wide, ranging from small clinics to
1,000-bed medical centers. Positions
currently available include Family
Practice, Internal Medicine, Cardiol-
ogy, Psychiatry, General and Ortho-
pedic Surgery, Otorhinolaryngology,
as well as Aerospace Medicine. For
qualifications and more information
write to 310 W Wisconsin Ave, Suite
380, Milwaukee WI 53202-2278,
Attn: Capt Sealey or call 1-800/242-
USAF. 5-7/85
124
WISCONSIN MEDICAL JOURNAL, JULY 1985: VOL. 86
MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
continued
Family Practitioner. The Racine Medi-
cal Clinic, a progressive cluster corpor-
ation of 31 -physicians is currently seek-
ing a family practitioner. Full benefits,
unlimited earnings, and a full and ex-
citing practice are offered. Please contact
Roger D Lacock, Administrator, Racine
Medical Clinic, 5625 Washington Ave,
Racine, WI 53406; ph 414/886-5000.
4tfn/85
Immediate opportunities for qualified
physicians who possess excellent clinical
and communication skills to join long-
standing group of Emergency Physicians.
Positions available in a popular Wiscon-
sin area bordering Illinois. If interested,
send resume to Barbara Wilczynski,
Medical Emergency, Service Associates
(MESA), SC, 15 S McHenry Road, Suite 2,
Buffalo Grove, IL 60090 or call collect
312/459-7304. 6tfn/83
Medical Director. New position in 50-
physician multispecialty clinic. To work
with administrative team and profes-
sional staff, plus part-time medical prac-
tice. For more information contact
James R Stormont, MD, The Monroe
Clinic, Monroe, Wis 53566; ph 608/328-
7000. p5-7/85
Family Practice Physician to share fully
equipped medical office in central Wis-
consin city. Opportunity for partnership
and eventual purchase of practice. Excel-
lent recreational, educational, hospital,
and civic advantages. Send curriculum
vitae to Dept 503 in care of the Journal.
6tfn/82
Internist or Family Practitioner to join
two Internists and General Surgeon in
growing, established. Green Bay area
practice. Send CV to John Brusky, MD,
1203 South Military Ave, Green Bay, WI
53404. 7tfn/84
Family Physician and Internist, Pedi-
atrician, OB/GYN, Board eligible /certi-
fied. Full or part-time, to join a busy,
established group of physicians in Mil-
waukee. Attractive income. Send cur-
riculum vitae to PO Box 17366, Milwau-
kee, WI 53217. 2-7/85
Wisconsin-BC/BE Pediatrician to
assume an established position of a
pediatrician leaving. Join a three-man
pediatric department. Call or write:
David L Lawrence, MD, 92 E Division
St, Fond du Lac, WI 54935; ph 414/
921-0560. p3-8/85
Internist. BC/BE internist needed to
join four internists in multispecialty
group in NE Wisconsin. Competitive
salary and benefits. Both subspecialty
and general medicine inquiries welcome.
Send CV to Neil Binkley, MD, 1510 Main
St, Marinette, Wis 54143; ph 715/735-
7421. 5-7/85
Family Practitioner needed to join two
FPs at the Ellsworth, Wisconsin office
of a progressive eleven-physician group.
Liberal fringes and financial package.
Forty miles from metropolitan Min-
neapolis/St Paul. Contact R M Hammer,
MD, River Falls, WI 54022; ph 715/425-
6701 or 612/436-8809. 4tfn/85
OB/GYN, and internist to join seven-
doctor family practice clinic in Cloquet,
Minnesota, a community of 14,000 (30,
000) service area, located 20 minutes
from Duluth-Superior. Clinic facility is
located one block from modern, well-
equipped, 77-bed hospital. Cloquet
enjoys a stable economy (forest
products). Additionally our community
is noted for its excellent school system.
First-year salary guarantee; paid mal-
practice, health, and disability insur-
ance; vacation and study time. Con-
tact John Turonie, Administrator,
Raiter Clinic Ltd, 417 Skyline Blvd, Clo-
quet, Minnesota 55720. Telephone
218/879-1271. 7-9/85
MEDICAL FACILITIES
Beaver Dam, Wisconsin. New medical
office 1250 or 2500 sq ft office space
available. Excellent opportunity for Der-
matology or Allergy practice. Call 414/
887-8887 or write PO Box 678, Beaver
Dam, WI 53916. 5-8/85
PHYSICIANS WANTED
Full or part-time PHYSICIANS
WANTED for emergency room
work throughout Wisconsin.
National Emergency Services
offers excellent income, paid
malpractice insurance, and
flexible scheduling. If you're
interested in exploring opportuni-
ties with NES and you would
like additional information, call
James Lucas at 1-800/537-3355,
5-7/85
MEDICAL MEETINGS-
CONTINUING MEDICAL
EDUCATION
WISCONSIN
SEPTEMBER 6-8, 1985: Wisconsin
Society of Anesthesiologists, American
Club, Kohler. g5-8/85
SEPTEMBER 12-14, 1985: Wisconsin
Society of Internal Medicine/American
College of Physicians Annual Meeting—
30th Anniversary, the Pioneer Inn, Osh-
kosh. Info: Wisconsin Society of
Internal Medicine, 611 E Wells St, Mil-
waukee, Wis 53202; ph 414/276-6445.
Contact: Sandra M Koehler, Executive
Director. 5-8/85
SEPTEMBER 13-14, 1985: Wisconsin
Neurosurgical Society, Sheraton, Racine.
g5-8/85
SEPTEMBER 13-14, 1985: Wisconsin
Surgical Society, Paper Valley Hotel &
Conference Center, Appleton. g2-8/85
SEPTEMBER 20-22, 1985: Wisconsin
Society of Otolaryngology— Head and
Neck Surgery, Apple Valley Motel, Apple-
ton. g6-9/85
THIS LISTING is compiled by the State
Medical Society of Wisconsin in coopera-
tion with others who wish to maintain a
centralized schedule of meetings and
courses of interest to Wisconsin physicians
and to avoid scheduling programs in conflict
with others. Hospitals, Clinics, Specialty
Societies, and Medical Schools are par-
ticularly invited to utilize this listing service.
There is a nominal charge for listing of Con-
tinuing Medical Education courses at the
following rates: .50* per word, with a mini-
mum charge of $20.00 per listing.
BOXED LISTINGS: $25.00 per column
inch. Listings of other scientific meetings
will be included at the discretion of the
editors.
COPY DEADLINE tor listings is 15th of the
month preceding the month of publication:
e.g., copy for the August issue is due by July
15. Address communications to: Wisconsin
Medical Journal, Box 1109, Madison, Wis-
consin 53701; or phone (area code 608)
257-6781; or toll-free in Wisconsin: 800/
362-9080.
FOR LISTING of other meetings see the
January 4, 1985 issue of the Journal of the
American Medical Association: Continuing
Education Opportunities for Physicians for
period January 1985 through December
1985.
WISCONSIN MEDICAL JOURNAL, JULY 1985: VOL. 86
125
MEDICAL YELLOW PAGES
MEDICAL MEETINGS-
CONTINUING MEDICAL
EDUCATION
continued
SEPTEMBER 18-20, 1985: "10th An-
nual Nuclear Cardiology Symposium, " pre-
sented by Cardiovascular Disease Pro-
gram, Milwaukee Clinical Campus,
School of Medicine, University of Wis-
consin Continuing Medical Education.
Red Carpet Hotel, Milwaukee. AMA
Category I, UW Extension CEUs and
VOICE credit. Contact: Sarah Aslakson;
University of Wisconsin-Extension; Con-
tinuing Medical Education; Room 465B
WARE Bldg; 610 Walnut St, Madison, WI
53705; ph 608/263-2856. 7/85
SEPTEMBER 20-21, 1985: Multiple
Sclerosis Conference. The Concourse Ho-
tel, Madison. Sponsored by Department
of Neurology, School of Medicine, Uni-
versity of Wisconsin; and Department of
Continuing Medical Education, Univer-
sity of Wisconsin-Extension. AMA Cate-
gory I, University of Wisconsin-Exten-
sion CEUs, AAFP prescribed credit, and
AOA Category 2-D credit. Contact: Sarah
Aslakson, University of Wisconsin-Ex-
tension, Continuing Medical Education,
Room 465B WARE Bldg, 610 Walnut St,
Madison, WI 53705; ph 608/263-2856.
7/85
Wisconsin Specialty
Society Meetings
• Wisconsin Society of Anesthesiolo-
gists, Sept 6-8, 1985, American
Club, Kohler
• Wisconsin Society of Physical Medi-
cine & Rehabilitation, Sept 11, 1985,
Sheraton Inn, Milwaukee
• Wisconsin Society of Internal Medi-
cine/American College of Physi-
cians Annual Meeting, Sept 12-14,
1985, Pioneer Inn, Oshkosh
• Wisconsin Surgical Society, Sept
13-14, 1985, Paper Valley Hotel &
Conference Center, Appleton
• Wisconsin Neurological Society,
Sept 27-28, 1985, Paper Valley Hotel
& Conference Center, Appleton
• Wisconsin Society of Otolaryngology
—Head and Neck Surgery, Sept 20-
22, 1985, Apple Valley Motel, Apple-
ton
• Wisconsin Dermatological Society,
Oct 26, 1985, Froederdt Memorial
Lutheran Hospital, Milwaukee
• Wisconsin Orthopaedic Society,
Nov 1, 1985, The Olympia Resort,
Oconomowoc
SEPTEMBER 20-21, 1985: The Coro-
nary Care Unit Conference. The Wiscon-
sin Center, Madison. Sponsored by De-
partment of Continuing Medical Educa-
tion, University of Wisconsin-Extension;
and Department of Medicine, School of
Medicine, University of Wisconsin. AMA
Category I, University of Wisconsin-Ex-
tension CEUs and AAFP prescribed
credit. Contact: Sarah Aslakson, Univer-
sity of Wisconsin-Extension, Continuing
Medical Education, Room 465B WARE
Bldg, 610 Walnut St, Madison, WI 53705;
ph 608/263-2856. 7/85
SEPTEMBER 27-28, 1985: Wisconsin
Neurological Society, Paper Valley
Hotel & Conference Center, Appleton.
g5-8/85
OCTOBER 4, 1985: Practical Aspects of
Vascular Disease. University of Wiscon-
sin Clinical Science Center, Madison.
Sponsored by University of Wisconsin
Medical School, Departments of Family
Medicine and Practice, Radiology, Sur-
gery, and Continuing Medical Education,
in cooperation with University of Wis-
consin Hospital and Clinics. AMA Cate-
gory I, AAFP, AOA Category 2-D, and
University of Wisconsin CEUs— all 7
hours. Contact: Sarah Aslakson, Depart-
ment of Continuing Medical Education,
610 Walnut St, Room 465B, Madison, WI
53705; ph 608/263-2856. 7/85
OCTOBER 10-11, 1985: Fall Sympo-
sium of Wisconsin Chapter: American
College of Emergency physicians &
SECOND ANNUAL CITIZENS'
CONFERENCE ON ALCOHOL
AND DRUG RELATED PROB
LEMS: BRIDGING RELATION
SHIPS
September 26, 1985 / Mead Inn
Wisconsin Rapids
Keynote Speaker: John K MacIver,
Attorney, Milwaukee
Workshop topics:
• AODA and the Criminal Justice
System
• Community Organization and
Advocacy
• Drug Abuse Treatment Trends
• Legislation
• Fetal Alcohol Syndrome
• Intoxicated Driver Program
• Innovative Prevention/ Inter-
vention Approaches
• AODA and Health
Info: Arlene Meyer, State Medical
Society: 1-800/362-9080 or 608/
257-6781. g7-8/85
Emergency Department Nurses As-
sociation. The Abbey, Fontana.
g7-9/85
OCTOBER 10-11, 1985: Update in Al-
lergy and Clinical Immunology II. The Inn-
Tower Hotel, Madison. Sponsored by De-
partment of Continuing Medical Educa-
tion and Department of Medicine, School
of Medicine, University of Wisconsin-
Madison. AMA Category I, University of
Wisconsin CEUs. Family Practice credit
has been applied for. Approximately 11
hours. Info: Ann Bailey, Continuing
Medical Education, 454 WARF Bldg, 610
Walnut St, Madison, WI 53705; ph 608/
263-2854. 7-9/85
OCTOBER 11-12, 1985: Eating Dis-
orders. The Westowner, Madison. Spon-
sored by Department of Continuing
Medical Education, University of Wis-
consin-Madison; Eating Disorders Pro-
gram, University of Wisconsin Hos-
pital; and Department of Pediatrics, Uni-
versity of Wisconsin-Madison. AMA
Category I, AAFP, AOA Category 2-D,
ADA pending, WNA pending, and Uni-
versity of Wisconsin CEUs— all 10 hours.
Contact: Sarah Aslakson, Department of
Continuing Medical Education, Room
465B, 610 Walnut St, Madison, WI
53705; ph 608/263-2856. 7/85
OCTOBER 18-19, 1985: Focus on Rheu-
matology-1985. University of Wisconsin
Clinical Science Center, Madison. Spon-
sored by Department of Medicine, School
of Medicine, University of Wisconsin;
and Department of Continuing Medical
Education, University of Wisconsin, in
cooperation with University of Wiscon-
sin Hospital and Clinics. AMA Category
I, AAFP, AOA Category 2-D, and Univer-
sity of Wisconsin CEUs— all 8V2 hours.
Contact: Sarah Aslakson, Department of
Continuing Medical Education, 610 Wal-
nut St, Room 465B WARF Bldg, Madison,
WI 53705; ph 608/263-2856. 7/85
OCTOBER 26, 1985: Wisconsin Derma-
tological Society, Froederdt Memorial
Lutheran Hospital, Milwaukee. g6-9/85
JANUARY 25-FEBRUARY 1, 1986:
Sports Medicine Cruise Seminar, SS Consti-
tution, Hawaiian Islands. Sponsored by
University of Wisconsin School of Medi-
cine, Continuing Medical Education.
AMA Category I credit 16 hours. Family
Practice credit pending, and 16 hours
University of Wisconsin CEUs. Contact:
Ann Bailey, Department of Continuing
Medical Education, 454 WARF Bldg, 610
Walnut St, Madison WI 53705; ph 608/
263-2854. 7-9/85
126
WISCONSIN MEDICAL JOURNAL, JULY 1985: VOL. 86
MEDICAL YELLOW PAGES
MEDICAL MEETINGS-
CONTINUING MEDICAL
EDUCATION
continued
OTHERS
SEPTEMBER 9-20, 1985 (Minnesota):
Third Annual Graduate Occupational
Health and Safety Institute, Earle Brown
Continuing Education Center, St Paul,
MN. Info: Bonnie Young, CME, St Paul-
Ramsey Medical Center, 640 Jackson St,
St Paul, MN 55101: ph 612/221-3977.
g6-8/85
SEPTEMBER 19-21, 1985 (Minne-
sota): Pulmonary and TB Update, Radisson
Plaza Hotel, St Paul. Info: Bonnie Young,
CME, St Paul-Ramsey Medical Center,
640 Jackson St, St Paul, MN 55101; ph
612/221-3977. g6-8/85
OCTOBER 3-4, 1985 (New York): 8th
Annual Current Concerns in Adolescent
Medicine— "A Practitioners Guide to Teen-
State Medical Society
of Wisconsin
Dates and locations of
ANNUAL MEETINGS
1986-1992
All meetings will be held in Milwau-
kee at the Milwaukee Exposition and
Convention Center and Arena
(MECCA) and the new Hyatt Regency
as the headquarters hotel with the ex-
ception of 1985, when the meeting will
be held at the La Crosse Convention
Center.
1986- April 17-19
1987- March 26-28
1988- April 28-30
1989- April 13-15
1990- April 26-28
1991- April 18-20
1992- April 23-25
Meeting days will be Thursday and
Friday; the first session of the House
of Delegates will convene on Thurs-
day, the second and third on Friday.
Scientific programming will be on Fri-
day and Saturday.
Further information: Commission on
Continuing Medical Education, State
Medical Society of Wisconsin, Box
1109, Madison, Wis 53701. Local tele-
phone: 257-6781; toll-free in Wiscon-
sin: 1-800/362-9080.
age Health Care," The Warwick Hotel,
New York City. Sponsored by: Division
of Adolescent Medicine, Department of
Pediatrics, Schneider Children's Hos-
pital, Long Island Jewish Medical Center,
New Hyde Park, New York. Credits: 13
Category 1 from ACCME and AMA. Info:
Ann J Boehme, Associate Director for
Continuing Education, Long Island Jew-
ish Medical Center, New Hyde Park,
New York 1 1042; ph 718/470-8650.
p7/85
OCTOBER 17-18, 1985 (Minnesota):
Toxic Chemicals in the Workplace: Health,
Legal, and Regulatory Issues, Earle Brown
Continuing Education Center, St Paul.
Info: Bonnie Young, CME, St Paul-
Ramsey Medical Center, 640 Jackson St,
St Paul, MN 55101; ph 612/221-3977.
g6-9/85
OCTOBER 25, 1985 (Minnesota): Pro-
moting Healthy Lifestyles For Pregnant
Women, Earle Brown Continuing Educa-
tion Center, St Paul. Info: Bonnie Young,
CME, St Paul-Ramsey Medical Center,
640 Jackson St, St Paul, MN 55101; ph
612/221-3977, g6-9/85
OCTOBER 31-NOVEMBER 1, 1985
(Minnesota): Latest Trends in Patient
Management: Radiology and Urology,
Radisson Plaza Hotel, St Paul. Info: Bonnie
Young, CME, St Paul-Ramsey Medical
Center, 640 Jackson St, St Paul, MN
55101. g6-10/85
OCTOBER 30 NOVEMBER 2, 1985:
La Crosse Health and Sports Science Sym-
posium. Info: Philip K Wilson, Executive
Director, La Crosse Exercise Program, 221
Mitchell Hall/UWL, La Crosse, WI 54601;
ph 608/785-8686. g6-9/85
NOVEMBER 1, 1985: Wisconsin Ortho-
paedic Society, The Olympia Resort,
Oconomowoc. g6-10/85
NOVEMBER 14-16, 1985 (Minnesota):
Clinical Strategies In Primary Care Medi-
cine, Radisson Plaza Hotel, St Paul. Info:
Bonnie Young, CME, St Paul-Ramsey
Medical Center, 640 Jackson St, St Paul,
MN 55101; ph 612/221-3977. g6-10/85
DECEMBER 5-7, 1985 (Minnesota):
Coronary Heart Disease: A Comprehensive
Review of Principles and Practice, Sheraton
Midway Hotel, St Paul. Info: Bonnie
Young, CME, St Paul-Ramsey Medical
Center, 640 Jackson St, St Paul, MN
55101; ph 612/221-3977. g6-ll/85
AMA
DECEMBER 8-11, 1985: Interim AMA
House of Delegates, Washington, DC.
JUNE 15-19, 1986: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 7-10, 1986: Interim AMA
House of Delegates, Las Vegas, NV.
JUNE 21-25, 1987: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 6-9, 1987: Interim AMA
House of Delegates, Atlanta, GA.
JUNE 26-30, 1988: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 4-7, 1988: Interim House
of Delegates, Dallas, TX. ■
ADVERTISERS
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Army Medical Department 114
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Ayerst Laboratories (Div of American
Home Products Corp) 14, 15, 16
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Centralized Billing Systems 120
Dista Products Co (Div of Eli
Lilly & Co) 7
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Marion Laboratories 11, 12
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PBBS Equipment 114
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Professionals Insurance
Company, The 119
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WISCONSIN MEDICAL JOURNAL, JULY 1985: VOL. 86
27
[news you can use
BOARD CERTIFICATION INCREASING RAPIDLY. Despite its voluntary nature board certification has been
increasing rapidly, AMA research economist Steven Culler, PhD and sociologist Edmund R Becker, PhD said
in an article published in the January issue of the Journal of Medical Education. Between 1971 and 1981 the
annual growth rate of physicians obtaining board certification was 7.2%, while the annual increase in all physi-
cians was 3.2%. By the end of 1981, 53.2% of US physicians were board-certified. The percentage is higher
(62.2%) if only nonfederal patient care physicians are considered. If the growth rate of the 1970s and early
1980s continues through 1989, nearly 70.4% of all physicians will be board-certified by the end of the decade.
By the turn of the century 90% will be. The AMA Center for Health Policy Research found that the board
certification was more prevalent for certain specialties, ages, types of practice, and locations of practice. Surgical
and medical specialists, for example, were the most likely to be board-certified (74.4% and 65.2%, respec-
tively), while general practitioners were the least likely to be (39.9%). Although board-certified physicians
had higher gross incomes on the average than their nonboard-certified counterparts, they also appeared to
have higher overheads that dissipated the economic advantage of board certification. Finally, comparisons
of the hours worked per week and weeks worked per year show only small differences between board-certified
and nonboard-certified physicians.
The authors also point out that an important aspect of a physicians's career, the decision to obtain specialty
board certification, is voluntary and does not appear to provide physicians with additional legal privileges
in the practice of medicine. Moreover physicians are not required to limit themselves to the practice specialty
in which they are certified. The certification boards are in no sense educational institutions, and the certificate
of a board is not to be considered a degree (ref: '82-'83 Directory of Residency Training Programs. Chicago, Illinois:
American Medical Association, 1982). In short, the authors emphasize that board certification does not confer
on any person legal qualifications or privileges, nor does it in any way interfere with or limit the professional
activities of a licensed physician. To become board-certified in a specialty, a physician needs to complete the
required graduate training and pass the board-certification examination. In spite of the fact that board certi-
fication does not enhance a physician's legal qualifications, there are several reasons why a physician may
be willing to fulfill the requirements to become board-certified, they say. One major reason is that board
certification may improve the possibilities for him to acquire admitting privileges to the hospitals of his choice.
In addition, he may use board certification to help gain referrals. Finally, the board-certified physician is usually
viewed by patients as having successfully completed certain additional requirements beyond those required
for license.*
GOVERNOR VETOES CHIROPRACTIC COVERAGE IN BUDGET BILL. On July 17 Governor Earl signed
into law the 1985-87 biennial budget, but vetoed mandatory chiropractic insurance coverage which would
have allowed for 28 visits per year to a chiropractor if an insurance policy included coverage of any diagnostic
or treatment services or procedure by a licensed physician or osteopath. The mandated coverage would have
been applicable to HMOs, PPOs, and any plan offered to state employes. Under current law, s. 628.33,
chiropractic coverage must be offered by all insurance companies offering accident and health coverage to
any purchasers who request it. This allows consumers the freedom of choice regarding what type of coverage
they feel is necessary.
The Governor, in vetoing the sections on mandatory chiropractic coverage, stated that such coverage
"erodes cost containment efforts of health insurers and results in higher priced policies and/or a reduction in
other services currently being covered under the plans. Many of the cost savings realized are a result of the
primary physician acting as a gatekeeper. This gatekeeper role functions as a control on excessive utilization of
costly services. Mandated chiropractic coverage erodes this gatekeeper function of the primary physician and
therefore, directly contributes to higher costs. In addition, mandated insurance benefits create incentives for
employers to self-insure. Most large employers in the state already self-insure health benefits for their
employes, and are thus exempt from any mandated coverage of chiropractic care. The Office of the Com-
missioner of Insurance estimates that more than 40 percent of the employes in the state are covered under
self-insured plans. Therefore, the mandated coverage for chiropractic care will strongly affect the employes
of smaller firms, the elderly and the individual policyholder. These are the groups that may be least able
to afford the increased costs of health care," the Governor stated.
The State Medical Society, as well as several legislators, formally requested such a veto.*
1
128
WISCONSIN MEDICAL JOURNAL. JULY 1985: VOL. 86
EXCERPTS FROM A SYMPOSIUM
"THE TREATMENT OF SLEEP DISORDERS"®
ii.
y . . highly effective
for both sleep induction and
sleep maintenance ff
Sleep Laboratory Investigator
Pennsylvania
. . onset of action is
rapid. . .provides sleep with
no rebound effect to agitate the
patient the following day A ^
Psychiatrist
California
. . appears to have
the best safely record of any
of the
benzodiazepines ff
Psychiatrist
California
After 15 years, the experts still concur about the
continuing value of Dalmane (flurazepam HCI/
Roche). It provides sleep that satisfies patients. . .
and the wide margin of safety that satisfies you.
The recommended dose in elderly or debilitated
patients is 15 mg. Contraindicated in pregnancy
dalmane;
flurazepam HCI/Roche
sleep that satisfies
1 5-mg/30-mg
capsules
Relerences: 1. Kales J, etai Clin Pharmacol Ther /Z 691 -
697, Jul^Aug 1971 2. Kales A, etai Clin Pharmacol Ther
18:356-363. Sep 1975 3. Kales A, elal Clin Pharmacol
Ther /9. 576-583, May 1976 4. Kales A, etai Clin Pharma-
col Ther 32:T8]-T88, Dec 1982 5. Frost JD Jr, DeLucchl
MR J Am Geriatr Sac 27:54]-5A6. Dec 1979 6. Dement
WC, etai: BehavMed, pp 25-31, Oct 1978 7. Kales A,
Kales JD: J Clin Psychopharmacol 3:\AQ-~\50, Apr 1983
8. Tennant FS, etai: Symposium on the Treatment ot Sleep
Disorders, Teleconterence, Oct 16, 1984 9. Greenblatt DJ,
Allen MD, Shoder Rl: Clin Pharmacol Ther 21 355-36],
Mar 1977
flurazepom HCI/Roche
Before prescribing, please consult complete product infor-
mation, 0 summary ot which follows:
Indications: Effective in all types of insomnia characterized
by difficulty in falling asleep, frequent nocturnal awakenings
and/or early morning awakening; in patients with recurring
insomnia or poor sleeping habits; in acute or chronic medical
situations requiring restful sleep. Objective sleep laboratory
data have shown effectiveness for at least 28 consecutive
nights of administration. Since insomnia is often transient
and intermittent, prolonged administration is generally not
necessary or recommended Repeoted therapy should only
be undertaken with appropriate patient evaluation.
Contraindications: Known hypersensitivity to flurazepam FICI,
pregnancy. Benzodiazepines may cause fetal damage when
administered during pregnancy Several studies suggest an
increased risk of congenitol malformations associated with
benzodiazepine use during the first trimester Warn patients of
the potential risks to the fetus should the possibility of becom-
ing pregnant exist while receiving flurazepam Instruct patient
to discontinue drug prior to becoming pregnant. Consider the
possibility of pregnancy prior to instituting therapy
Warnings: Caution patients about possible combined effects
with alcohol ond other CNS depressants An additive effect
may occur it alcohol is consumed the day following use for
nighttime sedation. This potential may exist for several days
following discontinuation Caution against hazardous occu-
pations requiring complete mentol alertness (e g., operating
machinery, driving). Potential impairment of performance of
such activities may occur the day following ingestion Not
recommended for use in persons under 1 5 years of age.
Though physical and psychological dependence have not
been reported on recommended doses, abrupt discantinuo-
tion should be avoided with graduol tapering of dosage for
those patients on medication for a prolonged period of time
Use caution in administering to addiction-prone individuals
or those who might increase dosage.
Precautions: In elderly and debilitated patients, it is recom-
mended that the dosage be limited to 15 mg to reduce risk ot
oversedation, dizziness, confusion and/or ataxia. Consider
potential additive effects with other hypnotics or CNS depres-
sants Emplay usual precautions in severely depressed
patients, or in those with latent depression or suicidal tenden-
cies, or in those with impaired renal or hepatic function
Adverse Reactions: Dizziness, drowsiness, lightheadedness,
staggering, ataxia and falling have occurred, porticularly in
elderly or debilitated patients Severe sedation, lethargy, dis-
orientation and coma, probably indicative of drug intolerance
or overdosage, have been reported. Also reported: headache,
heortburn, upset stomach, nausea, vomiting, diarrhea, con-
stipation, Gl pain, nen/ousness, talkativeness, apprehension,
irritability, weakness, palpitations, chest pains, body and joint
pains and GU complaints There have olso been rare occur-
rences of leukopenia, granulocytopenia, sweating, flushes,
difficulty in focusing, blurred vision, burning eyes, fointness,
hypotension, shortness of breath, pruritus, skin rash, dry
mouth, bitter taste, excessive salivotion, anorexia, euphoric,
depression, slurred speech, contusion, restlessness, holluci-
nations, and elevated SGOT, SGPT, total and direct bilirubins,
and alkaline phosphatase, and paradoxical reactions, e g.,
excitement, stimulation ond hyperactivity.
Dosage: Individualize for maximum beneficial effect Adults.
30 mg usual dosage, 15 mg may suffice in some patients.
Elderly or debilitated patients. 15 mg recommended initially
until response is determined.
Supplied: Capsules containing 15 mg or 30 mg flurazepam
HCI.
Roche Products Inc.
Monoti, Puerto Rico 00701
*i IN EXPERIENCE
Worldwide, ifs a known quantity. . . known know it better than any other hypnotic. The
tor sleep that satisfies. . only benzodiazepine hypnotic with more
than 15 years of continuing satisfactory
You know it helps patients toll asleep quickly performance. As always, caution patients
and stay asleep till morning. ' ® You know its about driving or drinking alcohol.
exceptionally wide margin of safety ^ ^ You Please see references and summary of producf informafion on reverse side
DALMANE®
flurazepam HCI/Roche
sleep that satisfies
Copyrighf © 1985 by Roche Products Inc. All rights reserved.
WISCONSIN
MEDICAL JOURNAL
Bone scan changes
' in a
Silo-filler's
marathon runner
disease
Case report of a 34 -year old mara-
The various oxides of nitrogen
thon runner with degenerative
are produced by the fermentation
changes in his left knee. Bone
process in dairy silos. These irri-
scans were done prior to and after
tative toxic gases can produce a
a recent marathon during a
clinical spectrum ranging from
symptomatic period. A 10% in-
htnnediate asphyxiation to delayed
crease of osteoblastic activity in
respiratory distress and with subse-
the symptomatic knee and a 3%
quent pernianent lung damage. A
increase in the asymptofnatic knee
case is reviewed and }neasures to
were found. Patients with sub-
prevent this tragic occurrence are
jective and objective findi}igs
prior to a marathon should be ad-
vised to reevaluate their intense
running goals. (See page 1 1 j
described. (See page 13}
Neisseria meningitidis serogroup Z
as a cause of meningitis
A case o/ Neisseria meningitidis serogroup Z meningitis i)i a 19-year-old )nale
is presented. The patietit was successfully treated with aq. Fenicillin-G. This
is the first case of serogroup Z meningitis in a young adult in the United States.
(Seepage 16}
,.“r^(CtEGE OF PHYSICIANS
fl. L/a
SEP 171980
WISCONSIN
MEDICAL JOURNAL
k
ISSN 0043-6542 /Established 1903
Owned and published by
State Medical Society of Wisconsin
Medical Editor
Victor S Falk MD, Edgerton
Editorial Board
Victor S Falk MD, Edgerton Chairman
Melvin F Huth MD, Baraboo
M C F Lindert MD, Milwaukee
Andrew B Crummy Jr MD, Madison
Richard D Sautter MD, Marshfield
Dean M Connors MD. Madison
George W Kindschi MD. Monroe
Charles FI Raine MD, Racine
Darrell L Witt MD. Wausau
Garrett A Cooper MD, Madison Emeritus
Editorial Director
Wayne J Boulanger MD, Milwaukee
Editorial Associates
R Buckland Thomas MD, Monroe
Russell F Lewis MD, Marshfield
Raymond A McCormick MD, Green Bay
Victor S Falk MD, Edgerton
Medical Editor
Staff
Earl R Thayer, Madison
Secretary-General Manager
State Medical Society of Wisconsin
H B Maroney II, Madison
Assistant Secretary-Corporate Counsel
State Medical Society of Wisconsin
Mrs Mary Angell, Madison
Managing Editor
Mrs Marjorie Stafford, Madison
Publications Assistant
[contents
SPECIAL FEATURES
President's Page
5 Maximum care at
minimum cost
John K Scott, MD, Madison
Editorials
6 What next?
Victor S Falk, MD,
Edgerton
Skulduggery in the Senate
Victor S Falk, MD,
Edgerton
7 —"that made Milwaukee
famous"
Victor S Falk, MD,
Edgerton
Special
26 Blue Book Update
26 AMA Physician's
Recognition Award
recipients
Public Health
27 Statewide network set up
for AIDS testing
August 1985
SCIENTIFIC MEDICINE
1 1 Bone scan changes in a
marathon runner; case
report
Gary N Guten, MD and
Don Craviotto, BS,
Milwaukee
12 Abstract: Splenic phago-
cytic function after partial
splenectomy and splenic
autotransplantation
Mark A Malangoni, MD, et al
Louisville, Kentucky and
Milwaukee
13 Silo-filler's disease; a
historical perspective and
report of a case
William J Maurer, MD
Marshfield
16 Neisseria meningitidis
serogroup Z as a cause of
meningitis
LeeAnne Nazer, MD and
Michael W Rytel, MD,
Milwaukee
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COPYRIGHT 1985
State Medical Society of Wisconsin
V ^
-A.
WISCONSIN MEDICAL JOURNAL (ISSN 0043-6542| is the official publication of the State Medical
Society of Wisconsin, devoted to the interests of the medical profession and health care in Wisconsin.
Its affairs are handled by the Editorial Board, subject to policy direction of the Society's Board of
Directors. The Managing Editor is responsible for the production, business operation, and coor-
dination of contents as well as the final responsibility of the entire publication. The Editorial Director
is responsible for Editorials. Unsigned Editorials express views consistent with the policies of the
State Medical Society of Wisconsin. Signed Editorials express personal views of the author for which
the Society takes no responsibility. Neither the Editors nor the State Medical Society will accept
responsibility for statements made or opinions expressed in the pages of the Journal. Indexed in
"Index Medicus," "Hospital Literature Index," and "Cambridge Scientific Abstracts."
I
I
1
Vol. 84 No. 8
c
CONTENTS
1
ORGANIZATIONAL
23 SMS June 29 Board
Meeting results
Physicians honored
Medicare changes due
October 1
24 Museum receives grant
Citizens' Conference on
AODA scheduled
Financial planning
seminar set, October
Fund fee assessments due
25 Doctor Pomainville
honored at Medical
Museum
32 CES FOUNDATION:
Contributions— May 1985
35 Obituaries
Rodney P Gwinn, MD,
Sturgeon Bay
Michael F Ries, MD,
Brownsville
Rudolph P Gingrass, DDS,
MD, Oconomowoc
Desmond H Callaghan, MD,
Hayward
Donald D Frawley, MD,
Sun City, Arizona
(Milwaukee)
Rodney B Fruth, MD,
Elm Grove
William E Bargholtz, MD,
Ashland
Bruno J Peters, MD,
Wauwatosa
Maurice H McCaffrey, MD,
Dunedin, Florida (Madison)
Paul E Rutledge, MD,
Washington Island
John Kimberly Curtis, MD,
Madison
38 Membership facts
DEPARTMENTS
29 Physician briefs
33 County societies;
Milwaukee . . . Outagamie
. . . Winnebago
34 Specialty societies:
Wisconsin Academy of
Family Physicians . . .
American Society of
Surgery of the Hand . . .
Society of Thoracic Radi-
ology . . . American
Academy of Dermatology
. . . American College of
Utilization Review Physi-
cians . . . American Col-
lege of Physicians . . .
Wisconsin Chapter,
American College of
Surgeons
45 Medical yellow pages
Physicians exchange
Medical facilities
Miscellaneous
Medical Meetings—
Continuing Medical
Education
Advertisers
Books received*
THE STATE MEDICAL SOCIETY OF WISCONSIN, created by the Territorial Legislature in 1841,
represents over 5700 member physicians in Wisconsin, comprising 55 county medical societies
and 27 medical specialty sections. The purpose of the Society is to "bring together the physicians
of the State of Wisconsin to advance the science and art of medicine and the better health of the
people of Wisconsin, and to secure the enactment and enforcement of just medical laws." The
major activities of the Society include continuing medical education, peer review, legislation,
community health education, scientific affairs, socioeconomics, health planning, services for
physicians, operation of a Charitable, Educational and Scientific E'oundation, and publication of
the Wisconsin Medical Journal.
Officers
President; John K Scoll, MD. Madison
President-Elect; Charles W Landis,
MD. Milwaukee
Secretary-General Manager:
Earl R Thayer, Madison
Treasurer; John J Foley, MD
Menomonee Falls
Board of Directors
Chairman: Darold A Trefferl, MD
Fond du Lac
Vice Chairman: Roger L
von Heimburg, MD, Green Bay
First District
Jerome W Rons Jr, MD. Cudahy
Carl S Eisenberg, MD, Milwaukee
Thomas A Hofbauer, MD,
Menomonee Falls
Wayne H Konetzki, MD, Waukesha
Fredrick Wood Jr, MD, Kenosha
William L Treacy, MD. Milwaukee
Richard D Fritz, MD, Milwaukee
William J Listwan, MD, West Bend
Glenn H Franke, MD, Milwaukee
Lucille B Glicklich, MD. Milwaukee
Second District
J D Kabler, MD. Madison
Cyril M Fletsko, MD. Madison
James J Tydrich, MD. Richland Center
Alwin E Schultz, MD, Madison
Kenneth 1 Gold. MD, Beloit
Third District
Pauline M Jackson, MD. La Crosse
Fourth District
John J Kief. MD, Rhinelander
Jung K Park. MD, Wisconsin Rapids
W George Locher, MD, Wausau
Fifth District
Darold A Treffert, MD. Fond du Lac
Kenneth M Viste Jr, MD, Oshkosh
C William Freeby, MD, Appleton
Sixth District
Roger L von Heimburg, MD. Green Bay
Joseph C DiRaimondo, MD. Manitowoc
Seventh District
Marwood E Wegner. MD. St Croix Falls
Philip J Happe, MD, Eau Claire
Eighth District
Joseph M Jauquet, MD. Ashland
>
President: Doctor Scott
President-Elect: Doctor Landis
Past President: Timothy T Flaherty,
MD, Neenah
Speaker: Duane W Taebel, MD,
La Crosse
Vice Speaker; Vernon M Griffin, MD,
Mauston
A,
It Pays
TO BE A
Member
SMS Services, Inc.
Announcing
ANOTHER ENDORSED PROGRAM
FOR SOCIETY MEMBERS
Workers' Compensation
Insurance
WITH AN ATTRACTIVE
Dividend Plan
UNDERWRITTEN AND MARKETED BY
THE DODSON INSURANCE GROUP
KANSAS CITY, MISSOURI
A.M. Best Rating A + (Excellent)
and Financial Size Category XIII
CALL TOLL-FREE
1-800-821-3760
P.O. BOX 1109, MADISON, WI 53701 • PHONE 608/257-6781 OR TOLL-FREE 1-800-362-9080
PRESIDENT'S PAGE
Maximum care at minimum cost
Questions: At what point does maximum care at minimum cost affect patient care?
Society is now looking at ways to help the physician control costs. Is fraud and abuse
being perpetrated on the public by medicine? What is the price of the fear and appre-
hension that the patient develops in certain acute care situations limited by DRGs
and the preadmission review program for Medicaid and Medicare?
The most recent WiPRO Reviewer informs us of changes in the WiPRO preadmis-
sion review (PAR) program for Medicare and Medicaid recipients. These changes
went into effect July 1, 1985.
WiPRO's original PAR program was negotiated in good faith and had been accepted
by the Health Care Financing Administration (HCFA) as part of WiPRO's medical
review contract. It is now viewed by HCFA to be out of compliance with law and
regulation. This is because the original approach to PAR was to issue an advisory find-
ing made by a nurse when a case was found to not meet criteria for admission. In such
cases HCFA now requires a binding PAR denial to be issued by a WiPRO physician
advisor, "PA."
In changing from advisory to binding PAR, any case that does not meet physician-
developed admissions screening criteria will be referred to a physician advisor. If
the advisor finds that a case lacks medical necessity for admission, a binding denial
notice must be issued and the beneficiary, practitioner, hospital, and fiscal inter-
mediary must be promptly notified. This binding denial means that no payment
would be made to the hospital if the patient were admitted with the same condition
and treatment plan as described in the PAR.
The beneficiary, practitioner, and hospital then have an opportunity to request a
reconsideration. WiPRO's program requires all elective admissions to be reviewed on
a preadmission basis. The concern of the State Medical Society is: Who is making the
judgment call for admission and care of the patient? Again, my question is: At what
point does the maximum care at minimum cost affect patient care?
There are many ways to treat different illnesses. In part this is because physicians
are "clones" of their residency background. But in no way are physicians perpetrating
fraud and abuse on the public in attempts, often mandated by regulation, to provide
only the minimum medically necessary care and thus control costs. A major ques-
tion remains: What happens to the doctor/patient relationship?
What about an elderly patient, falling, injuring her hip, seen in the emergency room
at night by the attending physician? The examination and x-ray films reveal no
apparent fracture of the hip. The patient is subsequently taken home and treated as
an outpatient. The x-ray findings in the AM reveal a fracture and the patient is
readmitted 12 hours later for further care. The admission is retrospectively denied
and there is a considerable amount of "hassle" between the PA reviewer, the physi-
cian, hospital, and patient as to payment.
There are entirely too many of these examples threatening good doctor /patient care.
Fear and apprehension are not components of a good doctor/patient relationship.
The State Medical Society, through its Physicians Alliance Commission, is seek-
ing evidence from physicians or patients which relates to untoward circumstances
or adverse effects that have occurred as a consequence of DRCs, PRO, insurance
plan rules, or other attempts to minimize cost while maximizing care. And let's
remember that if these systems produce good results, the Society should hear about
those, too.
In summary, please let the SMS know of your critique of the PAR program and
similar efforts in Wisconsin. We all know that regulation has come upon the
healthcare scene, but let's also be sure we do everything to make certain the patient
is treated fairly. ■
John K Scott, MD
EDITORIALS
Wayne J Boulanger, MD, Editorial Director
Unsigned editorials express views consistent with the policies of the State Medical Society of Wisconsin.
Signed editorials express personal views of the author for which the Society takes no responsibility.
What Next?
We must call WiPRO to obtain
permission to hospitalize a Medi-
care patient. Should there be a
later question about this, we must
also attempt to call a reviewer
within a limited number of days.
We must get a second opinion
before performing certain sur-
gical procedures on Medicaid
patients and patients covered by
certain insurance companies. The
rather strange thing about these
second opinions for Medicaid is
that should the second opiner
indicate that the procedure is not
necessary in his opinion, the
patient may still opt to have the
surgery performed.
As indicated in a recent edit-
orial, we must call Detroit to ob-
tain permission to hospitalize
employees of a particular in-
dustry as well as any of the em-
ployees' dependents. Should the
hospitalization extend beyond the
very limited number of days in-
itially granted, it is necessary to
call Detroit again for the exten-
sion. Also if it is necessary to
transfer the patient to a more
sophisticated facility for some
specialized care, it is again neces-
sary to call Mo-Town. Recently
some clinics have been billing the
industry for the time spent on
these telephone calls. Thus far
there has been no recompense—
but the physicians feel better for
having expressed their aggra-
vation.
Some of us are strongly advised
by WiPRO that we must decrease
our Medicaid patient admissions
by an arbitrary 20 percent. We
also are told that we must cut
down on the number of compli-
cations following cholecystec-
tomies.
HMOs tell us that there is an
overrun on laboratory work
when it is done outside a phy-
sician's office and that amount is
deducted from the physician's
capitation fund. This is true even
though the facility where the lab-
oratory procedures are carried
out belongs to the same HMO.
Now the Wisconsin Hospital
Rate-Setting Commission has
made some recommendations.
One is that Methodist Hospital
in Madison reduce its staff by 18
full-time equivalent employees
and that Divine Savior Hospital
in Portage reduce its staff by
about 26 full-time employees.
Is there no limit to the number
of regulating agencies? And just
who regulates the regulators?
What next?
.—Victor S Falk, MD, Edgerton
Skulduggery
in the Senate
Originally, this piece was to be
entitled "Sanity in the Senate."
The budget bill passed by the
Wisconsin Assembly included a
provision mandating all insur-
ance plans to include coverage for
chiropractic services. This pro-
vision was never voted on separ-
ately but was part of an omnibus
58-item amendment proposed by
the Assembly Democratic leader-
ship. Seventeen widely diverse
organizations urged the State
Senate to reject the language
mandating such chiropractic
coverage which they described as
"disturbing and counter-pro-
ductive to see a special interest
group (chiropractors) attempting
to foster cost increases by man-
dating additional health care
benefits." Among the groups
opposing the mandate were
Region 10 of the United Auto
Workers, the Coalition of Wis-
consin Aging Groups, the Office
of the State Insurance Commis-
sioner, and the Federation of
Cooperatives.
Despite the opposition of the
caucus of the Senate Democrats
and the President of the Senate,
the chiropractic coverage,
through some very adroit maneu-
vering, managed to remain in
the state budget bill. The bill
was finally passed by a weary
band of legislators. Although
the budget bill was a totally in-
appropriate place for such legis-
lation, it provided that as a three-
year test, chiropractic coverage
would be required in all health
insurance plans and participants
would be allowed 28 visits an-
nually. The number of visits per-
mitted was an absurdity in itself.
Fortunately, Governor An-
thony Earl had the wisdom to
veto the mandated chiropractic
coverage. The mandate had been
vetoed in the past years by acting
Governor Martin Schreiber and
again by Governor Earl. The
Medical Society is appreciative
of Governor Earl's courage and
perception in defeating this mea-
sure.
Just as inevitably as the weeds
come up in the spring, the well
funded and highly organized
chiropractic lobby promotes one
bit of legislation favorable to
chiropractic. They met with
success for several years, but
more recently their outrageous
demands for compulsory chiro-
practic coverage have been
vetoed by governors. Whereas
the chiropractors are able to de-
vote their entire effort to a single
project at each legislative session,
the State Medical Society is in-
volved in hundreds of bills rele-
vent to medicine. The Society op-
poses some, favors others, and at
times makes requests that certain
legislative measures be intro-
duced. For example, SMS is seek-
ing legislation currently in eight
major areas— only one of which is
6
WISCONSIN MEDICAL JOURNAL, AUGUST 1985: VOL. 84
SKULDUGGERY
EDITORIALS
professional liability which con-
stitutes an enormous legislative
agenda on its own. This broad
base of pertinent legislation
spreads the Society staff and con-
cerned physicians over a thin
layer. Unfortunately most phy-
sicians tend to be pretty apathetic
about legislative involvement.
—Victor S Falk, MD, Edgerton
Editorial Board comment: There are
still those, even in the Legislature, who
do not understand that as the coverage
of any insurance broadens, its use in-
creases and the costs to the purchaser
go up. Then comes the screaming about
escalating healthcare costs, and those
who opposed the increased coverage get
blamed for the increased cost. No mat-
ter what— we can't really win, but
thanks to Governor Earl we have a
respite.
—"that made Milwaukee famous"
The product that made Mil-
waukee famous is no longer
brewed there. However, two
medical terms have brought fame
to Milwaukee.
One is the "Milwaukee brace"
designed by Dr Walter Blount.
The other is "Milwaukee shoul-
der" first described by Dr Donald
J McCarty of Milwaukee in 1981. ^
Doctor McCarty indicated that
the features of "Milwaukee
shoulder" include: 1) the occur-
rence predominately in older
women; 2) shoulder pain and
marked limitation of motion; 3)
large recurrent shoulder effusions
characterized by mononuclear
cells with a low leukocyte count;
4) concomitant glenohumeral
osteoarthritis and/or rotator cuff
tear; and 5) the presence of hy-
droxyapatite on crystal analysis of
the aspirated synovial fluid.
The condition is not as rare as
supposed as another rheumatolo-
gist (Weiss^) reported an ad-
ditional four cases. Weiss pointed
out that the "Milwaukee shoul-
der" syndrome should be con-
sidered the diagnosis in elderly
women who present with shoul-
der swelling, pain, and limited
mobility. X-ray studies should
show osteoarthritis of the shoul-
der, and arthrography will dem-
onstrate a rotator cuff tear or
adhesive capsulitis. Synovial
fluid aspiration findings in-
clude copious, viscous, often
bloody fluid with a low leukocyte
count. Electron microscopy of the
fluid will reveal the presence of
hydroxyapatite crystals. Weiss
states the treatment consists of re-
peated shoulder aspiration fol-
lowed by injection of an intra-
articular steroid preparation
when needed. Appropriate
therapy has allowed elderly
patients who were otherwise
faced with nursing home place-
ment to continue self-care and
independent living.
—Victor S Falk, MD, Edgerton
‘McCarty DJ, Halverson PB, Carrera GF,
et al: "Milwaukee shoulder"— associa-
tion of microspheroids containing hydro-
xyapatite crystals, active collagenase,
and neutral protease with rotator cuff
defects. 1. Clinical aspects. Arthritis
Rheum 1981; 24:464.
^Weiss JJ, Good A, Schumacher HR: Four
cases of "Milwaukee Shoulder," with a
prescription of clinical presentation and
long-term treatment J Am Ger Soc 1985;
33:202B
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WISCONSIN MEDICAL JOURNAL, AUGUST 1985:VOL.84
7
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Consider the
causative organisms. . .
cefaclor
250-mg Pulvules’^ t.i.d.
offers effectiveness against
the major causes of bacteriai bronchitis
H. influenzae, H. influenzae, S. pneumoniae, S. pyogenes
(ampicillin-susceptible) (ampicillin-resistant)
6n«f Summary Consult the package literature for prescribing
intormation
Indications and Usage: Ceclor* (celaclor. Lilly) is indicated in the
treatment ot the toliowmg infections when caused tiy susceptible
strains ot the designated microorganisms
Lower resDiratorv infections including pneumonia caused by
Streptococcus pneumoniae tOiplococcus pneumoniae). Haemopfi
ilus influemae and 5 pyogenes (group A beta-hemolytic
streptococci)
Appropriate culture and susceptibility studies should be
performed to determine susceptibility of the causative organism
to Ceclor
Contraindication Ceclor is contraindicated in patients with known
allergy to the cephalosporin group ot antibiotics
Warnings IN PENICILLIN-SENSITIVE PATIENTS. CEPHALO-
SPORIN ANTIBIOTICS SHOULD BE ADMINISTERED CAUTIOUSLY
there is clinical and LABORATORY EVIDENCE Of PARTIAL
CROSS-ALLERGENICITY OF THE PENICILLINS AND THE
CEPHALOSPORINS. AND THERE ARE INSTANCES IN WHICH
PATIENTS HAVE HAD REACTIONS INCLUDING ANAPHYLAXIS
TO BOTH DRUG CLASSES
Antibiotics including Ceclor. should be administered cautiously
to any patient who has demonstrated some form ot allergy,
panicuiariy to drugs
Pseudomembranous colitis has been reponed with virtually all
broad-spectrum antibiotics (including macrohdes. semisyntheitc
penicillins, and cephalosporins), therefore, it is important to
consider its diagnosis in patients who develop diarrhea in
association with the use ot antibiotics Such colitis may range in
seventy from mild to life-threatening
Treatment with broad-spectrum antibiotics alters the normal
flora of the colon and may permit overgrowth of Clostridia Studies
indicate that a toiin produced by Clostridium ditticile is one
primary cause of antibiotic-associated colitis
Mild cases of pseudomembranous colitis usually respond to
drug discontinuance alone In moderate to severe cases manage-
ment should include sigmoidoscopy, appropriate bacteriologic
studies and fluid electrolyte, and protein supplementation
When the colitis does not improve after the drug has been
discontinued, or when it is severe, oral vancomycin is the drug
ot choice tor antibiotic-associated pseudomembranous colitis
produced by C difficile Other causes of colitis should be
ruled out
Precautions Genera! Precautions - If an allergic reaction to
Ceclor ’ (cefaclor, Lilly) occurs, the drug should be discontinued,
and. if necessary, the patient should be treated with appropriate
agents, e g . pressor amines, antihistamines, or corticosteroids
Prolonged use of Ceclor may result in the overgrowth of
nonsusceptible organisms Careful observation of the patient is
essential If superinfeclion occurs during therapy, appropriate
measures should be taken
Positive direct Coombs tests have been reported during treat-
ment with the cephalosporin antibiotics In hematologic studies
or in transfusion cross-matching procedures when antiglobulin
tests are performed on the minor side or in Coombs testing of
newborns whose mothers have received cephalosporin antibiotics
before parturition, it should be recognized that a positive
Coombs' test may be due to the drug
Ceclor should be administered with caution in the presence of
markedly impaired renal function Under such conditions, careful
clinical observation and laboratory studies should be made
because safe dosage may be tower than that usually recommended
As a result ot administration ot Ceclor. a false-positive reaction
for glucose in the urine may occur This has been observed with
Benedict s and Fehling's solutions and also with Clinitest"
tablets but not with Tes-Tape* (Glucose Enzymatic Test Strip
USP. Lilly)
Broad-spectrum antibiotics should be prescribed with caution in
individuals with a history ot gastrointestinal disease, particularly
colitis
Usage in Pregnancy - Pregnancy Category 8 - Reproduction
studies have been performed in mice and rats at doses up to 12
limes the human dose and in ferrets given three times the manimum
human dose and have revealed no evidence of impaired fertility
or harm to the fetus due to Ceclor* (cefaclor. Lilly) There are.
however, no adequate and well-controlled studies in pregnant
women Because animal reproduction studies are not always
predictive of human response, this drug should be used during
pregnancy only if clearly needed
Nursing Mothers - Small amounts of Ceclor have been delected
in mother's milk following administration ot single 500-mg doses
Average levels were 0 18. 0 20. 0 21 . and 0 16 mcg/ml at two.
three, four, and five hours respectively Trace amounts were
detected at one hour The effect on nursing infants is not known
Caution should be exercised when Ceclor is* administered to a
nursing woman
Usage in Children - Safety and effectiveness of this product for
use in infants less than one month of age have not been established
Adverse Reactions: Adverse eflects considered related to therapy
with Ceclor are uncommon and are listed below
Gastrointestinal symptoms occur in about 2 5 percent of
patients and include diarrhea (1 in 70)
Symptoms of pseudomembranous colitis may appear either
during or after antibiotic treatment Nausea and vomiting have
been reported rarely
Hypersensitivity reactions have been reported in about 1 5
ercent ot patients and include morbiliform eruptions (1 in 100)
ruritus. urticaria, and positive Coombs tests each occur in less
than 1 in 200 patients Cases of serum-sickness-like reactions
(erythema multiforme or the above skin manifestations accompanied
by arthritis/arthralgia and. frequently, lever) have been reported
These reactions are apparently due to hypersensitivity and have
usually occurred during or following a second course of therapy
with Ceclor Such reactions have been reported more frequently
in children than in adults Signs and symptoms usually occur a lew
days after initiation of therapy and subside within a few days
after cessation ot therapy No serious sequelae have been reported
Antihistamines and corticosteroids appear to enhance resolution
of the syndrome
Cases of anaphylaxis have been reported, half ot which have
occurred in patients with a history ot penicillin allergy
Other effects considered related to therapy included
eosinophilia |1 in 50 patients) and genital pruritus or vaginitis
(less than 1 in 100 patients)
Causal Relationship Uncertain - Transitory abnormalities in
clinical laboratory test results have been reported. Although they
were of uncertain etiology, they are listed below to serve as
alerting information for the physician
Hepatic - S\\gh\ elevations in SCOT. SGPT. or alkaline
phosphatase values (1 in 40)
Hematopoietic - Transient fluctuations in leukocyte count,
predominantly Ivmphocytosis occurring in infants and young
children (1 in 40)
Renal - Slight elevations in BUN or serum creatinine (less than
1 in 5(30) or abnormal urinalysis (less than 1 in 200)
I061782R]
Note Ceclor* (cefaclor, Lilly) is contraindicated in patients
with known allergy to the cephalosporins and should be given
cautiously to penicillin-allergic patients
Penicillin is the usual drug of choice in the treatment and
prevention of streptococcal infections, including the prophylaxis
of rheumatic fever See prescribing information
©1984, ELI LILLY AND COMPANY
Additional information available to
the profession on reguesi from
Ell Lilly and Company.
Indianapolis Indiana A6285
Eli Lilly industries. Inc
Carolina Puerto Rico 00630
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6) Appointnent Scheduling
7) Medical History
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SCIENTIFIC MEDICINE
Bone scan changes in a marathon
runner; case report
mately the same, the dose was ex-
actly the same, and the areas of
interest were set on the computer
to reflect similar localized sites.
Gary N Guten, MD and Dan Craviotto, BS
Milwaukee, Wisconsin
ABSTRACT. A case report of a 34-year-
old marathon runner with degenerative
changes in his left knee is presented.
Bone scans were done prior to and after
a recent marathon during a symptomatic
period. A 10% increase of osteoblastic
activity in the symptomatic knee and a
3% increase in the asymptomatic knee
were found. Patients with subjective and
objective findings prior to a marathon
should be advised to reevaluate their
intense running goals.
Key words: Bone scan; Running
The repetitive microstres-
ses of long distance running and
the association of long distance
running with musculoskeletal in-
jury are recognized by most clini-
cians and researchers. We pre-
sent a case history of a marathon
runner in whom changes were
studied in pre-marathon and post-
marathon bone scans. Rarely is
there the opportunity to study
these stresses objectively by the
bone scan technique.
Case history. The patient is a
34-year-old runner who has been
a long distance runner and mara-
thon runner for 16 years. He has
qualified for the Boston marathon
in sub-three hour marathon times,
and he runs 50 to 60 miles per
week on asphalt or paved sur-
faces. He has a history of intermit-
Doctor Guten is Director of the Sports
Medicine Institute at Good Samaritan
Medical Center, Milwaukee; Mr Craviotto
is a senior medical student, Medical Col-
lege of Wisconsin, Milwaukee. Reprint re-
quests to: Gary N Guten, MD, 940 North
23rd St, Milwaukee, Wis 53233. Copyright
1985 by the State Medical Society of Wis-
consin.
tent left knee difficulty secondary
to his ten-year involvement in
football and wrestling. Medial and
lateral partial menisectomies were
done in 1981 and 1982.
He had an excellent year of
marathon running in 1983 and
had no difficulties until late Sep-
tember 1983 when he developed
pain and swelling in his left knee
after a 16-mile run. Physical
examination in October revealed
slight thickening along the lateral
joint line with tenderness along
the lateral aspect of the knee and
distal femur. There was no effu-
sion. There was also medial joint
line tenderness and slight crepita-
tion. X-ray studies were sug-
gestive of early osteonecrosis of
the lateral femoral condyle and
early degenerative changes of the
medial compartment (Fig 1). A
bone scan was done (Fig 2) and
the patient was advised not to par-
ticipate in any marathon running
because of the marked osteo-
blastic activity noted on the bone
scan. However, against medical
advice, the patient competed in a
marathon approximately one
week later and finished at a 3.00
pace. His knee was extremely
painful and stiff, and he was seen
again with a slight effusion and in-
creased tenderness and crepita-
tion. A second bone scan was
done approximately 15 days after
the original scan and ten days
after the run.
Methods. Technetium 99m
methylene diphosphonate was
used in both scans. Time from
injection to scanning was approxi-
Results. Comparison of the pre-
marathon bone scan on October 5,
1983 with the post-marathon bone
scan on October 20, 1983 revealed
a 10% increase in activity over
the 15-day period. This excess
scan activity was localized to the
surface of the distal femur and the
Figure 1: Standing x-ray film of pa-
tient's knees. On the patient's left, note
early joint narrowing and degenerative
changes, and cystic changes in the
femoral condyle.
Figure 2: Bone scan prior to mara-
thon. Note intense osteoblastic activity
of the left knee.
1 1
WISCONSIN MEDICAL JOURNAL, AUGUST 1985:VOL.84
SCIENTIFIC MEDICINE
BONE SCAN— Guten & Craviotto
lateral tibial plateau. The normal
unaffected side showed a 3% in-
crease in activity after the mara-
thon.
Discussion. Although there are
hazards in drawing conclusions
from a single case, this case shows
a 10% increase in bone scan activ-
ities after a marathon in a knee
with preexisting degenerative
changes. The normal knee show-
ed a 3% increase in bone scan ac-
tivity and the patient experienced
no symptoms in his normal knee.
The lesson to this patient and
other marathon runners is that
they must learn to "listen to their
bodies." Athletes, running
coaches, and health providers
should be aware that pain in the
knee prior to a long distance run
is a symptom that caution should
be taken when doing a long dis-
tance run. Long distance running
will continue to be a good form of
aerobic activity with excellent
maintenance of musculoskeletal
and cardiovascular strength.
However, some caution is
necessary in a joint which is pain-
ful prior to the marathon. This
study demonstrates that destruc-
tive changes and osteoblastic ac-
tivities occur after the marathon in
symptomatic joints. Each runner
must evaluate the risk reward
ratio of any long distance run. In
this particular case the accelerated
degenerative changes in the knee
will probably override the cardio-
vascular benefits of intense mara-
thon running in this patient. Alter-
native aerobic exercise such as
swimming or biking is definitely
indicated in this patient.
Acknowledgment: The authors would
like to thank Debbie Bayee, Sports Medi-
cine & Knee Surgery Center, SC for her
technical and manuscript assistance. The
fine technical bone scans of Dr Leo Stock-
land of Family Hospital were greatly ap-
preciated.
REFERENCES
1 . Brubaker CE, James SL; Injuries to runners.
Am J Sports Med 1974;2:189-197.
2. Guten GN: Herniated lumbar disc associated
with running. Am J Sports Med 1981; 9(3):155.
3. Glick JM, Katch VL; Musculoskeletal injuries
in jogging. Arch Phys Aled 1970;51:123-126.
4. Guten G, Harvey D: Herniated lumbar disc
with leg paralysis associated in jogging. Wis
Afed/ 1977:76:51 19-S120.
5. James SL, Brubaker CE: Biomechanics of
running. Orthopaed Clin N Amer 1973;
4:609-707.
6. Slocum DB, James SL: Biomechanics of run-
ning./AAfA 1968;205:97-104.
7. Brill DR: Sports Nuclear Medicine, Bone im-
aging for lower extremity pain in athletes.
Chn Nucl Med 1983;8(3|:101-106.
8. Deutsch SD, Gandsman, EJ: The use of bone
scanning for the diagnosis and management
of musculoskeletal trauma. SurgCUn N Amer
1983;63|3):567-585.
9. Martin P: Bone scintigraphy in the diagnosis
and management of traumatic injury, Semin
Afnc/Afed 1983:13(2):104-122.H
ABSTRACT
Splenic phagocytic function after partial splenectomy
and splenic autotransplantation
MARK A MALANGONI, MD; LILLIAN G DAWES, MD; ELIZABETH A
DROEGE, MD: SHYAM A RAO, PhD; B DAVID COLLIER, MD; URIAS A
ALMAGRO, MD, Dept of Surgery, University of Louisville (MAM); Depart-
ments of Surgery (LAG, EAD), Radiology (SAR, BDC), and Pathology (UAA),
Medical College of Wisconsin, Milwaukee; and Surgical (MAM, LGD, EAD)
and Pathology (UAA) Services, Wood Veterans Administration Medical
Center, Milwaukee: Arc/; 1985; 120:275-278.
Partial splenectomy and splenic autotransplantation have
been advocated as preferable alternatives to total splenectomy
in order to avoid an increased risk of infection associated with
excision of the spleen. We investigated splenic reticuloen-
dothelial activity after splenic preservation procedures to
determine their effect upon the phagocytic function of the
spleen. Sprague-Dawley rats had either a sham laparotomy,
total splenectomy, hemisplenectomy, subtotal splenectomy, or
total splenectomy with intraperitoneal splenic autotransplanta-
tion. Nine weeks later, phagocytic function of the spleen
was determined by measuring organ uptake of Technetium-
99m sulfur colloid. Splenic phagocytic function after hemis-
plenectomy, subtotal splenectomy, and total splenectomy with
autotransplantation were significantly reduced when com-
pared to sham-operated animals. In order to correct for differ-
ences in splenic weight between experimental groups, a splenic
phagocytic index was calculated. Mean splenic phagocytic
indices for sham laparotomy (42.2 ± 2.9), hemisplenectomy
(44.9 ± 2.9), and subtotal splenectomy (43.2 ± 5.2) were simi-
lar; however, the phagocytic index was reduced markedly
after autotransplantation (15.8 ± 2.2, p< 0.0001 vs all other
groups).
These data indicate that the phagocytic function of the spleen
after hemisplenectomy and subtotal splenectomy correlates
highly with the weight of the splenic remnant; however,
splenic phagocytic function after splenic autotransplantation
remains reduced even after accounting for differences in
splenic weight.
This suggests that reticuloendothelial activity of the spleen
is proportional to splenic weight after partial splenic re-
sections but that function after autotransplantation is impaired
during regeneration of the autotransplanted spleen.*
12
WISCONSIN MEDICAL JOURNAL, AUGUST 1985: VOL. 84
SCIENTIFIC MEDICINE
Silo-filler's disease
A historical perspective and report of a case
William J Maurer, MD, Marshfield, Wisconsin
ABSTRACT. The various oxides of
nitrogen are produced by the fermen-
tation process in dairy silos. These ir-
ritative toxic gases can produce a clini-
cal spectrum ranging from immediate
asphyxiation to delayed respiratory dis-
tress and with subsequent permanent
lung damage. A case is reviewed and
measures to prevent this tragic occur-
rence are described.
Key words; Silo-filler's disease; Toxic
organic gas
TT HE FIRST FARM silos used in
American agriculture were con-
structed in about 1875.^ This
method of forage preservation
then came into rather general and
widespread usage. The picture of
farm buildings with an associated
silo is now a standard portrait of
a dairy farm.
This method of preserving feed
for dairy cattle is similar in con-
cept to the packing and fermenta-
tion that preserve certain foods
for human use. An example is the
conversion of cabbage to sauer-
kraut.
As with many technological
advances, there developed as-
sociated environmental concerns
or dangers, and this report is a re-
view of the hazards of the silo
gases generated during the fer-
mentation process.
It is so often the case that the
index description of a disease cor-
rectly describes the clinical con-
Publication support provided. Reprint re-
quests to: William J Maurer, MD, Marsh-
field Clinic, 1000 North Oak Ave, Marsh-
field, Wis 54449. Copyright 1985 by the
State Medical Society of Wisconsin.
dition and the cause. That is cer-
tainly true in the first reported
description of sudden death in a
silo. Hayhurst and Scott* de-
scribed a tragedy at the Ohio
State Hospital (Athens) in 1914 in
which four inmates of the institu-
tion jumped into a silo that was
filled to about 12 feet from the
top and were then asphyxiated.
These authors collected the silo
gas for analysis in the Depart-
ment of Chemistry at Ohio State
University. The gas was com-
posed of 38% carbon dioxide,
13.5% oxygen, and 48.5% of the
oxides of nitrogen. Since the
deaths in the silo were sudden
and appeared due to asphyxia-
tion, it was concluded that as-
phyxiation was caused by the car-
bon dioxide concentrations in the
silo, but the authors correctly
noted the high concentration of
the oxides of nitrogen in the silo.
There were previous medical
descriptions in the German litera-
ture of the toxic effects of nitric
oxide fumes^ and an article in
1912 by Wood^ described the ef-
fects of industrial exposure.
Toxic irritative gases were used
in World War I and reviewed in
a 1920 article by Winternitz'*
and a 1955 paper by McAdams^
of the Army Chemical Center.
By 1917, Wagner had described
the pathologic finding of bron-
chiolitis obliterans following the
inhalation of acrid fumes in gen-
eral® and Blumgart et al described
bronchiolitis obliterans occurring,
not only after inhalation of the
fumes of hydrochloric acid and
nitric acid but also after some in-
fectious diseases such as measles
or whooping cough. ^ He gave
credit to an initial description by
Lang in 1901 differentiating bron-
chiolitis obliterans from other
pathologic conditions such as in-
durating pneumonia, dissemi-
nated bronchopneumonia, and
organizing pneumonia.®
In the 1930s radiologists be-
came aware of the dangers of
burning nitrocellulose films liber-
ating carbon dioxide and nitrous
oxide with the transformation
on exposure to air of the nitrous
oxide to nitrogen dioxide, the
toxic gas. Nichols® noted that, in
the presence of water or moisture,
nitrogen dioxide liberates free
nitric acid, and he indicated free
nitric acid as the causative agent
of the toxic effects of the oxides of
nitrogen in the human lung.
In 1932 LeRossignol*® described
irritants and gases affecting work-
ers in a silo. He felt that the dan-
ger of gases in a silo may be due
to carbon dioxide with asphyxia-
tion, respiratory irritation from
volatile acids, or allergy following
sensitization caused by exposure
to protein-containing dusts. This
article set the stage for the even-
tual separation of the immediate
and delayed effects of silage gas
exposure and even the allergic
types of exposure such as farm-
er's lung.
In 1949 Peterson et al** of the
Wisconsin College of Agriculture
described the yellow silo gas as
occurring in the reduction of ni-
trates to nitrites and the liberation
of nitrous acid. Being very un-
stable at the temperature of si-
lage, nitrous acid would break up
into nitric oxide (NO) and nitro-
gen dioxide (NO2). The authors
noted that the production of this
yellow silage gas stops within
about ten days of the filling of a
silo.
WISCONSIN MEDICAL JOURNAL, AUGUST 1985:VOL.84
13
SCIENTIFIC MEDICINE
SILO-FILLER'S DISEASE-Maurer
During the intense industrial
effort of World War II there were
descriptions of nitric fumes pro-
duced by welding and arising in
the welding arc. For instance,
Camiel et ah^ noted that nitric
fumes occur in industries where
nitric acid is used such as in the
production of sulfuric, picric, and
chromic acids and in the manu-
facture of celluloid and nitro-
cellulose (gun powder), and in the
manufacture of artificial leather,
and the production of explosives
such as nitroglycerin or dyna-
mite. In 1951 Fostvelt*^ described
a case of silage gas poisoning and
attributed the anesthesia or un-
conscious state of the victim to
asphyxia due to carbon dioxide
and made no mention of exposure
to the oxides of nitrogen. In this
article were recommendations
for adequately ventilating the silo
area prior to and during entry.
The US Department of Agricul-
ture bulletins had been warning
of gas danger in silos since May
1939.'^
In 1956 Grayen^^ and Lowry‘S
published articles describing silo-
filler's disease as a "new disease
in agricultural workers.” These
articles correctly blamed delayed
respiratory effects on exposure
to nitrogen dioxide in silage gas
and attributed the first reported
case to Delaney in 1956.
By 1958 Leib et ah® described
chronic pulmonary insufficiency
secondary to silo-filler's disease.
In the same year Dickie et ah®
separated out diseases such as
farmer's lung or interstitial pneu-
monitis due to exposure to moldy
forage. In 1960 Cornelius et aF°
correctly pointed out that the de-
gree and type of injury depends
primarily upon the intensity and
duration of exposure. By 1961 the
condition of a severe relapse in
respiratory symptoms following a
latent period after exposure was
described by Rafii and Godwin.
In the 1960s there were more
detailed clinical, physiologic, and
pathologic studies®®^'^ of indi-
vidual patients, and a long-term
followup of a case was described
in 1971 by Ramirez et al.^® An-
other long-term followup was
published in 1973 by Scott and
Hunt®® and a case report by Fleet-
haus.®® Finally, to get us to the
space age, lung toxicity from ex-
posure to nitrogen dioxide has re-
sulted from an accident in a titan
missile silo.®®
Case report. A 54-year-old mar-
ried, white, male farmer was
brought to the emergency room
because of extreme shortness of
breath. He had finished filling his
silo with corn silage about 10 am.
Seven hours later he climbed into
the structure to reassemble the
forage unloader and to begin
throwing silage down by hand.
He was in the silo about one
hour, and during that time, no-
ticed that he was coughing. His
wife standing near the silo chute
recalled an odor like "bleach"
and noticed yellow-brown gas
flowing down the chute of the
silo. The blower that was nor-
mally used in the silo was not
present, as it was needed at a dif-
ferent silo. A few hours after
leaving the silo the patient's
cough increased and he became
short of breath. By 11:30 pm
when he arrived at the emer-
gency room, he was cyanotic
with a PO2 of 37. Extreme res-
piratory distress prompted in-
tubation and respiratory support.
There was no previous history of
silo-filler's disease or of farmer's
lung and he was known to be a
nonsmoker.
In October 1980 the patient had
been resuscitated from myo-
cardial infarction with ventri-
cular fibrillation.
Physical findings included ap-
prehension, respiratory distress,
bilateral wheezing, and cyanosis.
Body temperature was 37.3 C
(99.2 F) rectally. Blood pressure
was 158/80 mmHg. Pulse rate
was 94 and regular.
The initial chest film showed
fluffy bilateral alveolar infiltrates
consistent with acute pulmonary
edema. The electrocardiogram
showed a pulse rate of 95 with
left atrial enlargement, non-
specific ST-T wave changes, and
Q-waves in the anteroseptal leads
consistent with previous myo-
cardial infarction. Initial blood
hemoglobin was 17.2 Gm/100
ml, white blood cell count was
21,900 per cu mm, serum uric
acid was 10.1 units, serum cre-
atinine was 1.4 units, and blood
urea nitrogen was 28 Gm/ 100 ml.
Initial blood gases included PCO2
of 77, PO2 of 37 and pH of 7.15.
Serum hemoglobin was 202 with
normals being 33 to 140. Farm-
er's lung antigen was done and
showed that antibodies were
present to Micropolyspora faeni in
a titer of 1:320 and antibodies
were present to Aspergillus fumi-
gatus in a titer of 1 : 1 60.
The hospital course was char-
acterized by full respiratory sup-
port for five days and the use of
nasal oxygen for another seven
days. The patient was initially
treated with hydrocortisone 150
mg intravenously every six hours
and later prednisone 80 mg per
day tapering to 40 mg per day on
discharge. Intravenous fluids
with aminophylline were ad-
ministered during the early hos-
pitalization.
At the time of followup exam-
ination approximately one month
after discharge, the patient was
still taking prednisone 40 mg ev-
ery morning. Arterial blood gases
on room air showed PO2 of 60,
PCO2 of 36, pH of 7.52. Forced
vital capacity was 3.18 which was
67% of predicted. Both forced
vital capacity and the forced ex-
piratory volume had improved
since pulmonary function studies
were done in the hospital. The
chest film showed minimal inter-
stitial densities and was near
normal. Blood pressure had de-
creased to 114/80 mmHg. Uric
acid had returned to normal
levels. Blood urea nitrogen had
14
WISCONSIN MEDICAL JOURNAL, AUGUST 1985: VOL. 84
SILO-FILLER'S DISEASE-Maurer
SCIENTIFIC MEDICINE
decreased from 28 to 22 units and
the creatinine had decreased
from 1.4 to 0.9. The patient had
returned to work and was again
able to perform normal farm
duties, including reentering the
silo which had then been ade-
quately ventilated.
Discussion. The fermentation
process in a silo liberates carbon
dioxide and lactic acid from car-
bohydrates; and nitrates are
formed from the nitrogen content
of the forage. The nitrates then
oxidize into the various oxides of
nitrogen. Potassium nitrate by
anaerobic fermentation is
changed into potassium nitrite
and oxygen. These nitrates com-
bine with organic acids in silage
to form nitrous acid (HNO2). As
the temperature of the ensilage
rises with fermentation, the ni-
trous acid decomposes into water
and a mixture of nitrogen oxides
which include nitrogen trioxide
(N2O3), nitric oxide (NO), nitro-
gen dioxide (NO2), and nitrogen
tetroxide (N2O4). The nitrogen
trioxide is a brown gas, the nitro-
gen dioxide a red gas, and nitro-
gen tetroxide a yellow gas. Nitric
oxide is colorless. Nitric oxide is a
very stable gas. Nitrogen dioxide
readily polymerizes and has an
offensive odor. Nitrogen trioxide
dissociates very rapidly into NO
and NO2. Nitrogen tetroxide de-
composes to NO2.
Nitrogen dioxide in the pre-
sence of moisture or water forms
nitric acid, the irritant that causes
lung damage and acute pulmon-
ary edema. Nitrogen tetroxide
(N2O4) reacts with water to pro-
duce nitric and nitrous acids.^®
It is of interest medically as an
aside that nitrous oxide or nitro-
gen monoxide (N2O) was dis-
covered by Priestly in 1772, and
Sir Humphrey Davey noted that
inhalation of this gas may relieve
pain. In December 1844 the first
clinical application of nitrous
oxide as an anesthetic agent oc-
curred in the United States. This
nitrous oxide is a colorless inert
gas and at high temperature may
decompose into nitric oxide
which may form nitric acid and
cause pulmonary edema.
Because silos without adequate
ventilation are closed structures,
the silo gases, being heavier than
air, tend to collect just above the
silage. During the addition of
silage and prior to closing or
covering the silage, farmers may
jump into the silo to spread the
silage in an even manner and to
cover it.
The concentration of silage
gases is greatest in the first ten
days after forage is added to the
silo. In the event that a farmer
jumps into a silo with a high con-
centration of carbon dioxide and
nitrogen dioxide, asphyxiation
may be immediate. More com-
monly, the concentration is less
intense and the farmer notices an
irritating smell similar to that of
bleach or ammonia and may see
the yellow-reddish-brown gases.
As a result, work in the silo con-
tinues and the symptoms may not
occur until hours later, develop-
ing and increasing in severity like
a sunburn that becomes more ap-
parent many hours after the
exposure.
In many cases the severity of
cough and dyspnea seem to de-
crease in the next few days and
then, from two to three weeks
following exposure, an apparent
delayed reaction occurs which
may even be fatal. Untreated,
this syndrome coincides with the
formation of bronchiolitis ob-
literans.
Bronchiolitis obliterans is a
pathologic lesion that results
when injury to small conducting
airways is repaired by prolifera-
tion of granulation tissue. It is the
same final common pathway of
lung injury that may be seen with
fume exposures, infections,
drugs, connective tissue diseases,
and allergic reactions. Histologi-
cally, bronchiolitis obliterans is
characterized by plugs of granula-
tion tissue involving bronchioles
and alveolar ducts together with
extension of the organization
from distal alveolar ducts into
alveoli with variable degrees of
interstitial infiltration by mono-
nuclear cells. Fibrosis is usually
uniform in age suggesting that all
repair begins at the same time.
The distribution is patchy with
preservation of background archi-
tecture.
In acute exposure the radiolo-
gic signs are those of bilateral pul-
monary edema. In the delayed re-
action there occurs a miliary type
of involvement appearing similar
to miliary tuberculosis. This, too,
coincides with the pathologic
changes of bronchiolitis oblit-
erans.
Treatment depends upon the
clinical presentation of the ex-
posure. In overwhelming as-
phyxiation the treatment is tradi-
tional resuscitation and life sup-
port measures after removal of
the individual from the gaseous
environment. The delayed reac-
tion with severe shortness of
breath and pulmonary edema
needs to be evaluated and moni-
tored with arterial blood gases. In
our reported case we feel that the
early use of the respirator turned
a potentially fatal case into a case
of survival with minimal resi-
dual.
It is generally agreed that cor-
ticosteroids in high doses are
beneficial and that, although they
may be gradually decreased they
should be continued for four to
six weeks after severe exposure
to prevent development of bron-
chiolitis obliterans and perma-
nent respiratory damage and in-
sufficiency.*®
One must differentiate this dis-
ease from an allergic lung dis-
ease such as farmer's lung due to
moldy silage or other moldy farm
forage. It is, of course, possible
for a farmer to have both farm-
er's lung and to suffer respiratory
changes due to exposure to toxic
WISCONSIN MEDICAL JOURNAL, AUGUST 1985:VOL.84
15
SCIENTIFIC MEDICINE
SILO-FILLER'S DISEASE-Maurer
caustic silage gases. Clinically our
patient had silo-filler's disease,
but also his serum was positive
for farmer's lung antibodies.
As is the case with medical
illnesses, the best approach con-
sists of educating the farm pop-
ulation to the dangers of silo
gases, especially during the first
ten days after filling the silo, and
to preventive measures such as
adequate ventilation of the silo
with blowers prior to its entry.
Finally, should exposure occur,
understanding of the pathophys-
iology and various clinical pre-
sentations will lead to proper and
correct treatment with a mini-
mum of respiratory damage,
mortality, or morbidity.
REFERENCES
1. Hay hurst RE, Scott E: Four cases of sudden
death inasiloJAMA 1914:63:1570-1572.
2. Kunkel: Haiidbuch der taxikologic. JGNA
1901:282.
3. Wood FW: Poi.soningby nitric oxide fumes.
Arch hit Med 1912:10:475-504.
4. Winternitz MC: Collected Studies on the
Pathology of War Gas Poisoning. New Haven,
Conn, Yale University Press. 1920.
5. McAdams Jr Aj: Bronchiolitis obliterans.
Am JMed 1955,19:314-322.
6. Wagner JH: Bronchiolitis obliterans follow-
ing the inhalation of acrid fumes. Am ]
MedSa 1917:154:511-522.
7. Blumgart HL, Maemohom HE: Bronchiolitis
fibrosa obliterans: A clinical and patholo-
gical study. Med Clin N Amer i929:13:
197-214.
8. Lange W: Uber eine eigcnthumliche erk-
rankung der kleinen bronchien und bron-
chiolcn. Deutsch Arch F Klin Med 1901:
70:342.
9. Nichols BH: The clinical effects of the in-
halation of nitrogen dioxide. Am J Roent-
genol 1930:23:516-520.
10. LeRossignol WJ: Irritants ami gases affect-
ing workers in s\\o. JAMA 1932:98:2307.
11. Peterson WH, Thoma RW, Anderson RF:
Yellow gas from corn silage. Hoard's Daily-
man 1949:94:870-871.
12. Camicl MR, Berkan HS: Inhalation of pneu-
monia from nitric fumes. Radiol 1944:
42:175-182.
13. Foslvedt GA: Silage gas poisoning. Wis Med
71951:50:1103-1104.
14. Silos: types and construction. Farmers' Bul-
letin, No 1820, US Dept of Agriculture:
Warning— gas danger in silos. May, 1939,
revised Sept 1948.
15. Grayson RR: Silage gas poisoning: nitrogen
dioxide pneumonia, a new disease in agri-
cultural workers. Ann Intern Med 1956:
45:393-408.
16. Lowry T, Schuman LM: "Silo-filler’s dis-
ease"—a syndrome caused by nitrogen
dioxide. /AAfA 1956:162:153-160.
17. Delaney LT Jr, Schmidt HW, Stroebcl CF:
Silo-filler's disease. Proc May Clin 1956:
31:189-200.
18. Leib GM, Davis WN, et al: Chronic pul-
monary insufficiency secondary to silo-fil-
ler’s disease. Am J Med 1958:24:471-474.
19. Dickie HA, Rankin J: Farmers lung: an
acute granulomatous interstitial pneu-
monitis occurring in agricultural workers.
JAMA 1958: 167(9|: 1069-1076.
20. Cornelius EA, Betlach Ell: Silo filler's dis-
ease. Radiol 1960:74:232-238.
21. Rafii S, Godwin MC: Silo Filler's disease:
relapse following latent period. Arch Path
Lib Med 1961:72:424-433.
22. Moskowitz RL, Lyons HA, Cottle HR: Silo
filler's disease: clinical physiologic and
pathologic study of a patient. Am J Med
1964:36:457-462,
23. Evans Jr EG, McDonald LB, Porter RA:
Silo-filler’s di.sease: Report of two cases in
Henderson County. N Carolina Med J I960:
21:59-64.
24. Eichenberger G, Weber J, Hausser E: Pneu-
mopathic des ensileurs (silo filler's disease)
Schweiz Med Wschr 1956:96:1652-1655.
25. Ramirez RJ, Powell AR: Silo filler’s disease:
Nitrogen dioxide induced lung injury: Long
ABSTRACT. A case of Neisseria men-
ingitidis serogroup Z meningitis in a
19-year-old male is presented. The
patient was successfully treated with
aq. Penicillin-G. This is the first case
of serogroup Z meningitis in a young
adult in the United States.
Key words: Neisseria meningitidis;
Epidemiology; Vaccines
In recent years there has
been a shift in the serogroups of
Neisseria meningitidis responsible
for meningitis. Initially groups A,
B, C were responsible for most in-
fections, more recently there has
Ms Nazer was a senior medical student at
the Medical College of Wisconsin,
Milwaukee, when this article was written.
Doctor Rytel is Professor of Medicine and
Head, Division of Infectious Diseases,
Medical College of Wisconsin,
Milwaukee. Reprint requests to: Michael
W Rytel, MD, Division of Infectious
Diseases, MCOW, 8700 West Wisconsin
Ave, Milwaukee, Wis 53226. Copyright
1985 by the State Medical Society of
Wisconsin.
Icrm follow-up and review ol literature.
Ann Intern Med 1971:74:569-576.
26. Scott EG, Hunt WB Jr: Silo filler's disease.
Chest 1973:63(5):701-706.
27. Fleetham JA, Munt PW, Tunnicliffe BW:
Silo filler's disease. Can Med Assoc J 1978:
119|Sept):482-484.
28. Brcy RL, Seidenfeldt J: Lung toxicity result-
ing from exposure to nitrogen dioxide: A
possible occurrence due to titan missile ac-
cidents. Ariz Med 1981:38:344-348.
29. Grayson RR: Silage gas poisoning: Nitrogen
dioxide pneumonia, a new disease in agri-
cultural workers. Ann Intern Med 1956:
45:393-408.
30. Collins VJ: Principles of Anaesthesiology, 2nd
Ed, Lea and Febiger, Philadelphia 1976,
pp 1523-1538.
31. Epler GR, Colby TV, McCloud TC, et al:
Bronchiolitis obliterans organzing pneu-
monia. N Engl J Med 1985:312 (Jan):
152-158.
32. Gailitis J, Burns LE, Nally JB: Silo filler's
disease. N Engl J Med 1958:258(Mar):
543-544. ■
been an increase in cases caused
by the less well recognized groups
such as Y, and W-135. We report
here what we believe to be the
first case of group Z meningitis in
a young adult in the United States.
Case Report. A 19-year-old male
was in good health until he de-
veloped an occipital headache of
sudden onset while shoveling
snow. The severe headache per-
sisted that day, along with devel-
opment of a stiff neck, backache,
nausea, vomiting, fever and pho-
tophobia. The patient was brought
to an emergency room of a local
hospital after be became increas-
ingly clumsy and lethargic.
In the emergency room his tem-
perature was 38.3 C (101 F) and
he was obtunded. A computer-
ized tomographic (CT) scan of his
head showed no intracranial
hemorrhage. A lumbar puncture
was performed with an opening
pressure of 540 mm H2O. The
Neisseria meningitidis serogroup Z
as a cause of meningitis
LeeAnne Nazer, MD and Michael W Rytel, MD
Milwaukee, Wisconsin
16
WISCONSIN MEDICAL JOURNAL, AUGUST 1985: VOL. 84
NEISSERIA MENINGITIDIS-Nazer & Rytel
SCIENTIFIC MEDICINE
cerebrospinal fluid (CSF) was
cloudy with a white blood cell
count (WBC) of 6,300 per cu mm
with 100% neutrophils. The CSF
protein was 486 mg/dl and CSF
glucose was 37 mg/dl (simultan-
eous blood glucose was 178).
Gram stain revealed Gram-nega-
tive diplococci. Culture of CSF
was positive for Neisseria men-
ingitidis. The peripheral WBC
count was 26,400 per cu mm with
36% band forms. The patient was
transferred to Milwaukee County
Medical Complex.
Upon admission, the patient
was somnolent and his tempera-
ture was 38.7 C (101.6 F). He had
positive Kernig's and Brudzinski's
signs. There were no signs of men-
ingococcemia. The patient was
treated with aqueous penicillin G
for 10 days. Blood, throat, and
nasal cultures were negative.
Counter immunoelectroplioresis
(CIE) of CSF isolate revealed it to
be Neisseria meningitidis group Z.
The patient had an uneventful
recovery.
Discussion. In a review of the
literature, only one other case of
serious meningococcal disease
caused by serogroup Z in the USA
was found. In that case a two-
year-old boy had fatal fulminant
meningococcemia with dissimi-
nated intravascular coagulation
(DIC) and meningitis. ^ In that
same report^ a case of group X
meningococcemia and meningitis
was also reported. In the United
Kingdom a case of group Z men-
ingitis was reported in a woman
after rhinoplasty. ^ One could
postulate that the surgery led to
bacteremia with this common
carrier group. In this report we
have presented a case of group
Z meningitis without mening-
ococcemia or an identified pre-
disposing cause.
Currently the most frequently
encountered serogroups include
B, C, and Y. Recently there has
been an increase in meningococ-
cal disease by groups Y and
W-135, approaching the fre-
quency of groups B and C.^^
Group Y appears to cause a milder
disease with a greater occurrence
of pneumonia, arthritis, and
respiratory tract disease.® Sero-
group Z is usually associated with
the carrier state, most commonly
isolated from the throat and spu-
tum, and rarely from blood.® The
cases cited above represent the
only known reports where group
Z has been isolated from the CSF.
Even military personnel have not
seen any cases of group Z disease,
according to Dr W Zollinger at
Walter Reed Army Hospital (per-
sonal communication). Because
the rarer serogroup, namely
W-135, X,Y,Z,Z‘, rarely causes
systemic disease, it has been sug-
gested that they may be less viru-
lent or that there exists a greater
immunity to them in the popula-
tion.® But our review of the litera-
ture has shown that these groups
can cause severe clinical disease
and, therefore, can be just as
virulent as the more common
groups.
The emergence of these rarer
serogroups as causes of disease
may influence research on vac-
cines. Currently groups A and C
vaccines are available, and mili-
tary personnel have been using
a tetravalent vaccine of A, C, Y,
and W-135 for the last year. All
four vaccines are safe in adults,®
but Y and W-135 have not been
tested in children and C cannot
be used in children under two.
Group B meningococcus is still
the most common pathogen but
vaccine preparation has been dif-
ficult due to nonimmunogenicity
of the capsular polysaccharide. If
the incidence of the rarer sero-
groups continues to increase, es-
pecially due to the use of group Y
and W-135 vaccines in the mili-
tary, the addition of group Z or
perhaps all serogroups to a vac-
cine preparation may become
necessary.
Sulfonamide resistance is also
of interest relative to these newer
serogroups. Group Y has been
studied extensively because of its
recent increase in incidence, and
in the majority of Y isolates the
organism was sensitive to sulfo-
namides.® Sulfa resistance in
group Z is low, although it hasn't
been as well-quantified because of
its rare occurrence. Knowledge
of the specific serogroup and its
sulfa sensitivity are important
in prophylaxis of close contacts,
especially when rifampin may be
unavailable or contraindicated
such as due to allergy, in children
under five, in patients with active
liver disease and in patients on
oral contraceptives where its ef-
fectiveness is impaired.
REFERENCES
1. Ryan NJ, Hogen GR: Severe meningococcal
disease caused by serogroups X and Z. Am J
Dis Child 1980:134:1173.
2. Fallon RJ: Meningitis in an adult due to
Neisseria meningitis group Z. Lancet 1984:
2(Sept l):527-528.
3. Galaid El: Meningococcal disease in New
York City, 1973 to 1978. J Am Med Assoc
1980:244(191:2167-2171.
4. Smilack JD: Group Y meningococcal dis-
ease. Ann Intern Med 1974:81:740-745.
5. Koppes GM: Group Y meningococcal dis-
ease in United States Air Force recruits.
Am JMed 1977:62:661-666.
6. Risko JA: Neisseria meningitidis serogroup
Y: incidence and description of clinical ill-
ness. AmJMedSci 1974:267:345-352.
7. Brandstetter RD: Neisseria meningitidis sero-
group W-135 disease in adults. /AA4A 1981:
246(181:2060-2061.
8. Yee NM: Meningitis, pneumonitis and
arthritis caused by Neisseria meningitidis
group Y. JAMA 1975:232(13):1354-1355.
9. Griffiss JM: Safety and immunogenicity of
group Y and group W-135 meningococcal
capsular polysaccharide vaccines in adults.
Infect Immun 1981:34:725-732.
10. Wiggins GL: Prevalence of serogroups and
sulfonamide resistance of meningococci
from the civilian population in the United
States, 1964 -1970. Am J Public Health 1973:
63:59-65. ■
WISCONSIN MEDICAL JOURNAL, AUGUST I985:VOL.84
17
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WARNING
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Edema or hypertension requires therapy titrated to the individual. If this
combination represents the dosage so determined, its use may be
mote convenient in patient management. Treatment of hypertension
and edema is not statrc. but must be reevaluated as conditions in
each patient warrant
Contraindications; Concomitant use with other potassium-sparing agents
such as spironolactone or amiloride. Further use in anuria, progressive
renal or hepatic dysfunction, hyperkalemia Pre-existing elevated serum
potassium. Hypersensitivity to either component or other sulfonamide-
derived drugs
Warnings: Do not use potassium supplements, dietary or otherwise, unless
hypokalemia develops or dietary intake of potassium is markedly impaired.
If supplementary potassium is needed, potassium tablets should not be
used. Hyperkalemia can occur, and has been associated with cardiac irregu-
larities. It is more likely in the severely ill. with urine volume less than
one liter/day. the elderly and diabetics with suspected or confirmed renal
insufficiency. Periodically, serum K"*" levels should be determined. If hyper-
kalemia develops, substitute a thiazide alone, restrict intake Asso-
ciated widened ORS complex or arrhythmia requires prompt additional
therapy. Thiazides cross the placental barrier and appear in cord blood.
Use in pregnancy requires weighing anticipated benefits against possible
hazards, including fetal or neonatal jaundice, thrombocytopenia, other
adverse reactions seen in adults. Thiazides appear and triamterene may
appear in breast milk. If their use is essential, the patient should stop
nursing. Adequate information on use in children is not available. Sensitivity
reactions may occur in patients with or without a history of allergy or
bronchial asthma. Possible exacerbation or activation of systemic lupus
erythematosus has been reported with thiazide diuretics.
Precautions: The bioavailability of the hydrochlorothiazide component of
Oyazide' is about 50% of the bioavailability of the single entity. Theoreti-
cally, a patient transferred from the single entities of Oyrenium (triamterene,
SK&F CO.) and hydrochlorothiazide may show an increase in blood pressure
or fluid retention. Similarly it is also possible that the lesser hydro-
chlorothiazide bioavailability could lead to increased serum potassium levels.
However, extensive clinical experience with Oyazide' suggests that these
conditions have not been commonly observed in clinical practice. Do
periodic serum electrolyte determinations (particularly important in patients
vomiting excessively or receiving parenteral fluids, and during concurrent
use with amphotericin B or corticosteroids or corticotropin [ACTH]).
Periodic BUN and serum creatinine determinations should be made,
especially in the elderly, diabetics or those with suspected or confirmed
renal insufficiency. Cumulative effects of the drug may develop in patients
with impaired renal function. Thiazides should be used with caution in
patients with impaired hepatic function. They can precipitate coma in
patients with severe liver disease. Observe regularly for possible blood
dyscrasias, liver damage, other idiosyncratic reactions. Blood dyscrasias
have been reported in patients receiving triamterene, and leukopenia,
thrombocytopenia, agranulocytosis, and aplastic and hemolytic anemia
have been reported with thiazides. Thiazides may cause manifestation of
latent diabetes mellitus. The effects of oral anticoagulants may be
decreased when used concurrently with hydrochlorothiazide; dosage adjust-
ments may be necessary. Clinically insignificant reductions in arterial
responsiveness to norepinephrine have been reported. Thiazides have also
been shown to increase the paralyzing effect of nondepolarizing muscle
relaxants such as tubocurarine. Triamterene is a weak folic acid antagonist.
Do periodic blood studies in cirrhotics with splenomegaly. Antihypertensive
effects may be enhanced in post-sympathectomy patients. Use cautiously
in surgical patients. Triamterene has been found in renal stones in asso-
ciation with the other usual calculus components. Therefore, 'Oyazide'
should be used with caution in patients with histories of stone formation.
A few occurrences of acute renal failure have been reported in patients on
Oyazide' when treated with indomethacin. Therefore, caution is advised in
administering nonsteroidal anti-inflammatory agents with 'Oyazide'. The
following may occur: transient elevated BUN or creatinine or both, hyper-
glycemia and glycosuria (diabetic insulin requirements may be altered),
hyperuricemia and gout, digitalis intoxication (in hypokalemia), decreasing
alkali reserve with possible metabolic acidosis. 'Oyazide' interferes with
fluorescent measurement of quinidine. Hypokalemia is uncommon with
Oyazide', but should it develop, corrective measures should be taken such
as potassium supplementation or increased dietary intake of potassium-
rich foods. Corrective measures should be instituted cautiously and serum
potassium levels determined. Discontinue corrective measures and
Oyazide' should laboratory values reveal elevated serum potassium.
Chloride deficit may occur as well as dilutional hyponatremia. Concurrent
use with chlorpropamide may increase the risk of severe hyponatremia.
Serum FBI levels may decrease without signs of thyroid disturbance. Cal-
cium excretion is decreased by thiazides. Dyazidb' should be withdrawn
before conducting tests for parathyroid function.
Thiazides may add to or potentiate the action of other antihypertensive
drugs.
Diuretics reduce renal clearance of lithium and increase the risk of lithium
toxicity.
Adverse Reactions: Muscle cramps, weakness, dizziness, headache, dry
mouth; anaphylaxis, rash, urticaria, photosensitivity, purpura, other dermat-
ological conditions: nausea and vomiting, diarrhea, constipation, other
gastrointestinal disturbances; postural hypotension (may be aggravated by
alcohol, barbiturates, or narcotics). Necrotizing vasculitis, paresthesias,
icterus, pancreatitis, xanthopsia and respiratory distress including pneu-
monitis and pulmonary edema, transient blurred vision, sialadenitis, and
vertigo have occurred with thiazides alone. Triamterene has been found in
renal stones in association with other usual calculus components. Rare
incidents of acute interstitial nephritis have been reported. Impotence has
been reported in a few patients on 'Oyazide', although a causal relationship
has not been established.
Supplied: 'Oyazide' is supplied as a red and white capsule, in bottles of
1000 capsules; Single Unit Packages (unit-dose) of 100 (intended for
institutional use only); in Patient-Pak'” unit-of-use bottles of 100.
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COUNOL FINANCIAL AID TO FOUCaTON INC A
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BALANCED
Low incidence of side effects
CARDIZEM® (diltiazem HCl)
produces an incidence of adverse
reactions not greater than that
reported with placebo therapy,
thus contributing to the patient’s
sense of well-being.
'Cardizem is indicated in the treatment of angina pectoris due to
coronary artery spasm and in the management of chronic stable
angina (classic effort-associated angina) in patients who cannot
tolerate therapy with beta-blockers and/or nitrates or who remain
symptomatic despite adequate doses of these agents.
References:
1. Strauss WE, McIntyre KM, Parisi AF, et aJ: Safety and efficacy
of diltiazem hydrochloride for the treatment of stable angina
pectoris; Report of a cooperative clinical trial. Am J Cardiol
49:560-566, 1982. '
2. Pool PE, Seagren SC, Bonanno JA, et al: The treatment of exercise-
inducible chronic stable angina with diltiazem: Effect on treadmill
exercise. Chest 78 (July suppl);234-238, 1980.
Reduces angina attack frequency*
42% to 46% decrease reported in
multicenter study
Increases exercise tolerance*
In Bruce exercise test,^ control
patients averaged 8.0 minutes to
onset of pain; Cardizem patients
averaged 9.8 minutes (P<.005).
CAlUXIZEIUr
CdiUdazem HCl)
THE BALANCED
CALCIUM CHANNEL BLOCKER
Please see full prescribing information on following page.
2/84
PROFESSIONAL USE INFORMATION
cordizem.
(dilhcazenn HCI)
50 mg and 60 mg tablets
DESCRIPTION
CARDIZEM’ (diltlazem hydrochloride) is a calcium ion influx
inhibitor (slow channel blocker or calcium aniagonist). Chemically,
diltlazem hydrochloride is l,5-Benzothiazepln-4(5H|one,3-(acetyloxy)
■5-[2-(dlmethylamino)ethyl]-2,3-dihydro-2-(4-methoxyphenyl|-,
monohydrochloride, (+) -cis- The chemical structure Is:
CHpCHpNICHjIj
Diltlazem hydrochloride Is a white to olf-white crystalline powder
with a bitter taste It is soluble In water, methanol, and chloroform
It has a molecular weight of 450.98 Each tablet of CARDIZEM
contains either 30 mg or 60 mg diltlazem hydrochloride for oral
administraflon
CLINICAL PHARMACOLOGY
The therapeuflc benefits achieved with CARDIZEM are believed
to be related to its ability to Inhibit the influx of calcium ions
during membrane depolarization of cardiac and vascular smooth
muscle.
Mechanlsins of Action. Although precise mechanisms of Its
antianginal actions ate still being delineated, CARDIZEM Is believed
to act in the lollowino ways
1 Angina Due to Coronary Artery Spasm CARDIZEM has been
shown to be a potent dilator of coronary arteries both epicardlal
and subendocardial Spontaneous and ergonovine-induced cor-
onary artery spasm are Inhibited by CARDIZEM
2 Exertional Angina CARDIZEM has been shown to produce
increases in exercise tolerance, probably due to its ability to
reduce myocardial oxygen demand This Is accomplished via
reductions in heart rate and systemic blood pressure at submaximal
and maximal exercise work loads
In animal models, diltlazem Interferes with the slow inward
(depolarizing) cunent in excitable tissue. It causes excitation-contraction
uncoupling In various myocardial tissues without changes In the
configuration of the action potential Diltlazem produces relaxation
of coronary vascular smooth muscle and dilation of both large and
small coronary arteries at drug levels which cause little or no
negative inotropic effect The resultant increases in coronary blood
flow (epicardlal and subendocardial) occur In ischemic and nonischemic
models and are accompanied by dose-dependent decreases in sys-
temic blood pressure and decreases In peripheral resistance
Hemodynamic and Electrophyslologic EHects. Like other
calcium antagonists, diltlazem decreases sinoatrial and atrioventricu-
lar conduction In Isolated tissues and has a negative inotropic effect
in isolated preparations In the intact animal, prolongation of the AH
interval can be seen at higher doses
In man, diltlazem prevents spontaneous and ergonovine-provoked
coronary artery spasm It causes a decrease In peripheral vascular
resistance and a modest fall In blood pressure and, in exercise
tolerance studies in patients with ischemic heart disease, reduces
the heart rate-blood pressure product for any given work load
Studies to date, primarily in patients with good ventricular function,
have not revealed evidence of a negative inotropic effect; cardiac
output, ejection fraction, and left ventricular end diastolic pressure
have not been affected There are as yet few data on the interaction
of diltlazem and beta-blockers Resting heart rate is usually unchanged
or slightly reduced by dlltiazem.
Intravenous diltlazem In doses of 20 mg prolongs AH conduction
time and AV node functional and effective refractory periods approxi-
mately 20% In a study Involving single oral doses of 300 mg of
CARDIZEM In six normal volunleers, the average maximum PR
prolongation was 14% with no Instances of greater than first-degree
AV block Diltiazem-assoclated prolongation ol the AH interval is not
more pronounced in patients with first-degree heart block In patients
with sick sinus syndrome, diltlazem significantly prolongs sinus
cycle length (up to 50% in some cases).
Chronic oral administrallon of CARDIZEM in doses of up to 240
mg/day has resulted in small increases in PR interval, but has not
usually produced abnormal prolongation. There were, however, three
instances ol second-degree AV block and one Instance of third-
degree AV block in a group ol 959 chronically trealed patients.
Pharmacokinetics and Metabolism. Diltlazem Is absorbed
from the tablet formulation to about 80% of a reference capsule and
IS subiect 10 an extensive first-pass effect, giving an absolute
bioavailabillty (compared to inbavenous dosing) of about 40%. CARDIZEM
undergoes extensive hepatic metabolism in which 2% to 4% of the
unchanged drug appears In the urine In vitro binding studies show
CARDIZEM Is 70% to 80% bound to plasma proteins Competitive
ligand binding studies have also shown CARDIZEM binding Is not
altered by therapeutic concentrations of digoxin, hydrochlorothiazide,
phenylbutazone, propranolol, salicylic acid, or warfarin Single oral
doses of 30 to 120 mg of CARDIZEM result in detectable plasma
levels within 30 to 60 minutes and peak plasma levels Iwo to three
hours after drug administration The plasma elimination half-life
following single or mulllple drug administration Is approximately 3.5
hours Desacetyl diltiazem is also present In the plasma at levels ol
10% to 20% ol the parent drug and Is 25% to 50% as potent a
coronary vasodilator as diltiazem Therapeutic blood levels ol
CARDIZEM appear to be in the range of 50 to 200 ng/ml. There is a
departure from dose-linearity when single doses above 60 mg are
given, a 120-mg dose gave blood levels Ihree limes that of the 60-mg
dose There Is no information about the effect of renal or hepatic
Impairment on excretion or metabolism of diltiazem
INDICATIONS AND USAGE
1 Angina Pectoris Due to Coronary Artery Spasm. CARDIZEM
Is Indicated In the treatment of angina pectoris due to coronary
artery spasm. CARDIZEM has been shown efiective in the
treatment ol spontaneous coronary artery spasm presenting as
Prinzmetal’s variant angina (resting angina with ST-segment
elevation occurring during attacks)
2 Chronic Stable Angina (Classic Enort-Assoclated Angina).
CARDIZEM is Indicated in the management ol chronic stable
angina CARDIZEM has been efiective in controlled trials in
reducing angina frequency and Increasing exercise tolerance
There are no controlled studies ol the effectiveness ol the concomi-
tant use of dilliazem and beta-blockers or of the safety of this
combination In patients with impaired ventricular function or conduc-
tion abnormalities
CONTRAINDICATIONS
CARDIZEM is contraindicated In (1) patients with sick sinus
syndrome except In the presence ol a funclioning ventricular pacemaker,
(2) patients with second- or third-degree AV block except in the
presence of a functioning ventricular pacemaker, and (3) patients
with hypotension (less than 90 mm Hg systolic)
WARNINGS
1 Canllac Conduction. CARDIZEM prolongs AV node refrac-
tory periods without significantly prolonging sinus node recov-
er lime, except in patients with sick sinus syndrome This
effect may rarely result In abnomially slow heart rates (particularly
In patients with sick sinus syndrome) or second- or third-degree
AV block (six of 1243 patlenis for 0.48%). Concomllant use of
diltlazem with beta-blockers or digitalis may result In additive
effects on cardiac conduction A patient with Prinzmetal's
angina developed periods of asystole (2 to 5 seconds) after a
single dose of 60 mg of diltlazem
2 Congestive Heart Failure. Although diltiazem has a negative
inotropic effect In Isolated animal tissue preparations, hemodynamic
studies in humans with normal ventricular function have not
shown a reduction In cardiac index nor consistent negative
effects on contractility (dp/dt). Experience with the use of
CARDIZEM alone or in combination with beta-blockers in patients
with Impaired ventricular function is very limited Caution should
be exercised when using the drug in such patients
3 Hypotension. Decreases in blood pressure associated with
CARDIZEM therapy may occasionally result In symptomatic
hypotension
4 Acute Hepatic Injury. In rare Instances, patients receiving
CARDIZEM have exhibited reversible acute hepatic injury as
evidenced by moderate to extreme elevations of liver enzymes
(See PRECAUTIONS and ADVERSE REACTIONS.)
PRECAUTIONS
General. CARDIZEM (diltlazem hydrochloride) is extensively metab-
olized by the liver and excreted by the kidneys and in bile As with any
new drug given over prolonged periods, laboratory parameters should
be monitored at regular intervals The drug should be used with
caution In patients with Impaired renal or hepatic function In sub-
acute and chronic dog and rat studies designed to produce toxicity,
high doses of diltiazem were associated with hepatic damage In
special subacute hepatic studies, oral doses of 125 mg/kg and
higher in rafs were associated with histological changes In the liver
which were reversible when the drug was discontinued. In dogs,
doses of 20 mg/kg were also associated with hepatic changes;
however, these changes were reversible with continued dosing
Drug Interaction. Pharmacologic studies indicate that there
may be additive effects in prolonging AV conduction when using
beta-blockers or digitalis concomitantly with CARDIZEM. (See
WARNINGS)
Controlled and uncontrolled domestic studies suggest that con-
comitant use of CARDIZEM and beta-blockers or digitalis is usually
well tolerated Available data are not sufficient, however, to predict
the effects of concomitant treatment, particularly in patients with left
ventricular dysfunction or cardiac conduction abnormalities. In healthy
volunteers, diltlazem has been shown to increase serum digoxin
levels up to 20%
Carcinogenesis, Mutagenesis, Impairment of Fertility. A
24-month study in rats and a 21 -month study in mice showed no
evidence ol carcinogenicity. There was also no mutagenic response
in In vitro bacterial tests No intrinsic effect on fertility was observed
In rats
Pregnancy. Category C. Reproduction studies have been con-
ducted In mice, rats, and rabbits Administration of doses ranging
from five to ten times greater (on a mg/kg basis) than the daily
recommended therapeutic dose has resulted in embryo and fetal
lethality These doses. In some studies, have been reported to cause
skeletal abnormalities In the perinatal/postnatal studies, there was
some reduction in early individual pup weights and survival rates
There was an Increased Incidence ol stillbirths at doses of 20 times
the human dose or greater.
There are no well-controlled studies In pregnant women; therefore,
use CARDIZEM in pregnant women only if the potential benefit
justifies the potential risk to the fetus.
Nursing Mothers. It is not known whether this drug is excreted
in human milk Because many drugs are excreted in human milk,
exercise caution when CARDIZEM Is administered to a nursing
woman if the drug's benefits are thought to outweigh its potential
risks In this situation.
Pediatric Use. Safety and effectiveness in children have not
been established
ADVERSE REACTIONS
Serious adverse reactions have been rare in studies carried out to
date, but it should be recognized that patients with Impaired ventricu-
lar function and cardiac conduction abnormalities have usually been
excluded.
In domestic placebo-controlled trials, the incidence of adverse
reactions reported during CARDIZEM therapy was not greater than
that reported during placebo therapy
The following represent occurrences observed in clinical studies
which can be at least reasonably associated with the pharmacology
ol calcium influx inhibition In many cases, the relationsh'i to
CARDIZEM has not been established The most common occurrences,
as well as their frequency of presentation, are edema (2 4%),
headache (2.1%), nausea (1.9%), dizziness (1.5%), rash (1.3%),
asthenia (1.2%), AV block (11%). In addition, the following events
were reported infrequently (less than 1%) with the order of presenta-
tion corresponding to the relative frequency ol occurrence
Cardiovascular;
Nervous Syslem;
Gastroinleslinal:
Dermatologic;
Other:
Flushing, arrhythmia, hypotension, bradycar-
dia. palpitations, congestive heart failure,
syncope
Paresthesia, nervousness, somnolence,
tremor, insomnia, hallucinations, and amnesia
Constipation, dyspepsia, diarrhea, vomiting,
mild elevations of alkaline phosphatase. SCOT,
SGPT, and LDH
Pruritus, petechiae, urticaria, photosensitivity.
Polyuria, nocturia.
The following additional experiences have been noted:
A patient with Prinzmetal's angina experiencing episodes of
vasospastic angina developed periods of transient asymptomatic
asystole approximately five hours after receiving a single 60-mg
dose ol CARDIZEM
The following posimarkeling events have been reported infre-
quently in patients receiving CARDIZEM erythema multiforme; leu-
kopenia; and extreme elevations of alkaline phosphatase. SCOT,
SGPT, LDH, and CPK. However, a definitive cause and effect between
these events and CARDIZEM Iherapy is yel lo be esiablished
OVERDDSAGE OR EXAGGERATED RESPDNSE
Overdosage experience with oral diltiazem has been limited.
Single oral doses ol 300 mg of CARDIZEM have been well tolerated
by healthy volunteers In the event of overdosage or exaggerated
response, appropriate supportive measures should be employed in
addilion to gastric lavage. The following measures may be considered:
Bradycardia
High-Degree AV
Block
Cardiac Faiiure
Hypotension
Administer atropine (0 60 to 1.0 mg). If there
is no response to vagal blockade, administer
isoproterenol cautiously.
Treat as for bradycardia above Fixed high-
degree AV block should be treated with car-
diac pacing.
Administer inotropic agents (isoproterenol,
dopamine, or dobutamine) and diuretics.
Vasopressors (eg. dopamine or levarterenol
bitartrate)
Actual treatment and dosage should depend on the severity of the
clinical situation and the judgment and experience of the treating
physician
The oral/LDso's in mice and rats range from 415 lo 740 mg/kg
and from 560 to 810 mg/kg, respectively The intravenous LD^'s in
these species were 60 and 38 mg/kg, respectively. The oral LDso in
dogs is considered to be in excess of 50 mg/kg. while lethality was
seen in monkeys at 360 mg/kg. The toxic dose in man is not known,
but blood levels in excess of 800 ng/ml have not been associated
with toxicity
DOSAGE AND ADMINISTRATION
Exertional Angina Pectoris Due to Atherosclerotic Coro-
nary Artery Disease or Angina Pectoris at Rest Due to Coro-
nary Artery Spasm. Dosage must be adjusted to each patient's
needs Starting with 30 mg four times daily, before meals and at
bedtime, dosage should be increased gradually (given in divided
doses Ihree or four times daily) al one- to two-day intervals until
optimum response is obtained. Although individual patients may
respond to any dosage levei, the average optimum dosage range
appears to be 180 to 240 mg/day. There are no availabie data concern-
ing dosage requirements in patients with impaired renal or hepatic
function. If the drug must be used in such patients, titration should be
carried out with particular caution
Concomitant Use With Other Antianginal Agents:
1 Suhlingual NTG may be taken as required to abort acute
anginal attacks during CARDIZEM therapy
2 Prophylactic Nitrate Therapy -CARDIZEM may be safely
coadministered with short- and long-acting nitrates, but there
have been no controlled studies to evaluate the antianginal
effecliveness ol Ihis combination,
3 Betatilockers. (See WARNINGS and PRECAUTIONS.)
HDW SUPPLIED
Cardizem 30-mg tablets are supplied in bottles of 100 (NDC
0088-1771-47) and in Unit Dose Identification Paks of 100 (NDC
0088-1771-49). Each green tablet is engraved with MARION on one
side and 1771 engraved on the other. CARDIZEM 60-mg scored
tablets are supplied in bottles of 100 (NDC 0088-1772-47) and in Unil
Dose Idenlification Paks of 100 (NDC 0088-1772-49). Each yellow
tablel is engraved with MARION on one side and 1772 on the other.
issued 4/1/84
Another patient benefit product from
PHARMACEUTICAL DIVISION
MARION
LABORATORIES INC
KANSAS city, MISSOURI 64137
ORGANIZATIONAL
SMS June 29 Board Meeting results
The SMS Board of Directors
met in Madison Saturday, June
29, and took the following action:
• Peer review— Approved phy-
sician appointments to the newly
created SMS Task Force on Physi-
cian Review and Discipline. The
task force, chaired by Peter
Eichman, MD, Madison, was
created in response to the SMS
Secretary's report at the 1985
Annual Meeting. Its charge is to
"evaluate and make recom-
mendations for the improvement
of physician review and disci-
pline in the state of Wisconsin."
• Medical liability — Approved
physician appointees to the Task
Force on Medical Liability cre-
ated by the SMS Executive Com-
mittee on June 6. Chaired by Wil-
liam Listwan, MD, West Bend,
the purpose of the task force is to
monitor the current liability situ-
ation and to examine in-depth a
series of research projects relative
to long-term solutions to the
medical liability problem.
• H ealth consequences of
nuclear war — Agreed to co-
sponsor a conference on "Nu-
clear Decision - MakingiPast,
Present and Future" to be held
in Madison on October 25
and 26, 1985. Other sponsors
include the UW Dept of Letters
and Science, UW Office of Inter-
national Studies, UW Dept of
History, UW Dept of Medicine,
UW Dept of Scandanavian
Studies, Physicians for Social
Responsibility and Educators for
Social Responsibility.
• Litigation— Decided not to
become party at this time to the
case Sherman, et al v Wisconsin
Patients Compensation Fund, et al
which is challenging the constitu-
tionality of the Patient Compen-
sation Panel System.
• Medical liability — Supported
a provision in the Legislative
Council's bill on medical liability
which would change the statute
of limitations for physicians who
are state employees from the cur-
rent 120 days to the standard
three years which applies to pri-
vate practicing physicians. The
Board also went on record as
supporting another provision in
the bill which would include
state-employed physicians in the
Patients Compensation Fund and
the Patient Compensation Panel
System. The Board noted that
Medical College ot Wisconsin
faculty pay assessments and
premiums which are 42% of the
full rates.
• Psychiatric conference —
Agreed to co-sponsor with the
Wisconsin Psychiatric Assn and
others a conference on "Sex in
Therapy— Restructuring Broken
Lives" to be held September 13
and 14, 1985 in Milwaukee.
• Medicaid medical audit — De-
cided to continue the SMS Medi-
caid Medical Audit contract with
the Dept of Health and Social
Services providing anticipated
amendments are acceptable.
Under the contract, SMS serves
in an advisory capacity with
DHSS with regard to the appro-
priateness, quality and quantity
of medical services provided by
physicians to Medicaid re-
cipients.*
Physicians
honored
The Board of Directors has
presented Distinguished Service
awards to retired Board members
Charles W Landis, MD and
Joseph L Teresi, MD. The awards
were presented at the Board's
June meeting. Doctor Landis be-
gan his service to the Board of Di-
rectors in 1980, the year he was
elected president-elect of the
Milwaukee County Medical
Society. He was elected to the
SMS Board of Directors in 1984.
This April the SMS House of
Delegates elected Doctor Landis
president-elect of the State
Medical Society. continued ►
Medicare changes due October 1
Physicians who are currently treating Medicare patients and
are interested in changing their provider status (participating or
nonparticipating) are reminded that they must do so by October
1, 1985. A change in provider status can be obtained by writing
Wisconsin Physicians Service, Attn: CPCU, 1717 West Broad-
way, Madison, WI 53716. SMS cautions participating physicians
who change to nonparticipating status that they may want to
examine their fees closely because as a nonparticipating phy-
sician they must remain at the same level they had at the second
quarter of 1984. This may mean that some physicians may have
to roll back their current charges to Medicare patients. If you
have questions on this issue, contact Michelle Scoville at SMS
offices toll-free at 1-800-362-9080, or 608-257-6781.*
WISCONSIN MEDICAL JOURNAL, AUGUST I985;VOL.84
23
ORGANIZATIONAL
PHYSICIANS HONORED
► continued
Doctor Teresi began his service
to the County Medical Society's
Board in 1978, the year he was
elected secretary-treasurer of the
Society. He retired from the
Board in 1984.
The Wisconin Chapter of the
American Academy of Pediatrics
has named Carl S Eisenberg, MD,
Pediatrician of the Year for 1985.
Doctor Eisenberg is a member of
the State Medical Society Board
of Directors, an assistant clinical
professor at the Medical College
of Wisconsin, and on the staff of
the Milwaukee Medical Clinic. ■
Museum receives grant
The Fort Crawford Medical
Museum, operated by the So-
ciety's Charitable, Educational
and Scientific Foundation, has
been awarded a $1,000 grant
from the Institute of Museum
Services of the National Founda-
tion on the Arts and Humanities.
The grant is earmarked for the
Medical Museum to take part in
a Museum Assessment Program
operated by the American As-
sociation of Museums.*
Citizens' conference
on AODA scheduled
The Second Annual Citizens'
Conference on Alcohol and Other
Drug Related Problems will be
held Thursday, September 26 at
the Mead Inn in Wisconsin
Rapids.
The State Medical Society and
its Charitable, Educational and
Scientific Foundation are assist-
ing in sponsoring the conference
in order to share with citizens the
most recent information on
AODA problems as well as obtain
ideas to significantly reduce
AODA related problems in the
state.
Workshop topics will focus on:
AODA and the Criminal Justice
System; Community Organiza-
tion and Advocacy; Drug Abuse
Treatment Trends; Legislation;
Fetal Alcohol Syndrome; Intoxi-
cated Driver Program; Innovative
Prevention/Intervention Ap-
proaches and AODA and Health.
For registration and other infor-
mation contact Arlene Meyer at
SMS offices toll-free at 1-800-
362-9080 or at 608-257-6781*
Financial planning
seminar set, October
SMS Services, Inc has sched-
uled a "Personal Financial Plan-
ning Seminar” for October 3 at
the Marriott Inn in Brookfield.
The program will be highlighted
by presentations on the new
marital property law which will
go into effect January 1, 1986.*
Fund fee assessments due
Patients Compensation Fund
fee assessments were mailed to
physicians in early July. All
physicians (not exempt by virtue
of limited practice or government
employment) are required to pay
the Fund fee assessment.
The billing notice indicates
that payment is due by July 27,
1985, but the Fund Director has
advised SMS that because of de-
lays in mailing the notices, phy-
sicians will be given 30 days from
receipt of the notice to pay the
assessment.
As reported in a previous
Medigram, 1985-86 Fund fee
assessments are being increased
by 90% over last year's level.
However, the current amount
due is equal to the 1984 fee assess-
ment. The 90% increase will be
billed in two installments; in
January and April of 1986. This
billing procedure is necessitated
by state statute which provides
that if proposed rate changes
are not approved by June 1, then
the previous year's rate level
is billed and adjustments made at
a later date. Due to intense SMS
and member opposition to the
160% increase, the final rate
change was not approved by the
statutory deadline.
In addition, the Fund is in the
process of establishing an install-
ment payment plan. The 1985-86
assessment must be paid accord-
ing to the following schedule:
• amount equal to 1984 rate
due now,
• Vz of 90% increase due in
January 1986, and
• Ya of 90% increase due in
April 1986.
Beginning in July 1986, phy-
sicians will have the option of
paying the Fund fee assessment
in full or in quarterly install-
ments. The schedule of payment
for Patients Compensation Fund
fee assessments for 1985-86 is
as follows:
Schedule of payment for Patients Compensation Fund fee assessments for 1985-86
Current
January
April
Class
Amount Due
Payment
Payment
1
$ 952.00
$ 428.50
$ 428.50
2
1,905.00
857.50
857.50
3
2,449.00
1,102.00
1,102.00
4
2,939.00
1,322.50
1,322.50
5
4,899.00
2,204.50
2,204.50
6
5,878.00
2,645.00
2,645.00
7
6,858.00
3,086.00
3,086.00
8
476.00
214.00
214.00
9
10,287.00
4,629.00
4,629.00
*
24
WISCONSIN MEDICAL JOURNAL, AUGUST 1985: VOL. 84
ORGANIZATIONAL
Doctor Pomainville honored at Medical Museum
Leland C Pomainville, MD of
Wisconsin Rapids was honored
July 12 by the Charitable, Educa-
tional and Scientific Foundation of
the State Medical Society when
the Foundation dedicated a new
reading room, in his honor at
its Medical Museum in Prairie du
Chien.
Those present at the ribbon-
cutting ceremony, in addition to
Doctor Pomainville, were Prairie
du Chien Mayor James Bittner,
CES Foundation President Robert
T Cooney, MD, Portage, and
State Medical Society Secretary
Earl R Thayer of Madison.
Doctor Pomainville served as
treasurer of the CES Foundation
for 19 years until his retirement
earlier this year.
A native of Waumandee, Wis-
consin, Doctor Pomainville
earned his medical degree from
the University of Wisconsin
Medical School in Madison in
1931.
Following his internship and
residency at Milwaukee County
General Hospital, Doctor Po-
mainville returned to central Wis-
consin and began his practice of
medicine with his uncle. Dr F
X Pomainville, and his cousin.
Dr Francis Pomainville, in Wis-
consin Rapids. In 1939 he opened
his own office.
During World War II, Doctor
Pomainville served in the South
Pacific as a Navy surgeon.
In addition to his practice of
medicine. Doctor Pomainville
is well-known as a historian. He
is a charter member of the South
Wood County Historical Corpora-
tion and has held various offices
in that organization. He was the
first regional chairman of the
Wisconsin Council for State and
Local History, an affiliate of the
Wisconsin Historical Society, and
was the recipient of a commenda-
Cutting the ribbon . . . Doctor Pomainville and Dr Robert Cooney
tion from the American Associa-
tion of State and Local History.
Over the years Doctor Pomain-
ville has made countless contri-
butions to the CES Foundation
and its Medical Museum in
Prairie du Chien. Besides serving
as CES treasurer, for sixteen
years he presented the Beaumont
Award to an outstanding Doctor
of Surgery at the Society's Annual
Meeting. He was instrumental in
the development of a special dis-
play for the Medical Museum
featuring family doctors and is a
member of the "Beaumont 500,”
a group of individuals who have
given generous support to the
Museum. For many years he
served as the State Medical
Society's historian.
In dedicating the new reading
room in honor of Doctor Pomain-
ville, CES Foundation President
Robert T Cooney, MD said:
"May all who use the Pomain-
ville Reading Room gain as much
insight from books, history, and
through the sheer love of learning
as the man for whom the facility
is named."*
Doctor Pomainville in the reading room
WISCONSIN MEDICAL JOURNAL, AUGUST 1985:VOL.84
25
BLUE BOOK UPDATE
On page 131 of the June 1985
Blue Book issue, the following
correction should be made:
Leif Erickson Sr, MD, 440
South Perkins Blvd, Burlington,
WI 53105 is the chairman of the
Section on Family Physicians.
Also, on page 133 the president
of the Wisconsin Academy of
Family Physicians is Leif Erick-
son Sr, MD, 440 South Perkins
Blvd, Burlington, WI 53105; and
the Executive Director of the
Wisconsin Society of Internal
Medicine is Sandra M Koehler,
611 E Wells St, Milwaukee, WI
53202; Tel: 414/276-6445.
On page 123 of the June Blue
Book issue, the Environmental
and Occupational Health Com-
mittee should read as follows:
Environmental and Occupational Health
This committee shall be concerned with the health and safety
of persons in relation to their environment, including matters
relating to occupational and rural health.
Melvin S Blumenthal, MD, Monroe, 1986
Jacob Martens, MD, Wausau, 1986
Robert W Rage, MD, Marshfield, 1986
H'endelin Vi' Schaefer, MD, Sheboygan, 1986
Ruth R Schuh, MD, Watertown, 1986
CarIZenz, MD, West Allis, 1986
John S Moore, MD, Milwaukee, 1987
Henry A Anderson III, MD, Madison, 1987
John J Reck, MD, Sturgeon Bay, 1987
Erwin S Huston, MD, Milwaukee, 1987
John T Schmitz, MD, Milwaukee 1987
Raymond Johnson, MD, Milwaukee, 1987
Lawrence Smith, MD, Racine, 1987
Raid E Durkee, MD, Janesville, 1988
James T Raloucek, MD, Milwaukee, 1988
Vernon ,\ Dodson, MD, Madison, 1988, Chairman
Larry A Lindesmith, MD, La Crosse, 1988, V-Chairman
Edward R Horvath Jr, MD, Marshfield, 1988
Charles H' Eishburn, MD, New Berlin, 1988
Susan M H ester, MD, La Crosse, 1988
Mrs IV H' (Jame) Schaefer, Sheboygan, AuxiliaryB
AM A Physician's Recognition Award recipients
Listed below are those physicians in Wisconsin who have earned the AMA Physician's Recognition Award in
recent months. The State Medical Society of Wisconsin congratulates these physicians who have distinguished
themselves and their profession by their commitment to continuing education:
APRIL 1985
Barry, Daniel], Madison
*Bixby, Mark R, Grantsburg
*Blau, Edward B, Marshfield
’Breadon, George E, Monroe
*Burko, Henry, Milwaukee
Chia, James Kuao-Young, Wood
‘Cohen, David A, Edgerton
Cusick, Joseph F, Milwaukee
Duffy, Thomas M, Kenosha
‘Gardner, James D, Waukesha
‘Gingrass, Ruedi P, Milwaukee
‘Grundahl, Alvin T, West Bend
‘Holtey, Warren], Marshfield
‘Koob, Lynn D, Rice Lake
‘KreuI, Randolph W, Racine
‘Kulkoski, Bernard, Denmark
‘Larson, Sanford], Milwaukee
‘Meyer, Glen A, Milwaukee
‘Mulligan, Gerald M, Marshfield
‘Nowinski, Donald M, Wausau
‘Patton, Charles H, Racine
‘ Plautz, Arthur C, Janesville
‘Riegel, Fred B, St Croix Falls
‘Saarinen, David M, Ashland
‘Sackett, Joseph F, Madison
‘Sajjad, Syed M, Marshfield
‘Schmidt, Mary H, Marshall
‘Schroeder, Norman], Beaver Dan
‘Sellers, Robert L, Superior
‘Shahbandar, Hassan, Appleton
‘Tipping, Stuart], Marshfield
Walker, William E, Milwaukee
Walsh, Patrick R, Milwaukee
‘Washington, William L, Marshfield
‘Williamson, Warren H, Racine
‘Winters, Thomas F, Waukesha
MAY 1985
* Abellera, R Mario, La Crosse
‘Aufderheide, John F, Oshkosh
‘Bacon, Glenn A, Racine
Bennett, Lawrence N, Madison
‘Bernardoni, Robert], Darlington
‘Bock, Harvey M, Milwaukee
‘Boren, Clark H, Marinette
‘Brauer, Warren A, Sheboygan
‘Browell, John N, Marshfield
‘Buchanan, Keith E, Appleton
‘Burgarino, Joseph J, Milwaukee
Chuang, Tsu-Yi, Madison
‘Danforth, R Clarke, Milwaukee
‘Evert, Howard A, Menomonee Falls
‘Feinsilver, Donald L, Milwaukee
‘Ferrer, Modesto M, Tomahawk
‘Frase, Louis H, Eau Claire
‘Gehring, John V, Green Bay
Goodman, David A, Madison
‘Gueldner, Terry L, Manitowoc
‘Herdrich, Gary M, West Bend
‘Jacobson, Foster], Milwaukee
‘Keller', Thomas A, Manitowoc
‘Kropp, August D, Milwaukee
Linkus, Kevin A, Madison
‘Me Kenna, John E, Antigo
Nordin, John R, Milwaukee
‘Onderak, Edward P, Beloit
Perez, Celestino M, Port Washington
‘Rakow, Robert W, Milwaukee
Schmitz, Stephen R, Hudson
‘Schwartz, Herschel M, South Milwaukee
‘Speichinger, James P, Madison
‘Stineman, William F, Milwaukee
Stula, Gojko D, Milwaukee
Thomason, Jessica L, Milwaukee
‘Trevino, Rudolfo N, Milwaukee
‘Wagner, Marvin, Milwaukee
‘Webster, Stephen B, La Crosse
‘Yerex, Joyce A, Racine
‘Young, William W, St Croix FallsB
‘Members of the State Medical Society of Wisconsin
26
WISCONSIN MEDICAL JOURNAL, AUGUST 1985: VOL. 84
PUBLIC HEALTH
Statewide network set up for AIDS testing
The State Division of Health has
compiled a list of physicians who
would be interested in working ■
with HTLV-III positive clients. A
statewide network has been estab-
lished by the State Division of
Health to deter individuals from
donating blood in order to learn
their HTLV-III antibody status.
Pre-test and post-test counseling
will be provided at the testing
sites; however, the State Division
of Health anticipates that ongoing
medical, dental and psychological
care will be needed by those who
test antibody positive. Therefore,
to address this need the Division
of Health has compiled a list of
providers interested in working
with these clients. Any questions
about the statewide testing pro-
gram should be directed to Ms
Holly Dowling at (608) 267-3583.
Following is a list of alternate
testing sites for HTLV-III;
Southeastern Wisconsin
Brady East STD Clinic, 1240 East
Brady St, Milwaukee; 414/273-
2437
Herpes Health Center, Saint An-
thony's Hospital, 1004 N 10th St,
Milwaukee; 414/271-1965, ext
754
Marquette University Student
Health Services, Schroeder Com-
plex, Milwaukee; 414/224-7184
Milwaukee Health Department,
841 North Broadway, Milwaukee;
414/278-3621
Sixteenth Street Community
Clinic, 1036 South 16th St, Mil-
waukee; 414/672-1353
UW-Milwaukee Student Health
Services, University of Wisconsin-
Milwaukee, Norris Health Center,
Box 413, Milwaukee; 414/963-
4716
West Allis Health Department,
STD Clinic, 7120 West National,
West Allis; 414/476-3770
Waukesha County Health Depart-
ment, 515 West Moreland Blvd,
Waukesha; 414/548-7646
City of Kenosha Health Depart-
ment, 625 52nd St, Kenosha; 414/
656-8170
Racine Health Department, 730
Washington Ave, Racine; 414/
636-9498
Sheboygan City Health Depart-
ment, City Hall Annex, 709 North
7th St, Sheboygan; 414/459-3485
South Central and
Southwestern Wisconsin
Beloit Stateline Clinic, 539 Black-
hawk Blvd, South Beloit; 815/389-
3583
Beloit Student Health Services,
Beloit College, Beloit; 608/365-
3391, Ext. 331
Blue Bus Clinic, 1552 University
Ave, Madison; 608/262-7330
Madison Department of Public
Health, City -County Building, 210
Monona Ave, Room 507, Madi-
son; 608/246-4516
Northeast Family Medical Center,
3209 Dryden Dr, Madison; 608/
241-9020
Wingra Family Practice Clinic,
777 South Mills St, Madison; 608/
263-3111
Verona Family Practice Clinic,
524 West Verona Ave, Verona;
608/845-9531
Grant County Public Health Nurs-
ing Service, Courthouse, Lan-
caster; 608/723-6416
UW-Platteville Student Health
Services, 725 West Main St,
Platteville; 608/342-1891
Northeastern Wisconsin
Fond du Lac City Health Depart-
ment, 160 South Macy St, Fond du
Lac; 414/929-3290
UW-Oshkosh Student Health
Services, 777 Algoma Blvd, Osh-
kosh; 414/424-2424
Winnebago County Public Health
Department, 725 Butler Ave,
Winnebago; 414/235-5100, 414/
725-2653
North Central Wisconsin
Oneida County Nursing Services,
Courthouse, Rhinelander; 715/
369-6111
Portage County Health Depart-
ment, 817 Whiting Ave, Stevens
Point; 715/345-5350
UW-Stevens Point Student Health
Services, Delvin Hall, Stevens
Point; 715/346-4646
Northwestern Wisconsin
UW-La Crosse Student Health
Services, 1725 State St, La Crosse;
608/785-8559
La Crosse Health Department,
STD Clinic, Grandview Building,
1707 Main St, La Crosse; 608/
785-9723
UW-River Falls Student Health
Services, 409 Spruce St, River
Falls; 715/425-3292B
WISCONSIN .MEDICAL JOURNAL, AUGUST I985:VOL.84
27
in
Good Health
The State Medical Society of Wisconsin announces a
new program designed to improve physician-patient
communications and encourage greater pahent
feedback.
The program, entitled "Partners in Good Health,"
contains statement stuffers, reception area brochures,
patient feedback questionaires and a certificate of
participahon to be displayed in the recephon area.
Program brochures are available in quantity
by writing to;
The Communications Department
State Medical Society of Wisconsin
P.O. Box 1109
Madison, W1 53701
MUTUAL RESPECT
WORKING TOGETHER
EXCHANGE OE INFORMATION
QUESTIONS AND CONCERNS
INFORMED CONSENT
IN THE HOSPITAL
FEES FOR SERVICES
HEALTHY LIFESTYLE
Prepared and distributed
by the State Medical Society of Wisconsin
J
'Physician tfunnhers of State Medical Society of U'lsconsj^
PHYSICIAN BRIEFS
James Bloom, MD, Prairie du
Chien, has joined the medical
staff of Prairie Medicine, Ltd.
Doctor Bloom graduated from the
University of Iowa School of
Medicine and completed his
family practice residency pro-
gram in Mason City, Iowa. A
diplomate of the American Acad-
emy of Family Physicians, Doctor
Bloom was in private practice for
four years in Charles City, Iowa,
prior to moving to Prairie du
Chien.
Eric Nimmo, MD, Platteville, re-
cently became associated with
the Southwest Health Center and
is practicing in Cuba City and
Shullsburg. Doctor Nimmo grad-
uated from the Medical College
of Wisconsin, Milwaukee,
and completed his family practice
residency with St Michael Family
Practice Program which is af-
filiated with the Medical College
of Wisconsin.
Ramakrishna Vennam, MD, Sey-
mour, has joined the medical
staff of the Hittner Clinic in Sey-
mour. Doctor Vennam graduated
from Gunter Medical College in
India and completed his resi-
dency in Boston and in Kansas
City.
Frank J Pulito, MD,* has joined
the medical practice of Karen K
Cowan, MD* in Kiel. Doctor
Pulito graduated from Marquette
University Medical School and
completed his internship at Mil-
waukee County General Hospital.
He served in the United States
Navy during the Korean War.
Doctor Pulito had been in general
practice in the Milwaukee area
and was a staff physician at South-
ern Wisconsin Center for the de-
velopmentally disabled. He
served as president of the Mil-
waukee Neuropsychiatric Society
in 1977-1978.
Richard D Sautter, MD, * director
of medical education at the
Marshfield Clinic, has been
appointed an assistant dean for
clinical affairs at the University
of Wisconsin Medical School,
Madison. Doctor Sautter grad-
uated from the University of
Nebraska Medical School and
completed his internship at
Highland Alameda County
Hospital, Oakland, Calif. His
residency was served at the Uni-
versity of Iowa. Prior to joining
the Marshfield Clinic, Doctor
Sautter was an instructor at the
University of Iowa Medical
School.
Edwin L Overholt, MD, * director
of medical education at the
Gundersen Clinic, La Crosse, has
been appointed an assistant dean
for clinical affairs at the Univer-
sity of Wisconsin Medical School
in Madison. He graduated from
the University of Iowa Medical
School, and completed his res-
idency training at Fitzsimons
General Hospital, Denver, Colo.
Prior to joining the Gundersen
Clinic, he was chief of the De-
partment of Medicine at Fitz-
simons General Hospital.
Patricia McGuire, MD, Chippewa
Falls, has joined the medical staff
of St Joseph's Hospital. Doctor
McGuire graduated from St Louis
University School of Medicine
and completed her residency at
Gundersen Medical Foundation,
La Crosse, and also at Mayo
Clinic in Rochester.
Robert H Ehrhart, MD recently
opened his medical practice in
Sheboygan. Doctor Ehrhart
graduated from the University of
Pittsburgh School of Medicine and
served an internship at Bellevue
Hospital in New York. His resi-
dency was completed at Walter
Reed Army Medical Center,
Washington, DC. He most re-
cently completed a tour of duty as
a major in the US Army Medical
Corps.
Ean H Crennell, MD, Oshkosh,
has joined the medical practice of
Stephen S Dudley, MD, Ltd.
Doctor Crennell, a graduate of
Trinity College, University of
Dublin, served a residency at the
University of Wisconsin Medical
School, Madison. He also had
trained at the Mayo Clinic, and
was an anesthesiologist in Madi-
son for 18 years before entering
the specialty of ophthalmology.
John F Andrews, MD, Green Bay,
recently joined the medical staff
of the Beaumont Clinic. Doctor
Andrews graduated from the
University of Minnesota Medical
School and completed his resi-
dency at the University of Chi-
cago Hospital and Clinics and at
Michael Reese Hospital and
Medical Center. He previously
had practiced in Virginia, Minn.
James F Baumgartner, MD,*
West Bend physician for 39
years, is retiring from medical
practice. Doctor Baumgartner
had been associated with the
General Clinic of West Bend. He
graduated from Marquette Uni-
versity School of Medicine and
served his internship at the US
Naval Hospital in San Diego. He
has served as president of the
Washington County Medical
Society, was chief-of-staff of St Jo-
seph's Community Hospital, and
is a charter member of the board
of directors of St Joseph's Com-
munity Hospital.
Susan M Picchowski, MD, Green
Bay, has joined the medical staff
of the Beaumont Clinic in the
Department of Internal Medi-
cine. Doctor Piechowski grad-
uated from the University of Wis-
WISCONSIN MEDICAL JOURNAL, AUGUST 1985:VOL.84
29
PHYSICIAN BRIEFS
consin Medical School and com-
pleted her residency at the Wil-
liam Beaumont Hospital, Royal
Oaks, Mich. She previously had
practiced in Virginia, Minn.
Thomas J Knutson, MD, Pesh-
tigo, recently opened his medical
practice in Peshtigo. A 1980 grad-
uate from the University of Wis-
consin Medical School, Madison,
Doctor Knutson completed his
family practice residency in
Cheyenne, Wyo. He also has
been doing emergency medicine
work at Menominee County
Lloyd Hospital.
Francis P Larine, MD,* New
Holstein, has received the "1985
Distinquished Service Award"
from the University of Wisconsin
Medical Alumni Association. Doc-
tor Larme has practiced family
medicine in New Holstein since
1946 and has been a member of
the Calumet Memorial Hospital
medical staff since 1956 serving
in all officer and committee chair-
man positions. Doctor Larme was
active in the development and
construction of Calumet Home-
stead, the 104-bed skilled nursing
care home for which he has
served as medical director since
its opening in 1957.
David C Thies, MD, * Waukesha,
recently has become associated
with the Doctors Clinic of Elk-
horn. He graduated from the Uni-
versity of Iowa Medical School
and completed a residency pro-
gram at Waukesha Memorial
Hospital and the Medical Col-
lege of Wisconsin. He also has
been involved as a part-time
emergency room physician at
Oconomowoc Memorial Hos-
pital, at the Waukesha County
VD Clinic and with Planned
Parenthood of Wisconsin, Inc.
Richard E Rieselbach, MD, * Bay-
side, associate dean for the Mil-
waukee Clinical Campus of the
University of Wisconsin's Medi-
cal School, has been chosen to re-
ceive a Robert Wood Johnson
Health Policy Fellowship for
1985-86. Doctor Rieselbach is
professor and chairman of Mount
Sinai Medical Center's Depart-
ment of Medieine. He is a 1958
graduate of Harvard Medical
School and has been associated
with the University of Wisconsin
since he became an instructor in
medicine in 1965.
George H Lind, MD* and Pamela
B Wolfe, MD, * husband and wife
team from Shell Lake, have
opened the Clinton office of the
Beloit Clinic. Doctors Lind and
Wolfe graduated from the Uni-
versity of Wisconsin Medical
School, Madison, and completed
their residency at Mt Sinai Medi-
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30
WISCONSIN MEDICAL JOURNAL, AUGUST 1985; VOL. 84
PHYSICIAN BRIEFS
cal Institute in Milwaukee. They
had practiced in Shell Lake for
the past three years.
Scott Peschke, MD, Plymouth,
has become associated with the
Plymouth Clinic. Doctor Peschke
graduated from the University of
Wisconsin Medical School, Madi-
son, and completed his residency
training in Wausau.
Harold F Hardman, MD, * PhD,
Brookfield, recently received the
Medical College of Wisconsin's
"Distinguished Service Award."
Doctor Hardman had served as
the chairman of the school's de-
partment of pharmacology and
toxicology. He is a past president
of the Federation of American
Societies for Experimental Bio-
logy, and also has served as pres-
ident of the National Association
for Medical School Pharmacol-
ogy Chairmen from 1978 to 1980.
Jack A Klieger, MD, * Elm Grove,
has received the Medical College
of Wisconsin's "Distinquished
Service Award." Doctor Klieger
was recognized for his 40 years of
teaching and practice of obstet-
rics and gynecology at the Medi-
cal College. He was instrumental
in establishing the high risk
obstetrics program at St Joseph's
Hospital where he was director of
perinatology from 1976-1984. He
also served as chairman of the
Department of Obstetrics and
Gynecology from 1958-1970. He
is a graduate from the Marquette
University School of Medicine.
Marvin Wagner, MD, * Fox Point,
was named "Alumnus of the
Year" by the Medical College of
Wisconsin. He is clinical pro-
fessor of surgery and professor
of anatomy at the Medical Col-
lege and has served on the faculty
for 35 years. In 1980 he received
the Physician's Recognition
Award of the American Medical
Association and the Distin-
guished Service Award of MCW.
He graduated from Marquette
University Medical School in
1944.
OVER 66,000
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Practical information
on the medical aspects of
fitness and exercise.
Tennis elbow: Joint resoiution by
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Hypertrophic cardiomyopathy
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Effects of sunscreen use during
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Profile of Youth Soccer Injurtes
How I Manage Gout in Athletes
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Current Status of Meniscus Surgery
WISCONSIN MEDICAL JOURNAL, AUGUST 1985:VOL.84
31
PHYSICIAN BRIEFS
Timothy Wolter, MD, Chippewa
Falls, recently became associated
with MDs Paul M Ipel* and
Robert S Lea* in Chippewa Falls.
Doctor Wolter graduated from
the University of Minnesota
School of Medicine and has com-
pleted his family practice res-
idency in Sioux Falls, S Dak.
Vernard A Benn, MD, * Rosholt,
recently retired from his medical
practice of 49 years. Doctor Benn
graduated from the University of
Wisconsin Medical School, Madi-
son, and served his internship
and residency at the Medical
College of Virginia in Richmond.
He has no exact count of the
number of babies he delivered,
but knows it's "something over
5,000."
Martin E Klabacha, MD, Wood-
ruff, recently became associated
with the Lakeland Medical As-
sociates of Woodruff, Park Falls,
and Phillips. Doctor Klabacha
graduated from Loyola Univer-
sity Stritch School of Medicine
and completed his residencies at
Indiana University, Loyola Uni-
versity, and the Oregon Health
Sciences University. He most
recently has been practicing in
the Chicago area.
Albino L Settimi, MD, * Elm
Grove, has assumed the newly-
created position of Vice President
for Medical Affairs at Good
Samaritan Medical Center. Doc-
tor Settimi has had offices in
Elm Grove for more than 20
years and has been on the medi-
cal staff at Deaconess Hospital
and the Masonic Diagnostic
Center. ■
C E S
Foundation
of the State Medical
Society of Wisconsin
The Charitable, Educational and
Scientific Foundation of the
State Medical Society of Wis-
consin recognizes the generosity
of the following individuals and
organizations who have made
contributions during the month
of May 1 985.
VOLUNTARY
CONTRIBUTIONS
Neston C Alabarca, MD
Carroll A Bauer, MD
Robert S Bujard, MD
Eugene P Burke, MD
David J Carlson, MD
Gerald P Clarke, MD
Frances A Cline, MD
Dorothy R Conzelman, MD
Robert J Corliss, MD
Dane County Medical
Society Auxiliary
William B Davies, MD
Helen A Dickie, MD
Douglas K Diehl, MD
Martin B Fliegel, MD
Henry A Folb, MD
Paul S Fox, MD
D J Freeman, MD
David C Grout, MD
David S Haskell, MD
Ralph F Hudson, MD
J Howard Johnson, MD
Robert Karen, MD
Roger A Kjentvet, MD
Ralph A Kloehn, MD
Thomas J Koewler, MD
Stanley A KorduckI, MD
Diana L Kruse, MD
Ursula Kutter, MD
William J LaJoie, MD
Harry H Larson, MD
Elliot O LIpchik, MD
William J Listwan, MD
Roland Locher, MD
William L Lorton, MD
Robert M Lotz, MD
Michael H Mader, MD
Cecilio T Mendoza, MD
Glenn A Meyer, MD
Milwaukee County Medical
Society Auxiliary
George P Nichols, MD
Judith E Orie, MD
Joseph J Osterbauer, MD
David W Ovitt, MD
Sverre Quisling, MD
Vangala J Reddy, MD
Jonathan Rovinson, MD
Joseph B Schrock, MD
Richard T Shore, MD
Elizabeth A Steffen, MD
Ki Jun Wang, MD
Henry B Wengelewski. MD
Rodney D Wichmann, MD
DeLore Williams. MD
IN MEMORIAM
Mrs Jean Fodden
Donald D Frawley, MD
Rodney G Gwinn, MD
Richard E Jensen, MD
Mrs Patrick McGoldrick
Mr Frank Maguire
MEMORIAL
CONTRIBUTORS
James W Erchul, MD
Manitowoc County Medical
Society Auxiliary
Dr and Mrs Robert Schmidt
State Medical Society of
Wisconsin
HARRINGTONWRIGHT
SCHOLARSHIP FUND
Dane County Medical
Society Auxiliary
Milwaukee County Medical
Society Auxiliary
Outagamie County Medical
Society Auxiliary
AESCULAPIAN
SOCIETY
REGULAR
William H Annesley, Jr, MD
FORT CRAWFORD
MUSEUM
ENDOWMENT
FUND
Crawford County
SPECIAL GIFTS
The Professional Insurance
Company
32
WISCONSIN MEDICAL JOURNAL, AUGUST 1985: VOL. 84
* Physician members of Stale Medical Society of VV^scoMS/f?
COUNTY SOCIETIES
Community Conference issues medical ethics statement
MILWAUKEE: The Community
Conference on Medical Ethics
was formed in 1984 by the Medi-
cal Society of Milwaukee Coun-
ty's immediate past president,
John P Mullooly, MD.* The mis-
sion was to advise the Medical
Society's Board of Directors of
medical/ethical issues in the
community and draft statements
on ethical issues for consideration
by the Board. The statement on
The Withdrawal of Nutrition
and Hydration in Terminal
Adult Patients is the first com-
pleted work of the Conference.
The advisory statement was ap-
proved for publication in the So-
ciety's Membership Newsletter
as an official statement of the
Medical Society of Milwaukee
County. The Conference is com-
prised of physicians from the
Society's regular Ethics Com-
mittee and eight community and
religious leaders. Conference
members who drafted the state-
ment are: Christopher J Drayna,
MD;* Richard P Barthel, MD;*
Harry R Foerster Jr, MD;* Patrick
Coffey, Marquette University
Department of Philosophy; Rev
Richard Eyer, Columbia Hos-
pital; Sandra Christensen, Execu-
tive Director, Kindcare; Sister
Gabrielle Kowalski, Cardinal
Stritch College; Charlotte Theis,
Marquette University School of
Nursing; Rev Willard Steiner;
Rev Dick Robinson, Elmbrook
Church; and Connie Pukaite,
Executive Director, Association
for Retarded Citizens.
OUTAGAMIE: Fifteen members
were present at the May meeting
of the Outagamie County Medi-
cal Society. Guest speakers were
Ron Henrichs, Director of Com-
munications and Membership,
and Deborah Bowen Wilkie,
Field Representative, both of the
State Medical Society. Mr Hen-
richs spoke on "The REACH Pro-
gram" and Mrs Wilkie spoke on
the "Change in Malpractice Pre-
miums." New officers for 1985-
86 took place and they are MDs:
Marvin L Hall,* president; Nancy
J Homburg, * vice president, and
David R Finch,* secretary-treas-
urer, all of Appleton.
WINNEBAGO: Thirty-nine
members and guests were pres-
ent at the May meeting of the
Winnebago County Medical
Society held in Oshkosh. Ms
Terry Hottenroth, lobbyist for the
State Medical Society spoke on
the "1985 Legislative Goals."*
The Withdrawal of Nutrition and Hydration
in Terminal Adult Patients
Statement of the Community Conference on Medical Ethics. Approved by the
Board of Directors of the Medical Society of Milwaukee County, May 1985
In all societies, provision of food and water is perceived as a
critical part of human nurturing and caring for one another as
well as a physical necessity of life. Decisions regarding the pro-
vision of nutrition and hydration should be made in this context.
It shall be our position that it is obligatory to provide nutri-
tion and hydration except in certain circumstances.
Exceptions may be justified in the following health care con-
texts:
1) The patient is comatose and has an imminently terminal con-
dition wherein provision of nutrition /hydration will only
lengthen the dying process.
2) The patient is irreversibly comatose, has no terminal illness,
and the physician has reasonable knowledge that the patient
previously expressed desire for such withdrawal in such cir-
cumstances.
3) The patient is terminally ill, comatose, and/or incompetent,
and hydration /nutrition is causing or would cause consider-
able physical suffering.
4) The patient is terminally ill, competent, informed, under-
stands the consequences, and chooses to refuse nutrition/
hydration.
FOOTNOTE: Although the Committee respected the autonomy of the patient in
drafting these guidelines, there were also concerns for those who are asked to
assist the patient in his/her possible choice of refusal of nutrition /hydration
(i.e. physician nurse, institution, etc.), and for what a refusal of nutrition /hydra-
tion does to a society's morale, value for life, and sense of community. An
individual’s autonomy may be a sign of isolation, loneliness and despair, which
needs to be addressed.
DEFINITIONS: Terminal Illness: For the purpose of these guidelines, it is
agreed that terminal illness is an irreversible condition which will cause the
patient's death in the foreseeable future. A time frame which is bounded by
weeks to months and less than one year.
Imminently Terminal: For the purpose of these guidelines, it is agreed that the
term imminently terminal is a time frame bounded by hours to days.*
WISCONSIN MEDICAL JOURNAL, AUGUST 1985:VOL.84
33
SPECIALTY SOCIETIES
* Physician members of Slate Medical Society of
Wisconsin Academy of Family
Physicians, at its 37th Annual
Meeting June 12-15, elected
James L Esswein, MD,* Cam-
eron, as its president-elect for
1986-87. Doctor Esswein will
succeed Lief W Erickson, Sr,
MD,* Burlington, who is serving
as president for 1985-86. Theo-
dore C Fox, MD,* Antigo, re-
ceived the 1985 "Family Phy-
sician of the Year" Award at
the meeting. He is a past presi-
dent of WAFP. John L Rasch-
bacher, MD,* Waukesha, was
honored as the 1985 "Family
Practice Educator of the Year,"
and just recently retired as di-
rector of the Family Practice
Residency Program at Waukesha
Memorial Hospital. He was
nominated for this award by
John L Roschbacher, MD James L Esswein, MD
Curt G Grauer, MD Lief W Erickson. MD
Theodore C Fox. MD
many of his former students.
Curt G Grauer, MD,* Wausau,
received the 1985 "Geriatrician
of the Year" award for his devo-
tion and concern for his geriatric
patients.
Officers elected at the annual
meeting were: MDs John T
Bollinger,* Fall Creek, secretary-
treasurer; David E Westgard,*
La Crosse, speaker; Curtis W
Bush, * Beaver Dam, vice-speaker;
Robert F Purtell Jr,* Milwaukee,
delegate to the AAFP, and John
O Grade,* Elm Grove, alternate
delegate. New directors elected
were MDs James H Zellmer,*
Milwaukee; Ann Berlage, Madi-
son; and Alan D Strobusch,* New
London. Laurence J Velinden,
MD, Milwaukee, was elected as
the resident representative on
the Board of Directors and Mrs
Barbara A Hummel,* Milwau-
kee, was elected as the student
representative. Francis M Scham-
mel, MD,* Stoughton, was elected
chairman of the Board of Direc-
tors.
American Society of Surgery of
the Hand, has elected to member-
ship, Ruedi P Gingrass, MD,*
Milwaukee. Doctor Gingrass be-
comes the second active member
in Milwaukee and the third in
Wisconsin.
Society of Thoracic Radiology, at
its second annual meeting, has
installed Lawrence Goodman,
MD, Fox Point, president for the
year 1985-86. Doctor Goodman
is professor of radiology and di-
rector of pulmonary radiology at
the Medical College of Wiscon-
sin.
American Academy of Derma-
tology has named William C
Miller, MD,* Wausau, to the
Council on Governmental Liaison.
Doctor Miller also is a member of
the State Medical Society's Health
Care Cost Liaison Committee.
American College of Utilization
Review Physicians (ACURP) has
accepted Muhammad Y Ahmad,
MD, * Merrill, as a fellow. A main
goal of ACURP, established in
1973, is to reduce cost and main-
tain the high quality of health-
care.
American College of Physicians
recently announced the follow-
ing Wisconsin physicians to
fellows of the College. They are
MDs Richard A Reinhart,*
Marshfield, and Kristine M Lohr
of Wood.
Wisconsin Chapter, American
College of Surgeons, has elected
the following physicians to office
for the year 1985. They are
MDs Wayne J Boulanger,* Mil-
waukee, president; Sanford
Mackman,* Madison, president-
elect; Roger L von Heimburg, *
Green Bay, vice-president; and
Paul S Fox, Waukesha, secretary
who was elected to a three-year
term.
"WATS ' LINE
FOR MEMBERS
The in-WATS (toll-free) line
can be used to contact any-
one at SMS headquarters
(330 East Lakeside Street,
Madison) from anywhere
within the State of Wiscon-
sin between the hours of
8:00 am and 4:30 pm week-
days. The number to dial is:
1-800-362-9080
34
WISCONSIN MEDICAL JOURNAL, AUGUST 1985: VOL. 84
OBITUARIES
Rodney P Gwinn, MD, Sturgeon
Bay, died March 10, 1985 in Stur-
geon Bay. Born July 7, 1918 in
Seattle, Wash, Doctor Gwinn
graduated from the University of
Wisconsin Medical School,
Madison, and completed his resi-
dency in the Kine County Hos-
pital, Seattle, Wash. Doctor
Gwinn served in the United
States Air Force during World
War II and the Korean Conflict.
He had been associated for 15
years at Abbott Laboratories in
North Chicago, 111, in clinical re-
search and also was employed in
the same capacity 12 years at G D
Searle in Skokie, 111. He was an
associate professor in clinical
medicine at Northwestern Uni-
versity Medical School in Chi-
cago. He retired in Sturgeon Bay
in 1982. Doctor Gwinn was a
member of the Door-Kewaunee
County Medical Society and the
State Medical Society of Wis-
consin. Surviving are his widow;
two daughters, and a son.
Michael F Rics, MD, 78, Browns-
ville, died Mar 29, 1985 in
Brownsville. Born Feb 3, 1907 in
Lomira, Doctor Ries graduated
from the University of Wisconsin
Medical School, Madison, and
served his internship at St Louis
City Hospital, St Louis, Mo.
Doctor Ries practiced in the
Brownsville area until his retire-
ment in 1983. He served as chief-
of-staff at Waupun Memorial
Hospital and also was a member
of the St Agnes Hospital medical
staff. He was a member of the
Fond du Lac County Medical
Society, the State Medical Society
of Wisconsin, and the American
Medical Association. Surviving
are his widow, Margaret; three
sons, Stanley, Brownsville;
Thomas, Berlin; and Michael,
Eau Claire; two daughters, Mrs
Katherine Harden, Livermore,
Calif; Mrs Paul Gotberg, San
Diego, Calif; and three step-
daughters, Mrs. Velma Reichle,
Philadelphia, Pa; Mrs Carol
Cooke, Dayton, Ohio, and Mrs
Joann Sommers, Random Lake;
and two stepsons, Bruce Frei,
Venice, Fla, and Warren Frei of
Bettendorf, Iowa.
Rudolph P Gingrass, DDS, MD,
84, Oconomowoc Lake Village,
died Apr 5, 1985 in Ocono-
mowoc. Born Jan 20, 1901 in
Baraga, Mich, Doctor Gingrass
graduated from the Marquette
University School of Medicine,
Milwaukee, and served his in-
ternship at Milwaukee County
General Hospital. He was a
former member of the medical
staff of St Joseph's and St Fran-
cis hospitals, and also was a con-
sultant in Oral and Maxillofacial
Surgery at the Medical College
of Wisconsin and the Veterans
Administration Hospital in
Wood. Doctor Gingrass was a
professor emeritus of Oral and
Maxillofacial Surgery and also of
Plastic and Reconstructive Sur-
gery at the Medical College of
Wisconsin. Surviving are his
widow, Mary; and five children.
Desmond H Callaghan, MD,
78, Hayward, died Apr 9, 1985 in
Duluth, Minn. Born Nov 30, 1906
in Glenwood, Minn, Doctor Cal-
laghan graduated from the Uni-
versity of Minnesota School of
Medicine and served his intern-
ship at St Mary's Hospital in Du-
luth, Minn. He served as a United
States Naval Doctor with the 1st
Marine Division in the South
Pacific during World War II.
Doctor Callaghan practiced medi-
cine in Hayward until his retire-
ment in 1973. He was a member
of the Wisconsin Academy of
Family Physicians, Barron-Wash-
burn-Burnett County Medical
Society, the State Medical Society
of Wisconsin, and the American
Medical Association. Surviving
are his widow, Martha; one son,
John Lansing of St Paul, Minn;
two daughters, Mary Wanninger,
Edina, Minn, and Jane Pederson
of Rochester, Minn.
Donald D Frawley, MD, 84,
former Milwaukee physician,
died Mar 9, 1985 in Sun City,
Ariz. Born Aug 4, 1901 in Apple-
ton, Doctor Frawley graduated
from Marquette University
School of Medicine in 1925 and
served his internship at New
York Polyclinic Hospital. His
residency was completed at the
New York Eye and Ear In-
firmary. He had been an at-
tending staff member at
Milwaukee Children's Hospital
and a consulting physician at
Misericordia Hospital and St
Anthony's Hospital, Milwaukee.
He was a member of The Medical
Society of Milwaukee County,
the State Medical Society of Wis-
consin, and the American Medi-
cal Association. There are no im-
mediate survivors.
Rodney B Fruth, MD, 58, Elm
Grove, died Apr 13, 1985 in San
Diego, Calif. Born Oct 4, 1926 in
Connersville, Ind, Doctor Fruth
graduated from Albany Medical
College, Albany, New York. His
internship was served at Indian-
apolis General Hospital, Ind, and
his residency was completed at
the Veterans Administration Hos-
pital, Wood, Wis. Doctor Fruth
was medical director of Philstan
Psychiatric Clinic, Milwaukee,
and also had a private practice in
Elm Grove. He was a member of
the Wisconsin Psychiatric Asso-
ciation, the American Psychiatric
Association, The Medical Society
of Milwaukee County, the State
Medical Society of Wisconsin,
and the American Medical As-
sociation. Surviving is his widow,
Elaine.
WISCONSIN MI-mCAI. JOURNAL, AUGUST 1985:VOL.84
35
OBITUARIES
William E Bargholtz, MD, 80,
Ashland, died Apr 27, 1985 in
Ashland. Born Mar 16, 1905 in
Clinton, Iowa, Doctor Bargholtz
graduated from the University of
Iowa Medical School and served
his internship at Madison Gen-
eral Hospital. After internship.
Doctor Bargholtz practiced
medicine in Reeseville until he
moved to Ashland in 1943. In the
early 1950s, Doctor Bargholtz
Practicing Business
or Medicine?
ARE YOU READY
TO GIVE UP:
• Paying overhead?
• Managing office staff?
• Running a collection agency?
• Shelling out for
malpractice insurance?
• Being constantly "on call?"
• Hassling with medical insurance
companies?
• Marketing your services?
NAVY MEDICINE COULD
BE THE ANSWER!
Professional care: the best in
nredicines, diagnostic procedures
and equipment.
Professional growth: specialty
training, continuing medical educa-
tion conferences and postgraduate
education available— all costs
paid.
Professional support: most
paperwork handled by adminis-
trative staff, leaving you free to
practice medicine.
Professional rewards: subtract in-
surance, other overhead and admin-
istrative costs you now pay. And
you'll find Navy Physician salary
to be comparable.
And a lot more. You may find
this is the practice that's perfect
for you.
For nrore information, call or send
your Curriculum Vitae to: I.t.
Nancy Hill, Henry S Reuss Federal
Plaza, 310 W Wisconsin Ave, Suite
450, Milwaukee, W1 53203; 414/
291-1529 (call collect).
served on the State Medical So-
ciety of Wisconsin's Committee
on Cancer. He also served as
president of the Ashland-Bay-
field-Iron County Medical So-
ciety, was a member of the "50
Year Club" of the State Medical
Society of Wisconsin, and was a
member of the American Medical
Association. Surviving are his
widow, Luella; two daughters,
Susan and Betsey; and one son,
William.
Bruno J Peters, MD, 73, Wauwa-
tosa, died Apr 29, 1985 in Brook-
field. Born Sept 3, 1911 in Mil-
waukee, Doctor Peters graduated
from Marquette University
School of Medicine and com-
pleted his internship and resi-
dency at Milwaukee County
General Hospital. Doctor Peters
served in the U S Army Medical
Corps from 1942-1946. After
service he returned to Milwaukee
and organized the medical clinic
at Allen-Bradley. He was co-
founder of the Clinic of Internal
Medicine in Wauwatosa, and was
a long-time board member of the
Marquette Medical School and
the Medical College of Wiscon-
sin. He also was a former chief-
of-staff at St Luke's Hospital in
Milwaukee. In 1969 he was presi-
dent of the Milwaukee Academy
of Medicine and also was a
former president of the Mil-
waukee Chapter of the American
Diabetic Association. In 1975
Doctor Bruno was named Alum-
nus of the Year of the Marquette
Medical College of Wisconsin
Medical Alumni Association. He
retired in 1977. He was a mem-
ber of The Medical Society of
Milwaukee County, the State
Medical Society of Wisconsin,
and the American Medical Asso-
ciation. Surviving are his daugh-
ter, Frances Auger, Elm Grove;
four sons, Stephen R, Woodruff;
Michael B, Newark, Del; Thomas
J, Cottonwood, Ariz, and Mark
A of Portland, Ore.
Maurice H McCaffrey, MD, 84,
Dunedin, Fla, died May 15, 1985
in Dunedin. Born Jan 19, 1901
in Madison, Doctor McCaffrey
graduated from the University of
Pennsylvania School of Medicine
and had practiced medicine in
Pittsburgh until his retirement.
Surviving are his widow, Roberta
Lee of Dunedin, and one son,
Maurice of Hudson, Ohio.
Paul E Rutledge, MD, 84, Wash-
ington Island, died June 9, 1985
in Washington Island. Born Feb
4, 1901 in Danby, Mo, Doctor
Rutledge graduated from St
Louis University Medical School
in 1927 and served his internship
at St Mary's Hospital, St Louis,
Mo. Doctor Rutledge practiced
medicine in Missouri from 1927-
1960 and then moved to Wash-
ington Island in 1961 and prac-
ticed there until his retirement in
1977. Surviving are his widow,
Jean; two daughters, Mrs Gilbert
(Ann) Truax, Escanaba, Mich;
Mrs Clay (Jean) Blair, Washing-
ton Island; and two sons, Paul,
Akron, Ohio, and Charles of
Findlay, Ohio.
John Kimberly Curtis, MD, 85,
Madison, died July 5, 1985 in
Madison. Born Mar 14, 1905 in
Redland, Calif, Doctor Curtis
graduated from Columbia
Medical School, and served his
internship at Presbyterian and
Bellevue hospitals in New York.
After service in World War II,
Doctor Curtis moved to Madison
and entered private practice until
1951 when the Middleton Mem-
orial Veterans Administration
Hospital was opened. He was
named its first Chief of Medicine.
He retired in 1971. Surviving are
his widow, Margaret; two sons,
Kimberly, Missoula, Mont; James
of Coeur d'Alene, Idaho; and one
daughter, Catherine Sawyer of
Santa Fe, N Mex.a
36
WISCONSIN MEDICAL JOURNAL, AUGUST 1985: VOL. 84
American Physicians Life's comprehensive and competi-
tively priced line of insurance products is now being
offered exclusively through SMS Services Inc., to State
Medical Society members.
APL is a majority-owned subsidiary of Physicians
Insurance Company of Ohio (PICO) and a sister com-
pany of The Professionals Insurance Company, the
carrier of the SMS-endorsed Professional Liability
Insurance Plan.
APL coverages available to you through SMS Services
Inc., and its authorized insurance representatives
include:
• Innovative Universal Life coverages
• Low Cost Graded Premium Whole Life plan
• Yearly Renewable and Convertible Term Life protection
• Non-cancellable Disability Income programs
• Single and Flexible Premium Annuities
• Comprehensive Office Overhead Expense protection
Why not contact SMS Services Inc., today to find out
how American Physicians Life can solve all your life
insurance needs.
CONTACT:
SMS SERVICES INC.
330 EAST LAKESIDE STREET
P.O. BOX 1109
MADISON, WISCONSIN 53701
(608) 257-6781 OR TOLL FREE
1-800-362-9080
ORGANIZATIONAL
Membership facts
Whether you’re just starting medical school, maintaining a
full-time practice, or retiring, SMS has a membership classi-
fication to fit your individual needs. Election to membership
by the County Medical Society in which your principal place
of practice is located carries with it membership in the State
Medical Society of Wisconsin and, if you wish, the American
Medical Association. If you qualify for resident membership
at the time of your election, your membership dues are
greatly reduced. This may also qualify you for reduced dues
the first two years of your practice. In addition, two-physician
families may be eligible for a $50 discount on total SMS
membership dues. Dues for regular membership in 1985 are
$455 for SMS, $330 for AMA, and county society dues vary.
A more detailed listing of SMS membership classifications and
their corresponding dues follows:
State Medical Society of Wisconsin
DESCRIPTION OF MEMBERSHIP
CLASSIFICATIONS
Regular Member in active practice. Some are regular mem-
bers that have reduced SMS and/or AMA dues because they
are new practitioners (first year or two out of residency).
Resident: Physician who at January 1 of dues year is in an
approved training program as a hospital resident or research
fellow who is licensed to practice medicine and surgery in
Wisconsin.
Military Service: Members who are serving in the U S. armed
forces (generally not to exceed five years).
Associate: Member whose dues are waived because of fi-
nancial hardship due to illness or disability. This classifica-
tion is temporary and is reviewed on an annual basis.
Life: Member who has held membership in a state medical
society for 50 years or is a Past President of the State Med-
ical Society of Wisconsin.
Honorary: Member who was named by the Board of Direc-
tors in recognition of long and distinguished service to Itie
cause of medicine.
Your membership in organized medicine will help insure
the continued "safety" of your practice and quality care
for all patients. Your voice will be heard through par-
ticipation. Membership in the State Medical Society of Wiscon-
sin also requires membership in the county medical society
(AMA membership is optional but encouraged). For Regular,
Part-time Practice, or Over Age 70 membership classifi-
cations, dues may be paid in one lump sum or in two
equal installments: one-half of the total payable by Jan-
uary 1, the other half not later than May 15, 1985 which is
the removal date for those members who have not com-
pleted payment. You are urged to renew your membership.
Retired: Member who has completely retired from practice
(works less than 240 hours per year). All dues are waived
unless county society indicates they wish to charge county
dues.
Part-time Practice: Physician, regardless of age, who prac-
tices 1,000 hours or less during the calendar year but does
not qualify for retired membership.
Over Age 70: Member in active practice who is over 70 years
of age as of January 1.
Candidate: Member attending a medical school in Wiscon-
sin or fulfilling a postgraduate obligation prior to eligibility
for licensure.
Scientific Fellow: The Board of Directors may by invitation
and unanimous consent confer upon any person engaged in
teaching of or research in one or more of the basic sciences
at an accredited college or university, and not holding the
degree of Doctor of Medicine or Osteopathy, the status of
Scientific Fellow.
Emeritus: Retired members who have chosen not to renew
their license.
1985 DUES AMOUNTS FOR THESE
CLASSIFICATIONS
SMS
AMA
COUNTY
Regular
$455
$330
Normal County Dues
Resident
45.50
45
Varies
Military Service
-0-
220 or 45
-0-
Associate
-0-
-0-
-0-
Life
-0-
-0-'
-0-
Honorary
-0-
-0-'
-0-
Retired
-0-
-0-'
-0-
Part-time Practice
227.50
330'
Normal County Dues
Over Age 70
227.50
-0-'
Normal County Dues
Scientific Fellow
-0-
,-0-
Emeritus
-0-
-0-'
Candidate-
Freshman Year
Medical Student
-0-
20
Varies
Sophomore and
Succeeding Medical
Student Years
10
20
Varies
Postgraduate— One
10
45
Varies
'Physicians in the followihg categories may be eligible for exemption from
paying AMA dues: (1) Financial hardship and/or disability, (2) Age 65-69 and
retired from the practice of medicine, (3) Over age 70 regardless of retirement
status.
State Society dues are prorated on a monthly basis for
those elected to membership July 1 through September 30.
Those elected after September 30 have no dues payable for
the balance of the year in which they are elected. AMA dues
follow the same pattern except prorating is on a semiannual
basis rather than monthly basis.
To begin the membership process, if your practice is or will
be located in Wisconsin, or you have any questions, you may
contact your local county society or call the Membership
and Communications Division of the State Medical Society,
if in Wisconsin: 1-800-362-9080 (Madison area number:
257-6781).B
Economy
1985 The Up)Ohn Company
The Upjohn Company
Kalamazoo, Michigan 49001 USA
J-5491 June 1985 '
Afteranttrate,
addlSOPTlN^
(verapamil HCl/Knoll)
To protect your patients, as well as their quality of life,
add Isoptin instead of a beta blocker.
First, Isoptin not only reduces myocardial oxygen demand
by reducing peripheral resistance, but also increases coro-
nary perfusion by preventing coronary vasospasm and
dilating coronary arteries — both normal and stenotic.
These are antianginal actions that no beta blocker
can provide.
Second, Isoptin spares patients the
beta-blocker side effects that may
compromise the quality of life.
With Isoptin, fatigue, bradycardia and mental
depression are rare. Unlike beta blockers,
Isoptin can safely be given to patients with
asthma, COPD, diabetes or peripheral
vascular disease. Serious adverse
reactions with Isoptin are rare
at recommended doses; the
single most common side
effect is constipation (6.3%).
Cardiovascular contra-
indications to the use of
Isoptin are similar to those
of beta blockers: severe
left ventricular dysfunction,
hypotension (systolic pres-
sure <90 mm Hg) or cardio-
genic shock, sick sinus syndrome
(if no artificial pacemaker is present)
and second- or third-degree AV block.
So, the next time a nitrate is not enough, add
Isoptin ... for more comprehensive antianginal
protection without side effects which may
cramp an active life style.
ISOPTIN. Added
antianginal protection
without bete-blocker
side effects.
Please see brief summary on following page
isopnif
(vetopamll HCI/KnolO
80 mg and 120 mg scored, film-coated tablets
Contraindications: Severe left ventricular dysfunction (see Warnings), hypo-
tension (systolic pressure < 90 mm Hg) or cardiogenic shock, sick sinus syn-
drome (except in patients with a functioning artificial ventricular pacemaker),
2nd- or 3rd-degree AV block Warnings: ISOPTIN should be avoided in patients
with severe left ventricular dysfunction (e g., ejection fraction < 30% or
moderate to severe symptoms of cardiac failure) and in patients with any
degree of ventricular dysfunction if they are receiving a beta blocker (See
Precautions.) Patients with milder ventricular dysfunction should, if possible, be
controlled with optimum doses of digitalis and/or diuretics before ISOPTIN is
used. (Note interactions with digoxin under Precautions.) ISOPTIN may occa-
sionally produce hypotension (usually asymptomatic, orthostatic, mild and con-
trolled by decrease In ISOPTIN dose). Elevations of transaminases with and
without concomitant elevations in alkaline phosphatase and bilirubin have been
reported. Such elevations may disappear even with continued treatment; how-
ever, four cases of hepatocellular injury by verapamil have been proven by re-
challenge. Periodic monitoring of liver function is prudent during verapamil
therapy. Patients with atrial flutter or fibrillation and an accessory AV pathway
(e g. W-P-W or L-G-L syndromes) may develop increased antegrade conduction
across the aberrant pathway bypassing the AV node, producing a very rapid
ventricular response after receiving ISOPTIN (or digitalis). Treatment is usually
D.C. -cardioversion, which has been used safely and effectively after ISOPTIN.
Because of verapamil's effect on AV conduction and the SA node, 1° AV block
and transient bradycardia may occur. High grade block, however, has been
infrequently observed. Marked 1° or progressive 2° or 3° AV block requires a
dosage reduction or, rarely, discontinuation and institution of appropriate
therapy depending upon the clinical situation. Patients with hypertrophic car-
diomyopathy (IHSS) received verapamil in doses up to 720 mg/day. It must be
appreciated that this group of patients had a serious disease with a high mor-
tality rate and that most were refractory or intolerant to propranolol. A variety
of serious adverse effects were seen in this group of patients including sinus
bradycardia, 2° AV block, sinus arrest, pulmonary edema and/or severe hypo-
tension. Most adverse effects responded well to dose reduction and only rarely
was verapamil discontinued Precautions: ISOPTIN should be given cautiously
to patients with Impaired hepatic function (in severe dysfunction use about
30% of the normal dose) or impaired renal function, and patients should be
monitored for abnormal prolongation of the PR interval or other signs of exces-
sive pharmacologic effects. Studies in a small number of patients suggest that
concomitant use of ISOPTIN and beta blockers may be beneficial in patients
with chronic stable angina. Combined therapy can also have adverse effects on
cardiac function. Therefore, until further studies are completed, ISOPTIN should
be used alone, if possible. If combined therapy is used, close surveillance of vital
signs and clinical status should be carried out. Combined therapy with ISOPTIN
and propranolol should usually be avoided in patients with AV conduction
abnormalities and/or depressed left ventricular function. Chronic ISOPTIN treat-
ment increases serum digoxin levels by 50% to 70% during the first week of
therapy, which can result in digitalis toxicity. The digoxin dose should be re-
duced when ISOPTIN is given, and the patients should be carefully monitored to
avoid over- or under-digitalization. ISOPTIN may have an additive effect on
lowering blood pressure in patients receiving oral antihypertensive agents.
Disopyramide should not be given within 48 hours before or 24 hours after
ISOPTIN administration. Until further data are obtained, combined ISOPTIN and
quinidine therapy in patients with hypertrophic cardiomyopathy should prob-
ably be avoided, since significant hypotension may result. Clinical experience
with the concomitant use of ISOPTIN and short- and long-acting nitrates sug-
gest beneficial interaction without undesirable drug interactions. Adequate ani-
mal carcinogenicity studies have not been performed. One study in rats did not
suggest a tumorigenic potential, and verapamil was not mutagenic in the Ames
test Pregnancy Category C: There are no adequate and well-controlled studies
in pregnant women. This drug should be used during pregnancy, labor and
delivery only if clearly needed. It is not known whether verapamil is excreted in
breast milk; therefore, nursing should be discontinued during ISOPTIN use.
Adverse Reactions: Hypotension (2.9%), peripheral edema (1 .7%), AV block:
3rd degree (0.8%), bradycardia: HR < 50/min (1.1%), CHF or pulmonary
edema (0.9%), dizziness (3.6%), headache (1.8%), fatigue (1.1%), constipa-
tion (6.3%), nausea (1.6%), elevations of liver enzymes have been reported.
(See Warnings.) The following reactions, reported in less than 0.5%, occurred
under circumstances where a causal relationship is not certain: ecchymosis,
bruising, gynecomastia, psychotic symptoms, confusion, paresthesia, insomnia,
somnolence, equilibrium disorder, blurred vision, syncope, muscle cramp, shaki-
ness, claudication, hair loss, macules, spotty menstruation. How Supplied:
ISOPTIN (verapamil HCI) is supplied in round, scored, film-coated tablets con-
taining either 80 mg or 120 mg of verapamil hydrochloride and embossed with
"ISOPTIN 80" or "ISOPTIN 120" on one side and with "KNOLL" on the reverse
side. Revised August, 1984 2385
KNOLL PHARMACEUTICAL COMPANY
knON 30 NORTH JEFFERSON ROAD, WHIPPANY, NEW JERSEY 07981
2406
EMPLOYEES
APPRECIATE
THERAYROU
SAVINGS PLAN.
JUST ASK
THE PEOPLE AT
E-SYSTEMS.
“Boncis are a good
liquid investment,
and if I don’t use
them, they continue
to earn interest.”
— L.A. Fulcher
“I put myself and
my children through
school with Savings
Bonds. They’re
great!”
—Ken Sclater, Jr.
“I save them, but
when I want some-
thing extra, I know
they’re there. They’re
great for emergencies.”
—Jose Acosta
U.S. Savings Bonds now offer
higher, variable interest rates and a
guaranteed return. Your employees
will appreciate that. TTrey’ll also
appreciate your giving them the
easiest, surest way to save.
For more information, write to:
Steven R. Mead, Executive Director,
U.S. Savings Bonds Division, Depart-
ment of the Treasury, Washington, DC
20226.
US. SAVINGS BONDS
Paying BetterThan Ever
A public service of this publication.
I ^
^ '■
'3^ I 1
^ '.i'i
- <
/ ^
/
r- } 1^
^ -
1
3 l\ 5
a f-j ^
^ ^
^ /
f'
t y
~ • ^
“ n
■-
f
/
•H
✓
i ■
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'I
^ «
p ^
Centralized
BiW
Systems
^ INCORPORATED
SEGMENTATION
Your solution to profitable patient and insurance
billing management.
Centralized Billing Systems can provide the
complete picture, or just the part that your
practice is missing . , . from efficient and
professional billing management systems to
complete PC sofKvare or hardware.
• Stand Alone (PC)
Systems & Software
• Statement Processing
• Insurance Processing
• On-Line Inquiry
• Patient Recall
• Appointment Scheduling
• Batch (mail-in) Systems
For further information or no-obligotion
consultation please coll
3636 North 124th St. 3916 67th Street
Milwaukee, Wl 53222 Kenosha, Wl 53142
(414) 535-0100 (414) 658-8603
PHYSICIANS:
TRY AIR FORCE
EXPERIENCE.
Experience Air Force Medicine. It can be just
what you’d like your rriedical practice to be.
More time to practice medicine. More time
with your family. Even more time for your
hobbies. It’s all part of Air Force EXPERIENCE.
Talk to a member of our medical placement
team today. Find out how you can experience
the perfect medical practice as an AIR FORCE
PHYSICIAN.
FOR INFORMATION CALL:
414-258-2430
Outside area call collect
On the leading edge of technology
SMS Services
OBSTETRICIAN
Inc.
GYNECOLOGIST
is pleased to announce
a
Highly regarded multispecialty group in
central Wisconsin is seeking a fifth physician
PERSONAL
to practice all aspects of Obstetrics and
FINANCiAL
Gynecology. A modern 300-bed medical
center is adjacent to the practice and features
PLANNING
state-of-the-art equipment, including a
birthing center. Located in a scenic river
valley, the area is known for its varied
SEMINAR
recreational activities and excellent school
will be held on
system. For more information regarding this
and other exceptional practice opportunities,
please contact: MD Resources, Inc, Office
October 3
In The Park, 7385 Galloway Rd, Suite 200,
Miami, Florida 33173; ph 800/327-1585;
Fla only: 305/271-9213.
at the Marriott Inn
Brookfield
Watch for further details!
^ Acme
YOU CAN HELP
LatDoratories, Inc.
STOP BEDWETTING
Qualified, competent professionals are the
trademark of Acme Laboratories. For 35
For a large majority of
your Enuretic patients
• Ethical — prescription only
• Professional — you supervise
treatment
years, our certified orthotists and prosthetists
have earned a reputation for excellence,
helping people improve their lives.
Acme Laboratories .serves Wisconsin from
offices in Milwaukee, Green Bay. Fond du
Lac and Woodruff. We're pleased to be a
• Approximately 90 percent effective
designated HMO facility for southeastern
• Proven reliable and dependable
Wisconsin. Acme Laboratories accepts all
bell, pad, and light system
insurance, including Medicare and Medicaid.
• Low cost rental service — $14.00
per week (avg. 6-week treatment)
• Convenient mall order service
to the 48 states
10702 W. Burleigh St., Milwaukee, Wl 53222
414-259-1090
GREEN BAY ORTHOPEDIC
Division of Acme Laboratories, Inc.
For more information, call or write:
428 S. Adams St., Green Bay, Wl 54301
414-435-1461
525 E. Division St., Fond du Lac, Wl 54935
S. & L. SIGNAL COMPANY
414-923-6676
Affiliated with Northwoods Rehabilitation
Helping Enuretic Clients
Box LOA, Woodruff, Wl 54568
Since 1950
715-356-8000 Ext. 8872 |Lil
1142 Fleetwood Ave. Madison, Wl 53716
Phone: 608-222-7939
Acme Laboratories — where quality of Slyilj
Accepted for advertising in the AMA Journal
VxVx life IS our mam concern
44
WISCONSIN MEDICAL JOURNAL, AUGUST 1985: VOL. 84
MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
Family Practitioner. Marshfield Clinic
Department of Family Medicine is seek-
ing a BE/BC Family Practitioner for a
new position. The physician joining the
Clinic's expanding 5- member department
will enjoy the support of one of the na-
tion's largest multispecialty groups, share
the philosophy of family-oriented care
with a preventive focus, and enjoy full
hospital privileges but without the dis-
tractions of OB or surgical responsibili-
ties. Marshfield Clinic offers an excellent
salary plus extensive fringe benefits.
Please send curriculum vitae and the
names of several references to: E Grady
Mills, MD, Family Medicine Department
Chairman, Marshfield Clinic, Marshfield,
WI 54449 or call collect at 715/387-
5168. p6-8/85
Cardiology position desired in the
metropolitan Milwaukee area. University
trained in both invasive and noninvasive
cardiology. Heavy emphasis throughout
training in all aspects of critical care.
Board certified in internal medicine. Will
complete fellowship and be available in
August or September of 1986. Interested
parties should contact Dept 560 in care of
the Journal. 8-10/85
Internist-Infectious Disease Phy-
sician. The Racine Medical Clinic, a pro-
gressive cluster corporation of 32 phy-
sicians, is currently seeking an Internist-
Infectious Disease physician. Full bene-
fits, unlimited earnings and a full and
exciting practice are offered. Please con-
tact: Roger D Lacock, Administrator,
Racine Medical Clinic, 5625 Washington
Ave, Racine, WI 53406; ph 414/886-
5000. 6tfn/85
Family Practice physician MD or DO
Board eligible or certified. Contact Leon
Gilman, 4957 West Fond du Lac Ave,
Milwaukee, WI 53216 or call 414/871-
7900. 6-8/85
RATES: 50c per word, with a minimum
charge of $20.00 per ad. BOXED AD
RATES: $25.00 per column inch.
DEADLINE: Copy must be received by the
15th of the month preceding month of issue;
e.g., copy for the August issue is due July 15.
Send copy to: Wisconsin Medical Journal,
Box 1109, Madison, Wisconsin 53701: or
phone (area code 608) 257-6781; or toll-free
in Wisconsin: 800/362-9080.
Urgent care physician and internist.
Opportunities available as clinic services
expand. This 35-member multispecialty
group, including 13 internists, is housed
in a modern facility next to the 240-bed
Mercy Hospital and has a drawing area of
100,000. Send CV with inquiry; Ernest C
Deeds, MD, Box 551, Janesville, WI
53547. p8, 9/85
Wisconsin; Pediatrician with sub-
specialty interest to join multispecialty
clinic that includes general pediatricians,
pediatric hematologist, oncologist and
neonatologist in city of 150,000. Send
CV to Dept 561 in care of the Journal.
8tfn/85
Emergency physicians wanted. Part-
time positions available in a moderate
volume emergency room in Beloit, Wis.
Must have an active interest in com-
munity relations. ACLS required. ATLS
desirable. If interested, contact John
Maher, MD, Director, Emergency De-
partment, Beloit Memorial Hospital,
1969 W Hart Rd, Beloit, WI 53511.
8-9/85
Family practice physician, internist
and OB/GYN physicians needed to join
a multispecialty clinic in NE Wisconsin.
Excellent starting salary, full benefits,
partnership one year, HMO affiliated.
Contact Stephen C Caselton, MD, 2152
Riverside Ave, Marinette, Wis 54143;
ph 715/732-2211. p8-10/85
Family Practitioner. The Racine Medi-
cal Clinic, a progressive cluster corpor-
ation of 31-physicians is currently seek-
ing a family practitioner. Full benefits,
unlimited earnings, and a full and ex-
citing practice are offered. Please contact
Roger D Lacock, Administrator, Racine
Medical Clinic, 5625 Washington Ave,
Racine, WI 53406; ph 414/886-5000.
4tfn/85
Immediate opportunities for qualified
physicians who possess excellent clinical
and communication skills to join long-
standing group of Emergency Physicians.
Positions available in a popular Wiscon-
sin area bordering Illinois. If interested,
send resume to Barbara Wilczynski,
Medical Emergency, Service Associates
(MESA), SC, 15 S McHenry Road, Suite 2,
Buffalo Grove, IL 60090 or call collect
312/459-7304. 6tfn/83
Family Practitioner needed to join
established Family Practice group in East
Central Wisconsin city of 50,000 on
beautiful Lake Winnebago. Competitive
salary, fringes, excellent recreation area.
Send CV to MS Knier, MD, 555 S Wash-
burn, Oshkosh, Wis 54901; 414/426-0265.
lOtfn/ 84
Wanted— Board qualified— board cer-
tified obstetrician-gynecologist as an
associate. Modern well equipped facility.
Excellent starting salary and benefits in-
cluding profit sharing plan. Please contact
Elizabeth Allen Steffen, MD, 734 Lake
Ave, Racine, Wis 54303. 9tfn/83
Second Family Practitioner needed to
staff a satellite of a 38-physician multi-
specialty group in Kiel, a beautiful small
community in East Central Wisconsin. At-
tractive income arrangements, association
membership possible after one year, pen-
sion and profit sharing, extensive fringe
benefits. Contact R B Windsor, MD, 1011
North 8 St, Sheboygan, WI 53081; ph 414/
457-4461. c2tfn/85
Internist with or without subspecialty
interest. Board Certified or eligible, to
join six other internists in a well-estab-
lished, 23-man expanding multispecialty
group in prosperous lakeside south-
eastern Wisconsin city of 36,000. The
Internal Medicine Department currently
has subspecialties in cardiology, pul-
monary medicine, and medical on-
cology. Liberal fringe benefits. Initial
salary plus percentage as associate.
Full status in service corporation, with
incentive-oriented formula after first
year. Contact J F Kuglitsch, MD, Fond du
Lac Clinic, SC, 80 Sheboygan St, Fond
du Lac, Wis 54935; ph 414/923-7420
collect. 5tfn/85
Family Practice opportunity to join a
four-physician family practice group in
south central Wisconsin city of 15,000.
Pleasant community atmosphere within
1-1 1/2 hours of Madison and Milwaukee.
Excellent recreational area. First year
guaranteed salary. Contact: Chad
IBurchardt, Business Manager, Medical
Associates of Beaver Dam, Wis 53916; ph
414/887-7101. 5tfn/85
Family Practice Physician to share fully
equipped medical office in central Wis-
consin city. Opportunity for partnership
and eventual purchase of practice. Excel-
lent recreational, educational, hospital,
and civic advantages. Send curriculum
vitae to Dept 503 in care of the Journal.
6tfn/82
Internist or Family Practitioner to join
two Internists and General Surgeon in
growing, established. Green Bay area
practice. Send CV to John Brusky, MD,
1203 South Military Ave, Green Bay, WI
53404. 7tfn/84
Physicians needed full or part-time to
perform light physicals. Milwaukee area.
Professional liability provided. Phone
414/344-2100, Ms Jenkins. lOtfn/84
WISCONSIN MEDICAL JOURNAL, AUGUST 1985:VOL.84
45
MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
continued
West Bend, Wisconsin, General Clin-
ic, a (18) physician multispecialty group,
is seeking physicians in the specialties of
Internal Medicine, Family Practice, OB/
GYN, and Pediatrics. First-year salary
guaranteed. Corporate membership pos-
sible after one year. Excellent fringe
benefits. Located in scenic, recreational
area with close proximity to Milwaukee.
Please contact Hans W Schmelzling, Ad-
ministrator, General Clinic, 279 S 17th
Ave, West Bend, WI 53095; ph 414/338-
1123. 6tfn/85
Versatile Surgeon wanted to comple-
ment aggressive family practice group in
rural northeastern Minnesota resort com-
munity. Well-equipped 40-bed hospital
with proven surgical practice volume.
Outstanding outdoor recreational op-
portunities with time off to enjoy it.
Reply with CV to E Johnson, Ely Medical
Center, Ltd, 224 East Chapman Street,
Ely, Mn 55731; ph 218/365-3151. 6tfn/85
Obstetrician/Gynecologist, Board eli-
gible/certified, for Green Bay metropoli-
tan area. Large multispecialty clinic with
excellent salary and benefits. Call or
write: W J Mommaerts, Administrator,
West Side Clinic, sc, 1551 Dousman St,
Green Bay, WI 53403; ph 414/494-
5611 p6-9/85
MESA is on the MOVE
in
Northern Illinois, Wisconsin
and the Chicagoland Area
We are seeking Board Certified/
eligible and Emergency Trained
Physicians to join our growing
organization.
• Compensation/Benefit Packages
are highly competitive with adminis-
trative and educational support
services.
• Management and Staff positions
for Emergency Departments and
Ambulatory Care Centers.
• Excellent communication skills
and the desire to excel in Emergency
Medicine is a necessity.
MESA Medical Emergency Service
Associates, SC over 20 years of
excellence in Emergency Medicine.
Contact: Ms Debbie Carsky, Director
of Recruitment, 312/459-7304 (collect)
or write to 15 South McHenry Road,
Buffalo Grove, IL 60090. 8/85
Attractive opportunity for a Board
certified/eligible family physician to es-
tablish a new community practice. The
family practitioner will be eligible for
full-hospital privileges at Beloit Memorial
Hospital, a medium-sized acute care
facility. This opportunity offers a guaran-
teed financial and start-up package. In-
quiries or CV should be directed to
Gregory K Britton, Administrative Direc-
tor, Beloit Memorial Hospital, 1969 West
Hart Road, Beloit, Wisconsin 53511; ph
608/364-5104. p6-8;g9/85
Excellent opportunity for a Board cer-
tified or eligible internist to practice
in conjunction with an 8-member Inter-
nal Medicine Department of a 26-mem-
ber multispecialty group. The group is
located in southeastern Wisconsin, in a
city of 100,000 between two major
metropolitan areas of greater than one
million. If interested, please send CV to:
Stephen L Wagner, Kurten Medical
Group, 2405 Northwestern Ave, Racine,
WI 53404. All inquiries will be kept
confidential. 6tfn/85
Family Practice. Third Family Practice
physician needed to join multispecialty
group of 17 in Hartford, WI. Two branch
locations. All facilities modern and well
equipped. Guaranteed first year negoti-
able salary: usual fringe benefits. Con-
tact; Murlin Bernd, Clinic Manager,
1004 E Sumner St, Hartford, WI 53027;
ph 414/673-5745 p7-8/85
Family Practitioner needed to join two
FPs at the Ellsworth, Wisconsin office
of a progressive eleven-physician group.
Liberal fringes and financial package.
Forty miles from metropolitan Min-
neapolis/St Paul. Contact R M Hammer,
MD, River Falls, WI 54022; ph 715/425-
6701 or 612/436-8809. 4tfn/85
FAMILY PRACTITIONERS
INTERNISTS, OB /GYN
The UW Office of Rural Health is seek-
ing primary care specialists for more
than 50 communities throughout Wis-
consin. Opportunities are available
throughout Wisconsin for Board certi-
fied physicians trained in US medical
schools and residencies.
CONTACT:
Laurie Glowac or Fred Moskol
New Physicians for Wisconsin
University of Wisconsin
Department of Family Medicine
777 S Mills St, Madison, WI 53715
Phone 608/263-4095 7/85-6/86
OB/GYN, and internist to join seven-
doctor family practice clinic in Cloquet,
Minnesota, a community of 14,000 (30,
000) service area, located 20 minutes
from Duluth-Superior. Clinic facility is
located one block from modern, well-
equipped, 77-bed hospital. Cloquet
enjoys a stable economy (forest
products). Additionally our community
is noted for its excellent school system.
First-year salary guarantee; paid mal-
practice, health, and disability insur-
ance; vacation and study time. Con-
tact John Turonie, Administrator,
Raiter Clinic Ltd, 417 Skyline Blvd, Clo-
quet, Minnesota 55720. Telephone
218/879-1271. 7-9/85
Full-time physician wanted for es-
tablished Urgent Care center affiliated
with regional hospital. Board eligibility
or certification in primary specialty re-
quired. Competitive salary. 45-hours per
week. Benefit package. Paid malpractice.
Incentives, medium-sized city. Family-
oriented progressive community. Quality
school system, cultural advantages. Uni-
versity, abundant outside recreational op-
portunities. Send CV to Dept 558 in care
of the Journal. p6-8/85
Board Eligible Orthopedic Surgeon to
join established orthopedic practice in
East Central Wisconsin. Contact Dept 553
in care of the Journal. 2tfn/85
Otolaryngologist. BC/BE to join busy
ENT Department within 23-member
multispecialty group. Excellent benefits
and competitive salary. Call or write; W J
Mommaerts, Administrator, West Side
Clinic, sc, 1551 Dousman St, Green
Bay, WI 53403; ph 414/494-5611.
6-9/85
Physicians
• Board certified /eligible in family
practice.
• Clinic practice in Milwaukee
area.
• Family and occupational
medicine.
• Attractive salary and benefits.
Send CV to: Dept 562 in care of
the Journal.
Milwaukee Industrial Clinic
500 N 19th Street
Milwaukee, Wisconsin 53233
Attn; Carole Wheeler 8-9 / 85
46
WISCONSIN MEDICAL JOURNAL, AUGUST 1985; VOL. 84
MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
continued
Internist to join satellite of multi-
specialty clinic in Madison, Wisconsin.
Satellite is located ten miles from Mad-
ison and has one internist already prac-
ticing. Support from all departments anti-
cipated from multispecialty clinic. Fringe
benefits and salary attractive plus ex-
cellent working conditions, environment
and associates. New satellite is growing
and additional physician is needed to give
our patients quality care. Send resume to
Dept 556 in care of the Journal. p6-8/85
Wanted Board Certified Otolaryngol-
ogist. Head and neck surgeon. Join active
one-man practice. General otolaryngol-
ogy, head and neck surgery, facial plastic
surgery, nasal allergy. Computerized of-
fice with x-ray, audiologist, and hearing
aid dispensing. Northern Wisconsin near
Apostle Islands National Lakeshore. Con-
tact James A Hamp, MD, ENT Profes-
sional Associates, SC, 2101 Beaser Ave,
Suite 1, Ashland, WI 54806; ph 715/682-
9311. 4-9/85
Internist. BC/BE to join Internal Medi-
cine Department of multispecialty group.
Excellent benefits and competitive salary.
Call or write: W J Mommaerts, Admini-
strator, West Side Clinic, sc, 1551 Dous-
man St. Green Bay, WI 53403;
ph 414/494-5611 p6-9/85
Wisconsin-BC/BE Pediatrician to
assume an established position of a
pediatrician leaving. Join a three-man
pediatric department. Call or write:
David L Lawrence, MD, 92 E Division
St, Fond du Lac, WI 54935; ph 414/
921-0560. p3-8/85
MEDICAL FACILITIES
Beaver Dam, Wisconsin. New medical
office 1250 or 2500 sq ft office space
available. Excellent opportunity for Der-
matology or Allergy practice. Call 414/
887-8887 or write PO Box 678, Beaver
Dam, WI 53916. 5-8/85
For Sale: Coulter Cell Counter Hemo-
W 2 parameter (WBC-Hgb). Two and
one-half years old. Has been cared for
under service maintenance agreement.
Asking $1900— sells new for $5000. Call
Family Practice Associates of Green Bay,
Ltd, 414/433-3798. p8/85
MISCELLANEOUS
Physicians Signature Loans to
$50,000. Up to 7 years to repay. Competi-
tive fixed rate, with no points, fees, or
charges of any kind. No prepayment
penalties. Prompt, courteous service.
Physicians Service Assn, Atlanta, GA.
Toll-Free (800) 241-6905. lOeom/83
MEDICAL MEETINGS-
CONTINUING MEDICAL
EDUCATION
WISCONSIN
SEPTEMBER 6-8, 1985: Wisconsin
Society of Anesthesiologists, American
Club, Kohler. g5-8/85
SEPTEMBER 12-14, 1985: Wisconsin
Society of Internal Medicine/American
College of Physicians Annual Meeting—
30th Anniversary, the Pioneer Inn, Osh-
kosh. Info: Wisconsin Society of
Internal Medicine, 611 E Wells St, Mil-
waukee, Wis 53202; ph 414/276-6445.
Contact: Sandra M Koehler, Executive
Director. 5-8/85
SEPTEMBER 13-14, 1985: Wisconsin
Neurosurgical Society, Sheraton, Racine.
g5-8/85
Wisconsin Specialty
Society Meetings
• Wisconsin Society of Anesthesiolo-
gists, Sept 6-8, 1985, American
Club, Kohler
• Wisconsin Society of Physical Medi-
cine & Rehabilitation, Sept 11, 1985,
Sheraton Inn, Milwaukee
• Wisconsin Society of Internal Medi-
cine/American College of Physi-
cians Annual Meeting, Sept 12-14,
1985, Pioneer Inn, Oshkosh
• Wisconsin Surgical Society, Sept
13-14, 1985, Paper Valley Hotel &
Conference Center, Appleton
• Wisconsin Neurological Society,
Sept 27-28, 1985, Paper Valley Hotel
& Conference Center, Appleton
• Wisconsin Society of Otolaryngology
—Head and Neck Surgery, Sept 20-
22, 1985, Apple Valley Motel, Apple-
ton
• Wisconsin Dermatological Society,
Oct 26, 1985, Froederdt Memorial
Lutheran Hospital, Milwaukee
• Wisconsin Orthopaedic Society,
Nov 1, 1985, The Olympia Resort,
Oconomowoc
SEPTEMBER 13-14, 1985: Wisconsin
Surgical Society, Paper Valley Hotel &
Conference Center, Appleton. g2-8/85
SEPTEMBER 20-22, 1985: Wisconsin
Society of Otolaryngology— Head and
Neck Surgery, Paper Valley Motel, Apple-
ton. g6-9/85
SEPTEMBER 27-28, 1985: Wisconsin
Neurological Society, Paper Valley
Hotel & Conference Center, Appleton.
g5-8/85
OCTOBER 4-5, 1985: Wisconsin Asso-
ciation Parenteral Enteral Nutrition Third
Annual Symposium: The State-of-the-Art in
Nutritional Support 1985. Marriott Hotel,
Brookfield, WI. Outstanding guest
speaker panel. Joni Newborn 414-289-
8306 or Patricia Brosier 608-364 -5011.
p8/85
OCTOBER 10-11, 1985: Fall Sympo-
sium of Wisconsin Chapter: American
College of Emergency physicians &
Emergency Department Nurses As-
sociation. The Abbey, Fontana.
g7-9/85
OCTOBER 10-11, 1985: Update in Al-
lergy and Clinical Immunology II. The Inn-
Tower Hotel, Madison. Sponsored by De-
partment of Continuing Medical Educa-
tion and Department of Medicine, School
of Medicine, University of Wisconsin-
Madison. AM A Category I, University of
THIS LISTING is compiled by the State
Medical Society of Wisconsin in coopera-
tion with others who wish to maintain a
centralized schedule of meetings and
courses of interest to Wisconsin physicians
and to avoid scheduhng programs in conflict
with others. Hospitals, Clinics, Specialty
Societies, and Medical Schools are par-
ticularly invited to utilize this listing service.
There is a nominal charge for listing of Con-
tinuing Medical Education courses at the
following rates: 50c per word, with a mini-
mum charge of $20.00 per listing.
BOXED LISTINGS: $25.00 per column
inch. Listings of other scientific meetings
will be included at the discretion of the
editors.
COPY DEADLINE tor listings is 15th of the
month preceding the month of publication:
e.g., copy for the August issue is due by July
15. Address communications to: Wisconsin
Medical Journal, Box 1109, Madison, Wis-
consin 53701; or phone (area code 608)
257-6781; or toll-free in Wisconsin: 800/
362-9080.
FOR LISTING of other meetings see the
January 4, 1985 issue of the Journal of the
American Medical Association: Continuing
Education Opportunities for Physicians for
period January 1985 through December
1985.
WISCONSIN MEDICAL JOURNAL, AUGUST 1985:VOL.84
47
MEDICAL YELLOW PAGES
MEDICAL MEETINGS-
CONTINUING MEDICAL
EDUCATION
continued
Wisconsin CEUs. Family Practice credit
has been applied for. Approximately 1 1
hours. Info: Ann Bailey, Continuing
Medical Education, 454 WARE Bldg, 610
Walnut St, Madison, WI 53705; ph 608/
263-2854. 7-9/85
OCTOBER 17-18, 1985: Frontiers of
Nutrition and Cancer, Holiday Inn, South-
east, Madison. Sponsored by University
of Wisconsin-Madison, Department of
Continuing Medical Education, Wiscon-
sin Council, Department of Nutritional
Sciences, University of Wisconsin-Madi-
son; Clinical Nutrition Center; Medical
College of Wisconsin, Milwaukee; Ameri-
can Cancer Society, Wisconsin Division;
and Wisconsin Dietetic Association. AMA
Category I, University of Wisconsin
CEUs, AAFP Prescribed, AOA Category
2D, and ADA— all 11 hours. Contact:
Sarah Aslakson, Continuing Medical
State Medical Society
of Wisconsin
Dates and locations of
ANNUAL MEETINGS
1986-1992
All meetings will be held in Milwau-
kee at the Milwaukee Exposition and
Convention Center and Arena
(MECCA) and the new Hyatt Regency
as the headquarters hotel with the ex-
ception of 1985, when the meeting will
be held at the La Crosse Convention
Center.
1986- April 17-19
1987- March 26-28
1988- April 28-30
1989- April 13-15
1990- April 26-28
1991- April 18-20
1992- April 23-25
Meeting days will be Thursday and
Friday; the first session of the House
of Delegates will convene on Thurs-
day, the second and third on Friday.
Scientific programming will be on Fri-
day and Saturday.
Further information: Commission on
Continuing Medical Education, State
Medical Society of Wisconsin, Box
1109, Madison, Wis 53701. Local tele-
phone: 257-6781; toll-free in Wiscon-
sin: 1-800/362-9080.
Education, Room 465B WARE, 610
Walnut St, Madison, WI 53705; ph 608/
263-2856. 8/85
OCTOBER 26, 1985: Wisconsin Derma-
tological Society, Froederdt Memorial
Lutheran Hospital, Milwaukee. g6-9/85
OCTOBER 31 NOVEMBER 1, 1985:
Critical Care Conference. Inn on the Park
Hotel, Madison. Sponsored by University
of Wisconsin, School of Medicine, De-
partment of Medicine and Continuing
Medical Education; and University of
Wisconsin Hospital Trauma and Life
Support Center. AMA Category I and
University of Wisconsin CEUs— both ap-
proximately 12 hours. Contact: Sarah
Aslakson, Continuing Medical Educa-
tion, 610 Walnut St, Room 465B, Madi-
son, WI 53705; ph 608 / 263-2856. 8 / 85
JANUARY 25-FEBRUARY 1, 1986:
Sports Medicine Cruise Seminar, SS Consti-
tution, Hawaiian Islands. Sponsored by
University of Wisconsin School of Medi-
cine, Continuing Medical Education.
This space available
BOXED: $37.50
(11/2 column inches)
SECOND ANNUAL CITIZENS'
CONFERENCE ON ALCOHOL
AND DRUG RELATED PROB
LEMS: BRIDGING RELATION-
SHIPS
September 26, 1985 / Mead Inn
Wisconsin Rapids
Keynote Speaker: John K Maciver,
Attorney, Milwaukee
Workshop topics:
• AODA and the Criminal Justice
System
• Community Organization and
Advocacy
• Drug Abuse Treatment Trends
• Legislation
• Fetal Alcohol Syndrome
• Intoxicated Driver Program
• Innovative Prevention Hnter-
vention Approaches
• AODA and Health
Info: Arlene Meyer, State Medical
Society; 1-800/362-9080 or 608/
257-6781. g7-8/85
AMA Category 1 credit 16 hours. Family
Practice credit pending, and 16 hours
University of Wisconsin CEUs. Contact:
Ann Bailey, Department of Continuing
Medical Education, 454 WARF Bldg, 610
Walnut St, Madison WI 53705; ph 608/
263-2854. 7-9/85
OTHERS
SEPTEMBER 9-20, 1985 (Minnesota):
Third Annual Graduate Occupational
Health and Safety Institute, Earle Brown
Continuing Education Center, St Paul,
MN. Info: Bonnie Young, CME, St Paul-
Ramsey Medical Center, 640 Jackson St,
St Paul, MN 55101; ph 612/221-3977.
g6-8/85
SEPTEMBER 17-18, 1985: Hospital
Privileges and Specialty Medicine, a joint
conference of the American Board of
Medical Specialties and the American
Hospital Association, at the Marriott
Hotel O'Hare, Chicago, Illinois.
g8/85
SEPTEMBER 19 21, 1985 (Minne
sola): Pulmonary and TB Update, Radisson
Plaza Hotel, St Paul. Info: Bonnie Young,
CME, St Paul-Ramsey Medical Center,
640 Jackson St, St Paul, MN 55101; ph
612/221-3977. g6-8/85
OCTOBER 17-18, 1985 (Minnesota):
Toxic Chemicals in the Workplace: Health,
Legal, and Regulatory Issues, Earle Brown
Continuing Education Center, St Paul.
Info: Bonnie Young, CME, St Paul-
Ramsey Medical Center, 640 Jackson St,
St Paul, MN 55101; ph 612/221-3977.
g6-9/85
OCTOBER 25, 1985 (Minnesota): Pro-
moting Healthy Lifestyles For Pregnant
Women, Earle Brown Continuing Educa-
tion Center, St Paul. Info: Bonnie Young,
CME, St Paul-Ramsey Medical Center,
640 Jackson St, St Paul, MN 55101; ph
612/221-3977, g6-9/85
OCTOBER 31-NOVEMBER 1, 1985
(Minnesota): Latest Trends in Patient
Management: Radiology and Urology,
Radisson Plaza Hotel, St Paul. Info: Bonnie
Young, CME, St Paul-Ramsey Medical
Center, 640 Jackson St, St Paul, MN
55101, g6-10/85
OCTOBER 30 NOVEMBER 2, 1985:
La Crosse Health and Sports Science Sym-
posium. Info: Philip K Wilson, Executive
Director, La Crosse Exercise Program, 221
Mitchell Hall/UWL, La Crosse, WI 54601;
ph 608/785-8686. g6-9/85
48
WISCONSIN MEDICAL JOURNAL, AUGUST 1985: VOL. 84
MEDICAL YELLOW PAGES
MEDICAL MEETINGS-
CONTINUING MEDICAL
EDUCATION
continued
NOVEMBER 1, 1985: Wisconsin Ortho-
paedic Society, The Olympia Resort,
Oconomowoc. g6-10/85
NOVEMBER 14-16, 1985 (Minnesota):
Clinical Strategies In Primary Care Medi-
cine, Radisson Plaza Hotel, St Paul. Info:
Bonnie Young, CME, St Paul-Ramsey
Medical Center, 640 Jackson St, St Paul,
MN 55101: ph 612/221-3977. g6-10/85
DECEMBER 5-7, 1985 (Minnesota):
Coronary Heart Disease: A Comprehensive
Review of Principles and Practice, Sheraton
Midway Hotel, St Paul, Info: Bonnie
Young, CME, St Paul-Ramsey Medical
Center, 640 Jackson St, St Paul, MN
55101: ph 612/221-3977. g6-ll/85
DECEMBER 7-11, 1985 (Florida): 12th
Annual Symposium "Ear, Nose and Throat
Diseases in Children: A 1985 Update,"
Palm Beach. Info: Sandra K Arjona, Dept
of Pediatric Otolaryngology, Children's
Hospital of Pittsburgh, 125 DeSoto St,
Pittsburgh, PA 15213: ph 412/647-5466.
6, 8/85
AMA
DECEMBER 8-11, 1985: Interim AMA
House of Delegates, Washington, DC.
JUNE 15-19, 1986: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 7-10, 1986: Interim AMA
House of Delegates, Las Vegas, NV.
JUNE 21-25, 1987: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 6-9, 1987: Interim AMA
House of Delegates, Atlanta, GA.
JUNE 26-30, 1988: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 4-7, 1988: Interim House
of Delegates, Dallas, TX. ■
ADVERTISERS
Acme Laboratories 44
Advanced Technology Associates,
Inc 10
Medical Computer Systems
American Physicians Life 37
Centralized Billing Systems 43
Dista Products Co (Div of Eli
Lilly & Co) 9
Ceclor®
House of Bidwell 7
Knoll Pharmaceutical
Company 40, 41, 42
Isoptin®
Marion Laboratories 21, 22
Cardizem®
MD Resources, Inc 44
Medical Protective Company 8
Navy Medicine 36
PBBS Equipment 7
Peppino's 30
Physician and Sportsmedicine,
The 31
Professionals Insurance
Company, The 18
Roche Laboratories 51, BC
Dalmane®
SK&F Company 19
Dyazide®
S & L Signal Company 44
SMS Services, Inc 4
Upjohn Company, The 39
Motrin®
United States Air Force 43B
BOOKS RECEIVED
New books received are acknowledged
in this section. From these books, selec-
tions will be made for reviews in the in-
terest of the readers and as space permits.
Reviews are written by members of the
faculty of the University of Wisconsin
Medical School and by others who are par-
ticularly qualified. Most books here listed
will be available on loan from the Medical
Library Service, 1305 Linden Drive,
Madison, Wisconsin 53706: tel. 608/262-
6594.
Physician's Handbook, 21st edition.
Edited by Marcus A Krupp: Lawrence M
Tierney, Jr, Ernest Jawetz, PhD, Robert
L Roe: Carlos A Camargo, MD. Lange
Medical Publications, Drawer L, Los
Altos, CA 94022. 1985. Pages: 800. Price
$16.50.
Current Emergency Diagnosis &
Treatment. Edited by John Mills, MD,
Mary T Ho, MD, Patricia R Salber, MD
and Donald D Trunkey, MD. Lange
Medical Publications, Drawer L, Los
Altos, CA 94022. 1985. Pages: 864.
Price: $28.
Review of Medical Physiology.
Edited by William F Ganong, MD.
Lange Medical Publications, Drawer L,
Los Altos, CA 94022. 1985. Pages: 654.
Price: $22.50. ■
FORT CRAWFORD MEDICAL MUSEUM
PRAIRIE DU CHIEN, WISCONSIN
Open daily May 1 through October 31
10 a.m. to5 p.m.
Adults $2 Children $.50
Three building complex owned by the Charitable. Educational and Scientific
Foundation of the State Medical Society of Wisconsin.
WISCONSIN MEDICAL JOURNAL, AUGUST 1985:VOL.84
49
NEWS YOU CAN USE
SENATE RURAL HEALTH CAUCUS FORMED. Senators Quentin Burdick (D-ND) and Mark Andrews (R-ND)
in June announced the formation of the Rural Health Caucus, a bipartisan group of senators joining forces to
provide a united voice on rural health care issues in Congress. "The problems of insuring quality health care
to rural areas are growing ever more acute. A disproportionate number of America's elderly and poor citizens
live in rural areas, served by fewer and fewer doctors. These doctors often must contend with outdated facili-
ties, small staffs, and inadequate support facilities,” Senator Burdick said. "Our caucus is being formed to
make sure that rural America's special needs are heard as Congress establishes health care policy.
Senators Andrews and Burdick said that senators who represent rural states have joined the caucus, which
will serve as a forum for exchanging information on the unique problem of rural health care. "The health
problems of rural America are among the nation's most severe, yet the unique characteristics and special
needs of the 59 million people living in rural areas are often overlooked," Senator Andrews said.
The senators said that the special health care problems experienced by rural residents include: 1) high infant
mortality rates; 2) a high percentage of people suffering from debilitating chronic illnesses; 3) greater distances
to travel to reach medical facilities; 4) greater numbers of poor and elderly patients unable to afford insurance
and/or medical services; 5) low numbers of doctors, nurses, pharmacists, and other health care providers
per capita; 6) aging or inadequate hospitals, clinics, and nursing homes.
"As medical costs soar. Congress must find ways to contain health care and insurance costs," Senator Burdick
said. "The Rural Health Caucus will be the first line of defense against policies that don't meet the needs of
the people they are meant to serve. We intend to see that the needs of rural America are not overlooked."
"Clearly, rural America faces a myriad of health problems, many quite different from those in urban areas,"
Senator Andrews said. "Just as the Federal Government has an obligation to deal with the problems of urban
America, so does it have an obligation to help us in rural America. That obligation is not diminished just
because our rural voices are fewer and spread over greater distances."
— Health Lawyers News Report, July 1985B
HMO UPDATE. A recent 1984 survey by Lou Harris Associates found that one-half of all physicians now have
a favorable attitude towards HMOs, and the HMO patients have greater satisfaction with the quality of their
physicians than non-HMO members. These findings contrast with the results of similar studies which were
performed in 1980 and 1981, that determined that only 36 percent of physicians were favorably disposed to-
wards HMOs and that HMO patients were not as satisfied as fee-for-service patients with their care.
The survey also found that HMO membership is steadily increasing. The number of privately insured US
households with at least one member in an HMO rose from 6 percent in 1980 to 9 percent in 1984. Growing
numbers of physicians are also considering joining an HMO. In 1981, 27 percent of physicians who knew of but
did not practice in a prepayment plan in their area were thinking of affiliating with an HMO. By 1984, 46
percent of these physicians said they might join an HMO.
Employers and physicians now believe that HMOs can help control costs, according to the study. Fifty-nine
percent of senior executives (compared with 48 percent in 1980) reported favorable attitudes about HMOs
among senior management in the companies. Eighty-two percent of executives in companies offering HMOs
report a positive experience with HMOs, and 30 percent of these executives report that HMOs have led to
declining health care costs for the company.
Over two-thirds of the physicians surveyed said that HMOs are effective in controlling costs. HMOs were in
many instances responsible in forcing fee-for-service practitioners to reduce their fees in order to remain
competitive. The study found out that 12 percent of physicians (compared to 2 percent in 1981) had reduced
their fees and 14 percent said they had reduced hospitalization among their patients in order to compete with
an HMO in their area.
—Health Lawyers News Report, July 1985B
50
WISCONSIN MEDICAL JOURNAL, AUGUST 1985: VOL. 84
EXCERPTS FROM A SYMPOSIUM
"THE TREATMENT OF SLEEP DISORDERS"®
. highly effective
for both sleep induction and
sleep maintenance ff
Sleep Laboratory Investigator
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no rebound effect to agitate the
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ii
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Psychiatrist
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After 15 years, the experts still concur about the
continuing value of Dolmone (tlurozepom HCI/
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The recommended dose in elderly or debilitated
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DALMANE
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15-mg/30-mg
capsules
References: 1. KalesJ, etal: Clin Pharmacol Ther 12 691-
697, Jul-Aug 1971 2. Kales A, etal: Clin Pharmacol Ther
18 356-363, Sep 1975 3. Kales A, etal Clin Pharmacol
Ther /9 576-583, May 1976 4. Kales A, etal Clin Pharma-
col Ther 32 181-768, Dec 1982 5. Frost JD Jr, DeLucchi
MR: J Am Geriatr Sac 27 5ril-5A6, Dec 1979 6. Dement
WC, etal: BehavMed, pp 25-31, Oct 1978 7. Kales A,
Kales JD: J Clin Psychopharmacol 3:140-150, Apr 1983
8. Tennant FS, etal Symposium on the Treatment of Sleep
Disorders, Teleconference, Oct 16, 1984 9. Greenblatt DJ,
Allen MD, Shader Rl: Clin Pharmacol Ther 21 355-361,
Mar 1977
DALMANE S'
flurazepam HCI/Roche(w
Before prescribing, please consulf complete product infor-
mation, 0 summary of which follows:
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insomnia or poor sleeping habits, in acute or chronic medical
situations requiring restful sleep. Objective sleep laboratory
data have shown effectiveness for at least 28 consecutive
nights of administration. Since insomnia is often transient
and intermittent, prolonged administration is generally not
necessary or recommended Repeated therapy should only
be undertaken with appropriate patient evaluation.
Contraindications: Known hypersensitivity to flurazepam HCI,
pregnancy Benzodiazepines may cause fetal damage when
administered during pregnancy. Several studies suggest an
increased risk of congenital malformations associated with
benzodiazepine use during the first trimester Warn patients of
the potential risks to the fetus should the possibility of becom-
ing pregnant exist while receiving flurazepam Instruct patient
to discontinue drug prior to becoming pregnant Consider the
possibility of pregnancy prior to instituting therapy.
Warnings: Caution patients about possible combined effects
with alcohol and other CNS depressants An additive effect
may occur if alcohol Is consumed the day following use for
nighttime sedation This potential may exist for several days
following discontinuation Caution against hazardous occu-
pations requiring complete mental alertness (e g , operating
machinery driving). Potential impairment of performance of
such activities may occur the day tollowing ingestion. Not
recommended for use In persons under 15 years of age
Though physical ond psychological dependence have not
been reported on recommended doses, abrupt discontinua-
tion should be avoided with gradual tapering of dosage for
those patients on medication for o prolonged period of fime
Use caufion in administering to oddiction-prone individuals
or those who might increase dosage
Precautions: In elderly and debilitated patients, it Is recom-
mended that the dosage be limited to 15 mg to reduce risk of
oversedation, dizziness, confusion and/or ataxia Consider
potential additive effects with other hypnotics or CNS depres-
sants Employ usual precautions In severely depressed
patients, or in those with latent depression or suicidal tenden-
cies, or in those with impaired renal or hepatic function
Adverse Reactions: Dizziness, drowsiness, lighfheadedness,
staggering, ataxia and falling hove occurred, particularly in
elderly or debilitated patients Severe sedation, lethargy, dis-
orientation and coma, probably indicotive of drug intolerance
or overdosage, have been reported Also reported, headache,
heartburn, upset stomach, nausea, vomiting, diarrhea, con-
stipation, Gl pain, nervousness, talkativeness, apprehension,
irritability, weakness, palpitations, chest poms, body and joint
pains and GU complaints There have also been rare occur-
rences of leukopenia, granulocytopenia, sweating, flushes,
difficulty in focusing, blurred vision, burning eyes, faintness,
hypotension, shortness of breath, pruritus, skin rash, dry
mouth, bitter taste, excessive salivation, anorexia, euphoria,
depression, slurred speech, confusion, restlessness, halluci-
nations, and elevated SGOT, SGPT, total and direct bilirubins,
and alkaline phosphatase, and paradoxical reactions, e g ,
excitement, stimulation and hyperactivity
Dosage: Individualize for maximum beneficial effect Adults
30 mg usual dosage, 15 mg may suffice in some patients
Elderly or debilitated patients. 15 mg recommended initially
until response is determined.
Supplied: Capsules containing 15 mg or 30 mg flurazepam
HCI
Roche Products Inc
Manati, Puerto Rico 00701
*i FOR SLEEP
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Please see references and summary of producf informafion on reverse side
DALMANE
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sleep that satisfies
wiscoNSir^
MEDICAL JOURNAL
When the penalty
tax comes due
President Scott offers some inter-
esting corollaries relating to medi-
cine when he discusses Jeremy
Rifkin's book on entropy, a supreme
law of nature that governs every-
thing we do. (See page 5)
The urge
to reverse
Doctor Rengel responds to President
Scott's message on "The urge to
merge" by agreeing with him that
"there is great danger in this (HMOj
movement, ” and acknowledges that
physicians have "some responsi-
bility to try to reverse this process
even though it seems to be 'feuding
with windmills' at this point. " (See
page 12}
Hospitals, surgeons, and free-standing
surgical centers
Editorial Director Boulanger warns that free-standing surgical centers "could
well prove a haven for surgeons with questionable qualifications, and their
patients could be at risk. " He says it would be only fair that if "free-standing
surgical centers are going to be allowed to function as hospitals and skim off the
profitable cases, the least they should be required to do is provide services of the
same level of quality and safety as a hospital. " He offers some possible solutions.
(See page 9}
“ rrti»
OF PHVSICIANS
OCT 2 3 1985
WISCONSIN
MEDICAL JOURNAL
I
CONTENTS
1
September 1985
ISSN 0043-6542 /Established 1903
Owned and published by
State Medical Society of Wisconsin
Medical Editor
Victor S Falk AID. Edgerton
Editorial Board
Victor S Falk AID. Edgerton Chairman
Alelvin F Huth AID, Baraboo
AJ C F Lindert AID. Milwaukee
Andrew B Cruinmy Jr AID Madison
Richard D Sautter AID Marshfield
Dean AI Connors AID. Madison
George IV Kindschi AID. Monroe
Charles H Raine AID, Racine
Darrell L Witt AID. Wausau
Garrett A Cooper AID, Madison Emeritus
Editorial Director
Wayne J Boulanger AID. Milwaukee
Editorial Associates
R Buckland Thomas AID Monroe
Russell F Lewis AID. Marshfield
Raymond A AlcCormick AID. Green Bay
Victor S Falk AID Edgerton
Medical Editor
Staff
Earl R Thayer. Madison
Secretary -General Manager
State Medical Society of Wisconsin
H B Alaroney II. Madison
Assistant Secretary-Corporate Counsel
State Medical Society of Wisconsin
Airs Alary Angell, Madison
Managing Editor
Airs Alarjorie Stafford, Madison
Publications Assistant
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Journal, Box 1109, Madison, Wis 53701 Ph
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COPYRIGHT 1985
State .Medical Society of Wisconsin
SPECIAL FEATURES
President's Page
5 When the penalty tax
comes due
John K Scott, MD
Madison
Editorials
9 Hospitals, surgeons, and
free-standing surgical
centers
Wayne J Boulanger, MD
Milwaukee
Letters
12 The urge to reverse
Thomas N Rengel, MD
Wausau
Governor's chiropractic
veto action commended
John K Scott, MD, President
Earl R Thayer, Secretary
State Medical Society
of Wisconsin
Miscellaneous
34 Blue Book Update
46 AMA Physician's Recogni-
tion Award Recipients
Socioeconomics
39 Medicare participating
physician issue update
Brown CMS plan wins
acclaim
40 WISPAC: AMPAC leader
reports
William L Treacy, MD
Chairman, WISPAC
Board of Directors
News you can use
54 Malpractice conference
tapes available
JCAH publishes the
Hospice Project Report
SMS testifies on pituitary
gland removal legislation
Medicare participating
physician issue update
WISPAC needs your
support
SCIENTIFIC MEDICINE
15 Acute dissecting aneurysm
of the ascending thoracic
aorta causing obstruction
and embolism of right pul-
monary artery
Byung (RobertI H Kim, MD
Howard H Short, MD
Racine
18 Visceral larva migrans; a
case from the La Crosse
area
Frank Furlano, MD
William A Agger, MD
La Crosse
2 1 Anorectal giant condyloma
acuminatum
R Lee Kolts, MD
Bruce C Hubert, MD
Constance S Avecilla, MD
Marshfield
WISCONSIN MEDICAL JOURNAL (ISSN 0043-6542) is the official publication of the State Medical
Society of Wisconsin, devoted to the interests of the medical profession and health care in Wisconsin.
Its affairs are handled by the Editorial Board, subject to policy direction of the Society’s Board of
Directors. The Managing Editor is responsible for the production, business operation, and coor-
dination of contents as well as the final responsibility of the entire publication. The Editorial Director
IS responsible for Editorials. Unsigned Editorials express views consistent with the policies of the
State Medical Society of Wisconsin. Signed Editorials express personal views of the author for which
the Society takes no responsibility. Neither the Editors nor the State Medical Society will accept
responsibility for statements made or opinions expressed in the pages of the Journal. Indexed in
I "Index Medicus,” "Hospital Literature Index, " and "Cambridge Scientific Abstracts.”
STATE MEDICAL
SOCIETY
OF WISCONSIN
Vol. 84 No. 9
CONTENTS
24 Abstract: Microscopically
controlled surgical treat-
ment for squamous cell
carcinoma of the lower lip
Frederic E Mohs, MD
Stephen N Snow, MD
Madison
ORGANIZATIONAL
27 SMS Board encourages
negotiation in ER services
SMS Services, Inc Board
highlights
28 SMS Services, Inc endorses
WC program
SMS Leadership Conference
October 26 in Appleton
SMS to study health data
collection
Discount prices on type-
writers and copiers
30 "Your doctor's new suit
could cost you a barrel"
Financial Planning Seminar
set
SMS helps sponsor sexual
abuse workshop
32 Nominations sought for
SMS offices
CES Foundation Annual
Board meeting held
33 Obituaries
Harold Wagner, MD,
Kenosha
Raymond G Yost, MD,
Manitowoc
Lawrence G Patterson, MD,
Sun Lakes, Arizona
(Waupaca)
Adolph M Hutter Sr, MD,
Madison (Fond du Lac)
Richard B Smith, MD,
Brookfield
Marion K Ledbetter, MD,
Tulsa, Oklahoma
(Madison)
Earl A Hatleberg, MD,
Chippewa Falls
34 CES Foundation: Con-
tributions during months
of June and July 1985
41 1985 Physicians Alliance
Districts and Field Con-
sultants
48 Membership facts
DEPARTMENTS
43 Physician briefs
49 Medical Yellow Pages
Physicians exchange
Medical Meetings/CME
AdvertisersB
Officers
President: John K Scott, MD, Madison
President-Elect: Charles W Landis,
MD, Milwaukee
Secretary-General Manager:
Earl R Thayer. Madison
Treasurer: John J Foley, MD
Menomonee Falls
Board of Directors
Chairman: Darold A Treffert, MD
Fond dll Lac
Vice Chairman: Roger L
von Heimburg, MD, Green Bay
First District
Jerome W Rons Jr, MD, Cudahy
Carl S Eisenberg, MD. Milwaukee
Thomas A Hofbauer, MD,
Menomonee Falls
Wayne H Konetzki, MD, Waukesha
Fredrick Wood Jr, MD, Kenosha
William L Treacy. MD, Milwaukee
Richard D Fritz, MD. Milwaukee
William J Listwan, MD. West Bend
Glenn H Franke, MD, Milwaukee
Lucille B GUcklich, MD, Milwaukee
Second District
J D Kabler, MD, Madison
Cyril M Hetsko, MD, Madison
James J Tydrich, MD, Richland Center
Alwin E Schultz, MD, Madison
Kenneth I Gold, MD, Beloit
Third District
Pauline M Jackson, MD, La Crosse
Fourth District
John J Kief, MD. Rhinelander
Jung K Park, MD, Wisconsin Rapids
W George Locher, MD, Wausau
Fifth District
Darold A Treffert. MD, Fond du Lac
Kenneth M Viste Jr. MD. Oshkosh
C William Freeby, MD, Appleton
Sixth District
Roger L von Heimburg, MD, Green Bay
Joseph C DiRaimondo. MD. Manitowoc
Seventh District
Marwood E Wegner, MD. St Croix Falls
Philip J Happe, MD. Eau Claire
Eighth District
Joseph M Jauquet, MD. Ashland
THE STATE MEDICAL SOCIETY OF WISCONSIN, created by the Territorial Legislature in 1841,
represents over 5700 member physicians in Wisconsin, comprising 55 county medical societies
and 27 medical specialty sections. The purpose of the Society is to "bring together the iihysicians
of the Slate of Wisconsin to aiivance the science and art of medicine and the better health of the
people of Wi.sconsin, and to secure the enactment and enforcement of just medical laws." The
major activities of the Society include continuing medical education, peer review, legislation,
community health education, scientific affairs, socioeconomics, health planning, services for
physicians, operation of a Charitable, Educational and Scientific Foundation, and publication of
the Wisconsin Medical Journal.
President: Doctor Scott
President-Elect: Doctor Landis
Past President: Timothy T Flaherty,
MD. Neenah
Speaker: Duane W Taebel, MD,
La Crosse
Vice Speaker: Vernon M Griffin. MD.
Mauston
A,
S^ing All Yd
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American Physicians Life's comprehensive and competi-
tively priced line of insurance products is now being
offered exclusively through SMS Services Inc., to State
Medical Society members.
APL is a majority-owned subsidiary of Physicians
Insurance Company of Ohio (PICO) and a sister com-
pany of The Professionals Insurance Company, the
carrier of the SMS-endorsed Professional Liability
Insurance Plan.
APL coverages available to you through SMS Services
Inc., and its authorized insurance representatives
include:
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PRESIDENT'S PAGE
V
When the penalty tax comes due
JVT ANY OF US WHEN in College and medical school ran across the word entropy.
Entropy is a supreme law of nature and governs everything we do. I found a book
recently, "Entropy: A New World View, " by Jeremy Rifkin. He offers some interesting
corollaries relating to medicine.
The entropy law is the second law of thermodynamics. The first law states that
all matter and energy in the universe is constant, that it cannot be created or
destroyed. Only its form can change but never its essence. The second law, the
Entropy Law, states that matter and energy can only be changed in one direction,
that is, from usable to unusable, or from available to unavailable, or from ordered
to disordered.
In essence the second law says that everything in the entire universe began with
structure and value and is irrevocably moving in the direction of random chaos and
waste. According to the entropy law, whenever semblance of order is created
anywhere on earth or in the universe, it is done at the expense of causing an even
greater disorder in the surrounding environment. Entropy, therefore, gives us some
insight into why our traditional world view is crumbling.
Applying the law of entropy to medicine, one realizes that centralization, increased
specialization, and more elaborate equipment all translate into a greater expenditure
of energy. As more energy has been expended in the medical field, the corresponding
disorders have escalated. Although we as doctors don't much talk about it, the sad
truth is that the medical profession is no more immune from the entropy law than
any other activity in society.
Rifkin talks of pollution and the environment. He contends that as the dissipated
waste created by our high flow-through nonrenewable energy sources continues to
build up all along society's energy flow line, causing a dramatic escalation in physical
disorders of all kinds, a point will be reached where the population will have no choice
but to shift back into a low flow-through renewable energy base or face disease and
death in epidemic proportions. His view merits our consideration.
In his book Rifkin offers many thought provoking concepts on entropy and its
impact on our lives and society, but he sometimes oversimplifies the role of entropy
in healthcare. He says, for example, that "most of us are now aware that what little
value (entropy decrease) we receive from having x-rays done is often more than
outweighed by the long-range harm of radiation exposure (entropy increase)." He
goes on with another illustration of his point by stating that medically prescribed drugs
produce adverse effects that "now rank among the top 10 causes of hospitalization"
and account for "as many as 50 million hospital patient days a year."
While I perceive such overdramatizations to be a disservice to the profession and
the public, Rifkin's writing should not divert us from serious analysis of the entropic
process in relation to healthcare.
I fully agree with Rifkin's perception that our successive stages of economic and
social change have greatly increased the physiological and emotional strains on the
human being. We surely see this vividly demonstrated in the current and rampant
changes in medical economics and their relationship to quality care for the American
people. We must force ourselves to look seriously at the consequent impact of those
changes on our personal outlook as the patient's advocate, on our individual and col-
lective consciences as physicians, and on our personal physical and emotional stability
in a profession under pressure.
Skeptics might grant that the entropy process is at work, but so slowly that the
ultimate crisis is remote beyond human comprehension. I suggest that we in health-
care cannot be so casual. We are ever conscious of the well known "tradeoffs" in
the use of drugs, x-ray, and other surgical or medical intervention as we seek to cure
or relieve. We must appreciate that, in the environmental and health areas where
we have special interest, the "penalty tax of entropy increase is beginning to come
due."B
John K Scott, AID
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Wayne J Boulanger, MD, Editorial Director
EDITORIALS
Unsigned editorials express views consistent with the policies of the State Medical Society of Wisconsin.
Signed editorials express personal views of the author for which the Society takes no responsibility.
Hospitals, surgeons, and
free-standing surgical centers
Last August, representatives of
the Wisconsin Hospital Associa-
tion and the Wisconsin Chapter of
the American College of Surgeons
met to discuss questions which
have arisen with regard to free-
standing surgical centers around
the state. They found that they
were in complete agreement on at
least one key issue.
They agreed that current Wis-
consin standards in the regulation
of hospitals versus those applied
to surgical centers would appear
to put hospitals at a disadvantage
in competing for patients.
Because of the type of patients
utilizing free-standing surgical
centers, the centers tend to be
cheaper to operate than hospitals.
Surgical center patients are
usually healthy young adults who
come and go within one work
shift. They require no 24-hour-
nursing coverage, no meal serv-
ice, and minimal laboratory back-
up.
That probably won't change,
and in itself brings about unfair
competition, but that's not the
main issue. The chief concern has
to do with quality of care and the
protection of the patient.
For instance, Wisconsin Admin-
istrative Code H24 and federal
Medicare regulations require hos-
pitals to perform peer review
through the auspices of their med-
ical staffs. Free-standing facilities
are unregulated in this regard. Nor
do surgical centers have contin-
uing medical education require-
ments for their medical and nurs-
ing staffs.
The whole matter of obtaining
credentials and receiving hospital
privileges has been spelled out
pretty clearly for physicians who
work in hospitals. That is not true
of free-standing surgical center
staffs who are selected at the dis-
cretion of the management.
In short, the surgical center
could well prove a haven for
surgeons with questionable quali-
fications and their patients could
be at risk.
It seems only fair that if free-
standing surgical centers are going
to be allowed to function as hos-
pitals and skim off the profitable
cases, the least they should be re-
quired to do is provide services of
the same level of quality and
safety as a hospital. Their patients
deserve no less.
A possible solution to the prob-
lem would seem to be:
1 . Institution of peer review in-
cluding tissue committees at free-
standing surgical centers.
2. Requiring a formal affiliation
with a hospital for continuing care
of postoperative complications.
3. Requiring free-standing sur-
gical centers to maintain medical
records departments.
4. Setting standards similar to
those of hospital staffs for granting
practice privileges, and insisting
that privileges be granted only to
physicians who have at least one
active hospital staff appointment.
Perhaps tighter regulation
would tend to slow the prolifera-
tion of free-standing surgical cen-
ters. That might do much to cut
the cost of medical care in the long
run, even though it might lessen
"competition."
— Wayne J Boulanger, MD, Milwaukee ■
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WISCONSIN MEOICAI. JOURNAL, SEPTEMBER 1985: VOL. 84
9
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LETTERS
The Editors would like to encourage physicians to contribute to the LEITERS section where they can ventilate their frustrations as well as opinions. This feature
is intended to be lively and spirited as well as informative and educational. 4s with other material which is submitted for publication, all letters will be subject
to the usual editing. Address correspondence to: The Editor, Wisconsin Medical Journal, Box 1109, Madison, Wis 53701.
The urge to reverse
To President Scott: In response
to your topical message "The urge
to merge," {Wisconsin Medical
Journal, July 1985, page 4) I am
curious as to why in the face of
what you know of human nature
and foresee for the medical com-
munity, you agreed, nevertheless,
to join an HMO.
I agree with Dr Arnold Reiman
that there is a great danger in this
movement.
We physicians continue to be-
lieve that we are immune to the
pressures of big business or any
other force when it comes to our
management of patients. This is
nonsense. We are human beings
like anyone else and the majority
of us will succumb to the
pressures no matter how high-
minded our initial intentions
might be or how eloquently we
can advocate that this not happen.
Expanded
WATS
telephone
service
SMS members should find it
easier to reach the State Medical
Society at its toll-free number:
1-800-362-9080. Due to a grow-
ing volume of calls on the ex-
isting WATS line and the in-
creasing frequency of busy
signals members are experienc-
ing when trying to use the line,
SMS has installed a second in-
coming WATS line. The niunber
remains the same.
Essentially, we are "lemmings
rushing to the sea" and it is most
disturbing to hear someone in
your position, who obviously sees
the problem well and knows so
much better, proceed in this direc-
tion anyway.
The patient's best hope for a
committed relationship with his
personal physician has been
severely compromised by this
trend. We are selling the bridge,
backing ourselves into a corner,
and our knowledge of history
should tell us that there is simply
no way that the majority of us are
going to be able to continue to
practice the kind of medicine that
our consciences tell us is best. We
have families, need for job secur-
ity, and peer pressure; and the
To Governor Anthony Earl;
On behalf of the State Medical
Society of Wisconsin, we would
like to express our sincere appre-
ciation for your veto of the chiro-
practic insurance mandate in the
1985-87 biennial budget. It
seems unnecessary to reiterate all
of the problems associated with
this type of mandate, since you
are clearly well aware of the
negative aspects of mandating
chiropractic insurance coverage.
You are to be congratulated not
only for your commitment to
good public policy, as evidenced
by your veto of this item and
your accompanying veto message
but also for your courage to wield
large structure of an HMO simply
is not going to accommodate the
personal conscience of the in-
dividual physician. He will be out
of a job if he bucks the system
eventually. He will be at the
mercy of the administration of
your HMO ultimately.
I'm happy to see that you are
aware of and concerned about this
urge to merge. Those of us who
feel as you do, I believe, have
some responsibility to try to
reverse this process even though
it seems to be "feuding with wind-
mills" at this point.
—Thomas N Rengel, MD
425 Pine Ridge Blvd, #205
Wausau, Wisconsin 54401
the veto pen in the face of in-
tense political pressure to leave
this item intact.
We have been in contact with
a number of legislators urging
them to vote to sustain this veto
and are quite confident that the
veto will be sustained. Again,
our thanks to you for your com-
mitment on this issue.
—John K Scott, MD
President
—Earl R Thayer
Secretary
State Medical Society of Wisconsin ■
Governor's chiropractic veto action commended
1986 ANNUAL MEETING: APRIL 17-19, MILWAUKEE
12
WISCONSIN MEDICAl. JOCKNAL, SEPTEMBER 1985;VOL. 84
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Victor S Falk, MD, Medical Editor
SCIENTIFIC MEDICINE
Acute dissecting aneurysm of the
ascending thoracic aorta causing
obstruction and embolism of right
pulmonary artery
Computerized tomography (CT), angiography,
and clinical diagnoses
Byung (Robertj H Kim, MD and Howard H Short, MD, Racine, Wisconsin
ABSTRACT: This is the first known
case of acute dissecting aneurysm of
the ascending thoracic aorta causing
obstruction and embolism of the right
pulmonary artery described by com-
puterized tomographic (CTj examina-
tion. Followup digital and conventional
angiography confirmed the CT findings.
If one suspects this syndrome, CT
study should be utilized as the initial
diagnostic method before invasive
angiography. Once the correct diag-
nosis is established, prompt surgical
treatment should be considered.
Antithrombolytic and anticoagulant
treatment should be avoided.
Key words: Ascending aorta: Dissecting
aneurysm: Rupture: Pulmonary artery:
Pulmonary embolus
^Compression of the pulmonary
artery by an aneurysm has been
discussed frequently;’^ however,
reported cases of compression of
the pulmonary artery by an acute
dissecting aneurysm are ex-
tremely rare.®
In the author's knowledge this
is the first published case diag-
From St Mary's Medical Center, Racine:
Radiology Dept (BHK|, Cardiology Dept
(HHS). Publication support provided.
Reprint requests to: B H Kim, MD, St
Mary's Medical Center, 3801 Spring St,
Racine, Wis 53405 (ph 414/636-4311).
Copyright 1985 by the State Medical
Society of Wisconsin.
nosed by computerized tomog-
raphic (CT) examination.
The purpose of this report is to
further the awareness of the syn-
drome and the possible utilization
of CT study as a noninvasive
modality for the initial diagnostic
method.
Antithrombolytic and anti-
coagulant agents are contra-
indicated and should be avoided
in the treatment of pulmonary
embolism caused by an acute
dissecting aneurysm of the thor-
acic aorta.
Case report. A 64-year-old male
was admitted on Dec 7, 1983
with an onset of epigastric and
lower midsternal chest pain. The
patient had been asymptomatic
until the day prior to admission
when he developed a short epi-
sode of acute epigastric and retro-
sternal pain associated with
shortness of breath. This pain
spontaneously abated only to
return the day of admission, pre-
cipitating the Emergency Room
visit. No diaphoresis was noted,
but marked shortness of breath
was reported. There was no
radiation of chest pain and no
other associated symptoms.
During the Emergency Room
visit, epigastric and chest discom-
fort persisted; however, the dis-
comfort became less intense and
the vital signs remained stable.
An admission electrocardiogram
showed inferior wall myocardial
infarction, age undetermined.
The patient had a history of
diverticulosis and Crohn's dis-
ease. Coronary artery disease had
been documented in 1975 when a
coronary angiogram demon-
strated multiple vessel disease.
Coronary artery surgery with
two-vessel bypass had been ac-
complished in 1975.
Physical examination revealed
a well-developed, well-nourished
white male in no acute distress
but with epigastric discomfort.
Vital signs were stable without
tachycardia or hypertension.
Examination of the head and
neck revealed no abnormalities.
No venous distention or absent
arterial pulsations were noted.
The chest was clear to ausculta-
tion and percussion. Cardiac ex-
amination was normal without
murmurs, rubs, or gallops. Peri-
pheral pulses were all normal.
Neurological examination
showed no abnormalities.
Laboratory studies on admis-
sion showed some routine blood
studies to be abnormal. A total
white blood cell count was 19,600
per cu mm but with normal dif-
ferential. The hematocrit read-
ing was 46.3% and the hemoglo-
bin level was 15.4 gm/dl. Ab-
normal blood chemistries on
admission included a blood sugar
of 187 mg/dl and creatinine of
1.6 mg/dl. No other abnormality
was noted on laboratory study.
On admission the chest radio-
graph revealed an area of infil-
tration in the right base which
was not seen on a radiograph
from 1980. No other abnormali-
ties were noted. A lung scan ob-
tained the day of admission dem-
onstrated diminution of perfusion
of the right lower lung field,
etiology undetermined. The CT
WISCONSIN MEDICAL JOURNAL, SEPTEMBER 198.5: VOL. 84
15
SCIENTIFIC MEDICINE
ACUTE DISSECTING ANEURYSM-Kim & Short
Figure I— Computerized tomographic (CTj scan of the level of
the left pulmonary artery. The left pulmonary artery (black
arrowhead! is patent dci}ionstrating good contrast opacifica-
tion. The dissecting aneuiysm (curved arrow! arising from
posterior wall of aortic root (white arrow! is clearly identified.
Figure 2—CT scan at level of the aortopulmonary window.
The superior vena cava (black arrowhead! is compressed along
its medial a)id anterior wall by the dissecting aneuiysm of
the ascending aorta. Hemorrhage (white arrow) into aortopul-
monaiy window is obvious.
Figure 3— Digital subtraction angiography with contrast in-
jection was made at right atrium. Complete obstruction at
origin of the right pulmonaiy arteiy (cuived arrows! is identi-
fied. The pulmonaiy trunk (white arrow! and left pulmonaiy
arteiy (black arrow! are patent.
Figure 4— Digital subtraction angiography with delayed image
subtraction. Contrast filled ascending aorta (black arrow! de-
lineates its position to relate pulmonaiy outflow track. A com-
pression at proximal pulmonaiy trunk (arrowhead! is evident.
scan of the chest (Figs 1 & 2) on
Dec 8, 1983 showed right lower
lobe infiltration with compres-
sion of the superior vena cava by
a mass extending from the poster-
ior supra-aortic portion, and oc-
cupying the subcarinal portion of
the mediastinum. Dissecting
aortic aneurysm of the ascending
aorta with hemorrhage into the
mediastinum was considered.
The difficulty encountered was to
differentiate the above from a
possible superimposing mediasti-
nal tumor. A digital subtraction
angiographic (DSA) study of the
chest (Figs 3 & 4) was accomp-
lished on Dec 10, 1983 showing
complete occlusion of the right
pulmonary artery at the proximal
segment. A repeat lung scan on
Dec 13, 1983 showed complete
absence of perfusion of the right
lung. Because of the admitting
electrocardiogram, the patient
was initially treated in the Emer-
gency Room with 500,000 intra-
venous units of streptokinase.
After reviewing the outpatient
electrocardiogram, it was felt that
further streptokinase therapy
was not indicated; however, in-
travenous heparin was continued
16
WISCONSIN MEDICAL JOURNAL, SEPTEMBER 1985: VOL. 84
ACUTE DISSECTING ANEURYSM-Kim & Short
SCIENTIFIC MEDICINE
Figure 5—CT scan at level of carina. Further hem-
orrhage posterior to aortic root (black arrowhead} and
puhnona)y trunk is recognized where pulmonary trunk
is compressed along its posterior wall (curved black
arrows} by the hematoma.
through the early portion of the
hospitalization. After demon-
strating complete occlusion of the
right pulmonary artery with the
impression of a massive pul-
monary embolus, the patient
underwent twelve hours of intra-
venous therapy with urokinase.
A repeated lung scan did not
demonstrate any improvement in
the right lung perfusion after
urokinase therapy. An abdominal
CT scan showed no abnormality
in the abdominal aorta except
arteriosclerotic calcification. A
repeat CT scan of the thorax (Fig
5) on Dec 16, 1983 showed mini-
mal change. The size of the dis-
secting aneurysm was unchanged
but CT suggested further hemor-
rhage into the mediastinal struc-
ture. Extensive thrombus of the
pulmonary artery and right lower
lobe infiltration was unchanged.
The patient was transferred to
a University Center for definitive
therapy. Examination at that time
showed elevated venous pres-
sure; however, vital signs re-
mained stable. Preoperatively a
supra-aortic angiogram was
accomplished, documenting a
dissecting aneurysm of the
ascending aorta with further
extravasation of contrast into
what appeared to be the main
body of the pulmonary artery.
The patient underwent a sur-
gical exploration on Dec 19,
1983. During surgery, the pul-
monary artery was discovered
to be completely obstructed with
a very large thrombus which was
removed from the right pul-
monary artery and the main
pulmonary artery. The aortic
wall dissection was repaired
with anastomosis of the left
anterior descending vein graft
to the aortic wall graft. It was
thought that the dissection had
leaked and formed a large false
aneurysm posterior to the main
pulmonary artery and above the
roof of the left atrium. There was
also an apparent fistula between
this false aneurysm and the pul-
monary artery. Because of poor
left ventricular function and a
bleeding diathesis, the patient did
not survive the immediate post-
operative period.
A postmortem examination
confirmed dissection of the
ascending aorta with extension
into the main pulmonary artery
and hemorrhage in the right lung
and mediastinum.
Discussion. Generally, a dissect-
ing aneurysm of the ascending
thoracic aorta results in a more
serious and progressive clinical
outcome than a saccular an-
eurysm.
A nondissecting aneurysm may
present clinical signs of chronic
cor pulmonale, pulmonary ar-
tery stenosis, and aortic insuf-
ficiency,'* but the aneurysm may
also present varied manifesta-
tions depending upon whether
the compressed structures are the
blood vessels, nerves, esophagus,
trachea, or cardiac chambers.*
Once either a dissecting or non-
dissecting aneurysm ruptures,
the clinical outcome is serious.
Rupture of the aneurysm into
various adjacent structures is
well documented.^ ® ®
A dissecting aneurysm may
form a pulmonary obstruction,
5,6 7,9 11 aj-, aortopulmonary fis-
tula, ^ and a superior vena cava
syndrome.'**
Prompt diagnosis and surgical
treatment are imperative in these
cases. CT examination is the
initial diagnostic procedure of
choice for differentiation from
mediastinal tumor, and for eval-
uation of the extent of hemor-
rhage or thrombus in pulmonary
vessels and mediastinal struc-
tures.
Angiography will confirm the
obstruction and degree of stenosis
of pulmonary vessels and su-
perior vena cava.
Initially our patient appeared
rather healthy, certainly not ex-
hibiting a serious condition. Be-
cause of the patient's known car-
diac disease and possible lung
and mediastinal tumor, prompt
surgical treatment was not ac-
complished. Others have ob-
served that differentiation be-
tween an aneurysm and a para-
mediastinal tumor may be dif-
ficult or impossible to make using
CT or arteriography'®"' because
of the possibility of a mediastinal
tumor coexistent with a dissect-
ing aneurysm.
The possibility of intravascular
coagulopathy was not confirmed
in our patient as it rarely oc-
WISCONSIN MEDICAI. JOURNAL, SEPTEMBER 1985: VOL. 84
17
SCIENTIFIC MEDICINE
ACUTE DISSECTING ANEURYSM-Kim & Short
Visceral larva migrans
A case from the La Crosse area
Frank Fwiano, MD and William A Agger, MD, La Crosse, Wisconsin
curs. *2 15 In retrospect, gradual
hemorrhage into the right pul-
monary artery and mediastinum
was further complicated by anti-
thrombolytic and anticoagulant
agents which should have been
contraindicated.
REFERENCES
1. Bevin AG, Rojas RH, Stansel HC: Aneu-
r^-sm of the ascending aorta causing ob-
struction of the left pulmonary artery.
J Thome Cardiovasc Surg 1966; 52:245-248.
2. Yacoub MH, Baiinbridge MV, Gold RG:
Aneurysm of the ascending aorta present-
ing with pulmonary stenosis. Thorax 1966:
21:236-239.
3. Greave K: Angiographic image of the large
aneurysm of the ascending aorta with uni-
lateral distribution of pulmonary circu-
lation (abstract). AJR 1958: 70:907.
4. Kulkarni TP, Gandhi Mj, Datey KK: The
syndrome of compression of the pulmonary
artery by an aneurysm. Am Heart J 1963:
65:678-682.
5. Zeit RM. Cope C, Lippman M: Compres-
sion of pulmonary artery by aortic aneu-
rysm.JAMA 1981:246:1586-1587.
6. Nasrallah A, Coussous Y, El said G, et al:
Pulmonary artery compression due to acute
dissecting aortic aneurysm: clinical and
angiographic diagnosis. Chest 1975; 76:228-
230.
7. Buja LM, Ali N, Fletcher RD, et al: Steno-
sis of the right pulmonary artery: a compli-
cation of acute dissecting aneurysm of the
ascending aorta. Am Heart J 1972: 83:89.
8. Perryman RA. Gay WA: Rupture of dissect-
ing thoracic aortic aneurysm into the right
ventricle. Am J Cardiol 1972; 30:272.
9. Lewin DW, Randel WH Jr, Ratneer F:
Acquired arteriovenous fistula between the
aorta and a pulmonary artery: report of a
case in which a rupture of a syphilitic
aortic aneurysm was responsible. Amt Int
Med 1953: 38:601.
10. Riley DJ, Liu RT, Sayanoff S: Aortic dis-
section: a rare cause of the superior vena
cava syndrome. J Med Soc NJ 1981: 78:
187-189.
11. Charnsangavaj C: Occlusion of the right
pulmonary artery by acute dissecting aortic
aneurysm. A/R 1979; 132:274-276.
12. Puxeddu A. Ribacchi R, Scionti L, et al:
Disseminated intravascular coagulation
in dissecting aortic aneurysm. Pan Med
1981: 23:39-42.
13. Bieger R, Vreeken J, et al: Arterial Aneu-
rysm as a cause of consumption coagulo-
pathy. N Engl J Med 1971: 285:152.
14. Cate J, Timmers H, Becker AE: Coagulo-
pathy in ruptured or dissecting aortic aneu-
rysm. Am J Med 1975: 59:171.
15. Fine NL, Applebaum J, et al: Multiple coag-
ulation defects in association with dissect-
ing aneurysm. Arch Intern Med 1967: 119:
522.
16. Komaiko MS, Lee ME, Birnberg FA: The
contrast enhanced paravascular neoplasm:
a potential CT pitfall. J Comput Assist
Tomogr 1980: 4:516-520.
17. Miller Jr GA, Heaston DK, Moore Jr AU,
et al: CT differentiation of thoracic aortic
aneurysm from pulmonary masses ad-
jacent to the mediastinum. J Comput Assist
Tomogr 1984 (June): 8:|3|437-442.B
ABSTR/\CT. Visceral laiva migrans
is a parasitic syndrome uncommonly
seen in the midwestern United States.
Ingestion of infective larva of the com-
mon dog roundworm, Toxocara canis,
is the usual cause. Histoiy of pica and
handling infected puppies should in-
crease the suspicion of the illness. The
hallmark of the illness is marked
eosinophilia: however, the clinical
presentation may be variable. The dis-
order is usually self-limited and benign
but can lead to serious systemic compli-
cations. A case of visceral larva
migrans seen from the La Crosse area
is presented, and the illness is dis-
cussed.
Key words: visceral larva migrans;
Toxocara canis; Eosinophilia: Ocular
toxocariasis: Tliiabendazole
ith the exception of pin-
worms, the population of Wis-
consin has a low prevalence of
parasitic worm infestations. This
is not the case, however, of Wis-
consin's domestic animal popu-
lation. Therefore, in cases involv-
ing animal exposures, the pos-
sibility of accidental infestations
with zoonotic worms should be
considered by Wisconsin phy-
sicians.
Recently, we have reported
two cases of cutaneous larva
migrans^ and we now report an
unusual case of a woman with
Publication support provided. The
authors also wish to acknowdedge the fi-
nancial assistance of the Gundersen
Medical Foundation, Ltd. Reprint re-
quests to: William A Agger, MD, 1836
South Ave, La Crosse, Wis 54601 (ph
608/782-7300). Copyright 1985 by the
State Medical Society of Wisconsin.
visceral larva migrans (VLM).
This illness is caused by the mi-
gration in the somatic tissues of
the body of the larval stage of
animal ascaroid nematodes,
usually Toxocara canis, the com-
mon dog roundworm.2'3
The term "visceral larva
migrans” was introduced by
Beaver and associates'^ in 1952.
They reported three cases of a
syndrome in children which in-
cluded marked eosinophilia,
hepatomegaly, and a history of
pica. The larval nematode of
Toxocara canis was identified in
a liver biopsy of one of their
patients. Since that time, more
than 1900 cases have been re-
ported throughout the world.
Prior to 1978, the diagnosis of
VLM had been made on history,
clinical symptoms, and non-
specific laboratory values. Defi-
nitive diagnosis, visualizing the
nematode larva in tissue, was in-
frequently made due to the diffi-
culties of obtaining tissues and
the low sensitivity of approxi-
mately 20% positive of percu-
taneous liver biopsies.^ For-
tunately, an enzyme-linked im-
munosorptive assay (Elisa) is
now available and has been
found to be 80% sensitive and
92% specific for antitoxocara
antibody.^ The following is a case
report of a dog breeder who de-
veloped visceral larva migrans.
Case report. A 27-year-old Cau-
casian woman was first seen on
Dec 1, 1983 with the chief com-
plaint of sharp epigastric pain
exacerbated by inspiratory efforts
and eating. Similar complaints
18
WISCONSIN MEDICAL JOURNAL, SEPTEMBER 1985:\ OL. 84
VISCERAL LARVA MIGRANS-Furlano & Agger
SCIENTIMC MEDICINE
Figure I — Toxocara canis ovum from fecal concentrate of patient's dog (mag 450xj.
had occurred with increased
flatulence and intermittent night
sweats for six weeks prior to
being hospitalized at a nearby
hospital in November 1983.
During that hospitalization, her
examination was unremarkable,
but a peripheral blood smear of
5,400 white blood cells per cu
mm revealed 22% eosinophils.
Stool for ova and parasites was
negative. A barium enema dis-
closed a moderate-sized polypoid
mass in the cecum, and an ex-
ploratory laparotomy revealed
induration of the greater omen-
tum with adhesions and edema
involving the cecal area, and in-
flamed fallopian tubes.
Microscopic examination of the
inflamed serosal tissue removed
from the terminal ileum, cecum,
and appendix showed the lamina
propria to have been infiltrated
with plasma cells and eosino-
phils. Treatment for acute salpin-
gitis with penicillin G and amoxi-
cillin for a total of ten days was
given.
Two weeks after discharge she
again developed abdominal pains
very similar to the initial episode,
and she was referred to our
clinic. Further history revealed
that she had been breeding dogs
for the prior two years but had
recently gone out of business due
to a recurrent illness in the pup-
pies, characterized by gastro-
intestinal dysfunction and a very
high mortality rate.
The patient admitted to eating
sandwiches which she laid on the
kennel screens and often not
washing her hands as she worked
and ate.
Stool, obtained from one of her
few remaining dogs, contained
ova of hookworm, Coccidioides,
and Toxocara canis (Fig 1). In
addition, her Elisa test for Toxo-
cara antibody was positive at a
titer of 1:32.
The patient was feeling well by
the time the diagnosis was con-
firmed, but three months later
she returned with recurrent ab-
dominal pains and eosinophilia of
14%. Therefore, thiabendazole
at a dose of 25 mg per kg per day
for seven days was initiated. Re-
peat Toxocara antibodies were
1:64. With persistence of symp-
toms, the thiabendazole was
repeated at a dose of 25 mg per kg
twice a day for seven days. After
that course of therapy the patient
has become asymptomatic and
presently is doing well.
Discussion. The prevalence of
antibodies tested by the Elisa
method for Toxocara canis varies
with geographic location. In the
southeastern states, partly due to
clay soils and a humid climate,
the prevalence of positive titers is
as high as 10% in adults and 23%
in young children. However, in
the North Central United States,
VLM titers have been estimated
to be less than 1% (Personal
communication: Peter W Schantz
Parasitic Diseases Division,
Bureau of Epidemiology, Centers
for Disease Control).
Children are at greatest risk for
this infestation, especially those
with a history of pica and close
contact with puppies.® " The in-
festation rate in puppies is greater
than 80% and in adult dogs is
about 20%. Infective eggs can be
easily recovered from soil where
dogs defecate frequently, and the
eggs may remain viable for
weeks to months depending upon
climatic conditions.®
Puppies are frequently infested
due to transplacental and trans-
lacteal dissemination of larva
from the bitch. In the adult dog
the larva migrate to somatic tis-
sues and rarely complete their
life cycle. The exception is in
the pregnant bitch where, be-
cause of hormonal stimulation,
the larva migrate transplacentally
to complete their life cycle in the
developing puppies. Once there,
the larva spread through the liver
and lungs where they migrate out
of the alveolar capillaries into
the alveolus and are cleared and
swallowed. If there is a heavy
infestation, puppies at three
weeks of age, develop abdominal
distress, and mortality is not in-
frequent. Once mature and
WISCONSIN MEDICAL JOURNAL, SEETEMBER I985:VOL. 84
19
SCIENTIFIC MEDICINE
VISCERAL LARVA MIGRANS-Furlano & Agger
mated, the female worms may
pass up to 20,000 eggs per day
into the feces.^
If these eggs are ingested by
man, they hatch in the proximal
small intestine, penetrate into the
portal system and are blood
borne to all parts of the body,
especially the liver, central ner-
vous system, and occasionally
the eye. ‘2
The clinical manifestations
and severity of the illness vary
depending upon the number of
invading larva, the organ that is
involved, and the frequency of
reinfection.® The spectrum of ill-
ness may run from asymptomatic
to an acute febrile illness with
peripheral eosinophilia, anor-
exia, malaise, and hepatomegaly.
Other symptoms may include
cough and wheezing, in which
50% will have pulmonary infil-
trates on chest x-ray study. En-
cephalitis, meningitis, and epi-
lepsy in children also have been
associated with VLM.^^ skin
lesions include tender nodules of
the palms and soles, erythema
nodosum, purpura, fine papular
rashes, and erythematous urti-
carial rashes of the abdomen and
extremities. Other tissues that
have been involved include pan-
creas, kidney, heart, bone, in-
testinal wall, and mesenteric
lymph nodes. Because of the
infrequency of pica and the gen-
eral improved personal hygiene
in adults, the illness, as in our
case, is usually more mild due to
the decreased number of larva in-
gested. While VLM is rare in
adults, workers in kennels have
an increased risk of ascarid egg in-
gestion,
A chronic form of visceral larva
migrans known as ocular toxo-
cariasis is usually seen in older
children with the mean age being
7-8 years. 12 Common presenting
symptoms include decreased
visual acuity, strabismus, or eye
pain. Rarely does severe endoph-
thalmitis and retinal detachment
occur. This lesion is difficult to
distinguish clinically from retino-
blastoma. In one pathologic re-
view of eyes enucleated for pre-
sumed retinoblastoma, there
were several instances of toxocar-
iasis discovered.'® In this form
of the illness there is little peri-
pheral eosinophilia and antibody
titers tend to be lower.
The diagnosis of visceral larva
migrans cannot be made by ex-
amining stools for ova and para-
sites as the Toxocara species
rarely complete their full life
cycle in the human host. Thus,
with the appropriate history,
especially if coupled with a high
eosinophilic count, VLM should
be considered. The diagnosis can
usually be confirmed by an en-
zyme-linked immunosorption
assay, done at the Centers for
Disease Control in Atlanta,
Georgia.
Therapy is often unnecessary
as this illness is usually benign
and self-limited. However, once
the diagnosis has been con-
firmed, the patient should be fol-
lowed periodically, as individuals
have developed the ocular form
years after VLM.® In patients
with life-threatening myocardial,
central nervous system, or pul-
monary involvement, or in those
with active ocular lesions, corti-
costeroids are the treatment of
choice. Diethylcarbamazine and
thiabendazole, two antihel-
menthic agents, have been used
clinically and appear to relieve
symptoms and shorten the course
of illness."’
Preventive measures include
eliminating the infestation in
puppies and nursing bitches,
keeping children away from in-
fested puppies and contaminated
soil, and good handwashing after
handling puppies.®
Visceral larva migrans is an un-
usual infestation of people of
Wisconsin, but one that Wiscon-
sin physicians should be aware
of due to the variable presenta-
tion and potential severity.
REFERENCES
1. Boland TW, and Agger WAs .Cutaneous
larva migrans— recent experience in the
La Crosse area. Wis Med J 1980; 79(2|:
32-34.
2. Beaver PC, Jung RC, and Cupp E\V: CImiciit
Fanisilolog\’ 9tli Ed. Philaiielphia, Lea &
Febigei , 1984; pp 320-334.
3. Kal/ M, Desponimier DO, ami Gwad/ R:
Para.vhc Disease. New York, NY, Springer-
Verlag, 1982; pp .33-60.
4. Beaver PC, Snyder CH, Carrera GM, et at:
Chronic eosinophilia due to visceral larva
migrans. Report of three cases. Pediair
1952:9:7-19.
5. Fanning M, Hill A, Langer HM, and Key-
stone JS: Visceral larval migrans (toxo-
cariasis) in Toronto. Can Med Assoc J
1981: 124:21-26.
6. Glickman LT, Schantz PW, et al: Evaluation
of serodiagnostic tests for visceral larva
migrans. Am J Trap Med Hyg 1978; 27(5)
492-498.
7. Olte.sen EA; Vi.sceral larva migrans and
other unusual helminth infections. In Princi-
ples and Practices of Infectious Disease.
2nd Ed, Mandell G (ed). New York, John
C Wiley & Sons, 1985.
8. Worley G, Green JA, Frothingham TE, et al:
Toxocara canis infection: Clinical and epi-
demiological associations with seroposi-
tivity in kindergarten children. J Infect Dis
1984: 149(4):591-597.
9. Schantz PW, and Glickman LT: Toxocaral
visceral larva migrans. N Engl J Med 1978;
298:436-439.
10. Mok CH: Visceral larva migrans, A discus-
sion based on review of the literature.
ChnPediat 1968; 7|9|:565-573.
11. Schantz PW, Weis PE, et al: Risk factors
for toxocaral ocular larva migrans: A case
control study. Am J Pub Health 1980;
70(2):1269-1272.
12. Zinkham WH: Visceral larva migrans. A re-
view and reassessment indicating two
forms of clinical expression: visceral
and ocular. Am J Dis Child 1978: 132:627-
633.
13. Glickman LT, Cypess RH, et al; Toxocara
infection and epilepsy in children. J Pediatr
1979:94(l):75-78.
14. Jacobs DE, Woodruff AW, et al: Toxocara
infections and kennel workers. Br Med J
1977: 1 (6052):51.
15. Glickman LT, and Cypess RH: Toxocara
infection in animal hospital employees.
Am J Pub Health 1977; 67| 12); 1 193-1195.
16. Schimek RA, Perez WA, and Carrera GM:
Ophthalmic manifestations of visceral
larva migrans. Ann Ophthal 1979: 11|9|:
1387-1390.
17. Perrin J, Boxerbaum B, and Doershuk
CF: Thiabendazole and treatment of pre-
sumptive visceral larva migrans (VLM).
ClinPediat 1975; 14(2);147-150.B
20
WISCONSIN MEDICAL JOURNAL, SEPTEMBER 1985: VOL. 84
SCIENTIFIC MEDICINE
Anorectal giant condyloma
acuminatum
R Lee Kolts, MD; Bruce C Hubert, MD and Constance S Avecilla, MD
Marshfield, Wisconsin
ABSTRACT. Giant condyloma acuminatum originating in the anorectum has been
reported 12 times in the world's literature. Although benign histologically, these
tumors have been reported to display aggressive local growth and frequently become
nonresectable. Malignant transformation to a well-differentiated squamous cell car-
cinoma is common. We describe a single case' of giant condyloma acuminatum
beginning in the anal canal. The tumor measured 16 cm in diameter and caused
incontinence by preventing apposition of the anal sphincter. Local wide resection
with skin grafting resulted in a cure. The tumor was benign on histological exami-
nation. The surgeon confronted with an anorectal giant condyloma acuminatum
should aggressively remove it. Local resection may be adequate, but if the tumor is
advanced or involved in an abscess or fistula, abdominal perineal resection is indi-
cated. Chemotherapy or radiotherapy has not been effective to date.
Key words: Giant condyloma acuminatum: Anorectal tumor
Cjiant condyloma acuminatum
is an uncommon verrucous lesion
that predominantly occurs on
the uncircumcised penis. It also
has been described on the scro-
tum, vulva, vagina, perineum,
and anorectum. The first case
was described by Buschke in
1896 and, again, in 1925 by
Buschke and Loewenstein.^ The
commonly used eponym is thus
"Buschke-Loewenstein tumor."
These tumors are known for their
benign appearance on histologi-
cal examination, but clinically
they display malignant local
growth and extension. Recur-
rences are noted frequently even
after resection of all gross tumor.
Metastatic spread to local or
regional nodes does not occur.
Occasionally transformation of
From the Department of Surgery, Marsh-
field Clinic, Marshfield. Publication sup-
port provided. Reprint requests to: R Lee
Kolts, MD, Dept of Surgery, 1000 North
Oak Ave, Marshfield, Wis 54449 |ph
715/387-5221). Copyright 1985 by the
State Medical Society of Wisconsin.
giant condyloma has been ob-
served with a microscopic ap-
pearance of squamous cell car-
cinoma and with a propensity to
metastasize.
A single case of giant con-
dyloma acuminata originating
in anal canal is presented. Twelve
previously reported cases from
the world's literature are re-
viewed.
Case report. A 47-year-old man
was evaluated because of a ver-
rucous tumor in the perianal
region (Fig 1). This tumor had
first been recognized five years
earlier as a small lesion of the
anal canal. It had been treated
several times with podophylline,
but this was discontinued by the
patient because of severe pain.
Growth of the tumor had been
most remarkable over the pre-
vious two years. The patient's
lifestyle was severely restricted
because of disability produced
by the large mass. Cleansing of
the area to control odor and
tissue breakdown necessitated
bathing after each bowel move-
ment. The patient was also in-
continent of stool because the
tumor prevented apposition of
the anal sphincter. No other
symptoms relating to the gastro-
intestinal tract or genitourinary
tract were present. The patient
had a 60-pack-per-year history
of smoking and consumed
copious quantities of alcohol.
He denied previous anal sexual
intercourse or homosexual ac-
tivity. He had no history of pre-
vious venereal disease.
The tumor measured 16 cm
across, protruded 2 to 3 cm above
the surrounding skin, and ex-
tended internally to the dentate
line. Sphincter tone was de-
creased but proctoscopic exam-
ination was unremarkable be-
yond the tumor. Five condylo-
mata up to 1.5 cm were present
on the scrotum and in the right
groin. Inguinal nodes were not
enlarged. No other remarkable
physical findings were noted.
The patient was prepared for
surgery with a thorough two-
day mechanical bowel prepara-
tion. The giant condyloma was
excised with a 1-cm skin margin.
Dissection through the subcu-
taneous plane was carried down
through the anal canal and into
the submucosal plane of the
rectum. The distal rectal mucosa
was transected just above the
dentate line. No tumor was noted
above this level. The rectal mu-
cosa was transfixed at the dentate
line, and the remaining defect
was covered by a split thickness
skin graft. Groin and scrotal
tumors were also excised. The
patient was medicinally consti-
pated and kept in bed for five
days before removal of the pres-
sure dressings. The graft had
taken adequately, and complete
healing was noted over the next
weeks. The patient continues to
do well without evidence of
WISCONSIN MEDICAL JOURNAL, SEPTEMBER 1985:VOL. 84
21
SCIENTIFIC MEDICINE
GIANT CONDYLOMA— Kolts, Hubert & Avecilla
Figure I— A giant condyloma acuminata surrounds and replaces the anal canal.
The tumor measures 16 cm across. The patient is in the prone jackknife position.
recurrent disease after six
months. He is gradually regaining
anal continence.
Discussion. Twelve cases of
anorectal Buschke-Loewenstein
tumors have been reported in
the world's literature. Along with
the current case they are sum-
marized in Table 1. Patients'
ages range from 32 to 73 years,
the mean being 46 years. Ten of
13 patients were male. Patients
were aware of the tumor an aver-
age of 7.5 years by the time of
presentation, although the range
is three months to 23 years. Gen-
erally the tumor is minimally
symptomatic for the first several
years. The most common pre-
senting symptom is local pain ( 1 1
of 13 cases). This may be second-
ary t;o abscess formation, local
cellulitis, or fistula formation.
® ® Patients also may present with
complaints of abnormal defeca-
tion including incontinence^ or
constipation.^ 5 jg g result of
tumor interference with the
sphincter mechanism or obstruc-
tion by the tumor mass. The main
complaint in our patient was his
inability to maintain personal
hygiene because of the continu-
ous contact of stool with the
verrucose surface. All patients
are aware of an enormous mass.
Giant condylomata acumina-
tum is considered a variant of
common condyloma acuminata
and is thought to be passed by
venereal contact. Indeed the
causative agent is thought to be
the human papillomavirus. Of
the anorectal cases only one has
been reported in a patient with
a history of homosexual activity.®
Such activity is denied in two
other reports” (current case),
and a history of other venereal
disease is noted in one case.^ The
nine other reports do not mention
a sexual history.
The typical microscopic ap-
pearance of giant condyloma acu-
minatum is similar to common
condyloma acuminata with
acanthotic squamous epithelium,
hyperkeratosis, and papilloma-
tosis. Virus-like particles may be
seen by electron microscopy.®
Malignant transformation fre-
quently occurs in condyloma.
This was noted in five (38%) of
the 13 cases.^"'® ” ” These malig-
nancies are squamous cell carci-
nomas, and they display local in-
vasive and metastatic behavior.
The clinical behavior of the
22
WISCONSIN MEDICAL JOURNAL, SEPTEMBER 1985: VOL. 84
GIANT CONDYLOMA— Kolts, Hubert & Avecilla
SCIENTIFIC MEDICINE
Table 1 —anorectal giant condyloma acuminata
Reference
Age /Sex
Symptom
Duration
Treatment
Complications
Results
SiegeF
37/M
10 years
1. Excision and fistulotomy
2. Abdominal perineal resection,
pelvic lymphadenectomy
Multiple recurrences
Malignant transformation
Cure
(13 months)
Knoblich^
50/M
1 year
1. Biopsy
2. Colostomy
Abscess
Intraabdominal perforation
Death
Burns‘5
49/ M
23 years
1. Excisions— (multiple)
2. Abdominal perineal resection
3. Radiotherapy
Abscess
Malignant transformation
Cure
(7 months)
Shah®
32/F
14 years
1. Podophyllin
2. Colostomy, resection
3. Radiotherapy
4. Abdominal perineal resection
5. Chemotherapy
Multiple recurrences
Pelvic extension
Death
Shah®
73/F
4 years
1. Resection refused
2. Radiotherapy
Recurrence
Anorectal stricture
Progressive
tumor growth
. Drut“
39/M
12 years
1. Resection (2)
2. Drain abscess
3. Colostomy
4. Abdominal perineal resection
Local spread
Abscess
Malignant transformation
Inadequate
time
Sturm*®
49/M
6 years
1. Local resection
2. Resection
3. Abdominal perineal resection
Extensive spread
Multiple recurrences
Malignant transformation
Recurrent
squamous cell
carcinoma
Lock®
45/ F
1 year
1. Colostomy, biopsy
2. Abdominal perineal resection,
hysterectomy
Abscess
Rectovaginal fistula
Cure
(8 months)
South®
38IM
1 year
1. Multiple resections
2. Colostomy
3. Abdominal perineal resection
4. Chemotherapy
5. Radiotherapy
Extensive pelvic invasion
Death
Elliot®
39/M
15 years
1. Resection, colostomy
2. Drain abscess
3. Chemotherapy
4. Radiotherapy
Abscess
Pelvic extension
Recurrence
Death
Cure
Alexander"
35/M
4 years
Resection
None
(3 months)
Cure
Ejeckman®
61/M
3 months
Resection
Malignant transformation
(6 months)
Cure
Current Case
47/M
6 years
Resection, skin graft
None
(6 months)
giant condyloma acuminatum,
even in the absence of a malig-
nant pathology, displays local
malignant characteristics. Four
deaths have been reported sec-
ondary to extensive local exten-
sion of anorectal tumors.
Each of these was benign micro-
scopically. Two other cases had
extensive recurrent (nonresect-
able) disease at the time of report-
ing.® Spread to regional nodes
or distant sites has not been re-
ported without malignant trans-
formation. Local invasion and
local recurrences are frequent
and may be severe. Extension
into the pelvis may occur if it is
not prevented by early resection.
These tumors frequently produce
fistulae and anal abscesses.
Once the tumor is found in asso-
ciation with an abscess or fis-
tula, it is difficult to eliminate
and usually requires abdominal
perineal resection. This was per-
formed in seven of 13 cases. If the
tumor recurs, the recurrences
generally are noted within weeks
of resection but have been re-
ported as late as seven months.
Giant condyloma is occasion-
ally treated by nonsurgical
means. Podophyllin suspension
has been shown to be ineffective
and can produce changes in cell
WISCONSIN MEDICAL JOURNAL, SEPTEMBER 198,S:VOL. 84
23
SCIENTIFIC MEDICINE
GIANT CONDYLOMA — Kolts, Hubert & Avecilla
morphology suggesting squam-
ous cell carcinoma. Various other
chemotherapeutic regimens
have been tried in three cases
with no apparent success.®®
Radiotherapy also was used in
four patients. It produced some
shrinkage of tumor and relief of
symptoms in two cases'^® and
had no effect in one case.® The
fourth patient received cobalt-60
treatment postoperatively, and
no recurrent tumor was noted
after seven months.^® The roles
of both chemotherapy and radio-
therapy remain to be defined,
neither showing much promise
to date. However, immunother-
apy has been successfully used
in several cases of giant condylo-
ma acuminatum and appears
to have promise.
The current treatment of choice
is surgical. The surgeon should be
aggressive in removing the entire
tumor; and when possible, this
should be done at the first oper-
ation. Local resection may be
adequate. This may be performed
using skin grafts or allowing the
site to heal by secondary inten-
tion. In the presence of a fistula
or abscess, local resection and
drainage of the abscess has not
been successful. This is because
of local spread into the fistula
tract or abscess cavity. In these
situations abdominal peroneal
resection is generally indicated.
Lymph node dissections are not
of value but may be indicated
following malignant transforma-
tion. Following the patient at
frequent intervals for up to a year
after surgery is essential so that
local recurrences can be expe-
ditiously removed.
Summary. A case report of a
patient with a giant condyloma
acuminata originating in the anal
canal is presented and the current
literature is reviewed. This totals
13 cases in which the tumor be-
gan in the anorectum. Anorectal
giant condylomata are variants of
the common condyloma acumi-
nata. They are thought to be
spread by venereal contact. They
appear benign on pathological
examination but behave with
remarkable local aggression.
These tumors frequently undergo
malignant transformation; how-
ever, metastatic spread is not a
characteristic. Current treat-
ment is aggressive surgical re-
section, and close postoperative
followup. Local recurrent tumor
is frequently noted in spite of
previous resection of all gross
tumor. Immunotherapy may be-
come a therapeutic possibility in
the future.
REFERENCES
1. Buschke A, Loewenstein L: (Carcinoma-like
condyloma acuminata of the penis). Klin
Wochenschr 1925; 4:1726-1925, (German).
2. Siegel A: Malignant transformation of
condyloma acuminatum; review of the
literature and report of a case. Am ] Surg
1962; 103:613-617.
3. Knoblich R, Failing Jr JF: Giant condyloma
acuminatum (Buschke- Loewenstein tumor)
of the rectum. Am J Clin Pathol 1967;
48:389-395.
4. Drut R, Ontiveros R, Cabral DH: Perianal
verrucose carcinoma spreading to the
rectum: report of a case. Dis Colon Rectum
1975: 18:516-521.
5. Lock MR, Katz DR, et al: Giant condyloma
of the rectum; report of a case. Dis Colon
Rectum 1977; 20:154-157.
6. South LM, O'Sullivan jP, Gazet JC: Giant
condylomata of Buschke and Loewenstein.
Clin Onco/ 1977: 3:107-115.
7. Elliot MS, Werner ID, et al: Giant condyl-
oma (Buschke-Loewenstein tumor) of the
anorectum. Dis Colon Rectum 1979; 22:
479-500.
8. Shah 1C, Hertz RE: Giant condyloma
acuminatum of the anorectum; report of
two cases. Dis Colon Rectum 1972; 15:
207-210.
9. Ejeckam GC, Idikio HA, et al: Malignant
transformation in the anal condyloma
acuminatum. Can J Surg 1983; 26:170-173.
10. Gissman L, de Vilhers E, zur Hausen H:
Analysis of human genital warts (condyl-
oma acuminata) and other genital tumors
for human papillomavirus type 6 DNA.
IntJ Cancer 1982; 29:143-146.
11. Alexander RM, Kaminsky DB: Giant
condyloma acuminatum (Buschke-Loewen-
stein tumor) of the anus; case report and re-
view of the literature. Dts Colon Rectum
1979: 22:561-565.
12. Sturm JT, Christenson CE, et al: Squamous
cell carcinoma of the anus arising in a
giant condyloma acuminatum: report of
a case. DisColon Rectum 1975: 18:147-151.
13. Burns Fj, van Goidsenhoven GE: Condylo-
mata acuminata of the rectum with asso-
ciated malignancy. Proc R Soc Med 1970:
63 (suppl): 1 19-120.
14. Eftaiha MS, Amshel AL, et al; Giant and
recurrent condyloma acuminatum: ap-
praisal of immunotherapy. Dis Colon
Rectum 1982; 25:136-138.
15. Abcarian H, Smith D, Sharon N: The im-
munotherapy of anal condyloma acumina-
tum. DisColon Rectum 1976: 19:237-244. ■
ABSTRACT
Microscopically controlled surgical treatment for
squamous cell carcinoma of the lower lip
FREDERIC E MOHS, MD; STEPHEN N SNOW, MD, Chemosurgery Clinic,
Department of Surgery, University of Wisconsin Hospital and Clinics, Madison,
Wis: Surg Gynec Obst 1985 (Jan); 160:37-41
The total microscopic control of the excision of squamous cell
carcinoma of the lower lip that is achieved by excising the under-
side of each layer in the microscope by the systematic use of
frozen sections provides two main benefits: (1) assurance of com-
plete eradication of the cancer including the clinically unpredic-
table slender outgrowths that often extend well beyond the
clinically apparent borders, and (2) maximal sparing of adjacent
normal tissues. During the 40 years from 1936 to 1976
microscopically controlled surgery was used in the treatment of
1448 patients with a 5-year cure rate of 94.2 percent. Because of
the sparing of normal tissues many of the lesions are amenable
to anterior-posterior closure; but if the cancer is very deep, the
wound is converted into a wedge which can be sutured vertically
with good cosmetic and functional results. ■
24
WISCONSIN MEDICAL JOURNAL, SEPTEMBER 1985: VOL. 84
For professional liability insurance, the stakes are too
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ORGANIZATIONAL
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SMS Board encourages negotiation in ER services
In response to House of Dele-
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response to House Resolution
21, which requested the Board
to study and possibly implement
an appeals and monitoring sys-
tem for patients and physician.
• Voiced its opposition to US
Senate Bill 70, which would make
heroin available for cancer pain
relief. The Board noted that after
many studies, heroin has not dem-
onstrated an advantage over mor-
phine, methadone, and other pain
medications, but it does present
diversionary complications. The
SMS position on SB 70 will be com-
municated to the Wisconsin Con-
gressional Delegation, as well as the
AMA.
• Received an update on the ac-
tivities of the Medical Liability
Task Force from its chairman,
William Listwan, MD. Doctor
Listwan noted that of immediate
concern is a review of the panel
system in Wisconsin and an on-
going media campaign dealing
with the liability issue. The Task
Force also will address a support
system for physicians who have
been sued and their families,
and alternatives to the tort
system. The Board also appointed
the following physicians to the
Medical Liability Task Force:
Lucille Glicklich, MD, Mil-
waukee; Paul Fox, MD, Wau-
kesha; Matthew Meyer, MD,
The Board of Directors of the
SMS Services, Inc met August 24
at SMS Offices in Madison. The
following officers were elected
to succeed themselves for the
next year:
William P Crowley Jr, MD,
Madison, President
John P Mullooly, MD,
Milwaukee, Vice President
Earl R Thayer, Madison
Secretary
Richard W Edwards, MD,
Richland Center, Treasurer
A financial report through July
31, 1985 showed the following:
Pewaukee; and Edward Zupanc,
MD, Monroe.
• Noted that SMS member-
ship currently stands at 5,990, an
increase of nearly 10% over a
year ago. Lull dues-paying mem-
bers increased by 8%, while
candidate membership grew by
23% to 400. ■
SMS to seek small area
variation analysis
As a result of Board of Di-
rectors action August 24, SMS
will seek to become a demon-
stration project as part of an over-
all AMA program to evaluate
geographic variations in the
utilization of healthcare services.
This effort will support an
AMA policy directive to show the
capacity of private sector initia-
tives to manage utilization pat-
terns in a cost effective, quality-
conscious manner. It will be de-
veloped as part of the Society's
Task Force on Data Collection
and Use.B
Total assets $701,733
Shareholders equity .. 184,054
Net profit after provision
for State and
Federal taxes 62,532
The State Medical Society is
the sole shareholder of SMS
Services, Inc.
An insurance agency report
showed that 2,676 Society mem-
bers have enrolled in The Pro-
fessionals—professional liability
insurance plan. Since July 1984
over 400 new Society members
can be tracked directly to this
continued on next page
SMS Services, Inc Board highlights
WISCONSIN MEDICAL JOURNAL, SEPTEMBER 1985: VOL. 84
27
ORGANIZATIONAL
SMS Services, Inc endorses WC program
lent) and a financial size category
of XIII.
Following an extensive study,
SMS Services, Inc has endorsed
the Dividend Program for work-
ers' compensation insurance of-
fered by the Dodson Insurance
Group of Kansas City, Missouri.
The Dodson Plan was chosen
because Dodson has 30 years of
experience in providing suc-
cessful workers' compensation
Continued from preceding page
plan. The report also noted that
other casualty lines underwrit-
ten by The Professionals are an-
ticipated to be available by year
end. The report also stated that
the Society's group health plan
continues to grow. Efforts are
being made to substantially in-
crease the group size to further
spread the risk and make it an
even better membership benefit.
The Boarci announced that it
has endorsed the Dividend Pro-
gram for workers' compensa-
tion insurance offered by the
Dodson Insurance Group of Kan-
sas City, Mo. Letters to all So-
ciety members were mailed in
August, and some physicians
already have enrolled. A separate
article on this program appears
elsewhere in this issue.*
Discount prices
on typewriters
and copiers
SMS Services, Inc has negotiated an
agreement with Modern Business
Machines in Madison to provide
SMS members with a discount on
IBM Wheelwriter 3 Electronic and
IBM Wheelwriter Selectronic type-
writers (7K memory), with options.
Also available is a discount on the
Xerox Model 1020 and 1025 copiers
with options.
For further information contact
Noreen Krueger at SMS Offices in
Madison at 608-257-6781 or
1-800-362-9080, extension 141.
plans to more than 200 associa-
tions in 50 classes of business
including a number of medical
associations across the country,
its financial size and stability,
and its very attractive dividend
program, stated LeRoy A John-
son, executive vice president of
SMS Services, Inc.
In Wisconsin workers' com-
pensation premiums are estab-
lished by the State, thus pre-
miums from all insurance com-
panies are the same. The divi-
dends paid, however, determine
a participant's true cost. Divi-
dends in the Dodson Plan have
ranged from 30% to more than
40% per year in many cases. As
an example, physicians in Min-
nesota who participate in the
Dodson Plan have received divi-
dends averaging 36.47% since
1972. Dividends in this Plan are
paid promptly after policies ex-
pire on October 1 each year
based on claim costs. For those
who are interested Dodson also
offers various premium payment
plans without fees of any kind.
Policies under the Dodson Plan
are issued by Casualty Recipro-
cal Exchange, a member of the
Dodson Insurance Group since
1912, and a recognized leader
in providing workers' compen-
sation insurance, having an A.M.
Best group rating of A-i- (Excel-
Mr Johnson also noted that al-
though the SMS Services, Inc has
endorsed the Dodson Group, the
Dividend Program is handled
directly by the Dodson Group
and not through SMS Services,
Inc. Members interested in more
information should call Dodson
toll-free at 800-821-3760 and ask for
Direct Sales.*
SMS Leadership
Conference October 26
in Appleton
Representatives from all facets
of organized medicine in Wiscon-
sin will convene October 26 for an
all-day Leadership Conference at
the Paper Valley Inn, Appleton.
Two major speakers are sched-
uled to discuss where medicine is
headed— Uwe Reinhardt, Prince-
ton Professor of Economics, and
Eugene Mayberry, MD, chairman
of the Board of the Mayo Founda-
tion.
Special invitations have been
extended to officers, delegates,
directors, county medical society
officers, scientific specialty sec-
tion officers, specialty society of-
ficers, and all members of com-
missions and committees. The en-
tire membership, of course, is
welcome to attend.*
SMS to study health data collection
The Board of Directors at its
meeting August 24 authorized a
special task force to examine
the issue of the collection, analy-
sis, and release of Wisconsin
healthcare data, including hos-
pital and physician specific in-
formation.
The study is expected to pro-
duce recommendations for SMS
policy on how such data should
be developed, pooled, and used.
Many commercial as well as
governmental ventures are
moving into Wisconsin with pro-
posals to provide such data to
virtually any private or public
buyers.
SMS Board chairman, Darold A
Treffert, MD, will name the task
force shortly.*
28
WISCONSIN MEDICAL JOliRNAL, SEPTEMBER 1985: VOL. 84
Acme
Laboratories, Inc
Qualified, competent professionals are the
trademark of Acme Laboratories. For
years, our certified orthotists and prosthetists
have earned a reputation for e.xeellenee,
helping people improve their lives.
Acme Laboratories serves Wisconsin from
offices in Milwaukee, Green Bay, Fond du
Lac and Woodruff. We're pleased to be a
designated HMO facility for southeastern
Wisconsin. Acme Laboratories accepts all
insurance, including Medicare and Medicaid.
10702 W. Burleigh St., Milwaukee, Wl 53222
414-259-1090
GREEN BAY ORTHOPEDIC
Division of Acme Laboratories, Inc.
428 S. Adams St., Green Bay, Wl 54301
414-435-1461
525 E. Division St., Fond du Lac, Wl 54935
414-923-6676
Affiliated with Northwoods Rehabilitation
Box LOA, Woodruff, Wl 54568
715-356-8000 Ext. 8872
Acme Laboratories — where quality of
life is our main concern
YOU CAN HELP
STOP BEDWETTING
For a large majority of
your Enuretic patients
• Ethical — prescription only
• Professional — you supervise
treatment
• Approximately 90 percent effective
• Proven reliable and dependable
bell, pad, and light system
• Low cost rental service — $14.00
per week (avg. 6-week treatment)
• Convenient mall order service
to the 48 states
For more information, caii or write:
S. & L. SIGNAL COMPANY
Helping Enuretic Clients
Since 1950
1142 Fleetwood Ave. Madison, Wl 53716
Phone: 608-222-7939
Accepted for advertising In the AMA Journal
CARE FOR YOUR
COUNTRY
As an Army Reserve physician, you can serve
your country and communip' with just a small invest-
ment ot your time. You will broaden your professional
experience by working on ^
interesting medical projects
in your communiry'. Army
Reserve service is flexible, so it
won't interfere with your practice.
You 11 work and consult with top
physicians during monthly Reserve
meetings. You'll also attend funded
continuing medical education pro-
grams. You will all share the bond of '
being civic-minded physicians who are also commis-
sioned officers. One important benefit of being an officer
is the non-contributory retirement annuity you will get
when you retire from the Army Reserve. To find out
more, simply call the number below.
ARMY RESERVE.
BEAUYOUCANBE.
MAJOR DAVIDS BARRIE
COLLECT: (312) 926-3161
Practice
Made Perfect.
In Navy Medicine the emphasis is on patients, not paperwork.
As a Navy doctor you step into an
active and challenging group practice.
You work with state-of-the-art equip-
ment and the best facilities available.
Highly trained physician's assistants, XY'
hospital corpsmen, nurses and
hospital administrators not only
provide medical support, they
attend to almost all the papei^
work. As a result, you’re free to
make medical decisions based solely
on the needs of your patients.
Along with your professional development, you’ll enjoy
the lifestyle and fringe benefits of a Navy officer. Beginning
salaries are competitive with civilian practice for most
specialists.
To learn more about the Navy’s practice made perfect,
send your curriculum vitae or call:
Li Nancy Hill, Henry Rcuss Federal Plaza, Suite 430
310 West Wisconsin Ave, Milwaukee, Wl 53203
(414) 291-1529 (call colled)
BeThe Doctor
YouWant To Be. InThe Navy._
SMS helps sponsor
sexual abuse workshop
A two-day workshop on Sexual Abuse in
Therapy: A Multidisciplinary Approach to Recogni-
tion, Treatment, and Prevention was held Sep-
tember 13-14 at the Howard Johnson Motor
Lodge in Milwaukee. The State Medical Society
assisted in sponsorship of the workshop to pro-
vide education on the nature of the problem and
assistance in developing solutions. Workshop
topics focused on sexual involvement in therapy,
treatment of victim survivors in individual and
group therapy, legislative and legal actions,
and treatment of the assaultive /seductive
therapists. ■
ARMY PHYSICIANS
PRACTICE MEDICINE,
NOT LAW.
The Army Medical Department
believes in excellence in the practice of
medicine. That means allowing our phy-
sicians to work at perfecting their medi-
cal skills, and not being burdened with
endless insurance forms, malpractice
premiums, cash flow worries. And they
need not concern themselves with the
ability of the patient to pay.
Part of Army medical excellence is
prescribing the best possible care— not
the least care, nor most defensive care.
If you believe in this kind of compre-
hensive health care, you may wish to
explore the many exciting possibilities
Army Medicine has for you. We invite
your call:
Captain Scott Hendrickson
(312) 926-2040
ARMY MEDICINE.
BEAUYOUCANBE.
"Your (doctor's new suit
coul(d cost you a barrel"
That's the title of the latest
newspaper ad published by the
State Medical Society in its cam-
paign to bring public attention to
the medical liability issue. This sec-
ond ad ran in the August 25 Sunday
editions of eight major dailies
around the state. It emphasized the
escalating costs of liability in-
surance and the fact that only 20%
to 30% of premium dollars will
ever get to the injured patient. A
copy of the ad appears on the op-
posite page. Still another ad is
planned for publication to em-
phasize the growing impact of
malpractice on healthcare costs and
how they affect the availability of
quality healthcare. County medical
societies are urged to consider
sponsoring these same ads in their
local papers. Contact Ron
Henrichs, director of member-
ship/communications, at SMS Of-
fices in Madison. ■
Financial Planning
Seminar set
In cooperation with Reinhart,
Boerner, Van Dueuren, Norris &
Rieselbach, SC, Attorneys at Law,
the SMS Services, Inc will hold
its annual Personal Financial
Planning Seminar Thursday, Oc-
tober 3, at the Marriott Inn in
Brookfield. The program will
include topics on:
—Financial and Estate Planning
After 1984 Legislation (includ-
ing marital property law)
—Maximizing After Tax Income
—Qualified Retirement Plans
— Structure of Professional
Practice.
As in past years, the program will
be presented by the same highly
qualified faculty. A registration
form appears elsewhere in this
issue. Lunch is included in the
registration fee.H
30
WISCONSIN MEDICAL JOURNAL, SEPTEMBER 1985:VOL. 84
Your
doctor’s
new suit
could
cost you
a barrel.
Today it's not unusual at all lor malpractice
awards to reach one, two, even nine million
dollars.
And where does the money to pay these
awards come from? Your pocket! The cost of
malpractice insurance adds as much as $3 to
each visit to a physician, $5 a dav to the average
hospital bill, and up to $300 to the cost of some
births.
To cope with increasing numbers of suits and
awards, malpractice insurance premiums for
physicians tripled in the last five years. And this
increase in premiums is passed on to you every
time you set foot in a doctor's office, get into a
hospital bed or have surgery.
But what doctors find most distressing is know-
ing that only 20 to 30% of the premium dollars
will ever get to the injured patient. The vast ma-
jority of this money goes to insurance companies,
litigation costs and attorneys.
Doctors are working to relieve the problem by
imposing stricter sanctions on doctors who don't
meet accepted standards.
In the legislature. State Medical Society mem-
bers are also supporting a bill to assure patients
of adequate compensation in the unfortunate
event that true malpractice does occur and to
lower the cost of malpractice insurance.
Talk to your legislator and tell him/her you
want something done to help cure the malprac-
tice problem in Wisconsin and write us for a free.
Healthwatch brochure.
THE STATE
MEDICAL SOCIETY
OF WISCONSIN
P.O. Box 1109, Madison. 'Wisconsin 53701
The above ad is reprinted from the August 25 Sunday editions of the following newspapers: The Milwaukee Journal,
The Wisconsin State Journal, Appleton Post -Crescent, Racine Journal Times, The St Paul Pioneer Pi'ess-Dispatch, Green Bay
Press-Gazette, La Crosse Tribune, and Duluth News Tribune and Herald. See accompanying story on opposite page.
ORGANIZATIONAL
Nominations sought for SMS offices
The House of Delegates Nomi-
nating Committee will meet on
Saturday, October 26, in con-
junction with the SMS Leader-
ship Conference to be held at
the Paper Valley Inn, Appleton.
The committee will receive
nominations and interview candi-
dates for the following positions:
—President-elect for 1986-87
—Vice Speaker of the House of
Delegates for 1986-88 to suc-
ceed Vernon M Griffin, MD,
Mauston (completing second
two-year term)
— AMA Delegates for calendar
years 1987 and 1988 to suc-
ceed:
John K Scott, MD, Madison
Patricia] Stuff, MD, Bonduel
DeLore Williams, MD,
West Allis
—AMA Alternate Delegates for
calendar years 1987 and 1988
to succeed:
Cyril M Hetsko, MD, Madison
John P Mullooly, MD,
Milwaukee
John D Riesch, MD,
Menomonee Falls
All of the incumbents are eligible
for reelection.
Members of the Nominating
Committee, elected by the House
on April 25, are as follows:
District l— Jerome W Fons
Jr, MD, Cudahy; Robert F Purtell
Jr, MD, Milwaukee; John D
Riesch, MD, Menomonee Falls;
and Raymond E Skupniewicz,
MD, Racine.
District 2— Sandra Osborn,
MD, Madison; and James J
Tydrich, MD, Richland Center.
District 3— Stephen B Web-
ster, MD, La Crosse (chairman).
District 4— John E Thompson,
MD, Nekoosa (secretary).
District 5— Kenneth M Viste
Jr, MD, Oshkosh.
District 6— Rolf S Lulloff,
MD, Green Bay.
District 7— Merne W As-
plund, MD, Bloomer.
District 8— Charles R Long-
streth, MD, Ashland.
Specialty Sections— Philip
J Dougherty, MD, Menomonee
Falls.
(Note there are some changes
from the committee as reported
in the June Blue Book issue: In
District 6 Doctor Lulloff has re-
placed Robert T Schmidt, MD of
Green Bay and in District 8
Doctor Longstreth has replaced
Joseph M Jauquet, MD of Ash-
land.)
SMS members wishing to com-
municate with the Nominating
Committee may address letters
to the Committee at SMS Offices,
PO Box 1109, Madison, WI
5370 !.■
CES Foundation
Annual Board
meeting held
At the Annual Meeting of the
Charitable, Educational and
Scientific Foundation, held Au-
gust 24 at SMS Offices in Madi-
son, the Board of Trustees took
the following actions:
• Elected the following of-
ficers:
President— Robert T Cooney,
MD, Portage; Vice President—
Stephen B Webster, MD, La
Crosse; and Treasurer— Richard
W Edwards, MD, Richland
Center.
• Approved a budget of
$10,000 for the 1985 Wisconsin
Workshop on Health ($3,000
from SMS, $5,000 from SMS
Auxiliary, and $2,000 from
CESF). The program for senior
high students will be held Wed-
nesday, October 2, in Oshkosh.
The program will focus on teen-
age sexuality.
• Approved an operating bud-
get for the Fort Crawford Medi-
cal Museum.
• Received a $1,000 donation
to the Beaumont 500 Club from
the 1985 Staff of the State Medi-
cal Society.
• Approved a request from the
Green Lake/ Waushara County
Medical Society for two $500
grants to be given to two high
school teachers in Wisconsin for
development of innovative sci-
ence curriculum in the schools.
Also approved for the program
was an allotment of up to $500
to be used for materials. The CES
Foundation will then be a co-
sponsor of the program.
• Approved formation of an Ar-
tifact Review Committee to be
named by the President, to re-
view existing and new gifts of a
nonmonetary type, while deter-
mining a course of action to be
presented to the Finance Com-
mittee and the Board.
• Approved formation of a Fi-
nance Committee comprised of:
Robert T Cooney, MD, Portage,
President; Richard W Edwards,
MD, Richland Center, Treasurer;
and Ronald W Lewis, Madison,
Nonmedical Trustee.
• Voted to increase voluntary
contributions to the Foundation
by incremental $5.00 increases
over a period of three years (1986
voluntary contributions will then
be $25.00).
• Requested SMS to raise to
$25.00, the amount which is
donated for memorials for de-
ceased members. Currently the
memoriams are $15.00 per mem-
ber.
• Voted to encourage SMS to
provide certain administrative
services to the Foundation on an
annual basis. A proposal will be
forwarded to the SMS Finance
Committee. ■
.32
WISCONSIN MEDICAI JOURNAL, SEPTEMBER 1985:VOL. 84
OBITUARIES
Harold Wagner, MD, 66, Keno-
sha, died Mar 20, 1984 in
Kenosha. Born July 3, 1917 in
Chicago, IL, Doctor Wagner
graduated from the University of
Illinois School of Medicine in
1950 and served his residency at
Cook County Hospital in Chi-
cago. He served in the United
States Air Force from 1942-1946
during World War II. Doctor
Wagner was the Director of Labo-
ratories at St Catherine's Hospital
in Kenosha and also served as the
Kenosha County coroner. He was
a member of the Kenosha County
Medical Society, the State Medi-
cal Society of Wisconsin, and the
American Medical Association.
Surviving are his widow and two
children.
Raymond G Yost, MD, 81, Mani-
towoc, died May 9, 1985 in Boyn-
ton Beach, Florida. Born Jan 18,
1904 in Oshkosh, Doctor Yost
graduated from Marquette Uni-
versity School of Medicine in
1934 and served his internship at
Milwaukee County General Hos-
pital. Doctor Yost began his
medical practice in Manitowoc in
1935 and was a member of the
medical staff of Holy Family and
Memorial hospitals. He was a
member of the American Acade-
my of Family Physicians, Inter-
national College of Surgeons, and
a member of the American So-
ciety of Abdominal Surgeons. He
also was a member of the Manito-
woc County Medical Society, a
member of the "50 Year Club"
of the State Medical Society of
Wisconsin, and a member of the
American Medical Association.
Surviving are his widow, Marie;
and two daughters, Madelyn
Mlada, Sheboygan, and Kathie
Schipper of Green Bay.
Lawrence G Patterson, MD, 81,
Sun Lakes, Ariz, died May 24,
1985 in Chandler, Ariz. Born Jan
7, 1904 in Tippecanoe, Ohio,
Doctor Patterson graduated from
Ohio State University School of
Medicine in 1931 and served his
internship in Springfield, Ohio.
He practiced medicine in Wau-
paca for 19 years. Doctor Pat-
terson retired in 1971. Surviving
are his widow, Jeanette; one
daughter, Sara Jane Berge; and
two sons, Frederick and Law-
rence Jr.
Adolph M Hotter Sr, MD, 79,
Madison, died June 19, 1985 in
Janesville. Born Nov 26, 1905 in
Fond du Lac, Doctor Hutter grad-
uated from the University of Wis-
consin Medical School, Madison.
He served his residency at Re-
search Hospital, Kansas City,
Missouri, and completed his resi-
dency at University Hospital and
Clinics in Madison. He was in
private practice in Fond du lac
from 1933 until his retirement in
1979. He served as chief-of-staff
at St Agnes Hospital, Fond du
Lac, was a member of the execu-
tive committee and also served as
president of the Fond du Lac
County Medical Society. He was
a past president of the Wisconsin
Heart Association and served as
chairman of the Committee on
Aging of the State Medical So-
ciety of Wisconsin. He was a vet-
eran of World War II serving in
the United States Navy. He was
a member of the Dane County
Medical Society, the "50 Year
Club" of the State Medical
Society of Wisconsin, and a mem-
ber of the American Medical As-
sociation. Surviving are his
widow, Janet; one son, Adolph M
Hutter Jr, MD of Needham,
Mass; and one daughter, Mrs
Paul M Ryan of Janesville.
Richard B Smith, MD, 42, Brook-
field, died July 1, 1985 near
Kenora, Ontario. Born Feb 19,
1943 in Milwaukee, Doctor Smith
graduated from Marquette Uni-
versity School of Medicine and
served his internship at Mt Sinai
Hospital, Milwaukee. His resi-
dency was completed at Mil-
waukee County Hospital. A
radiologist on the medical staff of
Good Samaritan Medical Center,
Milwaukee, Doctor Smith was a
member of the American College
of Radiologists and the Roentgen
Ray Society. Surviving is his
mother of Bayside.
Marion K Ledbetter, MD, Tulsa,
Okla, died July 3, 1985 in Tulsa.
Born Nov 16, 1921 in Clarksville,
Tex, Doctor Ledbetter graduated
from the University of Oklahoma
School of Medicine and served
his internship at Methodist Hos-
pital, Indianapolis, Ind. Doctor
Ledbetter practiced medicine in
Madison where he was on the
medical staff of St Marys Hospital
Medical Center and also on the
faculty of the University of Wis-
consin Medical School. He
moved to Tulsa in 1979 and was
vice chairman and professor of
pediatrics at the Oral Roberts
University School of Medicine
and also chief of pediatric cardiol-
ogy at City of Faith Medical Re-
search Center at the time of his
death. Surviving are his widow,
Dixie; three sons, Marion, Madi-
son; Jeffrey, Seattle, Wash; and
Russell, Tulsa; three daughters,
Denise, Seattle, Wash; Robin,
Madison, and Laura of Tampa,
Fla.
Earl A Hatlebcrg, MD, 79, Chip-
pewa Falls, died July 11, 1985 in
Chippewa Falls. Born Feb 6,
1906, Doctor Hatleberg gradu-
ated from Rush Medical College,
Chicago, and served his intern-
ship at Swedish Covenant Hos-
pital in Chicago. His residency
was completed at the Monroe
Michigan Clinic Hospital. Doctor
Hatleberg practiced in Rice Lake
until 1941 when he entered the
United States Navy serving until
1946. He practiced in Chippewa
Falls until his retirement in
1976. He was a member of the
Chippewa County Medical So-
ciety, the State Medical Society of
Wisconsin, and the American
Medical Association.*
WISCONSIN MEDICAL JOURNAL, SEPTEMBER 1985: VOL. 84
33
BLUE BOOK UPDATE
On page 124 of the June Blue Book under
Managing Committee, Statewide Impaired Physician
Program, the new committee should read:
Gerald C Kempthorne, Ml), Spring Green, Chrmn
Roland E Herrington, Ml), Milwaukee
Fred H Koenecke Jr, MD, Madison
Arthur G Norris, Ml), Milwaukee
Michael M Miller, Ml), Eau Claire
William P McDaniel, MD, Milwaukee
On page 134 under Specialty Society officers, the
Wisconsin Society of Plastic Surgeons is as follows:
President John E Hamacher, MD (Aug 1986)
20 S Park St, Madison 53715
Secretary-Treasurer Sharon L Elias, MD (Aug 1986)
400 W Silver Spring Dr, Milwaukee 53217
Also, on page 132 under the Section on Plastic
Surgery the chairman and secretary are Doctors
Hamacher and Elias, respectively.
On page 122 under the Commission on Continuing
Medical Education, James T Houlihan MD, Wood-
ruff, has resigned.
On page 132 the Section on Therapeutic Radiology
has replaced the Section on Radiation Oncology;
therefore, the section officers under Radiation
Oncology should be listed under the Section on
Therapeutic Radiology, even though the specialty
society name is Wisconsin Society of Radiation
Oncologists.*
C E S
Foundation
of the State Medical
Society of Wisconsin
The Charitable. Educational and
Scientific Foundation of the
State Medical Society of Wis-
consin recognizes the generosity
of the following individuals and
organizations who have made
contributions during the months
of lune and July 1985.
JUNE
SPECIAL GIFTS
Elheldred Schaefer Estate
VOLUNTARY
CONTRIBUTIONS
Fred G Blum Jr, MD
Robert T Brazy, MD
Roy E Buck, MD
Donald E Chisholm, MD
Reynaldo P Gabriel. MD
Jack E Geist, MD
Olli Kaarakka, MD
Eugene M Kay. MD
Martin Klein, MD
Ronald L Kodras, MD
Loren A Leshan, MD
Jose V Montenegro III. MD
John S Rogerson, MD
Roger L Ruehl, MD
AESCULAPIAN
SOCIETY
Sustaining Membership
Clara V Hussey, MD
MUSEUM ENDOWMENT
FUND
Mrs W D Hoard, Jr
IMPAIRED PHYSICIAN
PROGRAM
Dr and Mrs Roland
Herrington
HARRINGTON-WRIGHT
SCHOLARSHIP FUND
Eau Claire/Dunn/Pepin County
Medical Auxiliary
POSTGRADUATE
WORKSHOP FOR
THE BASIC SCIENCES
Dr and Mrs Barry Rogers
JULY
VOLUNTARY
CONTRIBUTIONS
Larry R Brunziick MD
James H Fitzpatrick Jr, MD
Michael T Jaekels. MD
Howard H Johnson, MD
Roland R Liebenow, MD
Gerald T Mclnerrey, MD
Mei Fong Ngui, MD
Paul O Simenstad, MD
Waukesha County Medical
Auxiliary
BEAUMONT 500
State Medical Society of
Wisconsin
HARRINGTON-WRIGHT
SCHOLARSHIP FUND
Eau Claire/Dunn/Pepin County
Medical Auxiliary
Racine County Medical
Auxiliary
MEMORIALIZED
William E Bargholtz, MD
Desmond H Callaghan, MD
Rodney B Fruth. MD
Bruno J Peters, MD
Michael F Ries, MD
Raymond G Yost. MD
Roy Selby, MD
1985 Staff of the State
Medical Society of Wisconsin
MEMORIALS
SHEBOYGAN COUNTY
LOAN FUND
Sheboygan County Medical
Society Auxiliary*
34
WISCONSIN MEDICAL JOURNAL, SEPTEMBER 1985: VOL. 84
TABLETS
Sff ::,^
£^-
J-5491 June 1985
1<j85 The Upjohf i Company
The Upjohn Company
Kalamazoo, Michigan 49001 USA
I^john
Tbday, our children are computing basic math. Tomorrow,
they’ll be programming the future.
But before they can fill the computer screen with new
information, we’ll have to help fill ^eir minds. With
ideas. Information. Dreams. With the stimulation only a first-
rate college education can provide.
But they’ll need your help.
Because only with your help will colleges be able to cope
with the high cost of learning.
Rising costs and shrinking revenues are threatening the
abihty of colleges to provide the kind of education
tomorrow’s leaders will need to solve tomorrow’s problems.
So please give generously to the college of your choice.
You’ll be programming America for success for years
to come.
Give to the college of your choice.
CF
COUNOL FOR FINANCIAL AID TO EDUCATION INC A
> imKd
680 FIFTH AVENUE. NEW YORK f
BALAIICED
CALCIUM G
Low incidence of side effects
CARDIZEM® (diltiazem HCl)
produces an incidence of adverse
reactions not greater tlian that
reported with placebo therapy,
thus contributing to the patient’s
sense of well-being.
•Cardizem is indicated in the treatment of angina pectoris due to
coronary artery spasm and in the management of chronic stable
angina (classic efforbassociated angina) in patients who cannot
tolerate therapy with beta-blockers and/or nitrates or who remain
symptomatic despite adequate doses of these agents.
References:
1. Strauss WE, McIntyre KM, Parisl AE, et al: Safety and efficacy
of diltiazem hydrochloride for the treatment of stable angina
pectoris: Report of a cooperative clinical trial. Am J Cardiol
49:560-566, 1982. " "
2. Pool PE, Seagren SC, Bonanno JA, et aJ: The treatment of exercise-
inducible chronic stable angina with diltiazem: Effect on treadmill
exercise. Chest 78 (July suppl):234-238, 1980.
Reduces angina attack £reguency
42% to 46% decrease reported in
multicenter study
Increases exercise tolerance*
In Bruce exercise test,^ control
patients averaged 8.0 minutes to
onset of pain; Cardizem patients
averaged 9.8 minutes (P<.005).
GAKDEZEM
Cdiltiazem HCO
THE BALANCED
CALCIUM CHANNEL BLOCKER
Please see full prescribing Information on following page.
PROFESSIONAL USE INFORMATION
cordizem,
(dilliazem HCI)
AO mg and 60 mg tablets
DESCRIPTION
CARDIZEM*' (diltiazem hydrochloride) Is a calcium Ion influx
inhibitor (slow channel blocker or calcium antagonist) Chemically,
dlltiazem hydrochloride Is 1,5-Benzothlazepln-4(5H)one,3-(acetyloxy)
•5-[2-(dlmethylamlno)ethyl]-2,3-dlhydro-2-(4-methoxyphenyl)-,
monohydrochlorlde,(+) -els- The chemical structure Is
CHpCHjNICHjIj
Dlltiazem hydrochloride Is a white to oll-white crystalline powder
with a bitter taste It Is soluble In water, methanol, and chloroform
It has a molecular weight of 450 98 Each tablet o( CARDIZEM
contains either 30 mg or 60 mg dlltiazem hydrochloride (or oral
administration
CLINICAL PHARMACOLOGY
The therapeutic benefits achieved with CARDIZEM are believed
to be related to Its ability to Inhibit the Influx of calcium Ions
during membrane depolarization of cardiac and vascular smoofh
muscle
Mechanisms of Action. Although precise mechanisms of Its
antianginal actions are still being delineated, CARDIZEM Is believed
to act In the following ways:
f Angina Due to Coronary Artery Spasm CARDIZEM has been
shown to be a potent dilator of coronary arteries both epicardlal
and subendocardial Spontaneous and ergonovine-induced cor-
onary artery spasm are Inhibited by CARDIZEM
2 Exertional Angina CARDIZEM has been shown to produce
increases In exercise tolerance, probably due to Its ability to
reduce myocardial oxygen demand This is accomplished via
reductions in heart rate and systemic blood pressure at submaximal
and maximal exercise work loads
In animal models, dlltiazem interferes with the slow Inward
(depolarizing) current in excitable tissue It causes excitation-contraction
uncoupling In various myocardial tissues without changes In the
configuration of fhe action potential Dlltiazem produces relaxation
of coronary vascular smooth muscle and dilation of both large and
small coronary arteries at drug levels which cause little or no
negative inotropic effect The resultant increases In coronary blood
flow (epicardlal and subendocardial) occur In Ischemic and nonischemic
models and are accompanied by dose-dependent decreases In sys-
temic blood pressure and decreases In peripheral resistance
Hemodynamic and Electrophyslologic EHects. Like other
calcium antagonists, dlltiazem decreases sinoatrial and atrioventricu-
lar conduction In Isolated tissues and has a negative Inotropic effect
m isolated preparations In the Intact animal, prolongation of the AH
Interval can be seen at higher doses
In man, dlltiazem prevents spontaneous and ergonovine-provoked
coronary artery spasm It causes a decrease in peripheral vascular
resistance and a modest fall in blood pressure and. in exercise
tolerance studies In patients with Ischemic heart disease, reduces
the heart rate-blood pressure product for any given work load
Studies to date, primarily in patients with good ventricular function,
have not revealed evidence of a negative inotropic effect; cardiac
output, election fraction, and left ventricular end diastolic pressure
have not been affected There are as yet tew data on the Interaction
of dlltiazem and beta-blockers Resting heart rate is usually unchanged
or slightly reduced by dlltiazem
Intravenous dlltiazem in doses of 20 mg prolongs AH conduction
time and AV node functional and effective refractory periods approxi-
mately 20% In a study involving single oral doses of 300 mg of
CARDIZEM In six normal volunteers, the average maximum PR
prolongation was 14% with no instances of greater than first-degree
AV block Dlltlazem-assoclated prolongation of the AH Interval Is not
more pronounced In patients with first-degree heart block. In patients
with sick sinus syndrome, dlltiazem significantly prolongs sinus
cycle length (up to 50% In some cases).
Chronic oral administration of CARDIZEM In doses of up to 240
mg/day has resulted In small Increases In PR Interval, but has not
usually produced abnormal prolongation There were, however, three
Instances of second-degree AV block and one Instance of third-
degree AV block In a group of 959 chronically treated patients.
Pharmacokinetics and Metaboiism. Dlltiazem Is absorbed
from the tablet formulation to about 80% of a reference capsule and
Is subiect to an extensive first-pass effect, giving an absolute
bioavallablllty (compared to Inbavenous dosing) of about 40%. CARDIZEM
undergoes extensive hepatic metabolism In which 2% to 4% of the
unchanged drug appears In the urine. In vitro binding studies show
CARDIZEM Is 70% to 80% bound to plasma proteins Competitive
ligand binding studies have also shown CARDIZEM binding Is not
altered by therapeutic concentrations of dlgoxln, hydrochlorothiazide,
phenylbutazone, propranolol, salicylic acid, or warfarin. Single oral
doses of 30 to 120 mg of CARDIZEM result In detectable plasma
levels within 30 to 60 minutes and peak plasma levels two to three
hours after drug administration The plasma elimination half-life
following single or multiple drug administration is approximately 3,5
hours Desacetyl dlltiazem Is also present In the plasma at levels of
10% to 20% of the parent drug and Is 25% to 50% as potent a
coronary vasodilator as dlltiazem Therapeutic blood levels of
CARDIZEM appear to be In the range of 50 to 200 ng/ml There Is a
departure from dose-llnearlty when single doses above 60 mg are
given; a 120-mg dose gave blood levels three times that of the 60-mg
dose There Is no information about the effect of renal or hepaflc
Impairment on excretion or metabolism of dllflazem.
INDICATIONS AND USAGE
1 Angina Pectoris Due to Coronary Artery Spasm. CARDIZEM
Is Indicated In the treatment of angina pectoris due to coronary
artery spasm. CARDIZEM has been shown effective In the
treatment of spontaneous coronary artery spasm presenting as
Prinzmetal's variant angina (resting angina with ST-segment
elevation occurring during attacks)
2 Chronic Stabie Angina (Ciassic Edort-Associated Angina).
CARDIZEM Is Indicated In the management of chronic stable
angina CARDIZEM has been effective In controlled trials In
reducing angina frequency and Increasing exercise tolerance
There are no controlled studies of the effectiveness of the concomi-
tant use of dlltiazem and beta-blockers or of the safety of this
combination In patients with Impaired ventricular function or conduc-
tion abnormalities
CONTRAINDICATIONS
CARDIZEM Is contraindicated In (1) patients with sick sinus
syndrome except In the presence of a functioning ventricular pacemaker,
(2) patients with second- or third-degree AV block except In the
presence of a functioning ventricular pacemaker, and (3) patients
with hypotension (less than 90 mm Hg systolic).
WARNINGS
1 Cardiac Conduction. CARDIZEM prolongs AV node refrac-
tory periods without significantly prolonging sinus node recov-
ery time, except In patients with sick sinus syndrome This
effect may rarely result In abnormally slow heart rates (particularly
In patients with sick sinus syndrome) or second- or third-degree
AV block (six of 1243 patients for 0,48%). Concomitant use of
dlltiazem with beta-blockers or digitalis may result in additive
effects on cardiac conduction A patient with Prinzmetal's
angina developed periods of asystole (2 to 5 seconds) after a
single dose of 60 mg of dlltiazem.
2 Congestive Heart Faiiure. Although dlltiazem has a negative
inotropic effect in isolated animal tissue preparations, hemodynamic
studies In humans with normal ventricular function have not
shown a reduction in cardiac Index nor consistent negative
effects on contractility (dp/dt) Experience with the use of
CARDIZEM alone or in combination with beta-blockers in patients
with Impaired ventricular function is very limited Caution should
be exercised when using the drug In such patients
3 Hypotension. Decreases In blood pressure associated with
CARDIZEM therapy may occasionally result in symptomatic
hypotension
4 Acute Hepatic Injury. In rare Instances, patients receiving
CARDIZEM have exhibited reversible acute hepatic injury as
evidenced by moderate to extreme elevations of liver enzymes
(See PRECAUTIONS and ADVERSE REACTIONS.)
PRECAUTIONS
General. CARDIZEM (dlltiazem hydrochloride) Is extensively metab-
olized by the liver and excreted by the kidneys and In bile As with any
new drug given over prolonged periods, laboratory parameters should
be monitored at regular intervals The drug should be used with
caution In patients with Impaired renal or hepatic function In sub-
acute and chronic dog and rat studies designed to produce toxicity
high doses of dlltiazem were associated with hepatic damage In
special subacute hepatic studies, oral doses of 125 mg/kg and
higher In rats were associated with histological changes In the liver
which were reversible when the drug was discontinued In dogs,
doses of 20 mg/kg were also associated with hepatic changes;
however, these changes were reversible with continued dosing.
Drug Interaction. Pharmacologic studies Indicate that there
may be additive effects In prolonging AV conduction when using
beta-blockers or digitalis concomitantly with CARDIZEM. (See
WARNINGS).
Controlled and uncontrolled domestic studies suggest that con-
comitant use of CARDIZEM and beta-blockers or digitalis is usually
well tolerated Available data are not sufficient, however, to predict
the effects of concomitant treatment, particularly In patients with left
ventricular dysfunction or cardiac conduction abnormalities In healthy
volunteers, dlltiazem has been shown to increase serum dlgoxln
levels up to 20%
Carcinogenesis, Mutagenesis, Impairment of Fertility. A
24-month study in rats and a 21-month study in mice showed no
evidence of carcinogenicity. There was also no mutagenic response
in In vitro bacterial tests No intrinsic effect on fertility was observed
In rats
Pregnancy. Category C Reproduction studies have been con-
ducted In mice, rats, and rabbits Administration of doses ranging
from five to ten times greater (on a mg/kg basis) than the dally
recommended therapeutic dose has resulted In embryo and fetal
lethality These doses, in some studies, have been reported to cause
skeletal abnormalities. In the perinatal/postnatal studies, there was
some reduction In early Individual pup weights and survival rates.
There was an increased Incidence of stillbirths at doses of 20 times
the human dose or greater
There are no well-controlled studies in pregnant women; therefore,
use CARDIZEM in pregnant women only if the potential benefit
justifies the potential risk to the fetus
Nursing Mothers. It Is not known whether this drug Is excreted
in human milk Because many drugs are excreted In human milk,
exercise caution when CARDIZEM Is administered to a nursing
woman If the drug’s benefifs are thought to outweigh its potential
risks In this situation
Pediatric Use. Safety and effectiveness In children have not
been established
ADVERSE REACTIONS
Serious adverse reactions have been rate In studies carried out to
date, but It should be recognized that patients with impaired ventricu-
lar function and cardiac conduction abnormalities have usually been
excluded
In domestic placebo-controlled trials, the incidence of adverse
reactions reported during CARDIZEM therapy was not greater than
that reported during placebo therapy
The following represent occurrences observed in clinical studies
which can be at least reasonably associated with the pharmacology
of calcium Influx Inhibition In many cases, the relatlonsh'p to
CARDIZEM has not been established The most common occurrences,
as well as their frequency of presentation, are edema (2 4%),
headache (2.1%), nausea (1.9%), dizziness (1.5%), rash (1.3%),
asthenia (1.2%), AV block (1.1%). In addition, the following events
were reported infrequently (less than 1%) with the order of presenta-
tion corresponding to the relative frequency of occurrence
Cardiovascular
Nervous System:
Gastrointestinal
Dermatologic:
Other:
Flushing, arrhythmia, hypotension, bradycar-
dia, palpitations, congestive heart failure,
syncope
Paresthesia, nervousness, somnolence,
tremor. Insomnia, hallucinations, and amnesia.
Constipation, dyspepsia, diarrhea, vomiting,
mild elevations of alkaline phosphatase. SGOT,
SGPT, and LDH
Pruritus, petechlae, urticaria, photosensitivity.
Polyuria, nocturia
The following additional experiences have been noted:
A patient with Prinzmetal's angina experiencing episodes of
vasospastic angina developed periods of transient asymptomatic
asystole approximately five hours after receiving a single 60-mg
dose of CARDIZEM
The following postmarketing events have been reported infre-
quently in patients receiving CARDIZEM erythema multlforme; leu-
kopenia; and extreme elevations of alkaline phosphatase, SGOT,
SGPT, LDH, and CPK. However, a definitive cause and effect between
these events and CARDIZEM therapy Is yet to be established
OVERDOSAGE OR EXAGGERATED RESPONSE
Overdosage experience with oral dlltiazem has been limited
Single oral doses of 300 mg of CARDIZEM have been well tolerated
by healthy volunteers In tire event of overdosage or exaggerated
response, appropriate supportive measures should be employed in
addition to gastric lavage The following measures may be considered:
Bradycardia
High-Degree AV
Block
Cardiac Failure
Hypotension
Administer atropine (0.60 to 1.0 mg) If there
Is no response to vagal blockade, administer
isoproterenol cautiously.
Treat as lor bradycardia above Fixed high-
degree AV block should be treated with car-
diac pacing
Administer inotropic agents (isoproterenol,
dopamine, or dobutamlne) and diuretics.
Vasopressors (eg, dopamine or levarterenol
bltartrate).
Actual treatment and dosage should depend on the severity of the
clinical situation and the judgment and experience of the treating
physician
The oral/LDso’s in mice and rats range from 415 to 740 mg/kg
and from 560 to 810 mg/kg, respectively. The intravenous LD^'s in
these species were 60 and 38 mg/kg, respectively. The oral LDso in
dogs is considered to be in excess of 50 mg/kg, while lethality was
seen in monkeys at 360 mg/kg The toxic dose in man Is not known,
but blood levels in excess of 800 ng/ml have not been associated
with toxicity.
DOSAGE AND ADMINISTRATION
Eiertlonal Angina Pectoris Due to Atherosclerotic Coro-
nary Artery Disease or Angina Pectoris at Rest Dus to Coro-
nary Artery Spasm. Dosage must be adjusted to each patient's
needs Starting with 30 mg lour times dally, before meals and at
bedtime, dosage should be Increased gradually (given In divided
doses three or four times dally) at one- to two-day Intervals until
optimum response Is obtained Although Individual patients may
respond to any dosage level, the average optimum dosage range
appears to be 180 to 240 mg/day. There are no available data concern-
ing dosage requirements In patients with Impaired renal or hepatic
function. If the drug must be used In such patients, titration should be
carried out with particular caution
Concomitant Use With Other Antianginal Agents;
1 Sublingual NTG may be taken as required to abort acute
anginal attacks during CARDIZEM therapy
2 Prophylactic Nitrate Therapy -CARDIZEM may be safely
coadministered with short- and long-acting nitrates, but there
have been no controlled studies to evaluate the antianginal
effectiveness of this combination.
3 Bata4)lockers. (See WARNINGS and PRECAUTIONS.)
HOW SUPPLIED
Cardizem 30-mg tablets are supplied In bottles of 100 (NOC
0088-1771-47) and in Unit Dose Identification Paks of 100 (NOC
0088-1771-49). Each green tablet is engraved with MARION on one
side and 1771 engraved on the other CARDIZEM 60-mg scored
tablets are supplied in bottles of 100 (NOC 0088-1772-47) and in Unit
Dose Identification Paks of 100 (NDC 0088-1772-49) Each yellow
tablet Is engraved with MARION on one side and 1772 on the other.
Issued 4/1/84
Another patient benefit product from
PHARMACEUTICAL DIVISION
MARION
LABORATORIES INC
KANSAS CITY. MISSOURI 64137
SOCIOECONOMICS
Medicare participating physician issue update
With time running out on the
October 1 deadline for physicians
to make their Medicare deter-
minations on whether to be
'participating' or 'non-participat-
ing' under the second year of the
Deficit Reduction Act concept,
physicians still do not have the
decision-making information
they need since Congress has not
yet taken final action.
Under differing proposals
adopted by two separate com-
mittees the House would con-
tinue the fee freeze for another
year on 'non-participating' phy-
sicians. A House Ways and
Means Committee proposal
would grant reimbursement in-
creases of an unspecified amount
to participating physicians only,
and would continue the present
freeze on 'non-participating' phy-
sicians for 12 more months. How-
ever, under the approach adopted
by the Energy and Commerce
Committee, new reimbursement
tiers would be established. The
prevailing charge would be in-
creased at the FULL economic
index rate (approximately 4%) for
those physicians who:
—are currently 'participating'
and who continue to do so be-
ginning October 1, 1985; and
—are currently 'non-participat-
ing,' but who opt into the pro-
gram on October 1, 1985.
The prevailing charge would be
increased by one-half of the eco-
nomic index rate ( = approxi-
mately 2%) for those physicians
who:
—are currently 'participating,'
but who opt out of the pro-
gram beginning October 1,
1985; and
—are currently 'non-participat-
ing' and continue as such after
October 1, 1985, but are accept-
ing assignment on 100% of their
Medicare claims.
When Congress returned from
the recess on September 4, the
Senate Finance Committee was ex-
pected to consider the Medicare
fee freeze and 'participating/
non-participating' physician
issues. Those and other budget
matters likely will have to be
resolved in a House-Senate con-
ference. Because of the urgent
time constraints on physician
decision-making, the AMA plans
to notify the federation through
high-priority communciations
just as soon as Congress acts. The
State Medical Society also will
keep its members closely in-
formed regarding this issue and
recommends that physicians take
no definite contract action until
the final proposal is passed.*
Brown CMS plan
wins acclaim
A return-to-work program of
health cost containment started
by the Brown County Medical
Society with a local healthcare
coalition is being promoted as a
'model' by the American Medi-
cal Association. It is featured in a
28-page report by the AMA on
coalitions. Members may obtain
a copy by calling the AMA 312/
645-4716, Susan Kuntz.*
Medicare Participating Program Re-Cap
Below is a concise re-cap of the elements contained in the two proposals
affecting the Medicare participating physician issue.
Energy and Commerce Committee Proposal
84-85 Status 85-86 Status = Will Mean
Participating
Participating
Full economic
increase* in
prevailing charges
Non-participating
Participating
Full economic
increase* in
prevailing charges
Participating
Non-participating
1 /2 of a full
economic increase**
in prevailing charges
Non-participating
Non-participating
and accept assign-
ment on 100% of
Medicare patients
1 /2 of a full
economic increase"
in prevailing charges
Non-participating
Non-participating
Reimbursement and
charge levels will
continue to be
frozen for 12 months
House Ways & Means Committee Proposal
84-85 Status 85-86 Status = Will Mean
Participating or
Non-participating
Participating
Increase in
reimbursement
(not clear how much)
Participating or
Non-participating
Non-participating
Freeze in
reimbursement
and charge levels
will continue to be
frozen for 12 months
'Full economic increase = approximately 4%
"1/2 economic increase = approximately 2%
WISCONSIN MEDICAL JOURNAL, SEPTEMBER 1985: VOL. 84
39
SOCIOECONOMICS
AMP AC leader reports:
"Major upheaval in the health-
care environment is challenging
physicians to change the way in
which we practice medicine. We
in the medical community must
speak up, become a part of that
change, and guide the future
course toward the best possible
outcome for physicians and pa-
tients," American Medical Political
Action Committee (AMPAC)
Chairman Thomas R Berglund,
MD, told the AM A House of Dele-
gates.
In his report. Doctor Berglund
said AMPAC offered the best vehi-
cle for the medical community to
affect changes in the way physi-
cians practice medicine. Although
physicians' financial support of
AMPAC is vital for it to continue
the work that has earned it a repu-
tation as a respected leader and in-
novator in the political arena, this
is not enough, he said.
"Every interest group with a
special cause in Washington is rais-
ing money, particularly those with
an agenda opposing physicians' in-
terests. More importantly, those
groups are mobilizing their people.
encouraging their membership to
become active in the legislative
and political process. This upsurge
in grassroots activity is good for
democracy, good for America, and
good for physicians if we jump in-
to the parade and make it work to
our advantage," Doctor Berglund
said.
"Physicians and their spouses
can start by becoming AMPAC
members, but I urge you, in fact,
implore you to take one step be-
yond AMPAC membership— be-
come an active participant in the
political process. The excuse 'I am
too busy can no longer be used be-
cause you can give as little or as
much of your time as possible and
still have a crucial effect."
Beyond making a financial dona-
tion, the possibilities are endless,
he told the delegates. He offered
several suggestions for physicians:
To find a candidate who supports
their views and offer their services
as a health policy advisor, fund-
raiser, or campaign volunteer; to
participate at the local, state, or na-
tional level of party politics; or to
establish regular contact with
elected representatives to let them
know their views on certain issues.
Physicians need not stick to one
side of the political fence, nor all
group together under one party
banner. In fact, the more cam-
paigns we participate in, the more
certain we can be that our voices
will be heard on all sides," Doctor
Berglund said.
Doctor Berglund 's comments at
the June AMA meeting are true
not only at the national level but
also right here in Wisconsin.
Physician participation in the pro-
cess will help to effectively guide
the course of change.
1985-87 WISPAC
Board of Directors
William Treacy, MD, Milwaukee
DeLore Williams, MD, West Allis
Christina Keppel, MD, Milwaukee
Carl Eisenberg, MD, Milwaukee
Dean Miller, MD, Wauwatosa
Marcia Richards, MD, Milwaukee
Walter Gager, MD, Waukesha
Jay Schamberg, MD, Waukesha
Charles Pechous, MD, Kenosha
William Listwan, MD, West Bend
Donald Vangor, MD, Baraboo
Glenn Seager, MD, La Crosse
Bruce Hertel, MD, Rhinelander
Michael Mehr, MD, Marshfield
Kenneth Day, MD, Wausau
Paul Haskins, MD, River Falls
Philip Happe, MD, Eau Claire
John Oujiri, MD, Ashland
Charles Picard, MD, Superior
Henry Chessin, MD, Appleton
James Mattson, MD, Green Bay
Christopher Graf, MD, Sheboygan
Kenneth Viste, MD, Oshkosh
Darold Treffert, MD, Fond du Lac
Robert McDonald, MD, Madison
Sandra Osborn, MD, Madison
Mrs Bea Kabler, Madison
Timothy Flaherty, MD, Neenah
John K Scott, MD, Madison
Charles Landis, MD, Milwaukee
Robert Purtell, MD, Milwaukee
Mrs Jeri Cushman, Racine
Mrs Ann Shea, DePere
Mrs Jackie Dungar, Appleton*
40
WISCONSIN MEDICAL JOURNAL, SEPTEMBER 1985: VOL. 84
SAWVfH
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WAUKESHA
WAt-WORtH
KCMOSna
DISTRICT 1
Lois Riley
(414/271-4328)
County medical
societies
Milwaukee
Waukesha
Ozaukee
Washington
Sheboygan
Kenosha
Racine
Walworth
DISTRICT 4
County medical
societies
Ashland-Bayfield-
Iron
Douglas
Barron-Washburn-
Burnett
Sawyer
Polk
Pierce-St Croix
Chippewa
La Crosse
Monroe
Eau Claire-Dunn-
Pepin
Trempealeau-
Jackson-Buffalo
Vernon
Crawford
Price-Taylor
Rusk
Clark
DISTRICT 3
Deborah Bowen Wilke
(414/964-5046)
DISTRICT 2
Lanny Hardy
(608/257-6781)
County medical
societies
Columbia-Marquette
Adams
Green Lake-
Waushara
Lafayette
Richland
Jeffersor Dane
Green Dodge
Iowa Juneau
Grant Sauk
Rock
County medical
societies
Oneida-Vilas
Lincoln
Marinette-Florence
Forest
Langlade
Shawano
Outagamie
Brown
Door-Kewaunee
Calumet
Oconto
Marathon
Wood
Portage
Waupaca
Winnebago
Fond du Lac
Manitowoc
1985
Physicians
Alliance
Districts
and
Field Consultants
Physicians Alliance is a socio-
economic-leg islative-govern-
mental division of the State
Medical Society of Wisconsin
and is under the direction of the
Physicians Alliance Commis-
sion.
Turn of the century
trephine for cranial surgery
and tonsillotome for
removing tonsils.
We’ve been defending
doctors since
these were the
state of the art.
These instruments were the best available at
the turn of the century. So was our professional
liability coverage for doctors. In fact, we
pioneered the concept of professional
protection in 1899 and have been providing
this important service exclusively to doctors
ever since.
You can be sure we’ll always offer the most
complete professional liability coverage you
can carry. Plus the personal attention and
claims prevention assistance you deserve.
For more information about Medical
Protective coverage, contact your Medical
Protective Company general agent.
Jerome E. Kronsnoble, William E. Herte, 850 North Elm Grove Road, Elm Grove, WI 53122, (414) 784-3780
'Phvsician nicnihcrs of Stole Medical Society o/ VWsrf)/?5;«
PHYSICIAN BRIEFS
Albert J Motzel Jr, MD,* Wauke-
sha, has been elected vice-presi-
dent of medical staff affairs for
Waukesha Memorial Hospital.
Doctor Motzel joined the medical
staff of Waukesha Memorial Hos-
pital in 1958. He was appointed
director of medical education in
1971 and coordinator of medical
staff affairs in 1979. Since 1958
he has served on the faculty of
the Medical College of Wiscon-
sin, where he is now an associate
clinical professor of surgery.
Doctor Motzel served as presi-
dent of the State Medical Society
(1980-81) and president of the
Waukesha County Medical So-
ciety (1972-73).
P Michael Shattuck, MD, Berlin,
recently joined the medical prac-
tice of William C Piotrowski,
MD.* Doctor Shattuck graduated
from the Indiana University
Medical School and completed
his residency from the Fox Valley
Family Practice Residency Pro-
gram.
Mark H Andrew, MD, Viroqua,
recently joined the medical staff
of the Vig-Gundersen Clinic in
Viroqua. Doctor Andrew grad-
uated from the University of Wis-
consin Medical School, Madison,
and completed an internship and
residency at the Southwest Mich-
igan Area Health Education
Center, Kalamazoo, Mich.
Carol A Kotzan, MD, Madison,
recently joined the Jackson Clinic
and is the director of the Imme-
diate Care Department. Doctor
Kotzan is a graduate of the Uni-
versity of Michigan, Ann Arbor,
and the Medical College of Ohio,
Toledo. She served her intern-
ship at the Henry Ford Hospital,
Detroit, and completed her resi-
dency at the University of Wis-
consin Medical School, Madison.
Peter B Idsvoog, MD, Madison,
has joined the Department of In-
ternal Medicine at the Jackson
Clinic. Doctor Idsvoog graduated
from the University of Wisconsin
Medical School, Madison, where
he also completed his residency.
Prior to joining the Jackson
Clinic, Doctor Idsvoog served as
an emergency room physician at
St Claire Hospital in Monroe.
Joyce Brehm, MD, * Stoughton,
has begun her medical practice
with the Stoughton Dean Clinic.
Doctor Brehm graduated from
the University of Wisconsin
Medical School, Madison, and
completed her residency at the
University of Nevada Affiliated
Hospital. She formerly was as-
sociated with the Medical Center
of Monroe.
James R Kravig, MD, St Croix
Falls, has joined the medical staff
of River Valley Medical Clinic.
Doctor Kravig graduated from
the University of Minnesota
School of Medicine and com-
pleted his residency at Hennepin
County Medical Center.
Joseph B Fuller, MD, Superior,
recently became associated with
the Superior Clinic, Ltd. Doctor
Fuller graduated from the Uni-
versity of Iowa Medical School
and served his residency at the
University of Illinois College of
Medicine affiliated program.
Robert K Gribble, MD, Marsh-
field, has become associated with
the Department of Obstetrics and
Gynecology at the Marshfield
Clinic. Doctor Gribble graduated
from the University of Wisconsin
Medical School, Madison, where
he also completed his residency
at the University of Wisconsin
Hospital and Clinics.
Jess R Nickols Jr, MD, Monroe,
has begun his medical practice
with The Monroe Clinic. Doctor
Nickols served his internship at
the Baylor University Medical
Center, Dallas, TX, followed by
residencies at the University of
Arkansas and the University of
Massachusetts Medical School
in Worcester. He is a member of
the American Academy of Neu-
rology and will be associated with
MDs Sig Q Jew* and R Arthur
Gindin* in the Department of
Neurology and Neurosurgery at
the Clinic.
Kathleen Farah, MD, has become
associated with the medical staff
at Curtis Medical Clinic, Bald-
win. A graduate from the Univer-
sity of Minnesota Medical School,
Doctor Farah completed her resi-
dency in St Paul-Ramsey Medical
Center in Minnesota. The Clinic
is a division of Ramsey Clinic
which is based in St Paul. She
affiliated with the Baldwin Com-
munity Memorial Hospital.
Dana S Ziebcl, MD, Monroe, re-
cently became a member of the
medical staff of The Monroe
Clinic. Doctor Ziebel graduated
from the State University of New
York Upstate Medical Center in
Syracuse and completed her resi-
dency at Rush-Presbyterian-St
Luke's Medical Center in Chi-
cago.
David Chang, MD, Marshfield,
has joined the medical staff of the
Marshfield Clinic. Doctor Chang
graduated from the Korea Uni-
versity Medical School. He com-
pleted his residency at the Poly
Clinic Medical Center, Harris-
burg, PA, and the University of
Medicine and Dentistry in New-
ark, NJ. He also completed a fel-
lowship in pediatric anesthesiol-
ogy at Buffalo Children's Hospital
in New York.
Paul D Rasmussen, MD, Ocono-
mowoc, recently joined the
medical staff of the Wilkinson
Clinic SC. Doctor Rasmussen
graduated from the University of
Wisconsin Medical School, Madi-
son, and completed his internship
and residency at the Medical Col-
lege of Wisconsin in Milwaukee.
WISCONSIN MEDICAL JOURNAL, SEPTEMBER 1985: VOL. 84
43
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PHYSICIAN BRIEFS
Steven A Halsey, MD, Green Bay,
has joined Family Practice As-
sociates of Green Bay Ltd. He
graduated from the Mayo
Medical School, Rochester, MN,
and completed his residency at
Appleton in the Fox Valley Fam-
ily Practice Residency Program.
Douglas MacLean, MD, Mondovi,
recently Joined the Mondovi
Family Health Clinic. Doctor
MacLean is a graduate of the
University of Minnesota Medical
School where he also completed
his internship and residency.
Brian Harrison, MD, Mondovi,
recently Joined the Mondovi
Family Health Clinic. Doctor
Harrison graduated from the
Mayo Medical School in Roches-
ter, MN. He completed his resi-
dency at Appleton in the Fox Val-
ley Family Practice Residency
Program.
Kevin H Buggies, MD, Marsh-
field, has Joined the Department
of Neurosciences at the Marsh-
field Clinic. Doctor Ruggles grad-
uated from the University of
North Dakota School of Medicine
and served an internship at the
Medical College of Wisconsin,
Milwaukee. His residency was
completed at the National Naval
Medical Center, Bethesda, MD,
and at the National Institutes
of Health. He previously had
practiced at the Naval Regional
Medical Center in Oakland, CA.
Elson L So, MD, Marshfield, re-
cently became associated with
the Department of Neurosciences
at the Marshfield Clinic. Doctor
So graduated from the University
of Santo Tomas, Manila, The
Philippines, where he also served
his internship. His residency was
completed at the Bowman Gray
School of Medicine, Winston-
Salem, NC. Prior to Joining the
Clinic, Doctor So was an assistant
professor at the medical College
of Georgia, Augusta, and also was
the director of the EEC Labora-
tory at the Veterans Administra-
tion Medical Center in Augusta.
Paul A Caviale, MD, Manitowoc,
has Joined the medical staff of
Orthopaedic Associates of Mani-
towoc. Doctor Caviale is a grad-
uate of the Medical College of
Wisconsin, Milwaukee, and
served his internship at St Francis
Hospital, Wichita, KS. His resi-
dency was completed at St Fran-
cis Regional Medical Center in
Wichita.
Jodelle L Bentley, MD, Monroe,
has Joined the Department of Ob-
stetrics and Gynecology at The
Monroe Clinic. She graduated
from the University of Florida
College of Medicine in Gaines-
ville, and completed her intern-
ship and residency at the Uni-
versity of Texas Medical Center
Hospital. Prior to coming to Mon-
roe, Doctor Bentley was in pri-
vate practice with the Southwest
Medical Group in San Antonio,
TX.
Joseph M Benforado, MD, Madi-
son, has been elected vice presi-
dent of the United States Pharma-
copeial Convention for the term
from 1985-1990. Doctor Ben-
forado is professor of medicine at
the University of Wisconsin in
Madison. He is a graduate of the
New York State College of Medi-
cine at Syracuse and has taught
and did research in pharma-
cology at Harvard, Oxford, Eng-
land, and Buffalo. In his present
position as physician-clinical
pharmacologist, he teaches, sees
patients at the University Health
Service, and does consultation for
alcohol and other drug problems
at University Hospital and
Clinics, Madison. He has been a
USPC delegate since 1960 and
currently has review responsi-
bilities for the Credential Com-
mittee, Constitution and Bylaws
Committee, and USP Dl.
Robert K DeMott, MD, Lady-
smith, has Joined the medical
staff of Marshfield Clinic-Lady-
smith Center. Doctor DeMott
graduated from the University of
Wisconsin Medical School, Madi-
son, and completed his residency
at the University of Pittsburgh
Health Center.
William Janies Wittman, MD,*
Oconto Palls, recently became as-
sociated with Robert Artwich,
MD. * Doctor Wittman graduated
from the University of Minnesota
Medical School and completed
his internship at Sioux Valley
Hospital and his residency at the
Marshfield Clinic.
Sam Poser, MD, Columbus, has
Joined the Poser Clinic in Col-
umbus. Doctor Poser graduated
from the University of Wisconsin
Medical School, Madison, and
completed his residency at the
University of Hawaii.
Doctor Spellman Doctor Benforado
Robert J Spellman, MD,* New
Berlin, has been promoted to
medical director at the North-
western Mutual Life Insurance
Co in Milwaukee. Doctor Spell-
man was associate medical di-
rector before his promotion.
Doctor Spellman graduated from
Johns Hopkins Medical School,
Baltimore, in 1973. He is a mem-
ber of the teaching and examin-
ing faculty of the Board of Insur-
ance Medicine and also serves as
a consultant to the Risk Factor
Committee of the Wisconsin Heart
Association.
WISCONSIN MEDICAL JOURNAL, SEPTEMBER 1985: VOL. 84
45
PHYSICIAN BRIEFS
Richard A Cooper, MD, director
of the University of Pennsylvania
Cancer Center, has been named
dean and academic vice president
of the Medical College of Wis-
consin, Milwaukee. Doctor
Cooper, a native of Milwaukee,
returns after an absence of almost
30 years. He took office July 1,
1985. He currently serves on the
Advisory Group of the Presi-
dent's Cancer Panel/ ACS Survey
of Construction Requirements of
the Nation's Cancer Research
Facilities. He also serves on the
Cancer Center Support Review
Committee of the National Insti-
tutes of Health; and on the Food
and Drug Administration, Expert
for National Center for Drugs and
Biologicals. Doctor Cooper re-
ceived his BS degree from the
University of Wisconsin and is a
graduate of Washington Uni-
versity School of Medicine and
took his postgraduate training at
Boston City Hospital and at the
National Institutes of Health. He
has been director of the Uni-
versity of Pennsylvania Cancer
Center since 1977 and as asso-
ciate director since 1973.
Richard G Roberts, MD, * Dar-
lington, recently was appointed
to the Committee on Professional
Liability of the American Acade-
my of Family Physicians. The
Committee was created by the
Board of Directors for the pur-
pose of reviewing the medical
liability situation as it relates to
the family physician.
Larry McFariane, MD, recently
became associated with the
Riverview Clinic in Chippewa
Falls. Doctor McFariane grad-
uated from the University of Wis-
consin Medical School, Madison,
and completed his pediatric resi-
dency at the Marshfield Clinic/
St Joseph's Hospital in Marsh-
field. He most recently was in
private practice in Dickinson,
NDak.
Fred Ansfield, MD, * Clam Lake,
Emeritus Professor of Human
Oncology at the University of
Wisconsin, Madison, recently re-
ceived the "1985 Emeritus Fac-
ulty Award" from the Wisconsin
Medical Alumni Association for
his pioneering work in chemo-
therapy. Doctor Ansfield joined
the University of Wisconsin
Medical School in 1957. He is a
1933 graduate of the University
of Wisconsin Medical School and
served his internship and resi-
dency at the Milwaukee County
Hospital. He is a veteran, serving
in the US Army Medical Corps
during World War II, and the
recipient of the Bronze Star, the
Purple Heart, and the Silver
Star.H
AMA Physician's Recognition
Award Recipients
Listed below are those physicians in Wisconsin who have earned the
AMA Physician's Recognition Award in recent months. The State
Medical Society of Wisconsin congratulates these physicians who have
distinguished themselves and their profession by their commitment to
continuing education:
JUNE 1985
"Bauer, William, Milwaukee
"Bormann, Joel A, Cumberland
"Brazy, Robert R, West Allis
"Bujard, Robert S, Milwaukee
Coates, John T, Schofield
Cooper, Ronald J, Waukesha
"Dedmon, Robert E, Neenah
"El-Wakil, Mamdouh E, Superior
"Erickson, Scott S, Marshfield
"Fletcher, Fred W, Eagle River
"Freund, Bernard W, Kenosha
Gehring, Charles J, Sheboygan
Halsey, Steven A, Green Bay
"Handler, Bruce, La Crosse
Harrison, Brian D, Appleton
Johnson, Steven R, Milwaukee
Johnston, Hugh F, Madison
Korte, Stephen A, La Crosse
" Kunkel, James A, Marshfield
"Larson, Richard D, Marshfield
Maney, James P, Milwaukee
Me Laughlin, Janice M, Shorewood
Moore, Jordan A, Ashland
Neilley, Gregory S, Madison
"Praxel, Theodore A, Marshfield
"Rahr, Henry C, Green Bay
"Ramos, Teodoro M, Ripon
"Ries, Peter M, Marshfield
"Saladar, Rafael S, Beloit
"Schroeter, NealJ, Marshfield
"Shehab, Naglaa, Marshfield
Sperry, Leonard T, Milwaukee
'Members of the State Medical Society
of Wisconsin
Stone, Shirley J, Milwaukee
"Stueland, Dean T, Marshfield
"Sutton, Thomas M, Marshfield
"Tang, Thomas Tze-Tung, Milwaukee
Tempelis, Laurence, Wauwatosa
Thompson, Kenneth M, Milwaukee
Uber, Christine L, Wisconsin Rapids
"Zondlo, Joseph G, Green Bay
JULY 1985
"Alston, James A, Waukesha
"Brousseau, Edward R, Eau Claire
Chang, Chen -Kang, Madison
Factor, Robert M, Madison
"Falk, Victor S, Edgerton
"Galarnyk, Ihor A, Plain
"Gohdes, Paul N, Neenah
Hahn, Michael F, Janesville
"Halloran, William R, Milwaukee
"Holt, James J, Marshfield
"Josephson, Morton, Wauwatosa
"Kangayappan, Sivakami, Manitowoc
"Kim, Byung H, Racine
"Laing, Robert E, Racine
Miller, Lawrence H, Waupun
"Mills, E Grady, Marshfield
" Pederson, John F, La Crosse
Reganti, Venkata R, Neillsville
"Shapiro, Robert B, Madison
"Sovine, David L, Glendale
Thalberg, Steven A, Milwaukee
"Walbrun, Fred H, Pulaski
Waldron, John Becker, Rice Lake
* Walters-Jones, Beth, Reedsburg
"Zeldenrust, John C, Two RiversB
46
WISCONSIN MEDICAL JOURNAL, SEPTEMBER 1985: VOL. 84
OVER 66,000
FAMILY PHYSICIANS
READ THIS
JOURNAL
Practical information
on the medical aspects of
fitness and exercise.
Tennis elbow; Joint resolution by
conservative treatment.
Hypertrophic cardiomyopathy
and the athlete.
Effects of sunscreen use during
exercise in the heat.
Overuse injuries to the knee in
runners.
How I manage ingrown toenails.
the
physician
and
sfiortsniedicine
How I Manage Gout m Athletes
Heart Rate and PyCs Dunng Exercise
Current Status of Meniscus Surgery
CLASSICAL ITALIAN
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ELEGANT DINING • FINE WINES • INTIMATE
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ORGANIZATIONAL
Membership facts
Whether you're just starting medical school, maintaining a
full-time practice, or retiring, SMS has a membership classi-
fication to fit your individual needs. Election to membership
by the County Medical Society in which your principal place
of practice is located carries with it membership in the State
Medical Society of Wisconsin and, if you wish, the American
Medical Association. If you qualify for resident membership
at the time of your election, your membership dues are
greatly reduced. This may also qualify you for reduced dues
the first two years of your practice. In addition, two-physician
families may be eligible for a $50 discount on total SMS
membership dues. Dues for regular membership in 1986 are
$455 for SMS, $375 for AMA, and county society dues vary.
A more detailed listing of SMS membership classifications and
their corresponding dues follows:
State Medical Society of Wisconsin
DESCRIPTION OF MEMBERSHIP
CLASSIFICATIONS
Regular; Member in active practice. Some are regular mem-
bers that have reduced SMS and/or AMA dues because they
are new practitioners (first year or two out of residency).
Resident: Physician who at January 1 of dues year is in an
approved training program as a hospital resident or research
fellow who is licensed to practice medicine and surgery in
Wisconsin.
Military Service; Members who are serving in the U S. armed
forces (generally not to exceed five years).
Associate: Member whose dues are waived because of fi-
nancial hardship due to illness or disability. This classifica-
tion is temporary and is reviewed on an annual basis.
Life: Member who has held membership in a state medical
society for 50 years or is a Past President of the State Med-
ical Society of Wisconsin.
Honorary; Member who was named by the Board of Direc-
tors in recognition of long and distinguished service to ttie
cause of medicine.
15 MONTHS FOR THE PRICE OF 12!
Membership policy allows physicians to join their
county and state societies and the AMA, or just their
county and state societies. Physicians are encour-
aged to join organized medicine now. Regular mem-
bership dues for 1986 are: $455 for SMS, $375 for
AMA, and county society dues vary. However, phy-
sicians who join now will not pay any dues for the
balance of 1 985. That’s 1 5 months for the price of 1 2!
Membership applications may be obtained by con-
tacting the secretary of your county medical society
or by calling the Membership and Communications
Division at the State Medical Society offices in
Madison at 608/257-6781 or toll free; 800/362-9080. ■
Retired: Member who has completely retired from practice
(works less than 240 hours per year). All dues are waived
unless county society indicates they wish to charge county
dues.
Part-time Practice: Physician, regardless of age, who prac-
tices 1,000 hours or less during the calendar year but does
not qualify for retired membership.
Over Age 70: Member in active practice who is over 70 years
of age as of January 1.
Candidate: Member attending a medical school in Wiscon-
sin or fulfilling a postgraduate obligation prior to eligibility
for licensure.
Scientific Fellow: The Board of Directors may by invitation
and unanimous consent confer upon any person engaged in
teaching of or research in one or more of the basic sciences
at an accredited college or university, and not holding the
degree of Doctor of Medicine or Osteopathy, the status of
Scientific Fellow.
Emeritus: Retired members who have chosen not to renew
their license.
1986 DUES AMOUNTS FOR THESE
CLASSIFICATIONS
SMS
AMA
COUNTY
Regular
$455
$375
Normal County
Resident
45.50
45
Varies
Military Service
-0-
250 or 45
-0-
Associate
-0-
-0-
-0-
Life
-0-
-0-‘
-0-
Honorary
-0-
-0--
-0-
Retired
-0-
-0-'
-0-
Part-time Practice
227.50
375*
Normal County
Over Age 70
227.50
375*
Normal County
Scientific Fellow
-0-
-0-
Emeritus
-0-
-0-*
Candidate-
Freshman Year
Medical Student
-0-
20
Varies
Sophomore and
Succeeding Medical
Student Years
10
20
Varies
Postgraduate— One
10
45
Varies
'Physicians in the following categories may be eligible for exemption or reduc-
tion from paying AMA dues: (1) Financial hardship and/or disability. (2) Over 70
years of age or older and fully retired.
State Society dues are prorated on a monthly basis for
those elected to membership July 1 through September 30.
Those elected after September 30 have no dues payable for
the balance of the year in which they are elected. AMA dues
follow the same pattern except prorating is on a semiannual
basis rather than monthly basis.
To begin the membership process, if your practice is or will
be located in Wisconsin, or you have any questions, you may
contact your local county society or call the Membership
and Communications Division of the State Medical Society,
if in Wisconsin: 1-800-362-9080 (Madison area number:
257- 6781 ).■
48
WISCONSIN MEDICAL JOURNAL, SEPTEMBER 1985: VOL. 84
\
MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
Internist or psychiatrist who is Board
certified or eligible with training in in-
ternal medicine and psychiatry is de-
sired to direct a medical services de-
partment in a 150-bed psychiatric hos-
pital and coordinate consultation liaison
services with community health care
facilities and physicians. The hospital
is an agency of the Michigan Depart-
ment of Mental Health and is located in
Traverse City, Michigan, a diverse and
growing community on Lake Michigan
serving as a regional hub for north-
western lower Michigan. Traverse City
Regional Psychiatric Hospital is an
equal opportunity employer offering
regular hours, excellent benefits and
competitive salary. A position for a
qualified physician in internal medicine
or psychiatry, independent from other
specialty training may also be avail-
able. If interested, please contact G
Robert Miller, MD, Traverse City
Regional Psychiatric Hospital, Box C,
Traverse City, MI 49684. 9/85
OB/GYN: BC/BE to join three OB-GYNs
in 31-physician multispecialty group.
Beautiful lakefront community of 90,000
located between Milwaukee and
Chicago offers a wealth of cultural, edu-
cational, and recreational opportunities.
Well-equipped clinic and two local
hospitals; salary guarantee with in-
centive bonus; excellent fringe benefits
and early partnership. Send curriculum
vitae to: R D Lacock, Administrator,
Racine Medical Clinic, 5625 Washington
Ave, Racine, WI 53406. 9tfn/85
General and surgical solo practice for
sale. Gross in excess of $300,000. Grow-
ing desirable midwestern university
city with population 25,000. One very
well-equipped hospital in county of
60,000 a few blocks away. Owner will
remain to introduce. Contact Dept 563 in
care of the Journal. 9tfn/85
RATES: 50« per word, with a minimum
charge of $20.00 per ad. BOXED AD
RATES: $25.00 per column inch.
DEADLINE: Copy must be received by the
1 5th of the month preceding month of issue;,
e.g., copy for the August issue is due July 15.
Send copy to: Wisconsin Medical Journal,
Box 1109, Madison, Wisconsin 53701; or
phone (area code 608) 257-6781; or toll-free
in Wisconsin: 800/362-9080.
Ophthalmologist, subspecialty pediatrics
or glaucoma helpful but not required.
Board certified /Board eligible, to join one
other Board certified ophthalmologist in
rapidly expanding 40-member multi-
specialty group with high level ophthalmic
pathology. Must be willing to do general
ophthalmology. Immediate drawing area
100,000 with unopposed subspecialty re-
ferral area much higher. Located on Lake
Michigan with excellent recreational ac-
tivities. Optometric support available. First-
year salary. Association after one year with
income based solely on production with
superb benefits package. Contact D K Ay-
mond, MD, The Sheboygan Clinic, 1011
North 8 Street, Sheboygan, WI 53081; ph
414/457-4461. 9tfn/85
Pediatrics/Neonatology: Thirty-one
physician multispecialty group con-
veniently located between Chicago and
Milwaukee. Well-equipped clinic offer-
ing salary guarantee with incentive
bonus; excellent fringe benefits, and
early ownership. Neonatology skills
needed for Level II Nursery. Please send
curriculum vitae to R D Lacock, Admin-
istrator, Racine Medical Clinic, 5625
Washington Ave, Racine, WI 53406.
9tfn/85
General Internist. Marshfield Clinic,
one of the nation's largest multispecialty
private groups, is seeking several Board
certified/Board eligible General Internal
Medicine specialists to join its expanding
16-member section. Internal Medicine
Residency Program, University af-
filiation, Research Foundation, and large
regional referral base contributes to a
very stimulating environment. Unique
big city medicine opportunity in a
family-oriented rural setting. Please
send curriculum vitae to: John P Folz,
Assistant Director, Marshfield Clinic,
1000 North Oak Ave, Marshfield, WI
54449 or call collect at 715/387-5181.
9-11/85
Internist with or without subspecialty
interest. Board Certified or eligible, to
join six other internists in a well-estab-
lished, 23-man expanding multispecialty
group in prosperous lakeside south-
eastern Wisconsin city of 36,000. The
Internal Medicine Department currently
has subspecialties in cardiology, pul-
monary medicine, and medical on-
cology. Liberal fringe benefits. Initial
salary plus percentage as associate.
Full status in service corporation, with
incentive-oriented formula after first
year. Contact J F Kuglitsch, MD, Fond du
Lac Clinic, SC, 80 Sheboygan St, Fond
du Lac, Wis 54935; ph 414/923-7420
collect. 5tfn/85
Appleton, Wisconsin seeking phy-
sician for weekend coverage at family
practice clinic affiliated with local hos-
pital. Flexible hours and attractive com-
pensation. Submit resume to Emergency
Consultants, Inc, 2240 South Airport
Rd, Traverse City, MI 49684; 1-800/253-
1795 or in Michigan 1-800/632-3496.
p9/85
Primary care physicians — Family Prac-
tice, General Practice, or ER experience
desirable. To staff clinics for industrial,
walk-in, after hours and satellite medi-
cine. Excellent opportunity— guaranteed
salary, profit-sharing, great fringes.
Send CV to: Administrator, Manitowoc
Clinic, PO Box 3008, Manitowoc, WI
54220. 9-12/85
We are seeking three (3) Board certi-
fied/eligible family practice physicians
for a new Ambulatory Care Center in the
Milwaukee area; attractive work hours
and financial package. Please send CV or
call: Ms Debbie Carsky, Director of Re-
cruitment, MESA (Medical Emergency
Service Associates), 15 S McHenry Rd,
Buffalo Grove, IL 60089; 312/459-7304.
9/85
Family Practice: Thirty-one physician
multispecialty group conveniently lo-
cated between Chicago and Milwaukee.
Well-equipped clinic offering salary
gaurantee with incentive bonus; excel-
lent fringe benefits and early ownership.
Please send curriculum vitae to: R D
Lacock, Administrator, Racine Medical
Clinic, 5625 Washington Ave, Racine,
WI 53406. 9tfn/85
Ophthalmologist. Board certified/Board
eligible, to join one other Board certified
ophthalmologist in rapidly expanding
40-member multispecialty group with high
level ophthalmic pathology. Immediate
drawing area 100,000. Located on Lake
Michigan with excellent recreational activ-
ities. First-year salary. Association after one
year with income based solely on produc-
tion with superb benefits package. Contact
D K Aymond, MD, The Sheboygan Clinic,
1011 North 8 Street, Sheboygan, WI 53081;
ph 414/457-4461. 9tfn/85
Family Practice opportunity to join a
four-physician family practice group in
south central Wisconsin city of 15,000.
Pleasant community atmosphere within
1-1 Vi hours of Madison and Milwaukee.
Excellent recreational area. First year
guaranteed salary. Contact: Chad
Burchardt, Business Manager, Medical
Associates of Beaver Dam, Wis 53916; ph
414/887-7101. 5tfn/85
WISCONSIN MEDICAL JOURNAL, SEPTEMBER 1985: VOL. 84
49
MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
continued
Wanted Board Certified Otolaryngol-
ogist. Head and neck surgeon. Join active
one-man practice. General otolaryngol-
ogy, head and neck surgery, facial plastic
surgery, nasal allergy. Computerized of-
fice with x-ray, audiologist, and hearing
aid dispensing. Northern Wisconsin near
Apostle Islands National Lakeshore. Con-
tact James A Hamp, MD, ENT Profes-
sional Associates, SC, 2101 Beaser Ave,
Suite 1, Ashland, WI 54806; ph 715/682-
9311. 4-9/85
Internist. BC/BE to join Internal Medi-
cine Department of multispecialty group.
Excellent benefits and competitive salary.
Call or write: W J Mommaerts, Admini-
strator, West Side Clinic, sc, 1551 Dous-
man St. Green Bay, WI 53403;
ph 414/494- 5611 p6-9/85
Internist or Family Practitioner to join
two Internists and General Surgeon in
growing, established. Green Bay area
practice. Send CV to John Brusky, MD,
1203 South Military Ave, Green Bay, WI
53404. 7tfn/84
Physicians needed full or part-time to
perform light physicals. Milwaukee area.
Professional liability provided. Phone
414/344-2100, Ms Jenkins. lOtfn/84
MESA is on the MOVE
in
Northern Illinois, Wisconsin
and the Chicagoland Area
We are seeking Board Certified/
eligible and Emergency Trained
Physicians to join our growing
organization.
• Compensation/Benefit Packages
are highly competitive with adminis-
trative and educational support
services.
• Management and Staff positions
for Emergency Departments and
Ambulatory Care Centers.
• Excellent communication skills
and the desire to excel in Emergency
Medicine is a necessity.
MESA Medical Emergency Service
Associates, SC over 20 years of
excellence in Emergency Medicine.
Contact: Ms Debbie Carsky, Director
of Recruitment, 312/459-7304 (collect)
or write to 15 South McHenry Road,
Buffalo Grove, IL 60090. 9/85
Urgent care physician and internist.
Opportunities available as clinic services
expand. This 35-member multispecialty
group, including 13 internists, is housed
in a modern facility next to the 240-bed
Mercy Hospital and has a drawing area of
100,000. Send CV with inquiry: Ernest C
Deeds, MD, Box 551, Janesville, WI
53547. p8, 9/85
Wisconsin: Pediatrician with sub-
specialty interest to join multispecialty
clinic that includes general pediatricians,
pediatric hematologist, oncologist and
neonatologist in city of 150,000. Send
CV to Dept 561 in care of the Journal.
8tfn/85
Emergency physicians wanted. Part-
time positions available in a moderate
volume emergency room in Beloit, Wis.
Must have an active interest in com-
munity relations. ACLS required. ATLS
desirable. If interested, contact John
Maher, MD, Director, Emergency De-
partment, Beloit Memorial Hospital,
1969 W Hart Rd, Beloit, WI 53511.
8-9/85
Family practice physician, internist
and OB/GYN physicians needed to join
a multispecialty clinic in NE Wisconsin.
Excellent starting salary, full benefits,
partnership one year, HMO affiliated.
Contact Stephen C Caselton, MD, 2152
Riverside Ave, Marinette, Wis 54143;
ph 715/732-2211. p8- 10/85
Versatile Surgeon wanted to comple-
ment aggressive family practice group in
rural northeastern Minnesota resort com-
munity. Well-equipped 40-bed hospital
with proven surgical practice volume.
Outstanding outdoor recreational op-
portunities with time off to enjoy it.
Reply with CV to E Johnson, Ely Medical
Center, Ltd, 224 East Chapman Street,
Ely, Mn 55731; ph 218/365-3151. 6tfn/85
FAMILY PRACTITIONERS
INTERNISTS, OB/GYN
The U W Office of Rural Health is seek-
ing primary care specialists for more
than 50 communities throughout Wis-
consin. Opportunities are available
throughout Wisconsin for Board certi-
fied physicians trained in US medical
schools and residencies.
CONTACT:
Laurie Glowac or Fred Moskol
New Physicians for Wisconsin
University of Wisconsin
Department of Family Medicine
777 S Mills St, Madison, WI 53715
Phone 608/263-4095 7/85-6/86
Cardiology position desired in the
metropolitan Milwaukee area. University
trained in both invasive and noninvasive
cardiology. Heavy emphasis throughout
training in all aspects of critical care.
Board certified in internal medicine. Will
complete fellowship and be available in
August or September of 1986. Interested
parties should contact Dept 560 in care of
thejournal. 8-10/85
Internist-Infectious Disease Phy-
sician. The Racine Medical Clinic, a pro-
gressive cluster corporation of 32 phy-
sicians, is currently seeking an Internist-
Infectious Disease physician. Full bene-
fits, unlimited earnings and a full and
exciting practice are offered. Please con-
tact: Roger D Lacock, Administrator,
Racine Medical Clinic, 5625 Washington
Ave, Racine, WI 53406; ph 414/886-
5000. 6tfn/85
Family Practitioner needed to join
established Family Practice group in East
Central Wisconsin city of 50,000 on
beautiful Lake Winnebago. Competitive
salary, fringes, excellent recreation area.
Send CV to MS Knier, MD, 555 S Wash-
burn, Oshkosh, Wis 54901; 414/426-0265.
lOtfn/84
Second Family Practitioner needed to
staff a satellite of a 38-physician multi-
specialty group in Kiel, a beautiful small
community in East Central Wisconsin. At-
tractive income arrsingements, association
membership possible after one year, pen-
sion and profit sharing, extensive fringe
benefits. Contact R B Windsor, MD, 1011
North 8 St, Sheboygan, WI 53081; ph 414/
457-4461. c2tfn/85
Board Eligible Orthopedic Surgeon to
join established orthopedic practice in
East Central Wisconsin. Contact Dept 553
in care of the Journal. 2tfn/85
This space available
BOXED: $67.50
(IV2 column inches)
50
WISCONSIN MEDICAL JOURNAL, SEPTEMBER 1985: VOL. 84
MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
continued
West Bend, Wisconsin, General Clin-
ic, a (18) physician multispecialty group,
is seeking physicians in the specialties of
Internal Medicine, Family Practice, OB/
GYN, and Pediatrics. First-year salary
guaranteed. Corporate membership pos-
sible after one year. Excellent fringe
benefits. Located in scenic, recreational
area with close proximity to Milwaukee.
Please contact Hans W Schmelzling, Ad-
ministrator, General Clinic, 279 S 17th
Ave, West Bend, WI 53095; ph 414/338-
1123. 6tfn/85
Otolaryngologist. BC/BE to join busy
ENT Department within 23-member
multispecialty group. Excellent benefits
and competitive salary. Call or write: W J
Mommaerts, Administrator, West Side
Clinic, sc, 1551 Dousman St, Green
Bay, WI 53403; ph 414/494-5611.
6-9/85
Obstetrician/Gynecologist, Board eli-
gible/certified, for Green Bay metropoli-
tan area. Large multispecialty clinic with
excellent salary and benefits. Call or
write: W J Mommaerts, Administrator,
West Side Clinic, sc, 1551 Dousman St,
Green Bay, WI 53403; ph 414/494-
5611 p6-9/85
OB/GYN, and internist to join seven-
doctor family practice clinic in Cloquet,
Minnesota, a community of 14,000 (30,
000) service area, located 20 minutes
from Duluth-Superior. Clinic facility is
located one block from modern, well-
equipped, 77-bed hospital. Cloquet
enjoys a stable economy (forest
products). Additionally our community
is noted for its excellent school system.
First-year salary guarantee; paid mal-
practice, health, and disability insur-
ance; vacation and study time. Con-
tact John Turonie, Administrator,
Baiter Clinic Ltd, 417 Skyline Blvd, Clo-
quet, Minnesota 55720. Telephone
218/879-1271. 7-9/85
Family Practitioner needed to join two
FPs at the Ellsworth, Wisconsin office
of a progressive eleven-physician group.
Liberal fringes and financial package.
Forty miles from metropolitan Min-
neapolis/St Paul. Contact R M Hammer,
MD, River Falls, WI 54022; ph 715/425-
6701 or 612/436-8809. 4tfn/85
Wanted— Board qualified— board cer-
tified obstetrician-gynecologist as an
associate. Modern well equipped facility.
Excellent starting salary and benefits in-
cluding profit sharing plan. Please contact
Elizabeth Allen Steffen, MD, 734 Lake
Ave, Racine, Wis 54303. 9tfn/83
Attractive opportunity for a Board
certified/eligible family physician to es-
tablish a new community practice. The
family practitioner will be eligible for
full-hospital privileges at Beloit Memorial
Hospital, a medium-sized acute care
facility. This opportunity offers a guaran-
teed financial and start-up package. In-
quiries or CV should be directed to
Gregory K Britton, Administrative Direc-
tor, Beloit Memorial Hospital, 1969 West
Hart Road, Beloit, Wisconsin 53511; ph
608/364-5104. p6-8;g9/85
Excellent opportunity for a Board cer-
tified or eligible internist to practice
in conjunction with an 8-member Inter-
nal Medicine Department of a 26-mem-
ber multispecialty group. The group is
located in southeastern Wisconsin, in a
city of 100,000 between two major
metropolitan areas of greater than one
million. If interested, please send CV to:
Stephen L Wagner, Kurten Medical
Group, 2405 Northwestern Ave, Racine,
WI 53404. All inquiries will be kept
confidential. 6tfn/85
MEDICAL MEETINGS-
CONTINUING MEDICAL
EDUCATION
WISCONSIN
SEPTEMBER 27-29, 1985: Wisconsin
Psychiatric Association, Wisconsin
Center, Madison. g9/85
OCTOBER 4-5, 1985: Wisconsin Asso-
ciation Parenteral Enteral Nutrition Third
Annual Symposium: The State-of-the-Art in
Nutritional Support 1985. Marriott Hotel,
Brookfield, WI. Outstanding guest
speaker panel. Joni Newborn 414-289-
8306 or Patricia Brosier 608-364-5011.
p8/85; g9/85
OCTOBER 5-6, 1985: Wisconsin Al-
lergy Society, Hyatt, Milwaukee. g9/85
OCTOBER 10-11, 1985: Fall Sympo-
sium of Wisconsin Chapter: American
College of Emergency physicians &
Emergency Department Nurses As-
sociation. The Abbey, Fontana.
g7-9/85
OCTOBER 10-11, 1985: Update in Al-
lergy and Clinical Immunology II. The Inn-
Tower Hotel, Madison. Sponsored by De-
partment of Continuing Medical Educa-
tion and Department of Medicine, School
of Medicine, University of Wisconsin-
Madison. AMA Category I, University of
Wisconsin CEUs. Family Practice credit
has been applied for. Approximately 11
hours. Info: Ann Bailey, Continuing
Medical Education, 454 WARF Bldg, 610
Walnut St, Madison, WI 53705; ph 608/
263-2854. 7-9/85
OCTOBER 18, 1985: Understanding and
Caring for the Person with Dementia jinclud-
ing Alzheimer's Disease I. Ross Levine, MD,
Miriam Oliensis-Torres, MSW, faculty.
Holiday Inn, Fond du Lac, WI. Approved
for 5 hours of AMA/PRA Category I
credit. Fee: $30. Info: Training Depart-
ment, Mendota Mental Health Institute,
301 Troy Dr, Madison, WI 53704; ph 608/
244-2411. 9/85
OCTOBER 25-26, 1985: 1985 Confer-
ence on Back Pain Rehabilitation, Apple-
ton, Wisconsin. Sponsored by Theda
Clark Regional Medical Center, Neenah;
and Continuing Medical Education,
School of Medicine, University of Wis-
consin-Madison. AMA Category I, and
Continuing Education Hours— both
approximately 1 1 hours. Contact Sarah
Aslakson, Continuing Medical Educa-
tion, 610 Walnut St, 465B WARF Bldg,
Madison, WI 53705; ph 608/263-2856.
9/85
OCTOBER 26, 1985: Wisconsin Derma-
tological Society, Froederdt Memorial
Lutheran Hospital, Milwaukee. g6-9/85
NOVEMBER 1-2, 1985: Seminars in
Pediatrics. The University of Wisconsin
Clinical Science Center, Madison. Spon-
sored by the Departments of Pediatrics
and Continuing Medical Education,
School of Medicine, University of Wis-
THIS LISTING is compiled by the State
Medical Society of Wisconsin in coopera-
tion with others who wish to maintain a
centralized schedule of meetings and
courses of interest to Wisconsin physicians
and to avoid scheduling programs in conflict
with others. Hospitals, Clinics, Specialty
Societies, and Medical Schools are par-
ticularly invited to utilize this listing service.
There is a nominal charge for listing of Con-
tinuing Medical Education courses at the
following rates: 50c per word, with a mini-
mum charge of $20.00 per listing.
BOXED LISTINGS: $25.00 per column
inch. Listings of other scientific meetings
will be included at the discretion of the
editors.
COPY DEADLINE tor listings is 15th of the
month preceding the month of publication;
e.g., copy for the August issue is due by July
15. Address communications to: Wisconsin
Medical Journal, Box 1109, Madison, Wis-
consin 53701; or phone (area code 608)
257-6781; or toll-free in Wisconsin; 800/
362-9080.
FOR LISTING of other meetings see the
January 4, 1985 issue of the Journal of the
American Medical Association: Continuing
Education Opportunities for Physicians for
period January 1985 through December
1985.
WISCONSIN MEDICAL JOURNAL, SEPTEMBER 1985: VOL. 84
51
MEDICAL YELLOW PAGES
MEDICAL MEETINGS-
CONTINUING MEDICAL
EDUCATION
continued
consin-Madison. AMA Category I, AAFP
Prescribed, AOA Category 2-D, and
University of Wisconsin CEUs— all
approximately 11 hours. Contact: Sarah
Aslakson, Continuing Medical Educa-
tion, 465B WARE Bldg, 610 Walnut
St, Madison, W1 53705; ph 608/263-2856.
9/85
NOVEMBER 8, 1985: Recognizing and
Treating Anxiety, Fear, and Phobias in Chil-
dren. Thomas Kratochwill, PhD, faculty.
Conference Center, Mendota Mental
Health Institute, Madison, WI. Approved
for 6 hours of AMA /PR A Category I
credit. Fee: $30. Info: Training Depart-
ment, MMHI, 301 Troy Dr, Madison, WI
53704: ph 608/244-2411. 9/85
NOVEMBER 15-16, 1985: Treating
Depression and Manic-Depression Clinical
Update— 1985, Sheraton Convention
Center, Madison. Sponsored by Center
for Affective Disorders and Lithium
Information Center, University of Wis-
consin Department of Psychiatry, and
University of Wisconsin-Extension, De-
partment of Continuing Medical Ed-
ucation. AMA Category I— 10 hours; Uni-
versity of Wisconsin Continuing Educa-
ADVANCES AND
CONTROVERSIES IN
CARDIOLOGY- 1985
1985 AHA of Wisconsin
Annual Meeting
Friday, October 25, 1985
Hyatt Regency Hotel,
Milwaukee
8:30 am -3:30 pm
Special Presentations
by Top Experts on;
• Predictors of Outcome in
Patients with Coronary Disease
• Stress Test vs Radionucleide
Study vs Coronary Angiography
• TPA in Acute Myocardial
Infarction
• Magnetic Resonance in
Cardiac Diagnosis
CEU and CME Credits
To register or for additional
information contact: American
Heart Association of Wisconsin,
795 North Van Buren St, Mil-
waukee, Wisconsin 53202; ph
414/271-9999 or 800/242-9236.
9/85
lion Unit— 1.0. Fee: $175 includes one
lunch and refreshment breaks. Info: Ann
R Bailey, CME, 454 WARE Bldg, Madi-
son, WI 53705; ph 608/263-2854. 9/85
NOVEMBER 16, 1985: Wisconsin
Society of Pathologists, American Club,
Kohler. g9- 10/85
NOVEMBER 18-21, 1985 (Louisiana):
A Primary Care Update, the 70th Scientific
Assembly of Interstate Postgraduate
Medical Association. Accredited by ACC-
ME and eligible for 24 hours of Category
1 and 4 hours of Category 5 credit of the
AMA/PRA. Acceptable for 24 prescribed
hours credit by American Academy of
Family Physicians and 24 hours by the
College of Family Physicians of Canada.
Info: IPMANA, PO Box 1109, Madison,
WI 53701 g9-10/85
NOVEMBER 21-23, 1985: Update in
Infectious Diseases 1985. University of
Wisconsin Clinical Science Center,
Madison. Sponsored by Section of In-
fectious Disease, Department of Medi-
cine, and Continuing Medical Educa-
tion, School of Medicine, University of
Wisconsin, in cooperation with the
University of Wisconsin Hospital and
Clinics. AMA Category I, University of
Wisconsin CEUs— both 19 hours;
AAFP credit pending. Contact: Sarah As-
lakson, Continuing Medical Education,
610 Walnut St, 465B WARF Bldg, Madi-
son, Wisconsin 53705; ph 608/263-2856.
9/85
BIOFEEDBACK SOCIETY
OF WISCONSIN
1985 Annual Conference
La Crosse, November 8-10, 1985
Topics include; Optimizing Trans-
fer of Self-Regulation Training;
and Brain and Peripheral Laterli-
zation; by Charles Stroebel, MD,
PhD-past president, Biofeedback
Society of America.
Biofeedback Treatment in Chil-
dren and Adolescents by Elizabeth
Stroebel, MS, MEd— Hartford,
Conn.
Issues of Patient Compliance in Bio-
feedback Practice by Mark
Schwartz, PhD— Mayo Clinic.
For more information, contact
University Counseling Center,
UW-Stout, Menomonie, WI
54751; ph 715/232-2468. p9/85
JANUARY 25-FEBRUARY 1, 1986:
Sports Medicine Cruise Seminar, SS Consti-
tution, Hawaiian Islands. Sponsored by
University of Wisconsin School of Medi-
cine, Continuing Medical Education.
AMA Category I credit 16 hours. Family
Practice credit pending, and 16 hours
University of Wisconsin CEUs. Contact:
Ann Bailey, Department of Continuing
Medical Education, 454 WARF Bldg, 610
Walnut St, Madison WI 53705; ph 608/
263-2854. 7-9/85
OTHERS
OCTOBER 17-18, 1985 (Minnesota):
Toxic Chemicals in the Workplace: Health,
Legal, and Regulatory Issues, Earle Brown
Continuing Education Center, St Paul.
Info: Bonnie Young, CME, St Paul-
Ramsey Medical Center, 640 Jackson St,
St Paul, MN 55101; ph 612/221-3977.
g6-9/85
OCTOBER 25, 1985 (Minnesota): Pro-
moting Healthy Lifestyles For Pregnant
Women, Earle Brown Continuing Educa-
tion Center, St Paul. Info: Bonnie Young,
CME, St Paul-Ramsey Medical Center,
640 Jackson St, St Paul, MN 55101; ph
612/221-3977. g6-9/85
State Medical Society
of Wisconsin
Dates and locations of
ANNUAL MEETINGS
1986-1992
All meetings will be held in Milwau-
kee at the Milwaukee Exposition and
Convention Center and Arena
(MECCA) and the new Hyatt Regency
as the headquarters hotel.
1986- April 17-19
1987- March 26-28
1988- April 28-30
1989- April 13-15
1990- April 26-28
1991- April 18-20
1992- April 23-25
Meeting days will be Thursday and
Friday; the first session of the House
of Delegates will convene on Thurs-
day, the second and third on Friday.
Scientific programming will be on Fri-
day and Saturday.
Further information: Commission on
Continuing Medical Education, State
Medical Society of Wisconsin, Box
1 109, Madison, Wis 53701. Local tele-
phone; 257-6781; toll-free in Wiscon-
sin: 1-800/362-9080.
52
WISCONSIN MEDICAL JOURNAL, SEPTEMBER 1985: VOL. 84
MEDICAL YELLOW PAGES
MEDICAL MEETINGS-
CONTINUING MEDICAL
EDUCATION
continued
NOVEMBER 14 16, 1985 (Minnesota):
Clinical Strategies In Primary Care Medi-
cine, Radisson Plaza Hotel, St Paul. Info;
Bonnie Young, CME, St Paul-Ramsey
Medical Center, 640 Jackson St, St Paul,
MN 55101; ph 612/221-3977. g6-10/85
DECEMBER 4-6, 1985: (Illinois):
Neurology for the Non-Neurologist, The
Westin Hotel, Chicago. Contact: Uni-
versity Office of Continuing Education,
Rush University, 600 S Paulina, Chicago,
IL 60612; ph 312/942-7095. p9-ll/85
DECEMBER 5-7, 1985 (Minnesota):
Coronary Heart Disease: A Comprehensive
Review of Principles and Practice, Sheraton
Midway Hotel, St Paul. Info: Bonnie
Young, CME, St Paul-Ramsey Medical
Center, 640 Jackson St, St Paul, MN
55101; ph 612/221-3977. g6-ll/85
DECEMBER 27-30, 1985 (Florida):
Third International Symposium on Electro-
physiologic Basis for Diagnosis and Man-
agement of Cardiac Arrhythmias. Wynd-
ham Hotel, Orlando, FL. Sponsored by
University of Wisconsin, Continuing
Medical Education: Mount Sinai Medical
Center, Milwaukee, Wisconsin; Ameri-
can Heart Association (Central Florida
and Wisconsin Affiliates); Florida Heart
Institute, Orlando, Florida; and Con-
tinuing Education and Research Foun-
dation, Elm Grove, Wisconsin. AMA
Category I, AAFP Elective, AOA Cate-
gory 2-D, and University of Wisconsin
CEUs— all 19 hours. Contact: Sarah
Aslakson, University of Wisconsin, Con-
tinuing Medical Education, Room 465B
WARE Bldg, 610 Walnut St, Madison,
WI 53705; ph 608/263-2856. 9/85
FEBRUARY 11-16, 1986 (Mexico):
15th Annual Pediatric Postgraduate
Course: Pediatric Update 1986, at Camino
Real, Cancun, Mexico. Sponsored by: De-
partment of Pediatrics of the Schneider
WEEKLY SEMINARS
Most major ski areas. Club Med,
Disney World, Cruising aboard
Sailboats in the Virgin Islands or a
Mississippi Paddlewheeler. Topic:
Medical-legal issues.
Current Concept Seminars, Inc
(since 1980). 3301 Johnson St,
Hollywood, FL 33021; ph 800/
428-6069. $175. p9-12/85; 1-2/86
Children's Hospital, Long Island Jewish
Medical Center. Approved 21 credit
hours in Category 1 ACCME; AMA/PRA
and approval pending AAFP. Info: Ann J
Boehme, CME, Long Island Jewish
Medical Center, New Hyde Park, NY
1 1042; ph 718/470-8650. 9/85
FEBRUARY 13-14, 1986 (Michigan);
Tenth Annual Winter Pediatric Confer-
ence at Powderhorn Ski Area, Ironwood,
National Conference
on Health Policy
and Quality of Care
for Older Americans
Tuesday and Wednesday
November 12-13, 1985
Alexandria, Virginia
Radisson Mark Plaza Hotel
Cosponsors:
American Medical Association
American Association
of Retired Persons
American Hospital Association
American Nurses' Association
Conference Headquarters:
(312) 645-4727
Because of the paramount im-
portance of the critical issues
involved in assuring high quality
healthcare for older Americans,
the cosponsors are joining forces
to heighten a sense of common-
ality and interdisciplinary under-
standing of the problems that
confront the medical community.
Emphasis will be placed on the
vital areas of financing, delivery,
and assurance of high quality
healthcare.
Who should attend: All concerned
with healthcare and aging policy
including Congressional Mem-
bers, Government and Agency
Staff, Healthcare Professionals,
Institutional Administrators and
Staff, Advocates for Older Ameri-
cans.
Registration fee: $175 includes
admission to all sessions, two
lunches, and a reception.
Reservations: Call toll-free 1-800-
621-8335.
James H Sammons, MD, Execu-
tive Vice President of the Ameri-
can Medical Association, urges
physicians to attend this first
National Conference of its kind.
Michigan. Guest speaker is James A
Stockman, III, MD. Info: Marshfield
Medical Education Department or H
James Nickerson, MD, Marshfield Clinic,
1000 North Oak Ave, Marshfield, Wis-
consin 54449. 9-12/85:1-86
AMA
DECEMBER 8-11, 1985: Interim AMA
House of Delegates, Washington, DC.
JUNE 15-19, 1986: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 7-10, 1986: Interim AMA
House of Delegates, Las Vegas, NV.
JUNE 2 1-25, 1987: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 6-9, 1987: Interim AMA
House of Delegates, Atlanta, GA.
JUNE 26-30, 1988: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 4-7, 1988: Interim House
of Delegates, Dallas, TX. ■
ADVERTISERS
Abbott Northwestern 10, 11
Acme Laboratories 29
Advanced Technology Associates,
Inc 14
Medical Computer Systems
Air Force Medicine 44
American Physicians Life 4
Army Medicine 30
Army Reserve 29
Centralized Billing Systems 44
CyCare 7
Dista Products Co (Div of Eli
Lilly & Co) 13
Keflex®
House of Bidwell 9
Leasenu 8
Marion Laboratories 37, 38
Cardizem®
Med Flight 6
Medical Protective Company 42
Navy Medicine 29
PBBS Equipment 9
Peppino's 47
Physician and Sportsmedicine,
The 47
Professionals Insurance
Company, The 25
Roche Laboratories 55, BC
Dalmane®
S&L Signal Company 29
SMS Services, Inc 26
Upjohn Company, The 35
Motrin® ■
WISCONSIN MEDICAL JOURNAL, SEPTEMBER 1985: VOL. 84
53
NEWS YOU CAN USE
MALPR-XCTICE CONFERENCE TAPES AVAILABLE. Audiocassette tapes are now available from the May 10-1 1
medical malpractice conference sponsored by the State Medical Society. The conference featured national
authorities as well as local experts who addressed medical liability issues from a variety of perspectives. Speakers
included: Ira A Cohen, JD, New York City; Richard J Phelan, JD, Chicago; Richard G Roberts, MD, JD, Darlington;
Sara C Charles, MD, Chicago; and Elvoy Raines, JD, Boston. Practical suggestions offered included minimizing
the risk of suit, development of a solid defense in the event a claim arises, and the psychological impact of malprac-
tice suits on physicians. The tapes are available on a loan basis, free of charge from SMS Offices in Madison. Contact
Deb Powers in the Physicians Alliance Division. ■
JCAH PUBLISHES THE HOSPICE PROJECT REPORT. The Joint Conmiission on Accreditation of Hospitals (JCAH)
has announced publication of the Hospice Project Report. The Hospice Project began in March 1981 when the
WK Kellogg Foundation of Battle Creek, Michigan awarded a grant to JCAH to study the characteristics of
hospice care in the United States and to develop standards for hospice based on study findings. The two and
a half year study focused on determining the number of hospices, the organizational structures and services
of hospices, and the characteristics of the personnel involved in providing hospice care. More than 200 hospices
nationwide participated in the study, and the findings provide a complete profile of hospices in the United
States. To order your copy of the Hospice Project Report, send $25 per copy to: Cashier, JCAH, 875 North
Michigan Ave, Chicago, IL 6061 !.■
SMS TESTIFIES ON PITUITARY GLAND REMOVAL LEGISLATION. At a legislative hearing July 30 the State
Medical Society offered testimony in support of SB 219, which would allow removal of the pituitary gland in the
course of an autopsy. The pituitary gland would then be sent to the National Hormone and Pituitary Program
which extracts human growth hormone and distributes the hormone to physicians treating children needing it.
In its written testimony SMS indicated that SB 219 would increase the supply of a hormone essential in treating
hypopituitarism, yet at the same time it would provide appropriate safeguards surrounding the process of organ
removal including: 1) the transfer of pituitary gland may only be to the National Institutes of Health, and 2) removal
is authorized only when an autopsy is ordered by the coroner, medical examiner, or district attorney under s.
979.02, or when an autopsy is otherwise performed by a medical examiner. Chesley P Erwin, MD, medical ex-
aminer for Milwaukee County and a past president of the State Medical Society, has appeared on the Society's
behalf at previous hearings on this legislation. Members wishing more information on this legislation may con-
tact Terry Hottenroth of the Physicians Alliance Division at SMS Offices in Madison: 608-257-6781 or
1-800-362-9080.H
MEDICARE PARTICIPATING PHYSICIAN ISSUE UPDATE. With time running out on the October 1 deadline
for physicians to make their Medicare determinations on whether to be "participating" or "non-participating"
under the second year of the Deficit Reduction Act concept, physicians still do not have the decision-making in-
formation they need since Congress has not yet taken final action. State Medical Society members are urged by
President Scott to read the article appearing elsewhere in this issue explaining the two proposals affecting the
Medicare participating physician issue.*
WISPAC NEEDS YOUR SUPPORT. With the Legislature back in session from September 24 through October 18,
WISP AC is working throughout the state to increase physician mvolvement in the political process and strengthen
Medicine's position in the legislative forum. Much has been accomplished, but the stage is set to accomplish even
more. This year WISPAC set membership goals for each county medical society (40% of county medical society
membership). The following counties already have reached that level: Calumet, Clark, Fond du Lac, Grant, Green
Lake /Waushara, Juneau, Langlade, Manitowoc, Monroe, Oneida/Vilas, Sauk, Shawano, and Washington. WISPAC
members particularly are urged to persuade their colleagues to join. Further details appear in the WISPAC
column elsewhere in this issue.*
54
WISCONSIN MEDICAL JOURNAL, SEPTEMBER 1985: VOL. 84
EXCERPTS FROM A SYMPOSIUM
"THE TREATMENT OF SLEEP DISORDERS"®
ii
i . . highly effective
for both sleep induction and
sleep maintenance ff
Sleep Laboratory Investigator
Pennsylvania
. . onset of action is
rapid. . .provides sleep with
no rebound effect to agitate the
patient the following day
Psychiatrist
California
. . appears to have
the best safety record of any
of the benzodiazepines ff
Psychiatrist
California
After 15 years, the experts still concur about the
continuing value of Dolmone (flurozepom HCI/
Roche). It provides sleep that satisfies patients. . .
and the wide margin of safety that satisfies you.
The recommended dose in elderly or debilitated
patients is 15 mg. Contraindicated in pregnancy.
DALMANE
flurazepam HCI/Roche (g
sleep that satisfies
15-mg/30-mg
capsules
References: 1. Koles J, etal. Clin Pharmacol Ther 72 691-
697, Jul-Aug 1971 2. Kales A, etal: Clin Pharmacol Ther
78 356-363, Sep 1975 3. Kales A, etol Clin Pharmocol
Ther 79:576-583, May 1976 4. Kales A, etal: Clin Pharma-
col Ther32:78]-T88, Dec 1982 5. Frost JD Jr, DeLucchl
MR: J Am Geriatr Soc 27:5A]-M8, Dec 1979 6. Dement
WC, etal: BehavMed, pp 25-31, Oct 1978 7. Kales A,
Kales JD: J Clin Psychopharmacol 3:IA0-]50, Apr 1983
8. Tennant FS, el at: Symposium on the Treatment of Sleep
Disorders, Teleconference, Oct 16, 1984 9. Greenblatt DJ,
Allen MD, Shader Rl: Clin Pharmacol TTrer 27 355-361,
Mar 1977
DALMANE*
flurazepam HCI/Roche(w
Before prescribing, please consult complete product
information, o summary of which follows:
Indications: Etfective in all types of insomnia characterized
by difficulty in falling asleep, frequent nocturnal awakenings
and/or early morning awakening, in patients with recurring
insomnia or poor sleeping habits, in acute or chronic medical
situations requiring restful sleep Objective sleep laboratory
data have shown effectiveness for at least 28 consecutive
nights of administration Since insomnia is often transient
and intermittent, prolonged administration is generally not
necessary or recommended Repeated therapy should only
be undertaken with appropriate patient evaluation
Contraindications: Known hypersensitivity to flurazepam HCI,
pregnancy Benzodiazepines may cause fetal damage when
administered during pregnancy Several studies suggest an
increosed risk of congenital malformations associated with
benzodiozepine use during the first trimester Warn patients
of fhe potenfial risks to the fetus should the possibility of be-
coming pregnant exist while receiving flurazepam Insfruct
patienfs to discontinue drug prior to becoming pregnant Con-
sider the possibility of pregnancy prior to instituting therapy
Warnings: Caution patients about possible combined effects
with alcohol and other CNS depressants An additive effect
may occur if alcohol is consumed the day following use tor
nighttime sedation This potential may exist for several days
following discontinuation Caution against hazardous occu-
pations requiring complete mental alertness (e g . operating
machinery, driving) Potential impairment of performance of
such activities may occur the day following ingestion Not
recommended for use in persons under 15 years of age
Withdrawal symptoms rarely reported, abrupt discontinuation
should be avoided with gradual tapering of dosage for those
patients on medication for a prolonged period of time Use
caution in administering to addiction-prone individuals or
those who might increase dosage
Precautions: In elderly and debilitated patients, it is recom-
mended that the dosage be limited to 15 mg to reduce risk of
oversedation, dizziness, contusion and/or ataxia Consider
potential odditive effects with other hypnotics or CNS depres-
sants Employ usual precautions in severely depressed
patients, or in those with latent depression or suicidal tenden-
cies, or in those with impaired renal or hepatic function
Adverse Reoctions: Dizziness, drowsiness, lightheadedness,
staggering, ataxia and falling hove occurred, particularly in
elderly or debilitated patients Severe sedation, lethargy, dis-
orientation and coma, probably indicative of drug intolerance
or overdosage, have been reported Also reported headache,
heartburn, upset stomach, nausea, vomiting, diarrhea, con-
stipation, Gl pain, nervousness, talkativeness, apprehension,
irritability weakness, palpitations, chest pains, body and joint
pains and GU complaints There have also been rare occur-
rences of leukopenia, granulocytopenia, sweating, flushes,
difficulty in focusing, blurred vision, burning eyes, faintness,
hypotension, shortness of breath, pruritus, skin rash, dry
mouth, bitter taste, excessive salivation, anorexia, euphoria
depression, slurred speech, confusion, resflessness, halluci-
nofions, and elevated SGOT, SGPT, total and direct bilirubins,
and alkaline phosphatase, and paradoxical reactions, e g
excitement, stimulotion and hyperactivity
Dosage: Individualize for maximum beneficial effect Adults.
30 mg usual dosage, 15 mg may suffice in some patients
Elderly or debilitated polienis 15 mg recommended initially
until response is determined
Supplied: Capsules containing 1 5 mg or 30 mg flurazepam
HCI
Roche Products Inc.
Manoti, Puerto Rico 00701
FOR SLEEP
After more than 15 years of use, ifs #1 for sleep fhot sofisfies.
Pofients ore satisfied because fhey fall asleep fast and stay
asleep till morning. ^ ® And you're satisfied by the exceptionally
wide margin of safefy ^ ^ As always, caution patients about
driving or drinking alcohol.
Please see references and summary of product informotion on reverse side
flurazepam HGI/Roche ®
sleep that satisfies
Copyright © 1985 by Rc^e Products Inc, All rights reserved.
OJSI
WISCONSIN
MEDICAL JOURNAL
LIBRARY OF THE
COLLEGE OF PHYSICIAtiS
OF PHILADELPHIA
Replantation for ring avulsion injuries
Authors Rao and Feins present four cases of ring avulsion injuries, which
they acknowledge are difficult to treat. They show the results of such
injuries and recommend that replantation be carried out whenever
feasible. Also included is a diagram showing the method for preparation
and preservation for transplantation with a note of warning that early,
successful surgery depends on rapid transport. (See page 15)
/
w"
i
WISCONSIN
MEDICAL JOURNAL
( \
ISSN 0043-6542 /Established 1903
Owned and published by
State Medical Society of Wisconsin
f
CONTENTS
1
October 1985
Medical Editor
Victor S Falk MD, Edgerton
Editorial Board
Victor S Falk MD, Edgerton Chairman
Melvin F Hath MD. Baraboo
M C F Lindert MD, Milwaukee
Andrew B Crummy Jr MD, Madison
Richard D Sautter MD. Marshfield
Dean M Connors MD, Madison
George W Kindschi MD, Monroe
Charles H Raine MD, Racine
Darrell L Witt MD, Wausau
Garrett A Cooper MD, Madison Emeritus
SPECIAL FEATURES
President's Page
5 RX for a busy physician
John K Scott, MD
Madison
Editorials
News you can use
58 Changes made in unprofes-
sional conduct definition
President Reagan's tax
reform plan . . .
Future participation
rates . . .
Editorial Director
Wayne J Boulanger MD, Milwaukee
Editorial Associates
R Buckland Thomas AID, Monroe
Russell F Lewis MD. Marshfield
Raymond A McCormick MD, Green Bay
Victor S Falk MD, Edgerton
Medical Editor
Staff
Earl R Thayer, Madison
Secretary-General Manager
State Medical Society of Wisconsin
FI B Maroney II, Madison
Assistant Secretary-Corporate Counsel
State Medical Society of Wisconsin
Mrs Mary Angell, Madison
Managing Editor
Mrs Marjorie Stafford, Madison
Publications Assistant
NATIONAL ADVERTISING REPRESENTA-
TIVE: State Medical Journal Advertising
Bureau, Inc. 711 South Blvd, Oak Park, 111
60302. Ph 312/383-8800.
LOCAL (WISCONSINI ADVERTISING: Con-
tact: Mrs Mary Angell, Wisconsin Medical
Journal, Box 1109, Madison, Wis 53701. Ph
608/257-6781.
SUBSCRIPTION RATES: Members, $12.50
per year [included in dues): nonmembers,
$25.00. Single copy: current year, $2.00; pre-
vious years, $3.00. SPECIAL RATES: Foreign
and Canada. $30.00. Blue Book issue, $8.00.
Membership Directory issue, $15.00,
SCIENTIFIC MEDICINE
6 Saving more money in
MoTown
Victor S Falk, MD
Edgerton
Irradiated foods
Victor S Falk, MD
Edgerton
Letters
10 An overview of the
Medical Examining Board
Barbara Nichols, Secretary
Department of Regulation
and Licensing 19
State of Wisconsin
Madison
Socioeconomics
44 Hearing held on PT
practice without referral
47 SMS physicians testify for 20
additional mental commit-
ment standard
47 Bill waiving interest on
overdue insurance claims
rejected
Replantation for ring
avulsion injuries
Venkat K Rao, MD
Robert S Feins, MD
Madison
Lowering blood cholesterol
to prevent heart disease
NIH Consensus Develop-
ment Conference
Abstract: Microscopically
controlled surgery for
periorbital melanoma:
fixed-tissue and fresh-tissue
techniques
Frederic E Mohs, MD
Madison
Old versus new anti-
parkinsonian agents?
Norman C Reynolds Jr, MD
Milwaukee
i
SECOND CLASS POSTAGE PAID at
Madison, Wisconsin, and at additional mail-
ing offices.
PUBLISHED MONTHLY. "Acceptance for
mailing at special rate of postage provided for
in Section 1103, Act of October 3, 1917.
Authorized August 7, 1918." Address all com-
munications to THE WISCONSIN MEDICAL
JOURNAL. Street address: 330 East Lakeside
Street. Mailing address; Box 1109, Madison,
Wis 53701.
POSTMASTER: Send address changes to
Wisconsin Medical Journal, PO Box 1109,
Madison, Wis 53701.
COPYRIGHT 1985
State Medical Society of Wisconsin
V
A.
WISCONSIN MEDICAL JOURNAL (ISSN 0043-6542) is the official publication of the State Medical
Society of Wisconsin, devoted to the interests of the medical profession and health care in Wisconsin,
Its affairs are handled by the Editorial Board, subject to policy direction of the Society's Board of
Directors. The Managing Editor is responsible for the production, business operation, and coor-
dination of contents as well as the final responsibility of the entire publication. The Editorial Director
IS responsible for Editorials. Unsigned Editorials express views consistent with the policies of the
State Medical Society of Wisconsin. Signed Editorials express personal views of the author for which
the Society takes no responsibility. Neither the Editors nor the State Medical Society will accept
responsibility for statements made or opinions expressed in the pages of the Journal. Indexed in
"Index Medicus," "Hospital Literature Index," and "Cambridge Scientific Abstracts.”
STATE MEDICAL
SOCIETY
OF WISCONSIN
i
Vol. 84 No 10
CONTENTS
22 Tuberculous otomastoiditis
Bruce H Campbell, MD
Thomas B Chatton, MD
Michael J Chusid, MD
Russell S Yale, MD
Milwaukee
24 Reflex sympathetic
dystrophy snydrome:
Importance of early
diagnosis and appropriate
management
Sridhar V Vasudevan, MD
Bruce Myers
Milwaukee
28 Abstract: Microscopically
controlled surgery in the
treatment of carcinoma of
the penis
Frederic E Mohs, MD
Stephen N Snow, MD
Edward M Messing, MD
Michael E Kuglitsch, MD
Madison
ORGANIZATIONAL
30 SMS hosts Soviet physi-
cians at reception
31 Membership facts
32 Membership Directory-
Update
45 Physicians Alliance dis-
tricts and field consultants
48 Obituaries
Charles Francis Foley, MD
Sparta
Lucy A Vernetti, MD
Phoenix, Arizona (Hurley)
Francis E Gehin, MD
Stevens Point
Raymond J Murphy, MD
Green Bay
Lester E Haushalter, MD
Brookfield
Ruth E Church, MD
Whitewater (Waukesha)
DEPARTMENTS
49 Physician briefs
53 Medical Yellow Pages
Physicians exchange
Medical facilities
Miscellaneous
Medical Meetings—
Continuing Medical
Education
Advertisers*
THE STATE MEDICAL SOCIETY OF WISCONSIN, created by the Territorial Legislature in 1841,
represents over 5700 member physicians in Wisconsin, comprising 55 county medical societies
and 27 medical specialty sections. The purpose of the Society is to "bring together the physicians
of the State of Wisconsin to advance the science and art of medicine and the better health of the
people of Wisconsin, and to secure the enactment and enforcement of just medical laws." The
major activities of the Society include continuing medical education, peer review, legislation,
community health education, scientific affairs, socioeconomics, health planning, services for
physicians, operation of a Charitable, Educational and Scientific Foundation, and publication of
the Wisconsin Medical Journal.
Officers
President: John K Scott, MD, Madison
President-Elect: Charles W Landis,
MD, Milwaukee
Secretary-General Manager:
Earl R Thayer, Madison
Treasurer: John J Foley, MD
Menomonee Falls
Board of Directors
Chairman: Darold A Treffert, MD
Fond du Lac
Vice Chairman: Roger L
von Heimburg, MD, Green Bay
First District
Jerome W Fons Jr, MD, Cudahy
Carl S Eisenberg, MD, Milwaukee
Thomas A Hofbauer, MD,
Menomonee Falls
Wayne H Konetzki, MD, Waukesha
Fredrick Wood Jr, MD, Kenosha
William L Treacy, MD, Milwaukee
Richard D Fritz, MD, Milwaukee
William J Listwan, MD, West Bend
Glenn FI Franke, MD, Milwaukee
Lucille B Glicklich, MD, Milwaukee
Second District
J D Kabler, MD, Madison
Cyril M Hetsho, MD, Madison
James J Tydrich, MD, Richland Center
Alwin E Schultz, MD, Madison
Kenneth I Gold, MD, Beloit
Third District
Pauline M Jackson, MD, La Crosse
Fourth District
John J Kief, MD. Rhinelander
Jung K Park, MD, Wisconsin Rapids
W George Locher, MD, Wausau
Fifth District
Darold A Treffert, MD, Fond du Lac
Kenneth M Viste Jr, MD, Oshkosh
C William Freeby, MD, Appleton
Sixth District
Roger L von Heimburg, AID, Green Bay
Joseph C DiRaimondo, MD, Manitowoc
Seventh District
Marwood E Wegner, MD, St Croix Falls
Philip J Happe, MD, Eau Claire
Eighth District
Joseph M Jauquet, MD, Ashland
>
President: Doctor Scott
President-Elect: Doctor Landis
Past President: Timothy T Flaherty,
MD, Neenah
Speaker: Duane W Taebel, MD,
La Crosse
Vice Speaker: Vernon M Griffin, MD,
Mauston
who is number 1
in medical
office computer
systems in
Wisconsin?
HDX Clinical Hanagenent Systen
1) Financial Accounting
2) Insurance Clain Tracking
6) Appointnent Scheduling
7) Medical History
Not IBM nor Apple nor any other nationally-known
computer name. The answer is Advanced Technology
Associates. Number 1 means the most complete systems; the
most logical match of hardware, software and services. ATA is
the source for total packages — computers, terminals, printers,
special medical programs, careful installation, training for
your people and after-sale support.
Considering the scope of our Wisconsin experience, it
should not surprise you that ATA is endorsed by the State
Medical Society.
May we send you information listing your benefits from
a strictly medical office computer system? Call or write.
Advanced Technology Associates \
4710 W. North Avenue, Milwaukee, Wl 53208
(414)445-4280 ■
In Wisconsin call toll free 1-800-242-4280.
Endorsed by SMS Services, Inc For members of the State Medical Society ot Wisconsin.
PRESIDENT'S PAGE
RX for a busy physician
'The physician is only nature's assistant/Galen. Never go to one whose office
plants look sick /Smallwood. The practice of medicine is an art, not a trade; a calling,
not a business/ Osier.
No man is more worthy of esteem than a physician who exercises his art with cau-
tion and gives equal attention to the right and the poor/ Voltaire. Some people think
doctors can put scrambled eggs back into the shell /Canfield. Much are we beholden
to physicians who only prescribe the bark of the quinquina when they might oblige
their patients to swallow the whole tree/Dalrymple. The doctor must have at his
command a ready wit as dourness is repulsive both to the healthy and the sick/
Hippocates.
A physician is a person who works sixteen hours a day telling others to slow down
or they'll get high blood pressure; a doctor is a person who still has his tonsils, ade-
noids and appendix; obstetricians are doctors whose cases come out well even when
they're delayed on the golf course; a specialist is a doctor who trains his patients to
become ill only during office hours; patient's rule: it is not a matter of life and death,
it's much more important than that/ Anonymous.
The physician cannot prescribe by letter, he must feel the pulse/ Seneca. He who
conceals his ills cannot expect to be cured/ Proverb. It is far better to cure at the be-
ginning than at the end/Persius.
Surgery does the ideal thing, it separates the patient from the disease/Clendening.
Good medicine always tastes bitter/ Confucius. The best doctors in the world are
Doctor Diet, Doctor Quiet, and Doctor Merryman/ Swift.
I wonder why ye can always read a doctor's bill an ye never can read his purscrip-
tion/ Dunne. One reason physicians can be so happy about their work is the feeling
of security their patients give them/ Spencer. How ill the doctor fares, if none fare ill
but he/ Philemon.
John K Scott, MD
A rule of thumb in the matter of medical advice is to take everything any doctor
says with a grain of aspirin/ Ace. One of the chief objects of medicine is to save us
from the natural consequences of our vices and follies/Mencken.
REP 1 2 3 4 5 6 PRN
SIG: READ TWICE DAILY AS NEEDED TO RELIEVE TENSION.
M.D.
Generic substitution not permitted
With all the frustrations facing physicians today, I thought in the President's Page
I would add a bit of levity and common sense to our daily routine. After reading the
above, sit back and think how common sensical our ancestors were. Not bad advice
to help all of us travel the bumpy road of frustrations together!*
WISCONSIN MEDICAL JOURNAL, OCTOBER 1985:VOL. 84
5
EDITORIALS
Wayne J Boulanger, MD, Editorial Director
Unsigned editorials express views consistent with the policies of the State Medical Society of Wisconsin.
Signed editorials express personal views of the author for which the Society takes no responsibility.
Saving more money in MoTown
The Patient had a breast tumor
that clinically appeared to be
malignant. This was confirmed by
mammography. Her insurance
coverage required a call to Detroit.
It is only fair at this point to com-
ment that the response of opera-
tors has been cut down from a
45-minute wait to quite a prompt
response.
It was explained to the operator
that the patient was to be sched-
uled for a breast biopsy and frozen
section and that it was anticipated
that this would be followed by
more definitive surgery. At the
mention of the words "breast
biopsy," the operator said that
according to her book this was an
outpatient procedure and hospital
admission was denied. It was ex-
plained that further surgery was
undoubtedly to follow and the
operator finally said this called for
a conference. Later in the day, a
sympathetic Detroit general sur-
geon called and reiterated that the
patient could not be admitted to
the hospital for breast biopsy no
matter what else was planned. He
suggested three alternatives. The
first was to proceed with the
biopsy under general anesthesia
to be followed by frozen section
and then discharge the patient
from the hospital. At some later
date the more definitive surgery
could be carried out, even though
this would involve a second anes-
thetic, second operating room
charge, a second recovery room
charge, and whatever else goes
into the hospital adding machine.
The second alternative was to per-
form the initial procedure, then
wake the patient and discuss the
situation with her, and then call
Detroit. This discussion with a
groggy, recently anesthetized pa-
tient might prove to be a little
hazardous in a legal confrontation.
The third alternative, and the one
which was selected, was to pro-
ceed with the biopsy and frozen
section and after the pathologist
had rendered his decision, to have
someone call Detroit and request
permission to admit the patient to
the hospital. This was done and
the response from Detroit was
"do you have a second opinion?"
The representative of the surgeon
allowed that the diagnosis by the
pathologist from the frozen sec-
tion could constitute a valid
second opinion.
On the first postoperative day
the surgeon and the patient's hus-
band received letters from the in-
surance carrier denying hospital
admission on the basis of the
original request. Also noted were
the dire consequences and appeal
procedures. By the time the pa-
tient was discharged from the
hospital on the fourth postopera-
tive day, there was still no formal
permission to admit the patient to
the hospital.
What a waste of time (and
money), what a frustrating situa-
tion, and what a way to have to
practice medicine!
— Victor S Falk, MD, Edgerton
Irradiated foods
The American Council on Sci-
ence and Health recently pub-
lished a report on the irradiation
of foods. 'The process has been
studied by American scientists
for more than 40 years, but most
Americans are unfamiliar with
the subject and the safety of ir-
radiated foods.
Irradiation is the use of ionizing
radiations on food and does not
make the food radioactive. Irra-
diation is currently used to
sterilize more than 30 percent of
the sterile disposable medical de-
vices used in the United States.
The same technique can also be
applied to foods. A high-dose ir-
radiation treatment can kill all
the microorganisms that might
grow in food, and sterilized food
can be stored in sealed contain-
ers for years at room temperature
without being spoiled by micro-
organisms. Radiation-sterilized
foods are not yet commercially
available in the United States, but
they have been enjoyed by astro-
nauts and by some hospital pa-
tients who are confined to special
sterile environments.
Processes that decrease the
number of microorganisms in
food without completely steriliz-
ing it have many uses. The pas-
teurization of milk is one example
as it destroys any disease-produc-
ing microorganisms that might be
present in milk and delays
spoilage by greatly reducing the
number of spoilage microorgan-
isms. Radiation also can delay the
spoilage of highly perishable
fresh fish and shellfish, reduce
the number of microorganisms in
spices, destroy some types of dis-
ease-causing bacteria and para-
sites, and extend the shelf life of
fruits such as strawberries by
delaying mold growth. This has
little or no effect on flavor. In the
future, it is possible that the pas-
teurization-type treatment may
be used to ensure the safety of
fresh meat and poultry since
these foods are frequently con-
taminated by microorganisms
such as Salmonella.
Low-dose irradiation can kill
insects in grains and other stored
food and could be substituted for
the fumigant ethylene dibromide
which is now banned. The radia-
tion would facilitate the interstate
and international shipment of
6
WISCONSIN MEDICAL journal, OCTOBER 1985: VOL. 84
EDITORIALS
fruits and vegetables where such
shipment is now often prohibited.
This would apply to such situa-
tions as the Mediterranean fruit
fly infestations in California and
Florida.
A very low-dose irradiation
treatment inhibits sprouting of
vegetables such as potatoes,
onions, and garlic and can re-
place chemicals currently used
for this purpose. It also delays the
ripening and extends the shelf
life of fruits such as bananas,
mangos, papayas, guavas, and
avocados. A low-dose of radiation
can also eliminate the potential
hazard of trichinosis in fresh
pork. The irradiation treatment
works by sexually sterilizing
Trichinella spiralis, the parasite
that causes trichinosis, so that it
cannot mature. There are about
100 cases of trichinosis transmit-
ted by commercial pork in the
United States each year.
Irradiation does not make the
food radioactive and the irradia-
tion does not generate radioactive
waste. At least 28 countries have
approved some application of
radiation.
In 1984 the American Medical
Association sent a letter to Con-
gress stating that food irradiation
is safe, may be an important sub-
stitute for pesticides, and can
control bacterial contamination
of some foods. In the United
States, irradiation has been ap-
proved for three specific pur-
poses: sprout inhibition of white
potatoes, insect disinfestation of
wheat and wheat flour, and con-
trol of microorganisms and in-
sects in spices and other season-
ings. The FDA has proposed
permitting the irradiation of fruits
and vegetables to "inhibit growth
and maturation" (i.e., prevent
sprouting, delay ripening) ; permit
irradiation of any food for the
purpose of insect control; and
permit irradiation of foods within
certain limits if it could be shown
that irradiation would accom-
plish its intended purpose. Also
it would no longer require irradi-
ation to be declared on retail food
labels.
The Americal Council on Sci-
ence and Health concluded that
the irradiation could have many
benefits for U.S. consumers by
increasing the variety of tech-
niques that can be used to pro-
vide a safe, wholesome con-
venient food supply and that the
proper use of food irradiation
does not present a health hazard.
— Victor S Falk, MD, Ed^erion ■
PHYSICIANS
TRY AIR FORCE
EXPERIENCE
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WISCONSIN MEDICAL JOURNAL, OCTOBER 1985: VOL. 84
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LETTERS
The Editors would like to encourage physicians to contribute to the LETTERS section where they can ventilate their frustrations as well as opinions. This feature
is intended to be lively and spirited as well as informative and educational. .4s with other material which is submitted for publication, all letters will be subject
to the usual editing. Address correspondence to: The Editor, Wisconsin Medical Journal, Box 1109, Madison, Wis 53701.
An overview of the Medical Examining Board
To THE State Medical Society;
The Medical Examining Board
has been the subject of some in-
terest from many sources over
the recent months. In order to
bring about a better understand-
ing, the Board prepared a com-
prehensive overview of its
operations. (Copies were sent to
the Governor, Legislature,
Media, and Public. It is being
published below at the request of
the Board of Directors.) Some
highlights of the report are as
follows:
24
HOUR
Radio
dispatched
truck fleet
for
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SCHOOLS, ETC.
AUTHORIZED PARTS
AND SERVICE FOR
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Throughout Wisconsin
and Upper Michigan
SALES
Boiler room accessories
O2 trims
Cleveland controls
and Car automatic bottom
blowdown systems
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ON ALL MAKES
Complete Mobile Boiler Room
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Stevens Point— 715/344-7310
Green Bay— 414/494-3675
Madison— 608 / 249-6604
PBBS EQUIPMENT CORP.
5401 N Park Dr
PO Box 365
Butler, WI 53007
Phone: 414/781-9620
• The Board's responsibilities
cover a broader spectrum than
just discipline.
• Due process in disciplinary
matters is required, and should
be a guaranteed right of all citi-
zens, but it hinders the timely
disposition of cases.
• Additional personnel are
necessary to expeditiously inves-
tigate and prosecute alleged
incompetent licensees of the
Board.
We hope this overview ad-
dresses some of the concerns
leveled at the Board. If additional
information is desired, please feel
free to contact a member of the
Medical Examining Board listed
below:
Susan F Behrens MD, Beloit
Chairman
William] Hisgen, MD, Madison
Vice Chairman
Gwen Jackson, Milwaukee
Secretary
Judy Crain, Green Bay
Joseph L Ousley, MD, Marshfield
William E Walker, MD,
Milwaukee
Helen H Ahn, MD, Tomah
Patricia R Raftery, DO, Sparta
Sarah J Pratt, MD, Sheboygan
George W Arndt, MD, Neenah
—Barbara Nichols, Secretary
Department of Regulation
and Licensing
State of Wisconsin
1400 East Washington Avenue
PO Box 8936
Madison, Wisconsin 53708
(608-266-2112)
♦ * ♦
In the recent months, there has
been much interest from the pub-
lic, the media and the Legislature,
regarding the functions of the
Medical Examining Board. The
members of the Medical Examin-
ing Board have been concerned
that the public is not fully aware
of responsibilities or how these
responsibilities are accomplished.
The duty of Medical Examining
Board is the protection of the
public. Interest is centered most
recently in discipline of physi-
cians who are guilty of unprofes-
sional conduct. This, however, is
not the only statutory respon-
sibility of the Board.
Who are the members of the Medical
Examining Board?
The current Board is composed
of ten members, two citizen
members and eight physicians,
one of whom is a Doctor of Oste-
opathy. The members are nom-
inated by the Governor and
appointed with the advice and
consent of the Senate to four year
terms. A Board member may
serve a maximum of two terms.
The current Board members'
specialties include: internal medi-
cine, family practice, general
surgery, psychiatry and pedi-
atrics. No member of the Medical
Examining Board may be an of-
ficer in a private organization
which promotes that profession.
What are the Medical Examining
Board's responsibilities?
The responsibilities of the Med-
ical Examining Board include
licensing and disciplining the pro-
fessionals under its jurisdiction,
proposing statutes to help with
that process, serving as advisors
to the Governor and Legislature,
establishing standards of con-
duct, and promulgating rules to
administer the statutes. The Med-
ical Examining Board has under
its jurisdiction, physicians,
podiatrists, physical therapists,
and physician assistants. The
10
WISCONSIN MEDICAL JOURNAL, OCTOBER 1985: VOL. 84
LETTERS
latter three groups have advisory
councils which report directly to
the Medical Examining Board.
When are the meetings?
The Board has twenty meeting
days per year— a full working
month. The meetings average
nine to ten hours per day, often
extending into the evening. The
per diem reimbursement for this
is twenty-five dollars per day.
In addition, each Board mem-
ber is involved with a standing
committee, which meets 4-6 full
days per year. A Board Mem-
ber's responsibilities include tes-
timony before the legislative
committees and presentations to
citizen groups throughout the
state. Several Board members
hold posts in The National Feder-
ation of State Medical Boards and
related organizations.
Who is granted a license to practice
medicine?
Before being considered for a
license to practice medicine, a
candidate must have finished col-
lege and medical school at ac-
credited institutions. He or she
must have completed an intern-
ship, and must have passed a
series of examinations document-
ing basic general knowledge in all
fields of medicine.
Each must then pass an oral
examination before the Board.
Approximately 800 physicians
are newly licensed to practice
Medicine and Surgery in Wis-
consin each year.
The oral examination: Only six states
require some type of oral examination.
The members of the Wisconsin Exam-
ining Board feel strongly that the oral
examination has merit. The examina-
tion identifies a number of individuals
whose deficiencies have been suf-
ficiently questionable that they con-
stitute a clear danger to the health,
welfare and safety to Wisconsin's
citizens. If there were no oral examina-
tion, these individuals would have been
licensed, since their other credentials
were in order. It is much easier to not
let them start practicing at all, than to
find they are not knowledgeable after
they have been practicing for some
time. An example of how useful this is
involves the recent scandals about a
few foreign medical schools. Since each
candidate has to appear in person and
discuss his or her basic medical
knowledge, it would be much more
difficult for a person who has fraudu-
lent credentials to be licensed in a
state which gives oral examinations.
This is an added safeguard for the
people of Wisconsin in the licensing of
physicians.
Five of our twenty meeting
days are spent in administering
individual oral examinations.
Only the physician members of
the Board can directly examine
licensee applicants since the
questions primarily deal with
clinical medicine. Other areas
tested are good knowledge of
prescriptive practices with re-
gards to controlled substances
such as narcotics, understanding
of the statutes and rules regarding
the practice of medicine in Wis-
consin and communications
skills. Each oral examination re-
quires fifteen to thirty minutes.
At times there may be 200 to 250
applicants on each examination
day. Because of the Medical Ex-
amining Board's need to free up
time for other critical matters,
qualified physicians already
licensed in Wisconsin, are
screened and hired at a nominal
fee to assist with oral examina-
tions. It is hoped that in the
future there will be an adequate
number of non-Board physicians
to assume the full responsibility
of examining licensee applicants.
If applicants fail the oral exami-
nation, they will then have to be
examined by the entire Medical
Examining Board. If applicants
fail the oral examination a total
of three times, the Board will
require that additional postgradu-
ate training be taken. Approxi-
mately two to four percent of
physicians fail the examination
the first time they take it.
Discipline:
Disciplinary measures involve
a major segment of the Board's
time at each meeting. Physicians
are subject to discipline when
they commit unprofessional con-
duct as defined by the statutes
and rules of the Board. The rule
most often cited is the "danger
rule", recently defined by the
Wisconsin Supreme Court as
"that practice which constitutes
a danger to the health, welfare,
and safety of a patient by fail-
ing to meet the level of minimal
competence established in the
profession and by posing unac-
ceptable risks which a minimally
competent licensee would have
avoided or minimized."
Any citizen can register a com-
plaint against a physician. There
is protection from civil liability
from those who, in good faith,
provide information to the Board
concerning possible unprofes-
sional conduct. All cases from the
Patient Compensation Panel in
which negligence is found are
automatically referred to the
Medical Examining Board for re-
view. A finding of negligence by
the PCP must rise to the level of
unprofessional conduct as de-
fined in the statutes. Cases in
which a physician's hospital
privileges have been restricted
or suspended for more than 30
days are also an automatic Board
referral. Moreover, a major area
of discipline includes impaired
physicians, those who have been
practicing while impaired with
drugs, alcohol, or mental illness.
Physicians are reported who are
practicing with physical or
mental incapacity, also.
All complaints are assigned to a
Division of Enforcement attorney
and investigator and a member of
the Medical Examining Board,
who serves as the Board Advisor.
The Board member functions to
give medical and consumer ex-
pertise in advising the investi-
gators and attorneys on facts re-
lated to medicine. All of the facts,
including testimony of the plain-
tiff and witnesses, patient hos-
pital records and Patient Com-
pensation Panel depositions are
1 1
WISCONSIN MEDICAL JOURNAL, OCTOBER 1985:VOL. 84
LETTERS
reviewed by a Board member on
his or her own time. These case
reviews constitute a majority of
the many hours of "homework"
that are required of each Board
member. This may average forty
to sixty hours between Board
meetings.
The investigation is handled by
investigators from the Division of
Enforcement in the Department
of Regulation and Licensing.
Right now, there are 2.75 full-
time equivalent investigators as-
signed to the Board.
Once the investigation is
completed, the Board advisor
decides if there is merit to the
charge of unprofessional conduct.
If the Board member feels that
unprofessional conduct occurred
he or she recommends that the
case be taken to public hearing.
The statutes allow the Board to
reprimand, suspend, revoke, or
limit a license.
There is much emphasis on aue
process in all of the handling of
disciplinary cases and during the
hearing process. Expert witnesses
are hired to review the cases and
give testimony. A hearing exam-
iner hears the case and renders a
decision, which includes findings
of fact, conclusions of law and
order regarding discipline.
The hearing examiner is an at-
torney in the Department of
Regulation and Licensing. He or
she has all the rights of a judge.
Once the Board issues a formal
complaint against a physician, the
hearing examiner schedules the
date of the hearing. The hearing
examiner at that point may issue
postponements, take depositions,
consider motions and handle all
other aspects of the hearing. The
Board has no input on expediting
the matter once the formal com-
plaint has been issued varies
from three months to three years.
At present, the Medical Exam-
ining Board has only one hearing
examiner, who also has other
responsibilities. He is hearing ex-
aminer for six other boards and
legal counsel to seven other
boards.
The prosecuting attorneys are
supplied to the Board by the De-
partment of Regulation and
Licensing.
At present, there are 2.1 full-
time equivalent attorneys. This
is, three attorneys spend part of
their time on Medical Examining
Board cases. Each attorney has a
backlog of approximately twenty
cases in which complaints have
been issued and they are waiting
to go to hearing. Each attorney
can take only five or six cases per
year to hearing.
Once the order has been issued
from the hearing examiner, the
case is then brought back to the
Board for approval. If the defen-
dant disagrees with the Board's
decision, the defendant may ap-
peal to the courts for review.
While there is strict adherence
to due process, such a process
may lead to a delay in the res-
olution of a case. One case has
gone to the Supreme Court in the
appeal process. From the time of
the Board's initial decision, until
it got to the high court, took three
years.
If the Board member feels that
there is no merit to a complaint,
the case is presented to the entire
Board for approval of the case be-
ing closed. On occasion. Board
members have disagreed with the
Board advisor and have advised
taking the case to public hearing.
The Board may close a case based
on lack of evidence or prosecu-
torial discretion. Because of a
lack of staff, more cases are
closed without formal hearing
than desireable. These are low-
priority cases which deal with
problems that do not present a
clear danger to the public or in-
volve physicians who are no
longer practicing in this state. The
Medical Examining Board ac-
knowledges the possible merit of
these cases, but to pursue them
would prevent dealing with more
serious cases.
There is a backlog of 350 pend-
ing complaints. It takes a min-
imum of eighteen months for a
case to reach final disciplinary
action and it frequently takes
longer than eighteen months.
Even if the case is closed for lack
of evidence, twelve months have
often elapsed. Needless to say,
this is a major impedance to ex-
pediting the entire disciplinary
process.
Other responsibilities.
Additional Board time is in-
volved in regular meetings with
impaired physicians who have
been given limited licenses, re-
quiring oversight of their prog-
ress. Many of these individuals
appear before the Board two
times per year.
Moreover, the Board receives
many inquiries concerning the
practice of medicine or interpre-
tation of statutes and rules
governing the practice of medi-
cine and the Board must respond
to these.
The Medical Examining Board
is available to the Legislature for
consultation on proposed legisla-
tion. From time to time, the
Board may pursue legislation or
promulgate rules to implement
existing statutes.
Patient Compensation Panel cases.
A number of issues face the
Medical Examining Board. Per-
haps the most controversial
involves Patient Compensation
Panel cases. At present, the Medi-
cal Examining Board receives all
cases in which negligent acts
have been found by the Panel.
The Board agrees that there are
some acts of negligence that are
so serious that the physician
should receive official Board dis-
cipline. However, there are some
acts of negligence that do not
necessarily fall below the "min-
imal competency" standard.
12
WISCONSIN MEDICAL JOURNAL, OCTOBER 1985:VOL. 84
LETTERS
Also, some of the patient com-
pensation awards are made on
the basis of "sympathy verdicts”
on the part of the Panel when no
significant mistake has been
made on the part of the physician
despite the fact that there was a
bad result.
To take all of these cases to
hearing indiscriminately would
impede the handling of the cases
of more serious import. Auto-
matic referral of all malpractice
claims would also hopelessly en-
cumber the system. The Board
agrees that it is important to re-
view all cases settled without
Patient Compensation Panel
hearings, since such settlements
allow the deficient physician to
hide from public scrutiny. If
such comprehensive reviews are
mandated, the work load would
increase substantially. A more
expeditious way of reviewing
these cases must be developed.
The main asset in having all of
these cases referred to the Board
is to allow the Board to be aware
of patterns in practice. An inor-
dinate number of malpractice
cases, even if each in and of it-
self does not fall below the
minimum standard, indicates
that a person's practice should be
investigated, as the pattern devel-
oped may fall below the mini-
mum standard.
Public members (non-physician
members of the Examining Board).
There is a current proposal to
expand the number of citizen
members. While citizen members
provide valuable input for Board
decision-making, physicians are
needed to critically assess most of
the quality-of-care issues that are
raised in disciplinary complaints.
As the case load increases, more
physicians will be needed in this
vital review process.
While the Medical Examining
Board supports the trend to have
more citizen participants on all
regulatory boards, it is recom-
mended that the professional
membership of the Board not be
decreased.
What, then can be done to improve
the discipline process?
It is critically important to hire
more attorneys, investigators,
hearing examiners and ancillary
staff to deal with the current
backlog and future increased
workload. While a temporary
contract with a private firm will
assist with the backlog, it will
not be a long term solution for
future workload increases. The
number of cases each Board
member now reviews is manage-
able, but will exceed the capacity
of the Board members to be the
only reviewers in the future. The
Medical Examining Board might
consider a contract with private
physicians for initial case re-
views. However, those cases
initially determined to be without
merit would still have to come
before the full Board for closure.
It is recommended that all well-
trained witnesses in the Medical
Examining Board proceedings be
guaranteed immunity from civil
liability. This would encourage
more witnesses to participate in
the process.
When a physician is an imme-
diate and grave threat to patients,
the Medical Examining Board
may suspend his license for sixty
days prior to holding a hearing.
The Medical Examining Board
recommends a statutory amend-
ment to extend this suspension
beyond 60 days, until the final
order regarding his license is
adopted by the Medical Examin-
ing Board.
The Medical Examining Board
realizes that the public's percep-
tion is that they are not com-
pleting our tasks in a timely
fashion. However, they wish to
emphasize that the Medical Ex-
amining Board has many statu-
tory responsibilities. It is also
unfortunate that the public is not
aware of the countless and often
unrecognized hours of volunteer
service given by the Board
member.
The delays per se are actually
beyond the control of the Medical
Examining Board members. The
Board has been asking for more
staff for three years without any
changes having been made. They
cannot accomplish their assigned
task without being given the per-
sonnel to do the job.
In this summary, we have tried
to describe the Medical Examin-
ing Board's composition and re-
sponsibilities. It is hoped that the
public can also become aware of
the operating processes and solu-
tions that are seen as imperative
in allowing the Board to ac-
complish the task of protecting
Wisconsin citizens. ■
70th Scientific Assembly
Interstate Postgraduate
Medical Association
Primary Care Update
New Orleans, Louisiana
Monday, November 18
• Morning— Cardiology
• Afternoon— Gastroenterology
• Evening— Canadian Reception
and "Management of the Difficult
Headache Patient"
Tuesday, November 19
• Morning— Geriatrics
• Afternoon— Pediatrics
• Evening— Medical movies
Wednesday, November 20
• Morning— Endocrinology
• Afternoon— Gynecology
Thursday, November 21
• Morning— Update on Current
Trends and Technology
Program eligible for 24 hours of Category
1 and 4 hours of Category 5 credit of the
Physician's Recognition Award of the
AMA.
Registration info: Interstate Postgraduate
Medical Association, PO Box 1 109, Madi-
son, W1 53701; or call 608/257-6781.
WISCONSIN MEDICAL JOURNAL, OCTOBER 1985: VOL. 84
13
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SCIENTIFIC MEDICINE
\ /
Replantation for ring avulsion injuries
Venkat K Rao, MD and Robert S Feins, MD. Madison, Wisconsin
ABSTRACT. Ring avulsion injuries are
difficult to treat. The options are re-
plantation or amputation. Four cases
are presented and the results by replan-
tation shown. Replantation is recom-
mended for these injuries whenever
feasible.
Key words: Hand injuries; Microsur-
gery; Replantation; Avulsion injuries.
Ring-avulsion injuries-
degloving or tearing away the soft
tissue of the finger— commonly
occurs when a wedding band or
ring is caught on a sharp edge or
object. Although the ring finger
is most commonly involved, this
injury also occurs to the little
finger. The treatment of this in-
jury has changed with the avail-
ability of increasingly sophisti-
cated microsurgical techniques.
Ring avulsion injuries have
been classified according to
severity d
Class I; Skin and soft tissue
injury with the retention of
adequate circulation.
Class II; Some intact soft tis-
sue without adequate circula-
tion.
Class III: Complete amputa-
tion.
Class III injuries typically
involve avulsion at the level of
the ring and disarticulation of the
distal interphalangeal (DIP) joint.
From the Replantation Service, Division
of Plastic and Reconstructive Surgery,
University of Wisconsin Medical School,
Madison. Publication support provided.
Reprint requests to: Venkat K Rao, MD,
Division of Plastic Surgery, 600 Highland
Ave, Madison, Wis 53792 (ph 608/263-
1367). Copyright 1985 by the State Medi-
cal Society of Wisconsin.
Class II and Class III injuries may
be treated by amputating or re-
planting the affected digit. This
report discusses the management
of four severe Class II and Class
III ring-avulsion injuries.
Material and methods. From
August 1982 to August 1984, four
patients with ring avulsion in-
juries were treated by the Univer-
sity of Wisconsin Replantation
Service. Alternative treatments,
including amputation and replan-
tation, were discussed with the
patients. All the patients desired
replantation.
Case reports. Case 1. This was a
39-year-old woman whose wed-
ding ring caught on an edge when
she fell from a boat dock. The
injury resulted in a Class III
avulsion of the ring finger of the
nondominant hand and disarticu-
lation at the DIP joint (Fig 1). The
extensor tendon remained intact,
but the flexor digitorum pro-
fundus tendon was avulsed from
the musculotendinous junction.
Replantation was performed with
vein grafts and primary nerve
repair. After the operation, the
finger was examined hourly and
skin temperature was monitored
with a probe. The patient had an
uneventful recovery and started
occupational therapy four weeks
after the operation (Figs 2, 3).
Case 2. This was a 40-year-old
farmer who caught his left ring
finger in a farm machine and
suffered a Class III avulsion. Re-
plantation was performed with-
out vein grafts, and the patient
Table 1— Summary of patients
Use of vein
Patient
Age
Class
grafts
Success
1
39
Severe II
+
+
2
40
III
-
-
3
30
Severe II
+
4
21
III
+
+
Table 2
—Active range of motion
Joint* and range of motion jdegreesi
Patient
MP
PIP
DIP
1
0-95
10-100
40-40
2
0-95
—
—
3
0-85
35-100
20-20
4
0-95
35-100
20-20
‘Metacarpophalangeal (MP), proximal interphalangeal (PIP)
distal
interphalangeal (DIP)
WISCONSIN MEOICAI JOURNAL, OCTOBER 198.5;VOL. 84
15
SCIENTIFIC MEDICINE
REPLANTATION-Rao & Feins
did well until the second post-
operative day when finger
temperature decreased. Reex-
ploration revealed a clotted
arterial anastomosis. A vein graft
was harvested and interposed,
but blood flow could not be
reestablished, and the finger was
amputated at the proximal
phalanx. The patient made a good
postoperative recovery, but he
has difficulty grasping small ob-
jects, such as coins, because of
the gap in the hand secondary to
the amputation.
Case 3. This was a 30-year-old
truck driver who leaped from the
back of a truck and caught his
ring on an edge, suffered a de-
gloving injury with near total
avulsion of the finger (Class II)
(Fig 4). The degloved finger was
replanted with vein grafts and
primary nerve repairs. The pa-
tient did well and began occu-
pational therapy four weeks after
the operation (Figs 5, 6).
Case 4. This was a 21 -year-old
man who caught his left ring
finger in a fence when he jumped
from a farm machine. The acci-
dent resulted in complete avul-
sion of the ring finger (Class III).
Replantation was performed with
vein grafts, primary nerve re-
pairs, and the fusion of the DIP
joint. The patient made an un-
eventful recovery and began
occupational therapy four weeks
after the operation.
Results. Table 1 summarizes
the patient population, severity
of injury, and outcome of replan-
tation.
Each patient recovered quite
well; the active range of motion
of the affected digit, after occupa-
tional therapy, is summarized in
Table 2.
There was no return of motion
at the DIP joint because the flexor
digitorum profundus tendon was
not repaired (Table 2). All pa-
tients had a normal range of
motion at the MP joint and a
varying range of motion at the
PIP joint. The patient whose
finger was amputated reported
difficulty in grasping small ob-
jects, a problem related to the gap
left between the fingers. Sensi-
bility in all patients, measured by
two-point discrimination, was
about 10 mm.
Discussion. Ring-avulsion in-
juries are difficult to treat. Usual-
ly the soft tissue of the finger is
degloved from the tendons or
bones. Although tempting, a flap
or skin graft will not be useful
and should be avoided. Thus, the
only two choices of treatment are
primary amputation and replan-
tation.
A successful replant, measured
by finger viability, is difficult for
ring-avulsion injuries. The major
obstacle to success is the high in-
cidence of vascular thrombosis
that results from more extensive
intimal damage than is initially
recognized under the operating
microscope. Long segments of the
digital arteries and veins must be
debrided, and the defect must be
bridged with vein grafts.
The severe trauma of ring avul-
sion usually precludes a full
range of motion for the injured
Preparation and
preservation
for transplantation
What type of patients
Patients with clean cut, crush
or avulsion amputations of the
following are candidates for re-
plantation:
• Thumb
• Single or multiple fingers
• Major extremities such as arms
or legs
• Scalp, facial, or penile avulsions
• Severe hand injuries
How to prepare and preserve
parts
Cooling the amputated part
lengthens the time the part re-
mains replantable. If the part is
warm, it may last only up to 12
hours (for digits) and up to 8
hours (for limbs). To cool body
parts:
• Wrap part in moist, sterile
gauze or towel
• Place in plastic bag or other
container
• Put container on ice for
transport
• Do not use dry ice, or allow part
to freeze
Early, successful surgery
depends on rapid transport!
16
WISCONSIN MEDICAL JOCKNAL, OCTOBER 1985: VOL. 84
REPLANTATION-Rao & Feins
SCIENTIFIC MEDICINE
Figure I— Ring avulsion injury.
Figure 2— Palmar view nine months
postoperatively.
Figure 3— Dorsal view nine months
postoperatively.
Figure 4— Class II ring avulsion
injury (note ring!
Figure 5— Dorsal view nine
months postoperatively.
Figure 6— Finger flexion nine
months postoperatively.
WISCONSIN MEDICAI. JOIJRNAE, OCTOBER 1985:VOL. 84
17
SCIENTIFIC MEDICINE
REPLANTATION-Rao & Feins
finger. However, because the
ring finger is not a border digit,
the lack of full range of motion in
the presence of good MP motion
and moderate PIP motion does
not appreciably impair hand
function. Besides disfigurement,
primary amputation at the meta-
carpophalangeal joint or proximal
phalanx usually causes difficulty
in grasping small objects in the
palm of the hand. This disability
can be treated with a ray resec-
tion, but it results in decreased
grip strength, because of the
decreased palm width.
Replantation for ring avulsion
injury produces a satisfactory
functioning digit and should be
considered a more desirable op-
tion than primary amputation.
REFERENCES
1. UrbaniakJR, Evans JP, Bright DS: Microvas-
cular management of ring avulsion injuries.
JHandSurg 1981;6:25-30.
2. Flagg SV, Finseth FJ, Krizek TJ: Ring avul-
sion injury. Plast Recontr Surg 1977; 59:241-
246.
3. Nissenbaum M: Class IIA ring avulsion
injuries: an absolute indication for microvas-
cular repair . J Hand Surg 1984;9:810-815.
4. Wilgis EF, Redfern AB: Replantation and
revascularization of ring avulsion injuries.
MD State Med J 1980;29:22-23.
5. Tsu-Min Tsai, Manstein C, DuBon R, et al:
Primary microsurgical repair of ring avulsion
amputation injuries. J Hand Surg 1984;
9A:68-72.B
NIH Consensus Development Conference
Lowering blood cholesterol to prevent heart disease
Earlier this year the National
Heart, Lung, and Blood Institute
and the Office of Medical Appli-
cations of Research of the Na-
tional Institutes of Health (NIH)
held a Consensus Development
Conference on Lowering Blood
Cholesterol to Prevent Heart Dis-
ease. After hearing presentations
on the subject by scientific ex-
perts, a consensus panel issued a
report containing conclusions and
recommendations concerning
lowering blood cholesterol. Free,
single copies of this consensus
statement are available from:
Michael J Bernstein, Office of
Medical Applications of Research,
National Institutes of Health,
Building 1, Room 216, Bethesda,
Maryland 20205. Published below
are the Panel's conclusions:
Elevated blood cholesterol
level is a major cause of coronary
artery disease. It has been estab-
lished beyond a reasonable doubt
that lowering definitely elevated
blood cholesterol levels (specific-
ally blood levels of low-density
lipoprotein, cholesterol) will re-
duce the risk of heart attacks due
to coronary heart disease. This has
been demonstrated most conclu-
sively in men with elevated blood
cholesterol levels, but much evi-
dence justifies the conclusion that
similar protection will be afforded
in women with elevated levels.
After careful review of genetic,
experimental, epidemiologic, and
clinical trial evidence, we recom-
mend treatment of individuals
with blood cholesterol levels
above the 75th percentile (upper
25 percent of values). Further, we
are persuaded that the blood
cholesterol level of most Ameri-
cans is undesirably high, in large
part because of our high dietary
intake of calories, saturated fat,
and cholesterol. In countries with
diets lower in these constituents,
blood cholesterol levels are lower,
and coronary heart disease is less
common.
There is no doubt that appropri-
ate changes in our diet will reduce
blood cholesterol levels. Epidemi-
ologic data and over a dozen clin-
ical trials allow us to predict with
reasonable assurance that such a
measure will afford significant
protection against coronary heart
disease.
For these reasons we recom-
mend that:
1. Individuals with high-risk
blood cholesterol levels (values
above the 90th percentile) be
treated intensively by dietary
means under the guidance of a
physician, dietitian, or other
health professional; if response to
diet is inadequate, appropriate
drugs should be added to the treat-
ment regimen. Guidelines for chil-
dren are somewhat different, as
discussed below.
2. Adults with moderate-risk
blood cholesterol levels (values
between the 75th and 90th per-
centiles) be treated intensively by
dietary means, especially if addi-
tional risk factors are present.
Only a small proportion should re-
quire drug treatment.
3. All Americans (except
children under 2 years of age)
be advised to adopt a diet that
reduces total dietary fat intake
from the current level of about 40
percent of total calories to 30 per-
cent of total calories, reduces
saturated fat intake to less than 10
percent of total calories, increases
polyunsaturated fat intake but to
no more than 10 percent of total
calories, and reduces daily choles-
terol intake to 250 to 300 mg or
less.
4. Intake of total calories be re-
duced, if necessary, to correct
obesity and adjusted to maintain
ideal body weight. A program of
regular moderate-level exercise
will be helpful in this connection.
5. In individuals with elevated
blood cholesterol, special at-
tention be given to the manage-
18
WISCONSIN MEDICAL JOURNAL, OCTOBER 1985: VOL. 84
LOWERING BLOOD CHOLESTEROL
SC I E \ T I F I C ,\1 E I ) I C I \ E
ment of other risk factors (hyper-
tension, cigarette smoking, dia-
betes, and physical inactivity).
These dietary recommenda-
tions are similar to those of the
American Heart Association and
the Inter-Society Commission for
Heart Disease Resources.
We further recommend that:
6. New and expanded programs
be planned and initiated soon
to educate physicians, other
health professionals, and the
public to the significance of ele-
vated blood cholesterol and the
importance of treating it. We
recommend that the National
Heart, Lung, and Blood Institute
provide the focus for development
of plans for a National Cholesterol
Education Program that would
enlist participation by and contri-
butions from all interested organ-
izations at national, state, and
local levels.
7. The food industry be encour-
aged to continue and intensify
efforts to develop and market
foods that will make it easier for
individuals to adhere to the rec-
ommended diets and that school
food services and restaurants
serve meals consistent with these
dietary recommendations.
8. Food labeling should include
the specific source or sources
of fat, total fat, saturated and
polyunsaturated fat, and choles-
"WATS " LINE
FOR MEMBERS
The in-WATS (toll-free) line
can be used to contact any-
one at SMS headquarters
(330 East Lakeside Street,
Madison) from anywhere
within the State of Wiscon-
sin between the hours of
8:00 am and 4:30 pm week-
days. The number to dial is:
1-800-362-9080
terol content as well as other
nutritional information. The
public should be educated on how
to use this information to achieve
dietary aims.
9. All physicians be encouraged
to include whenever possible
a blood cholesterol measurement
on every adult patient when that
patient is first seen; to ensure
reliability of data, we recommend
steps to improve and standardize
methods for cholesterol measure-
ment in clinical laboratories.
10. Further research be encour-
aged to compare the effective-
ness and safety of currently rec-
ommended diets with that of
alternative diets; to study human
behavior as it relates to food
choices and adherence to diets; to
develop more effective, better
tolerated, safer, and more eco-
nomical drugs for lowering blood
cholesterol levels; to assess the ef-
fectiveness of medical and sur-
gical treatment of high blood
cholesterol levels in patients with
established clinical coronary
artery disease; to develop more
precise and sensitive noninvasive
artery imaging methods; to apply
basic cell and molecular biology to
increase our understanding of
lipoprotein metabolism (particu-
larly the role of HDL as a protec-
tive factor) and artery wall
metabolism as they relate to cor-
onary heart disease.
11. Plans be developed that will
permit assessment of the im-
pact of the changes recommended
here as implementation proceeds
and provide the basis for changes
when and where appropriate. ■
ABSTRACT
Microscopically controlled surgery for periorbital
melanoma: fixed-tissue and fresh-tissue
techniques
FREDERIC E MOHS, MD, Chemosurgery Clinic, Department of Surgery,
University of Wisconsin Hospital and Clinics, Madison, Wis: J Dermatol Surg
Oncol 1985 (Mar); 1 1 :284-291
Micrographic surgery for the microscopically controlled
excision of malignant melanomas is especially useful around such
important structures as the eyes because the method permits
maximal sparing of normal tissues without jeopardizing the
patients' chances of being cured. The tissue of the melanomatous
area is excised layer by layer and the entire underside of each
layer is scanned in the microscope to precisely locate the unpre-
dictable outgrowths that may extend for a considerable distance
beyond the clinically observed borders. The fixed-tissue tech-
nique, by which the tissues are subjected to chemical fixation in
situ, is used for most periorbital melanomas. However, the fresh-
tissue technique, followed by brief cauterization of the excisional
surface with dichloroacetic acid is used for melanomas on the lid
margins or bulbar conjunctiva because of the danger of the fix-
ative damaging the eye in these areas. In addition to the certainty
with which the primary melanoma is eradicated, the manage-
ment of possible invisible satellites is improved since they are not
disturbed, disseminated or covered with a graft or flap and they
can be removed expeditiously when they become clinically
visible. ■
WISCONSIN MEDICAL JOURNAI., OCTOBER I98.5:VOL. 84
19
SCIENTIFIC MEHICINE
Old versus new antiparkinsonian agents?
Norman C Reynolds Jr, MD, Milwaukee, Wisconsin
ABSTRACT. Current medical
treatment for patients with Parkin-
son's disease assists patients to re-
gain or at least to maintain some
degree of control in motor function
as the disease progresses. In our
search for more potent agents with
greater effectiveness, many phy-
sicians have abandoned the use of
older medications such as anti-
cholinergic agents. In order to
avoid fluctuations in motor per-
formance and unwanted side ef-
fects of the newer, more potent
agents, the author recommends a
conservative medication program
making use of both drugs with
tonic effects (less potent} and drugs
with phasic effects (more potent}
on motor performance. Guidelines
for the rational use of anticholin-
ergic drugs as an integral part of
an anti-Parkinson medication
program are outlined.
Key words: Parkinsonism; Antiparkin-
sonian agents
NUMBER of new pharmacol-
ogic agents are being evaluated to
improve motor deficiency aspects
of Parkinson's disease. 'These in-
clude the aporphinesd lergotrile,^
and mesulergine,^ with bromo-
criptine‘^'5 (Parlodel®) already re-
leased, first in 2.5 mg and more
recently in 5.0 mg oral dosage
forms. These new agents have
Doctor Reynolds is Associate Profes-
sor of Neurology (Milwaukee Clinical
Campus], University of Wisconsin
Medical School, Madison, and Director of
Movement Disorder Clinic, Mount Sinai
Medical Center, Milwaukee. Reprint
requests to: Norman C Reynolds Jr,
MD, Mount Sinai Medical Center, 950
North 12th Street, PO Box 342, Mil-
waukee, Wis 53201 (ph 414/289-8099).
Copyright 1985 by the State Medical
Society of Wisconsin.
direct dopamine receptor effects
in the striatum, independent of
the failing metabolic machinery
of the dopamine producing neu-
rons of the substantia nigra. The
new agents provide a major hope
for continuing therapy as dopa-
minergic neurons decline.
Another major emphasis in
newer agents is to provide some
alternatives in reducing fluctua-
tions in motor and mental per-
formance, the "On-Off Effect."
Rather than looking forward to a
new solution for "On-Off Ef-
fects" or a new agent with sus-
tained potency in the face of
motor decline, doctors should
consider a major step backwards
to reestablish goals of more con-
ventional treatment. In addition,
the cost savings of older medica-
tions compared to the newer
medications can be substantial.
The basis of conventional drug
therapy relates to synaptic cir-
cuitry of nigrostriatal projections.
The dopamine secreting inhibi-
tory neurons in the substantia
nigra are lost in the process of
deterioration in the extrapyra-
midal motor system. The stria-
tum loses its dopamine inhibi-
tory control and is left with an
imbalanced excitatory acetylcho-
line output (Fig 1). To rebalance,
either anticholinergic drugs or
dopamine agonists can be added
to the circuit system with mar-
ginal to moderate improvement
in motor control. This involves
less bradykinesia, less rigidity,
and more fluid movement in
ambulation and facial expression.
Improvement in tremor is often
less than improvement in the
other aspects of motor activity.
Figure I— Relationship of dopamine in-
hibition (1} and acetylcholine excitation
(E} in extrapyramidal motor control.
Since the loss of dopamine ef-
fects is the key element relating
to motor disability, the use of
L-dopa is a popular treatment
mode.® As a metabolic precursor
to dopamine, L-dopa by its very
nature leads to fluctuations in
central control. The phasic ef-
fects of L-dopa relate to metabolic
conversion to dopamine by a
decarboxylase enzyme. Levels of
dopamine rise and fall with syn-
thesis and use. Central neuronal
decarboxylase provides synaptic
dopamine while peripheral or
systemic decarboxylase detracts
from central levels by prema-
turely producing dopamine
which cannot pass the blood-
brain barrier. Toxic systemic side
effects of L-dopa have been les-
sened considerably with the
introduction of carbidopa in car-
bidopa/L-dopa combinations
[eg, Sinemet®). As a peripheral
systemic decarboxylase inhibitor,
carbidopa allows rapid thera-
peutic central levels of L-dopa at
lower doses. The central levels
provide rapid therapeutic bene-
20
WISCONSIN MEDICAL JOURNAL, OCTOBER 198,S:\'OL. 84
ANTIPARKINSONIAN AGENTS-Reynolds
SCIENTIFIC MEDICINE
fits (20-30 minutes); however,
such central effects last only
three to four hours.
In an effort to provide maximal
motor improvement, successive
dosage increases of Sinemet®
produce wider excursions in
central levels and in associated
motor performance in many
patients. In some patients, tran-
sient high central levels of L-dopa
lead to transient but annoying
side effects or "On Effects." "On-
Effects" of abnormal involuntary
movements are frustrating to the
patient but surpassed by the an-
noyance of "On-Effects" of hal-
lucinations and delusions in sus-
ceptible individuals. "Off-Ef-
fects" occur when the central ef-
fects of Sinemet® fail to provide
sustained improvement in motor
control and typically occur before
the next dose of Sinemet® is
taken. The presence of "On-Off
Effects" relating to the use of
drugs with phasic effects like
Sinemet® can be minimized by
giving lower doses more fre-
quently than every four hours
(Fig 2).
Many of us are prescribing
carbidopa/ L-dopa (Sinemet®) and
are looking forward to newer
agents which report less fluctua-
tions in performance. At the same
time, a large number of us are
overzealous about providing
up-to-date and more potent
Figure 2— Tonic (Tj and phasic (Pj in-
fluences relative to untreated motor
deficiency (Of
agents and are ignoring some
earlier and more conservative
treatments. Prior to the advent of
Sinemet® the use of amanta-
dine and numerous anticholiner-
gic agents provided stable (albeit
less potent) improvement on a
twice daily dosage schedule. Al-
though sustained improvement
with amantadine (Symmetrel®) is
typically lost as early as six
months after its use, amantadine
can be replaced with antichol-
inergic agents and reintroduced
later for additional effectiveness
when needed. The conservative
use of agents like amantadine and
anticholinergic drugs buys time
for the patient and when com-
bined with a mild to moderate
exercise program can be ef-
fective for up to a few years be-
fore the addition of carbidopa/
L-dopa becomes inevitable. The
addition of phasic drugs at this
time is superimposed on a higher
level of control and need not be
prescribed in doses which en-
courage fluctuations in perform-
ance or unnecessary "On-Ef-
fects" (Fig 2).
On the other hand, patients al-
ready afflicted with "On-Off Ef-
fects" at moderate to high doses
of carbidopa/ L-dopa need a modi-
fication in their medication pro-
gram. This should involve at-
tempts at increasing tonic agents
(eg; anticholinergic drugs) and
decreasing phasic agents (eg,
Sinemet®) and giving the latter
more frequently at lower doses if
necessary. Another alternative at
this time is the addition of bromo-
criptine (Parlodel®) with later
decreases in Sinemet® if mental
changes or abnormal involuntary
movements occur. Although
bromocriptine (Parlodel®) is less
phasic than Sinemet® and can be
given two or three times a day,
there are pre-synaptic inhibitory
effects which limit the percentage
of low dose (2.5 mg two or three
times a day) responders to a
small number. Typically effective
doses are 40-60 mg in addition to
the Sinemet® already being
taken. Although the higher doses
of Parlodel® provide adequate
post-synaptic dopamine-like
effects, the numbers of tablets re-
quired and their expense are often
prohibitive.
Although the use of anticholin-
ergic drugs is an older treatment
mode, a variety of these drugs
are available for use for more
than one purpose (Fig 3). Neutral
anticholinergic drugs can be
used to provide a basic tonic im-
provement in motor performance
without anti-psychotic or anti-
anxiety effects. If psychotic or
anxiety symptoms occur, the
neutral agent can be replaced
with an anticholinergic drug
which also has mild anti-psy-
chotic or anti-anxiety effects
totally or at selected times. This
is preferable to the use of benzo-
diazepines (eg, Valium®) which
may retard motor performance
and may encourage depression.
Higher doses of Mellaril® or
stronger neuroleptics (eg, Hal-
dol®, Thorazine®, Prolixin®) which
bind more avidly to the striatal
dopamine receptors should
be avoided since these reverse
Anxiolytic/
Neutral
Activating
Antipsychotic
Cogentin®
Tofranil®
Benadryl®
0.25-2.0 mg
10-25 mg
25-50 mg
2 times
bedtime or
4 times
a day
2 times
a day
a day
as needed
Artane®
Aventyl®
Parsidol®
5 mg SA
10-25 mg
10-50 mg
daily
bedtime or
2 or
or
2 times
3 times
2.5 mg
a day
a day
2 or 3
times
as needed
a day
Deactivating
Sinequan®
Mellaril®
10-25 mg
10-25 mg
Akineton®
bedtime
2 or
2 mg
2 to 4
3 times
a day
times
a day
as needed
Figure 3— Anticholinergic drugs.
WISCONSIN MEDICAL JOURNAL, OCTOBER 1985: VOL. 84
21
SCIENTIFIC MEDICINE
ANTIPARKINSONIAN AGENTS-Reynolds
Tuberculous otomastoiditis
Bruce H Campbell, MD; Thomas B Chatton, MD;
Michael J Chusid, MD; and Russell S Yale, MD
Milwaukee, Wisconsin
the positive effects of anti-
parkinson treatment. Occasion-
ally certain individuals show an
intolerance to anticholinergic
drugs and may display an atro-
pine-like psychosis or confusional
state. In such cases only low
doses may be tolerated. Re-
ductions in phasic dopamine
agonists should also be con-
sidered. If sleep is impaired with
or without signs of depression, a
dose of a neutral agent at bedtime
can be replaced by low-dose
doxepin (Sinequan®). If fhere is
a low energy level during the
day, low-dose imipramine (Tofra-
nil®) can be used as a replace-
ment agent for neutral anticholin-
ergic drugs at bedtime or twice
daily.
Although the search for newer
agents has merit, a major step
backwards to reconsider effective
use of older agents also has merit.
Because a number of patienfs dis-
play an intolerance to anticholin-
ergic medication, low starting
doses are recommended (Fig 3). A
conservative treatment plan can
postpone or even totally avoid
the added burden of ineffective
high doses of agents {eg, Sine-
met®) which may beset the pa-
tient with fluctuations in per-
formance and untoward mental
effects.
REFERENCES
1. Cotzias GC, Papavasiliou PS, Tolosa ES,
et al: Treatment of Parkinson's disease with
aporphines. New Engl J Med 1976; 294;567-
572.
2. Lieberman AN, Gopinathan G, Estey E, et al:
Lergotrile in Parkinson disease; further
studies. Neurol (Minneap) 1979; 29.267-272.
3. JankovicJ, Orman J, Jansson B: Placebo-con-
trolied study of mesulergine in Parkinson's
disease. Afearo/ (NY) 1985; 35:161-165.
4. Bateman DN, Coxon A, et al: Treatment of
on-off syndrome in parkinsonism with low
dose bromocriptine in combination with
levodopa. J Neurol Neurosurg Psychiat 1978;
41:1109-1113.
5. Lees A], Stern GM: Sustained bromocriptine
therapy in previously untreated patients
with Parkinson's disease. / Neurol Neurosurg
Psychiat 1981; 44:1020-1023.
6. Rajput AH, Stern W, Laverty WH: Chronic
low-dose levodopa therapy in Parkinson's
disease: an argument for delaying levodopa
therapy. Neurol (Cleveland) 1984: 34:
991-996.B
ABSTRACT. The incidence of pul-
monary tuberculosis and related
tuberculous infections has mark-
edly decreased in the United
States. However, patients such as
the one reported here are still seen
on occasion with tuberculous
otomastoiditis. This condition
should be considered in any pa-
tient with a chronically draining
ear that does not respond to anti-
biotic therapy. Patients with tuber-
culous otitis media frequently de-
velop severe hearing loss and facial
paralysis. Therapy is primarily
medical, although in selected cases
surgery may be necessary.
Key words: Tuberculosis: Otitis media;
Mastoiditis
T HE INCIDENCE OF tuberculosis
has decreased in many areas of
the United States to the point that
some health agencies are cau-
tiously reviewing the cost ef-
fectiveness of mass screening
procedures in low risk set-
tings.'^ The following case illus-
trates that Mycobacterium tubercu-
From the Departments of Otolaryngology
(BHC, RSY) and Pediatrics (TBC, MJC) of
the Medical College of Wisconsin, Mil-
waukee, and Milwaukee Children's Hos-
pital, Milwaukee. Reprint requests to:
Michael] Chusid, MD, Milwaukee Chil-
dren's Hospital, 1700 West Wisconsin
Ave, Milwaukee, Wis 53233 (ph 414/
933-4295. Copyright 1985 by the State
Medical Society of Wisconsin.
losis infection must be considered
in the differential diagnosis of
otitis media unresponsive to
usual antibiotic therapy.
Case report. The patient was a
2355-Gm product of a normal
full-term pregnancy. Her family
had recently moved to the inner
city of Milwaukee from rural
Mississippi. She was first seen at
11 months of age with mild res-
piratory symptoms and a fever.
Chest radiographic studies re-
vealed a right perihilar infiltrate.
A Tine test was interpreted as
negative. When the patient was
14 months of age, her maternal
aunt was discovered to have cavi-
tary tuberculosis. At age 16
months, the patient developed a
draining left ear which did not
respond to adequate courses of
amoxicillin, trimethoprim/sulfa-
methoxazole, and cefaclor. Cul-
ture of the drainage revealed
mixed skin flora.
At 20 months of age, the patient
was evaluated after an episode of
vomiting and falling to the left.
She was a small, alert 20-month-
old child. There was a small
amount of purulent drainage
from the left ear. Pale tissue com-
pletely obscured the left tym-
panic membrane. There were no
periauricular lymph nodes or
sinuses, and few cervical lymph
nodes. The right ear was normal.
The remainder of the examina-
22
WISCONSIN MEDICAL JOURNAL, OCTOBER 1985:VOL. 84
OTOMASTOIDITIS-Campbell, Chatton, Chusid & Yale
SCIENTir IC MEDICINE
tion was normal. Laboratory
studies revealed a hemoglobin
level of 9.7 mg/dl, white blood
cell count of 8100//^P with a
normal differential and an ery-
throcyte sedimentation rate of
74 mm/hour. The urinalysis was
normal. Spinal fluid had three
mononuclear cells/^P, a glucose
of 63 mg/dl, and protein of
12 mg/dl. Chest radiographic
studies showed an infrahilar infil-
trate. A caseating granuloma was
found in a biopsy of the tissue in
the left ear canal. A 5 TU purified
protein derivative (PPD) skin
test had 25 mm of induration at
72 hours. Temporal bone tomog-
raphy showed significant des-
truction of the ossicles on the left
side. Left-sided hearing loss
was documented by brainstem
evoked response audiometry
(ERA) and brainstem auditory
evoked potential (AEP) measure-
ments. The left ear demonstrated
marked prolongation of latency-
intensity measurements on ERA
testing and wave V latency on
AEP. Specific testing for apparent
threshold was not performed.
Ziehl-Nielsen stains of the ear
drainage and gastric aspirates
were negative. Cultures of the ear
drainage and biopsy material
were subsequently positive for
Mycobacterium tuberculosis after
eight weeks incubation.
Therapy was begun with ison-
iazid 10 mg/kg/day and rifampin
10 mg/kg/day, but the family
was unable to maintain the treat-
ment regimen. Ear drainage and
granulation tissue persisted for
three months. An elective radical
mastoidectomy was performed.
The mastoid cavity was filled
with pale granulation tissue and
loculated areas of pus. Cultures
and smears of the mastoid con-
tents were negative, but Langh-
ans giant cells and areas of caseat-
ing necrosis were seen micro-
scopically.
Eighteen months postoperative-
ly and after one year of isoniazid
and rifampin therapy, the pa-
tient's mastoid cavity has re-
mained dry.
Discussion. The morbidity and
mortality from tuberculosis has
decreased, yet over 28,500 new
cases were reported in this
country in 1978. ^ In the general
population, the case rate of tuber-
culosis is 13.1 per 100,000, but
the incidence is higher among
residents of crowded, low-in-
come communities, the east
coast, the Mexican border, Appa-
lachia, and among Native Ameri-
cans.
Tuberculous otitis presents
much as any other suppurative
ear disease, but quickly develops
severe manifestations. "Classic"
signs and symptoms were de-
scribed by Turner and Fraser^ in
1915 and have been reiterated by
other authorities:® painless
aural discharge of insidious onset;
early and disproportionately
severe hearing loss; profuse pale
granulation tissue in the mastoid
and external auditory canal; peri-
auricular node enlargement;
periauricular sinuses; subperio-
steal abscesses; and facial nerve
paralysis. Children are more
likely than adults to develop
facial paralysis or temporal bone
destruction.’’
The diagnosis of tuberculous
otitis is made primarily through
laboratory testing. In Jeane's and
Friedmann's report” only four
of ten cultures and two of 11
smears were positive, yet all
patients had tuberculous granula-
tion tissue histologically. Multiple
specimens probably increase the
diagnostic yield.
Treatment regimens always
include antituberculous chemo-
therapy. Surgical intervention is
controversial since, with proper
drug therapy, the ear drainage
usually resolves. BirrelL^ eradi-
cated disease in all eight of his
patients and effected improve-
ment in three of four facial
paralyses with chemotherapy
alone. It is generally agreed, that
if the patient is compliant with
his or her medications, surgery
should only be performed if
complications intervene.^
Long-term followup has shown
that patients regain little of the
lost hearing. Craig® reviewed
eight cases that had been fol-
lowed for at least 11 years. All
had significant residual hearing
losses, similarly, facial nerve
function usually does not return
if lost during the suppurative
phase, although reports of re-
covery have been published.'* ®
Tuberculous otomastoiditis is
rare. However, its sequelae, in-
cluding permanent hearing loss
and facial paralysis, are signifi-
cant. Cultures and smears of ear
drainage have high false-negative
rates, and the clinician must be
alert to the possibility of the
disease in high-risk populations
even in the face of negative test
results.
REFERENCES
1. Edwards PQ: Tuberculin testing of chil-
dren. Pediatr 1974; 54;628-630.
2. Reichman LB, et al: Toward eradication
—A contemporary tuberculosis control
strategy. Am Rev Resp Dis 1978; 118:641-
644.
3. 1978 Tuberculosis Statistics: States and Cities:
us Department of Health, Education, and
Welfare / Public Health Service / Center for
Disease Control. DHEW Publication No.
(CDC) 80-8249, 1979.
4. MacAdam AM, Rubio T: Tuberculosis
otomastoiditis in children. Am J Dis Child
1977: 131:152-156.
5. Turner AL, Fraser JS: Reports for the
Year 1914 from the Ear and Throat De-
partment of the Royal Infirmary, Edin-
burgh. Part III. Tuberculosis of the middle
ear cleft in children; a clinical and patho-
logical study. J Laryngol Otol 1915; 30:
209-235.
6. Myerson MC: Tuberculosis of the Ear,
Nose, and Throat. Charles C Thomas,
Springfield, Illinois, 1944.
7. Wallner LJ: Tuberculous otitis media.
The Laryngoscope 1953: 63:1058-1065.
8. Craig DH: Tuberculous mastoiditis: review
of eight cases. J Laryngol Otol 1962: 76:
623-638.
9. Lucente FE, Tobias GW, et al: Tuberculous
otitis media. The Laryngoscope 1978: 88:
1107-1116.
10. Windle-Taylor PC, Bailey CM: Tuberculous
otitis media: a series of 22 patients. The
Laryngoscope 1980; 90:1039-1044.
1 1. Jeanes AL, Friedmann I: Tuberculous of the
middle ear. Tubercle 1960;41:100-110.
12. Birrell JF: Aural tuberculosis in children.
Proc Roy Soc Med 1973; 667:331-338. ■
WISCONSIN MEDICAL JOURNAL, OCTOBER 1985: VOL. 84
23
SCIENTIFIC MEDICINE
Reflex sympathetic dystrophy syndrome: Importance
of early diagnosis and appropriate management
Sridhar V Vasudevan, MD and Bruce Myers, Milwaukee, Wisconsin
ABSTRACT. Reflex sympathetic dystrophy syndrome (RSDSI is a well-recognized
clinical condition characterized by pain and tenderness, usually in the distal parts
of an extremity, vasomotor instability, and trophic skin changes. Although the cause
is unclear, autonomic nervous system dysfunction is presumed to be the under-
lying basis. It is reported following cerebral vascular accidents, myocardial in-
farctions, cervical trauma, and a variety of soft-tissue injuries. Scintigraphy is the
most sensitive indicator of the presence of the syndrome, characterized by increased
periarticular radionuclide activity. A wide array of treatment modalities has been
suggested, but sympathetic blockade or systemic corticosteroid therapy has been
reported to be the most successful when employed early. This paper describes a
patient with a cerebral vascular accident in whom RSDS developed rather abruptly.
Early and prompt diagnosis was made using roentgenograms and scintiscans. The
patient responded dramatically to systemic corticosteroid therapy after sympathetic
blockade failed. Scintiscans following treatment with systemic steroids showed im-
provement. It is suggested that when RSDS is suspected, scintiscans be obtained
and systemic steroids be used promptly to prevent sequelae of the syndrome.
Key words: Sympathetic dystrophy: Scintigraphy; Sympathetic blocks; Corticosteroids:
Physical therapy
R-EFLEX SYMPATHETIC dys-
trophy syndrome (RSDS), is
a well- documented clinical
entity which has been given num-
erous titles including causalgia,
Sudeck's atrophy, shoulder- hand
syndrome, acute atrophy of the
bone, posttraumatic osteoporosis,
reflex neurovascular dystrophy,
and the like.^ It is characterized
by the following: (1) pain and
tenderness in the extremity;
(2) pitting or nonpitting edema of
the extremity; (3) trophic changes
of the skin including atrophy.
Doctor Vasudevan is Assistant Profes-
sor, Dept of Physical Medicine and
Rehabilitation, Medical College of
Wisconsin, 1000 North 92nd St, Mil-
waukee, Wis 53226 (ph 414/259-1414).
Mr Myers is a Senior Medical Student,
Medical College of Wisconsin, 8701
Watertown Plank Road, Milwaukee, Wis
53226. Publication support provided.
Reprint requests to Doctor Vasudevan at
the above address. Copyright 1985
by the State Medical Society of Wis-
consin.
hair loss, and nail changes;
(4) vasomotor instability varying
from Raynaud's- type phenomena
to warmth, erythema, and hyper-
hydrosis; and (5) pain and limited
range of motion of involved
joints.'"^
The radiologic features char-
acteristically include juxta-ar-
ticular osteopenia late in the
course of RSDS.*'^® Scintilation
scans show an increase uptake of
isotope in periarticular tissues,
usually early in the course of the
disease. Kozin et aR report that
scintiscans with technetium have
been found to be more sensitive
than roentgenograms, with more
specificity in the diagnosis of
RSDS.
RSDS has been associated with
trauma. It has been reported
following cervical spine syn-
drome, spinal cord injury, cere-
bral vascular accidents with
hemiplegia. Herpes zoster, and
the like. In approximately one-
third of the cases no definitive
precipitating event can be identi-
fied.’
There is disagreement regard-
ing the underlying cause of
RSDS. The pathogenesis of RSDS
in any given patient may be re-
lated to both peripheral and
centrally mediated factors.^'’ The
peripheral theory postulates de-
velopment of artificial synapses
between sympathetic efferents
and pain carrying afferent fibers
leading to cross-firing. Central
theory includes overactivation of
posterior horn neurons which
facilitates activity of internuncial
pool and also involves hypothala-
mus, limbic system, and the
like.'’ The results of the over-
active sympathetic system are
chronic ischemia, vasomotor in-
stability, and dystrophic changes.
Similarly, there is disagreement
in regard to the most appropriate
treatment for RSDS. The consen-
sus is that early treatment will
achieve the best results, and pre-
vention of RSDS is essential. ’'3®
Schutzer and Gossling® recently
reviewed the treatment of RSDS.
The most frequently used treat-
ment modalities have included
physical therapy approaches,
sympathetic interruption, and
use of corticosteroids.
Case report. A 55-year-old, right-
handed female had three epi-
sodes of transient ischemic at-
tacks. Evaluations revealed a sub-
clavian steal syndrome with sig-
nificant narrowing of the sub-
clavian artery, stenosis of the
left carotid artery, and some
plaque formation. On June 5,
24
WISCONSIN MEDICAL JOURNAL, OCTOBER 1985: VOL. 84
REFLEX SYMPATHETIC DYSTROPHY-VasiKlcvan & Myers
scTKNTii ic mi dictm;
Figure 1 (A) and (B)— X-ray films of bilateral wrists dated August 15, 1984. The left (Aj is normal. The right (Bj demonstrates
areas of slight demineralization, particularly in the periarticular areas throughout the hand. The distribution and prominence of
lucent areas are suggestive of reflex sympathetic dystrophy syndrome.
1984 she underwent left carotid
endarterectomy. Postoperatively
she was noted to have a right
hemiparesis, and a computerized
tomographic (CT) scan revealed
an infarction in the left cerebral
cortex. Her major deficits were
weakness in the right upper
extremity and aphasia.
The language deficits resolved
over a period of a few weeks.
Speech pathology evaluation
did not reveal any residual defi-
cits after one month. Her right
upper extremity revealed flaccid
paresis when examined on June
14, 1984. She was ambulatory
with no hypertonus or upper
motor neuron signs in the right
lower extremity. Sensory ex-
amination of right upper and
lower extremities were normal.
On July 23, 1984 she presented
with complaints of right upper
extremity pain, mainly in the
shoulder. Range of motion of the
right shoulder, which was normal
in the examination of June 14,
was found to be significantly re-
stricted allowing 90° forward
flexion, 60° of abduction, 15° of
external rotation, and 10° of in-
ternal rotation. There was mild
tenderness over the right
shoulder.
The right wrist revealed mild
puffiness, especially on the dor-
sal aspect, with nonpitting
edema. There was no discolora-
tion and the wrist felt warm,
without tenderness. A diagnosis
of periarthritis of the shoulder
was made and the patient was
started on sulindac (Clinoril®) 150
mg two times a day. Physical
therapy, consisting of ultrasound
to the right shoulder followed
by passive exercises with stretch
and active exercises, was also
prescribed.
By August 6, 1984 there had
been no improvement. In the
meantime she developed pain in
her right hand and had restricted
wrist range of motion allowing
only 35° of flexion and 20° of
extension. Tenderness of the
WISCO.X’SIN MFDICAI [Ol HNAL, OCTOBER 198,5:VOE. 84
25
SCIENTIFIC MEDICINE
REFLEX SYMPATHETIC DYSTROPHY-Vasudevan & Myers
■/
Figure 2— Technetium scintiscan taken on August 15, 1984.
Static images demonstrate increase in uptake in the wrist and
hand suggestive of reflex sympathetic dystrophy syndrome.
Figure 3— Followup technetium scan of October 16, 1984.
Static scan continues to show slight abnormal uptake in the
bones of the right hand and wrist but are less than when
compared to August 15, 1984.
right wrist was noted and the
hand was warm to palpation
compared to the other hand.
X-ray films of the right shoul-
der were obtained which re-
vealed bone reabsorption in the
humerus with a "salt and pep-
per" appearance in the cortex.
X-ray studies of both wrists re-
vealed asymmetry. The left hand
was normal. The right hand re-
vealed areas of slight deminerali-
zation particularly in the periarti-
cular areas throughout the hand
(Figs lA and IB).
A bone scan obtained on Au-
gust 15, 1984 was done with tech-
netiunri^m MDP. Static images
demonstrated slight increase in
uptake in the shoulder girdle,
humerus, wrist, and hand. Find-
ings indicated an increased up-
take in the right wrist, compatible
with reflex sympathetic dys-
trophy syndrome (Fig 2).
The patient was treated with
three stellate ganglion blocks.
The first block provided some
relief of the pain in the right
upper extremity but the two sub-
sequent blocks produced no
relief.
On examination of August 13,
1984 she seemed to be extremely
aiTxious, was in significant pain,
and was unable to use the arm.
Restriction of the shoulder and
wrist continued to be present,
and all movements were very
painful.
Following a rheumatological
consultation she was started on
60 mg of prednisone a day in
divided doses for one week, then
the dosage was tapered over the
next two weeks.
Within a period of three to four
days following the initiation of
steroid therapy she began no-
ticing improvement. The pain in
the right shoulder subsided and
the pain in the right wrist had
subsided by one week. Range of
motion also revealed improve-
ment. When seen on September
10, 1984 her shoulder range of
motion had increased to 165° for-
ward flexion, 160° abduction,
65° of external rotation, and 20°
of internal rotation, all without
pain. This was only a few degrees
limitation compared to the other
side. The right wrist had normal
range of motion without any
pain. She also revealed dramatic
functional improvements. She
was able to dress herself and was
able to use her hand in functional
activities, such as tying shoe-
laces.
A followup scintiscan was ob-
tained on October 16, 1984. The
flow study had reverted to
normal on the right, but static
studies revealed increase uptake
of isotope in the right hand and
wrist. However, this was a sig-
26
WISCONSIN MEDICAL JOURNAL, OCTOBER 1985: VOL. 84
REFLEX SYMPATHETIC DYSTROPHY-Vasudevan & Myers
SCIENTIF-IC MEDICINE
nificant improvement over the
scan done on September 15, 1984
(Fig 3).
The patient has been seen since
then; and as of December 1984,
she has had no recurrence of the
problem. There has been marked
improvement in the right upper
extremity functioning, and ex-
cept for some mild problems in
manipulating fine objects, she is
totally independent in the use of
the right upper extremity. No
pain or limitation of motion of the
affected extremity is noted.
Discussion. Reflex sympathetic
dystrophy syndrome (RSDS) pre-
sents with the constellation of
symptoms consisting of pain and
tenderness in a limb, associated
with signs or symptoms of
vasomotor instability, trophic
changes, and swelling. Schutz-
er and Gossling^ have recently
reviewed the presentation of
RSDS and discussed the under-
lying pathophysiology and the
treatment approaches.^ The
pathogenesis of RSDS is variable
and unclear. It is related to both
peripheral and centrally medi-
ated effects.
The diagnosis of RSDS in its
earliest stages is at times very
difficult. Uematsu^ discussed
the lack of reliable methods to ob-
jectively evaluate the condition
prior to the development of
typical trophic changes. He pro-
poses the temperature asym-
metry noted by noninvasive
telethermography as helpful in
early diagnosis of sympathetic
dysfunction before trophic or
myofascial changes occur.
Kozin et aR emphasize the role
of scintigraphic studies as a very
sensitive and specific diagnostic
tool in detecting early reflex
sympathetic dystrophy syn-
drome. Scintiscans proved to be
far more specific than roentgeno-
graphy with no sacrifice in sensi-
tivity. They also note that scinti-
graphs appear to be useful as a
guide to therapy and noted that
90% of the patients with positive
scintigraphs experienced a good
to excellent response to cortico-
steroid therapy compared to 34%
of the patients with negative scin-
tigraphs.^ This suggested that
scintigraphy may be used as both
a diagnostic aid and a predictor
of therapeutic response. In our
patient symptoms developed
abruptly, initial scintigraphy
was positive, and the patient's
condition responded rather
dramatically to steroids. The
followup scan paralleled the
clinical improvement. This has
been observed by Kozin et aR
who noted that scintigraphs,
which were positive initially,
were normal following cortico-
steroid therapy, suggesting that
scintigraphy may demonstrate
an active, potentially reversible
process.
Sympathetic blockade, using
stellate ganglion blocks or local
guanethidine blocks, has been
used in the treatment of RSDS.® ®
Goodman^® used ultrasound over
the stellate ganglion followed by
concomitant therapy with phy-
sical medicine procedures in the
treatment of shoulder-hand syn-
drome.^® In this study six of the
seven patients experienced
marked to complete relief of
pain, decreased edema, and re-
turn of function.
The rationale for using sympa-
thetic blockade in patients with
RSDS is interruption of abnormal
reflex mediated by the autonomic
nervous system. Blockade can
be achieved by regional sympa-
thetic block or surgical sympa-
thectomy. Alternatively, intra-
venous infusion of reserpine or
guanethidine, agents that ef-
fectively produce a transient
chemical sympathectomy, also
has been used.®®® The use of
regional sympathetic blockade in
a patient who has not responded
to physical therapy serves both
diagnostic and therapeutic func-
tions. Patients who do not experi-
ence any pain relief from a tech-
nically successful block should
be suspected of having a problem
other than RSDS.® Although in
early stages, a prolonged curative
effect is reported from a single
stellate or lumbar sympathetic
block, multiple blocks are often
required for pain control. The
most commonly accepted prac-
tice is to limit the number of
blocks to a maximum of three or
four. If a patient demonstrates
good clinical response but re-
quires more than four blocks,
surgical sympathectomy should
be considered.® “
Kleinert et aP® report 80% of
their patients who were resistant
to other medical management
and physical therapy experienced
pain relief from one or more stel-
late ganglion blocks. Of these,
81% had required no further
treatment for one to five years of
followup. Nineteen percent (19%)
experienced a temporary re-
sponse but ultimately required
surgical sympathectomy. Only
17% of the patients in this group
were not permanently improved.
Lankford and Thompson" also
report favorable results with
sympathetic blockade. They
found that 89% of their patients
with causalgia and 80% with
other dystrophic variants re-
ported complete long-term pallia-
tion. The technique of intra-
venous infusion of guanethidine,
described by Hannington-KifR in
1974, is based upon the principle
that guanethidine functions as a
false transmitter, being actively
taken up by the sympathetic
nerve endings and displaces nor-
epinephrine from its storage sites.
Glynn et al® demonstrated a sig-
nificant pain reduction following
blocks with intravenous guane-
thidine compared with phy-
siological saline. However, sev-
eral patients who were treated
with intravenous saline also
experienced amelioration of pain,
suggesting a strong placebo
effect.
WISCONSIN MEDICAL JOURNAL, OCTOBER 1985: VOL. 84
27
SCIENTIFIC MEDICINE
REFLEX SYMPATHETIC DYSTROPHY-Vasudevan & Myers
Kozin et al^ report 63% of the
patients in a study had a good to
excellent response to systemic
corticosteroid therapy, and this
figure was increased to 82% and
63% in subsets with definite and
probable RSDS respectively. Five
patients who were given stellate
ganglion blockade after cortico-
steroid therapy showed no im-
provement in this study. None of
the 20 patients who received stel-
late ganglion blocks in this study
had improvement.
The mechanism of action of
corticosteroids in treatment of
RSDS is still not clear. The potent
anti-inflammatory properties of
prednisone may account for the
therapeutic effect. It is also
hypothesized that corticosteroids,
by their destablizing effects on
basement membranes, can re-
duce capillary permeability and
therefore decrease the plasma
extravasation that is commonly
associated with the early stage of
RSDS.23
The experience of our patient
supports the efficacy of cortico-
steroid therapy in RSDS. Our
patient, within a short period of
onset of symptoms, revealed the
radiologic diagnostic criteria of
juxta-articular osteopenia. In
addition, scintigraphy with tech-
netium was definitely positive
and valuable in diagnosis. This
patient responded rather dra-
matically to corticosteroid
therapy.
Summary. We present a patient
who, following a cerebral vas-
cular accident, developed right
hemiparesis. Within a short
period she developed features of
reflex sympathetic dystrophy
syndrome. Reports in the litera-
ture on reflex sympathetic dys-
trophy syndrome (RSDS) empha-
size early diagnosis. Early diag-
nosis was made both clinically
and using scintigraphy. A series
of three stellate ganglion blocks
did not provide relief. Oral corti-
costeroid therapy offered excel-
lent and dramatic improvement,
both noted clinically and by scin-
tigraphy.
We suggest that in patients
undergoing rehabilitation, symp-
toms of limb pain should be care-
fully evaluated for early RSDS.
Appropriate diagnostic tests,
especially scintigraphy should
be considered, and treatment
programs initiated early to pre-
vent the disabling sequelae of
reflex sympathetic dystrophy
syndrome.
REFERENCES
1. McCarty DJ: Arlhntis and Allied Gmditiuns,
9lh ed. Philadelphia, Lea and Febiger,
1979, pp HIM 120.
2. Kozin F, Ryan LM, Carerra GF, et al: The
reflex sympathetic dystrophy syndrome
(RSDS|. III. Seinligraphic studies, further
evidence for the therapeutic efficacy of
systemic corticosteroids, and proposed
diagnostic criteria. Am J Med 1981; 1:23-30.
3. Schutzer SF, Gossling HR: The trealment of
reflex sympathetic dystrophy syndrome.
J Bone Ji Surg |Am) 1984: 66 |4|:625-629.
4. Uematsu S: Thermography in the diag-
nosis of the reflex sympathetic dystrophy
syndrome. In Ring EFJ, Phillips B (ed):
Recent Advances m Medical Thermology.
New York, Plenum Press, 1982,
pp 379-395.
5. Chu DS, Petrillo C, et al: Shoulder- hand
syndrome: Importance of early diagnosis
and treatment. J Am Gerialr Soc 1981:
2:58-60.
6. Glynn CJ, Basedow RW, Walsh [A: Pain
relief following postganglionic sympathetic
blockade with IV guanethidine. BrJ Anaesih
1981; 12:1297-1302.
7. Subbarao J, Stillw'cll GK: Reflex sympa-
thetic dystrophy syndrome of the upper
extremity: analysis of total outcome of
management of 125 cases. Arch Phy Med
Rehab 1981; 11:549-554.
8. Goldner JL: Causes and prevention of
reflex sympathetic dystrophy, y Hand Surg
1980: 5(3):295-296.
9. Hannington-Kiff JG: Pharmocological target
blocks in hand surgery and rehabilitation.
J Hand Swg [Bf] 1984; 9(l):29-36.
10. Goodman CR: Treatment of shoulder-hand
syndrome combined ultrasonic applica-
tion to stellate ganglion and physical
medicine. NY Stale J Med 1971 (Mar);
71:559-562.
11. Lankford LL, Thompson JE: Reflex sympa-
thetic dystrophy — Upper and lower
extremity: Diagnosis and management.
In Instructional Course Lectures, The
American Academy of Orthopedic Surgeons.
Vol 26. St Louis, CV Mosby Co, 1977,
pp 163-178.
12. Kleinerl HE, Cole NM, Wayne L, et al:
Postlraumatic sympathetic dystrophy.
Ortho Clin 1973: 4:9l7-927.m
ABSTRACT
Microscopically controlled surgery in the
treatment of carcinoma of the penis
FREDERIC E MOHS, MD; STEPHEN N SNOW, MD; EDWARD M MESSING,
MD: MICHAEL E KUGLITSCH, MD, Department of Surgery, Chemosurgery
Clinic and Urology Division, University of Wisconsin Clinical Science Center,
Madison, Wis: J Urol 1985 (June); 133: 961-966
Microscopically controlled excision of squamous cell car-
cinomas of the penis provides substantial assurance of eradica-
tion of the primary neoplasm, including its clinically unpredic-
table outgrowths, without the need to remove a wide extra margin
of apparently normal tissue. The tissue-sparing benefit permits
preservation of maximal amounts of normal tissue and normal
functions. Except for the initial surgical debulking of the main
mass, the deeper extensions into the erectile tissues are removed
with the fixed-tissue technique because the fixation of the tissues
eliminates the difficulty in achieving hemostasis in the non-
contractile vascular spaces. In a series of 29 consecutive cases the
5-year cure rate in the 25 determinate cases was 68 percent which
ranks among the highest in the literature. The primary carcinoma
was eradicated in 23 of the 25 lesions (92 percentj.H
28
WISCONSIN MEDICAL JOURNAL, OCTOBER 1985: VOL. 84
ALZHEIMER’S DEMENTIA
Cure of the disease is still out of reach.
In as devastating a condition as this,
even the most modest relief of
symptoms — or for that matter keeping
them from getting worse or merely
slowing their intensification — is a
great contribution to patient and family.
HYDERGINE® LC (ergoloid mesylates) is
indicated for patients over age sixty
who manifest signs and symptoms of
idiopathic mental decline. It appears
that individuals who respond to
HYDERGINE LC therapy are those who
would be considered to suffer from
some ill-defined process related to
aging or to suffer from some
underlying condition such as
Alzheimer’s dementia.
Before prescribing HYDERGINE therapy, the possibility that the patient’s signs and
symptoms arise from a potentially reversible and treatable condition should be
excluded. In addition, because the presenting clinical picture may evolve to suggest
an alternative treatment, the decision to use HYDERGINE therapy
should be continually reviewed.
HYDERGINE® LC
(ergoloid mesylates)
liquid capsules, 1 mg
THE ONLY PRODUCT INDICATED FOR ALZHEIMER’S DEMENTIA.
® 1985 Sandoz, Inc.
HYD-1085-13
For Brief Summary, please see following page.
HYDERGMELC
liquid capsuies
1 mp -"YS"*
Indications; Symptomatic relief of signs and
symptoms of idiopathic decline in mental capacity
(i.e., cognitive and interpersonal skills, mood, self-
care, apparent motivation) in patients over sixty.
It appears that individuals who respond
to HYDERGINE therapy are those who would
be considered clinically to suffer from some
ill-defined process related to aging or to have some
underlying dementing condition, such as primary
progressive dementia, Alzheimer’s dementia, senile
onset, or multi-infarct dementia. Before pre-
scribing HYDERGINE® (ergoloid mesylates), the
physician should exclude the possibility that signs
and symptoms arise from a potentially reversible
and treatable condition, particularly delirium and
dementiform illness secondary to systemic disease,
primary neurological disease, or primary
disturbance of mood. Not indicated for acute or
chronic psychosis regardless of etiology (see
Contraindications).
Use of HYDERGINE therapy should be continually
reviewed, since presenting clinical picture may
evolve to allow specific diagnosis and specific alter-
native treatment, and to determine whether any
initial benefit persists. Modest but statistically
significant changes observed at the end of twelve
weeks of therapy include: mental alertness, confu-
sion, recent memory, orientation, emotional labil-
ity, self-care, depression, anxiety/fears, cooperation,
sociability, appetite, dizziness, fatigue, bother-
some(ness), and overall impression of clinical
status.
Contraindications: Hypersensitivity to the drug:
psychosis, acute or chronic, regardless of etiology.
Precautions: Because the target symptoms are of
unknoun etiology, careful diagnosis should be
attempted before prescribing HYDERGINE (ergo-
loid mesylates) preparations.
Adverse Reactions: Serious side effects have not
been found. Some transient nausea and gastric
disturbances have been reported, and sublingual
irritation with the sublingual tablets.
Dosage and Administration: 1 mg three times daily.
Alleviation of symptoms is usually gradual and
results may not be observed for 3-4 weeks.
How Supplied: HYDERGINE LC (liquid capsules):
1 mg, oblong, off-white, branded “HYDERGINE LC
1 mg" on one side, “A" other side. Packages of 100
and 500. (Encapsulated by R. R Scherer, N.A.,
Clearwater, Florida 33518).
HYDERGINE (ergoloid mesylates) tablets (for
oral use); 1 mg, round, white, embossed
“HYDERGINE 1“ on one side, “A" other side.
Packages of 100 and 500.
Each liquid capsule or tablet contains ergoloid
mesylates USP as follows: dihydroergocornine
mesylate 0.333 mg, dihydroergocristine mesylate
0.333 mg, and dihydroergocryptine (dihydro-
alpha-ergocryptine and dihydro-beta-ergocryptine
in the proportion of 2:1) mesylate 0.333 mg. repre-
senting a total of 1 mg.
Also available: HYDERGINE sublingual tablets;
1 mg, oval, white, embossed “HYDERGINE" on one
side. “78-77" other side. Packages of 100 and 1000.
0.5 mg, round. white, embossed “HYDERGINE 0.5"
on one side. “A" other side. Packages of 100 and
1000.
HYDERGINE liquid: 1 mg/ml. Bottles of 100 mg
with an accompanying dropper graduated to deliver
1 mg. IHYD-ZZ24-6 15 84|
Before prescribing, see package circular for full
product information. hyd-ioss-is
DORSEY PHARMACEUTICALS
Division of Sandoz. Inc.* East Hanover. NJ 07936
A SANDOZ COMPANY
ORGANIZATIONAL
SMS hosts Soviet physicians
at reception
On Saturday, September 28,
the State Medical Society hosted a
reception and dinner at SMS Of-
fices for a group of four Soviet
physicians who were visiting
Wisconsin.
Special guests included N Boch-
kov, Director of the Institute of
Medical Genetics; Y Lopuchin,
Director of the Institute of Phys-
iochemical Medicine, Dr Kole-
snikow, biochemist and embryol-
ogist, Laboratory of Clinical and
Experimental Medicine, USSR
Academy of Medical Sciences;
and N Nickolaeva, Department
of Rehabilitation, USSR Cardiol-
ogy Research Center.
SMS President John K Scott,
MD, was the official host.H
Practice
Made Perfect.
In Navy Medicine the emphasis is on patients, not paperwork.
As a Navy doctor you step into an
active and challenging group practice
You work with state-of-the-art equip-
ment and the best facilities available.
Highly trained physician’s assistants,
hospital corpsmen, nurses and
hospital administrators not only
provide medical support, they
attend to almost all the pape^
work. As a result, you’re free to
make medical decisions based solely
on the needs of your patients.
Along with your professional development, you’ll enjoy
the lifestyle and fringe benefits of a Navy officer. Beginning
salaries are competitive with civilian practice for most
specialists.
To learn more about the Navy’s practice made perfect,
send your curriculum vitae or call:
Lt Nancy Hill. Henry Reuss Federal Plaza, Suite 450
310 West Wisconsin Ave, Milwaukee. Wl 53203
(414) 291-1529 (call collect)
BeThe Doctor
\bu Want To Be. InThe Navy._
ORGANIZATIONAL
Membership facts
Whether you’re just starting medical school, maintaining a
full-time practice, or retiring, SMS has a membership classi-
fication to fit your individual needs. Election to membership
by the County Medical Society in which your principal place
of practice is located carries with it membership in the State
Medical Society of Wisconsin and, if you wish, the American
Medical Association. If you qualify for resident membership
at the time of your election, your membership dues are
greatly reduced. This may also qualify you for reduced dues
the first two years of your practice. In addition, two-physician
families may be eligible for a $50 discount on total SMS
membership dues. Dues for regular membership in 1986 are
$455 for SMS, $375 for AMA, and county society dues vary.
A more detailed listing of SMS membership classifications and
their corresponding dues follows:
State Medical Society of Wisconsin
DESCRIPTION OF MEMBERSHIP
CLASSIFICATIONS
Regular Member in active practice. Some are regular mem-
bers that have reduced SMS and/or AMA dues because they
are new practitioners (first year or two out of residency).
Resident: Physician who at January 1 of dues year is in an
approved training program as a hospital resident or research
fellow who is licensed to practice medicine and surgery in
Wisconsin.
Military Service: Members who are serving in the U S. armed
forces (generally not to exceed five years).
Associate: Member whose dues are waived because of fi-
nancial hardship due to illness or disability. This classifica-
tion is temporary and is reviewed on an annual basis.
Life: Member who has held membership in a state medical
society for 50 years or is a Past President of the State Med-
ical Society of Wisconsin.
Honorary: Member who was named by the Board of Direc-
tors in recognition of long and distinguished service to the
cause of medicine.
14 MONTHS FOR THE PRICE OF 12!
Membership policy allows physicians to join their
county and state societies and the AMA, or just their
county and state societies. Physicians are encour-
aged to join organized medicine now. Regular mem-
bership dues for 1986 are: $455 for SMS, $375 for
AMA, and county society dues vary. However, phy-
sicians who join now will not pay any dues for the
balance of 1985. That’s 14 months for the price of 12!
Membership applications may be obtained by con-
tacting the secretary of your county medical society
or by calling the Membership and Communications
Division at the State Medical Society offices in
Madison at 608/257-6781 or toll free: 800/362-9080. ■
Retired: Member who has completely retired from practice
(works less than 240 hours per year). All dues are waived
unless county society indicates they wish to charge county
dues.
Parl-time Practice: Physician, regardless of age, who prac-
tices 1,000 hours or less during the calendar year but does
not qualify for retired membership.
Over Age 70: Member in active practice who is over 70 years
of age as of January 1.
Candidate: Member attending a medical school in Wiscon-
sin or fulfilling a postgraduate obligation prior to eligibility
for licensure.
Scientific Fellow: The Board of Directors may by invitation
and unanimous consent confer upon any person engaged in
teaching of or research in one or more of the basic sciences
at an accredited college or university, and not holding the
degree of Doctor of Medicine or Osteopathy, the status of
Scientific Fellow.
Emeritus: Retired members who have chosen not to renew
their license.
1986 DUES AMOUNTS FOR THESE
CLASSIFICATIONS
SMS
AMA
COUNTY
Regular
$455
$375
Normal County Dues
Resident
45.50
45
Varies
Military Service
-0-
250 or 45
-0-
Associate
-0-
-0-
-0-
Life
-0-
-0--
-0-
Honorary
-0-
-0-'
-0-
Retired
-0-
-0-'
-0-
Part-time Practice
227.50
375*
Normal County Dues
Over Age 70
227.50
375*
Normal County Dues
Scientific Fellow
-0-
.-0-
Emeritus
-0-
-0-*
Candidate-
Freshman Year
Medical Student
-0-
20
Varies
Sophomore and
Succeeding Medical
Student Years
10
20
Varies
Postgraduate— One
10
45
Varies
‘Physicians In the following categories may be eligible for exemption or reduc-
tion from paying AMA dues: (1) Financial hardship and/or disability, (2) Over 70
years of age or older and fully retired.
State Society dues are prorated on a monthly basis for
those elected to membership July 1 through September 30.
Those elected after September 30 have no dues payable for
the balance of the year in which they are elected. AMA dues
follow the same pattern except prorating is on a semiannual
basis rather than monthly basis.
To begin the membership process, if your practice is or will
be located in Wisconsin, or you have any questions, you may
contact your local county society or call the Membership
and Communications Division of the State Medical Society,
if in Wisconsin: 1-800-362-9080 (Madison area number:
257-6781).B
ORGANIZATIONAL
Membership Directory— Update
The following information is being provided from Membership reports and from individual members for updating the
1985 Membership Directory as published in the July 1985 issue of the Wisconsin Medical Journal. Because of space limi-
tations address changes and phone numbers will not be included in this Update; however, they will be changed in
Membership records. County transfers will be included when processing has been completed by the Membership
Department.
Changes in practice specialties (as used by the AMA|
and changes in Board-certified specialties as listed by
the American Board of Medical Specialties.
(changes only with member's name; practice specialties appear
before the slash j/l and Board-certified specialties appear after
the slash. I
BARRON/
WASHBURN/
BURNETT
Roger V Branham MD
Route 2, Box 17
Rice Lake WI 54868
BROWN
CDIM/CDIM
Matthias Fuchs MD
ORS / ORS
Richard D Horak MD
ORS / ORS
Wayne S Mohr MD
DANE
PD
John M Bohn MD
P
Barbara L Calhoun MD
IMPUD/IMPUD
Geoffrey R Priest MD
R Browning Windsor Jr,
MD
305 N 95th St
Milwaukee WI 53226
DODGE
DR / R
Douglas E Bricker MD
1 1 6 Monroe St
Beaver Dam WI 53916
PTH FP / PTH FP
Victor W Caceres MD
FP/FP
Charles W Frinak MD
1200 North Center St
Beaver Dam WI 53916
DOUGLAS
GS FP / FP
Dwain L Stone MD
3 18-2 1st Ave East
Superior WI 54880
EAU CLAIRE/ DUNN/
PEPIN
Steven C Immerman MD
826 S Hastings Way
Eau Claire WI 54701
GRANT
FP
William L Bender MD
Rte 1, Box 151
Viroqua WI 54665
IM CD/IM
Maruthi M P Kantameni
MD
207 East Skelly
Cuba City WI 53807
JEEPERSON
GP OBG GS
E Allen Miller MD
LACROSSE
OBG / OBG
Martha H Blaisdell MD
815 South 10th St
La Crosse WI 54601
OTO HNS
Scott B Blanke MD
815 South 10th St
La Crosse WI 54601
PD GS
Bethann Bonner MD
1900 South 7th St
La Crosse WI 54601
FP
Scott D Brunk MD
2022 Adams St
La Crosse WI 54601
IM
Roland B Christian MD
2213-BS7th St
La Crosse WI 54601
ORS
Richard P Driessnack MD
212 South 1 1th St
La Crosse WI 54601
IM EM / IM
Robert W Ellwein MD
700 West Ave South
La Crosse WI 54602
FP/FP
Brett A Feighner MD
700 West Ave South
La Crosse WI 54601
OBG / OBG
Jerome H Gundersen MD
1836 South Ave
La Crosse WI 54601
FP
Theodor Habel MD
502 Washington
Westby WI 54667
EM
Milton R Me Millen MD
1252 Cliffwood Lane
La Crosse WI 54601
FP
David A Onsrud DO
815 South 10 St
La Crosse WI 54601
LINCOLN
IM
David C Yang MD
716 East 2nd St
Merrill WI 54452
MANITOWOC
GS TS CDS / GS
Terry L Gueldner MD
MILWAUKEE
Manuel M Aquino MD
4893 N Green Bay Rd
Milwaukee WI 53209
PS HS / PS
Dilip K Das MD
3124 South 27th St
Milwaukee WI 53215
ON HEM IM/IMHEM
Nicholas F Geimer MD
PUDIM/PUDIM
Paul M Guzzetta MD
Stephen W Hargarten MD
PO Box 503
Milwaukee WI 53201
AN/ AN
Daniel R Heilman MD
7405 N Braeburn Lane
Milwaukee WI 53209
GS CDS OS/GS
Bahram Namdari MD
HS/ORS
Mysore S Shivaram MD
FP/FP
Steven R Sirus MD
P/P
K Kwang Soo MD
TS/GS TS
Alfred J Tector Jr MD
.32
WISCONSIN MEDICAL JOURN AL, OCTOBER 1985; VOL. 84
MEMBERSHIP DIRECTORY-UPDATE
ORGANIZATIONAL
MONROE
FP/FP
Michael T Pace MD
315 West Oak St
Sparta WI 54656
ONEIDA/VILAS
N/N
Ellen L Parriss MD
OUTAGAMIE
OM
James M Quayle MD
OZAUKEE
ORS / ORS
Allah W Bhatti MD
GSCDS/GS
Aykarethu O Mammen MD
OBS GYN
Indira Mammen MD
GP
Charles W Lagoski DO
504 South Main St
River Falls WI 54022
PORTAGE
GSCDS/GS
Richard P Boyer MD
ROCK
AN / PTH
Yon Doo Ough MD
SAUK
GPR / RNM
Robert E Polcyn MD
SHEBOYGAN
OPH / OPH
Robert W Pointer MD
WAUPACA
GSGP
Luis L Galang MD
WALWORTH
OTO HNS
Robert K Wolter MD
7 Ridgeway Court
Elkhorn WI 53121
WASHINGTON
Peter CJoosse MD
1004 East Sumner
Hartford WI 53027
WAUKESHA
Marta C Muller MD
1024 East State St
Milwaukee WI 53202
WINNEBAGO
ORS PYM P / ORS
Gay R Anderson MD
WOOD
P/P
William H Hey wood MDB
Doctors! Watch your mail for the
1986 membership dues statement
scheduled to arrive in mid-Novem-
ber. See page 31 of this issue for
further details.
Are you ready
lor your future?
, Af GdpK»Mllfer we or© experts at ^
the business aspect of m'^icat
Our professionaf consuttants wilt ;
tailor solutions to your special needs . . . ^
sotuttans that result in increased pro*
ductivity, optimal patient services and V '
maximized income for today — and
tomorrow^
• financial projections
• Office management <• Organizational
'/ planning • Focilitles planning •Tax
preparation ♦ Personal financial planning
• Billing service , ♦ Compute bDllng ...
’ Aiifhevvdueof a1Uli*HmebusiriMs^
mofiogwr crfiai port- time cost.
G41
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i277SW.Noi«iAve. m
. BiOOkfletd,Wi5300S
A (444) 784-95S9
f^onning today , . . a se«»^ 4om<Miow.
WISCONSIN MEDICAL JOURNAL, OCTOBER 1985: VOL. 84
33
It Pays
TO BE A
Member
SMS Services, Inc.
THi HIGHWAY TOSAWHGS FOR MiDKAL ASSOCIATIOH lUmBERS:
Av/s f&aUJires GM cars. Chevrolet Cheve^e. '
SPKIAL NiW low RATES FROM AVIS.
New from Avis: an uncomplicated set of
uniform flat rates especially for Medical
Association members. It means a low rate for
each applicable car group across the U.S.
And, of course, unlimited mileage is included
at participating locations in the U.S.
Now there’s no need to compute your savings
using percentage discounts. With new Medical
Association flat rates from Avis, it’s easy to
know your rate before you go.
MENTION YOUR AVIS
WORLDWIDE DISCOUNT NUMBER: A/A 628800
$33
a day
Chevrolet Chevette.
Avis also offers a 5% discount
on SuperValue weekly rates.
Save with new Avis Medical Association flat
rates the next time you rent a car. To
reserve a car, call Avis toll free:
U800-331-1212
We try harder. Faster.'
AV/S
Flat rates are nondiscountable, available at all corporate and participating licensee locations in the contiguous U.S. and subject to change without notice. Car must be returned to
renting city, or a one-way service fee will apply. These rates are not available in Manhattan. Friday, 1 PM through Sunday, 3 PM and during holidays. An additional charge per day
may apply in certain locations, including Newark Airport, NJ; LaGuardia Airport, NY; Kennedy Airport, NY and all Manhattan. NY locations. Check with Avis for the amount.
©1985 Avis Rent A Car System, Inc,, Avis®
P.O. BOX 1109, MADISON, WI 53701 • PHONE 608/257-6781 OR TOLL-FREE 1-800-362-9080
Before prescribing, see complete prescribing information in SK&F CO.
literature or PDR. The following is a brief summary.
*
WARNING
This drug is not indicated for initial therapy of edema or hypertension.
Edema or hypertension requires therapy titrated to the individual. If this
combination represents the dosage so determined, its use may be
more convenient in patient management. Treatment of hypertension
and edema is not static, but must be reevaluated as conditions in
each patient warrant.
Contraindications: Concomitant use with other potassium-sparing agents
such as spironolactone or amiloride. Further use in anuria, progressive
renal or hepatic dysfunction, hyperkalemia. Pre-existing elevated serum
potassium. Hypersensitivity to either component or other sulfonamide-
derived drugs.
Warnings: Do not use potassium supplements, dietary or otherwise, unless
hypokalemia develops or dietary intake of potassium is markedly impaired.
If supplementary potassium is needed, potassium tablets should not be
used. Hyperkalemia can occur, and has been associated with cardiac irregu-
larities. It is more likely in the severely ill. with urine volume less than
one liter/day, the elderly and diabetics with suspected or confirmed renal
insufficiency. Periodically, serum K"*" levels should be determined-. If hyper-
kalemia develops, substitute a thiazide alone, restrict K'*' intake. Asso-
ciated widened ORS complex or arrhythmia requires prompt additional
therapy. Thiazides cross the placental barrier and appear in cord blood.
Use in pregnancy requires weighing anticipated benefits against possible
hazards, including fetal or neonatal jaundice, thrombocytopenia, other
adverse reactions seen in adults. Thiazides appear and triamterene may
appear in breast milk. It their use is essential, the patient should stop
nursing. Adequate information on use in children is not available. Sensitivity
reactions may occur in patients with or without a history of allergy or
bronchial asthma. Possible exacerbation or activation of systemic lupus
erythematosus has been reported with thiazide diuretics.
Precautions: The bioavailability of the hydrochlorothiazide component of
'Dyazide' is about 50% of the bioavailability of the single entity. Theoreti-
cally. a patient transferred from the single entities of Dyrenium (triamterene.
SK&F CO.) and hydrochlorothiazide may show an increase in blood pressure
or fluid retention. Similarly, it is also possible that the lesser hydro-
chlorothiazide bioavailability could lead to increased serum potassium levels.
However, extensive clinical experience with 'Dyazide' suggests that these
conditions have not been commonly observed in clinical practice. Do
periodic serum electrolyte determinations (particularly important in patients
vomiting excessively or receiving parenteral fluids, and during concurrent
use with amphotericin B or corticosteroids or corticotropin [ACTH]).
Periodic BUN and serum creatinine determinations should be made,
especially in the elderly, diabetics or those with suspected or confirmed
renal insufficiency. Cumulative effects of the drug may develop in patients
with impaired renal function. Thiazides should be used with caution in
patients with impaired hepatic function. They can precipitate coma in
patients with severe liver disease Observe regularly for possible blood
dyscrasias, liver damage, other idiosyncratic reactions. Blood dyscrasias
have been reported in patients receiving triamterene, and leukopenia,
thrombocytopenia, agranulocytosis, and aplastic and hemolytic anemia
have been reported with thiazides. Thiazides may cause manifestation of
latent diabetes mellitus. The effects of oral anticoagulants may be
decreased when used concurrently with hydrochlorothiazide; dosage adjust-
ments may be necessary. Clinically insignificant reductions in arterial
responsiveness to norepinephrine have been reported. Thiazides have also
been shown to Increase the paralyzing effect of nondepolarizing muscle
relaxants such as tubocurarine. Triamterene is a weak folic acid antagonist.
Do periodic blood studies in cirrhotics with splenomegaly. Antihypertensive
effects may be enhanced in post-sympathectomy patients. Use cautiously
in surgical patients. Triamterene has been found in renal stones in asso-
ciation with the other usual calculus components. Therefore, Dyazide'
should be used with caution in patients with histories of stone formation.
A lew occurrences of acute renal failure have been reported in patients on
Dyazide' when treated with indomethacin. Therefore, caution is advised in
administering nonsteroidal anti-inflammatory agents with 'Dyazide'. The
following may occur: transient elevated BUN or creatinine or both, hyper-
glycemia and glycosuria (diabetic insulin requirements may be altered),
hyperuricemia and gout, digitalis intoxication (in hypokalemia), decreasing
alkali reserve with possible metabolic acidosis. 'Dyazide' interferes with
fluorescent measurement of quinidine. Hypokalemia Is uncommon with
'Dyazide', but should it develop, corrective measures should be taken such
as potassium supplementation or increased dietary intake of potassium-
rich foods. Corrective measures should be instituted cautiously and serum
potassium levels determined. Discontinue corrective measures and
Dyazide' should laboratory values reveal elevated serum potassium.
Chloride deficit may occur as well as dilutional hyponatremia. Concurrent
use with chlorpropamide may increase the risk of severe hyponatremia.
Serum PBI levels may decrease without signs of thyroid disturbance. Cal-
cium excretion is decreased by thiazides. 'Dyazide' should be withdrawn
before conducting tests for parathyroid function.
Thiazides may add to or potentiate the action of other antihypertensive
drugs.
Diuretics reduce renal clearance of lithium and increase the risk of lithium
toxicity.
Adverse Reactions: Muscle cramps, weakness, dizziness, headache, dry
mouth: anaphylaxis, rash, urticaria, photosensitivity, purpura, other dermat-
ological conditions; nausea and vomiting, diarrhea, constipation, other
gastrointestinal disturbances: postural hypotension (may be aggravated by
alcohol, barbiturates, or narcotics). Necrotizing vasculitis, paresthesias,
icterus, pancreatitis, xanthopsia and respiratory distress including pneu-
monitis and pulmonary edema, transient blurred vision, sialadenitis, and
vertigo have occurred with thiazides alone. Triamterene has been found in
renal stones In association with other usual calculus components. Rare
incidents of acute interstitial nephritis have been reported. Impotence has
been reported in a few patients on 'Dyazide', although a causal relationship
has not been established.
Supplied: 'Dyazide' is supplied as a red and white capsule, in bottles of
1000 capsules: Single Unit Packages (unit-dose) of 100 (intended for
institutional use only); in Patient-Pak'" unit-of-use bottles of 100.
BRS-DZ:L39
In Hypertension*...
When Need to
Conserve K+
Remember the Unique
Red and White Capsule:
Your Assurance of
SK&F
isa Serum K+ and BUN should be checked periodically (see Warnings and Precautions).
Potassium- Sparing
DYAZIDF
25 mg Hydrochlorothiazlde/50 mg Triamterene/SKF
Over 19 Years of Confidence
a product of
SK&F CO.
Carolina, PR, 00630
The unique
red and white
Dyazide* capsule:
'tour assurance of
SK&F quality
f SK&F Co. 1983
On nitrates,
but angina stfll
strikes...
Aftera nitrate,
addlSOFnff
(verapamil HCl/Knoll)
To protect your patients, as well as their quality of life,
add Isoptin instead of a beta blocker.
First, Isoptin not only reduces myocardial oxygen demand
by reducing peripheral resistance, but also increases coro-
nary perfusion by preventing coronary vasospasm and
dilating coronary arteries — both normal and stenotic.
These are antianginal actions that no beta blocker
can provide.
Second, Isoptin spares patients the
beta-blocker side effects that may
compromise the quality of life.
With Isoptin, fatigue, bradycardia and mental
depression are rare. Unlike beta blockers,
Isoptin can safely be given to patients with
asthma, COPD, diabetes or peripheral
vascular disease. Serious adverse
reactions with Isoptin are rare
at recommended doses; the
single most common side
effect is constipation (6.3%)
Cardiovascular contra-
indications to the use of
Isoptin are similar to those
of beta blockers: severe
left ventricular dysfunction,
hypotension (systolic pres-
sure <90 mm Hg) or cardio-
genic shock, sick sinus syndrome
(if no artificial pacemaker is present)
and second- or third-degree AV block.
So, the next time a nitrate is not enough, add
Isoptin ... for more comprehensive antianginal
protection without side effects which may
cramp an active life style.
ISOPTIN. Added
antianginal protection
without beta-blocker
side effects.
Please see brief summary on following page
isoPTirf
(verapamil HCI/Knoll)
80 mg and 120 mg scored, film-coated tablets
Contraindications: Severe left ventricular dysfunction (see Warnings), hypo-
tension (systolic pressure < 90 mm Hg) or cardiogenic shock, sick sinus syn-
drome (except in patients with a functioning artificial ventricular pacemaker),
2nd- or 3rd-degree AV block Warnings: ISOPTIN should be avoided in patients
with severe left ventricular dysfunction (e.g., ejection fraction < 30% or
moderate to severe symptoms of cardiac failure) and in patients with any
degree of ventricular dysfunction if they are receiving a beta blocker. (See
Precautions.) Patients with milder ventricular dysfunction should, if possible, be
controlled with optimum doses of digitalis and/or diuretics before ISOPTIN is
used. (Note interactions with digoxin under Precautions.) ISOPTIN may occa-
sionally produce hypotension (usually asymptomatic, orthostatic, mild and con-
trolled by decrease in ISOPTIN dose). Elevations of transaminases with and
without concomitant elevations in alkaline phosphatase and bilirubin have been
reported. Such elevations may disappear even with continued treatment; how-
ever, four cases of hepatocellular injury by verapamil have been proven by re-
challenge. Periodic monitoring of liver function is prudent during verapamil
therapy. Patients with atrial flutter or fibrillation and an accessory AV pathway
(e g. W-P-W or L-G-L syndromes) may develop increased antegrade conduction
across the aberrant pathway bypassing the AV node, producing a very rapid
ventricular response after receiving ISOPTIN (or digitalis). Treatment is usually
D.C. -cardioversion, which has been used safely and effectively after ISOPTIN.
Because of verapamil's effect on AV conduction and the SA node, 1° AV block
and transient bradycardia may occur. High grade block, however, has been
infrequently observed. Marked 1° or progressive 2° or 3° AV block requires a
dosage reduction or, rarely, discontinuation and institution of appropriate
therapy depending upon the clinical situation. Patients with hypertrophic car-
diomyopathy (IHSS) received verapamil in doses up to 720 mg/day. It must be
appreciated that this group of patients had a serious disease with a high mor-
tality rate and that most were refractory or intolerant to propranolol. A variety
of serious adverse effects were seen in this group of patients including sinus
bradycardia, 2° AV block, sinus arrest, pulmonary edema and/or severe hypo-
tension. Most adverse effects responded well to dose reduction and only rarely
was verapamil discontinued. Precautions: ISOPTIN should be given cautiously
to patients with impaired hepatic function (in severe dysfunction use about
30% of the normal dose) or impaired renal function, and patients should be
monitored for abnormal prolongation of the PR interval or other signs of exces-
sive pharmacologic effects. Studies in a small number of patients suggest that
concomitant use of ISOPTIN and beta blockers may be beneficial in patients
with chronic stable angina. Combined therapy can also have adverse effects on
cardiac function. Therefore, until further studies are completed, ISOPTIN should
be used alone, if possible. If combined therapy is used, close surveillance of vital
signs and clinical status should be carried out. Combined therapy with ISOPTIN
and propranolol should usually be avoided in patients with AV conduction
abnormalities and/or depressed left ventricular function. Chronic ISOPTIN treat-
ment increases serum digoxin levels by 50% to 70% during the first week of
therapy, which can result in digitalis toxicity. The digoxin dose should be re-
duced when ISOPTIN is given, and the patients should be carefully monitored to
avoid over- or under-digitalization. ISOPTIN may have an additive effect on
lowering blood pressure in patients receiving oral antihypertensive agents.
Disopyramide should not be given within 48 hours before or 24 hours after
ISOPTIN administration. Until further data are obtained, combined ISOPTIN and
quinidine therapy in patients with hypertrophic cardiomyopathy should prob-
ably be avoided, since significant hypotension may result. Clinical experience
with the concomitant use of ISOPTIN and short- and long-acting nitrates sug-
gest beneficial interaction without undesirable drug interactions. Adequate ani-
mal carcinogenicity studies have not been performed. One study in rats did not
suggest a tumorigenic potential, and verapamil was not mutagenic in the Ames
test. Pregnancy Category C: There are no adequate and well-controlled studies
in pregnant women. This drug should be used during pregnancy, labor and
delivery only if clearly needed. It is not known whether verapamil is excreted in
breast milk; therefore, nursing should be discontinued during ISOPTIN use.
Adverse Reactions: Hypotension (2.9%), peripheral edema (1 .7%), AV block:
3rd degree (0.8%), bradycardia: HR < 50/min (1.1%), CHF or pulmonary
edema (0.9%), dizziness (3.6%), headache (1.8%), fatigue (1.1%), constipa-
tion (6.3%), nausea (1.6%), elevations of liver enzymes have been reported.
(See Warnings.) The following reactions, reported in less than 0.5%, occurred
under circumstances where a causal relationship is not certain: ecchymosis,
bruising, gynecomastia, psychotic symptoms, confusion, paresthesia, insomnia,
somnolence, equilibrium disorder, blurred vision, syncope, muscle cramp, shaki-
ness, claudication, hair loss, macules, spotty menstruation. How Supplied:
ISOPTIN (verapamil HCI) is supplied in round, scored, film-coated tablets con-
taining either 80 mg or 120 mg of verapamil hydrochloride and embossed with
"ISOPTIN 80" or "ISOPTIN 120" on one side and with "KNOLL" on the reverse
side. Revised August, 1984. 2385
Iwl KNOLL PHARMACEUTICAL COMPANY
knoll 30 NORTH JEFFERSON ROAD, WHIPPANY, NEW JERSEY 07981
2406
EMPLOYEES
APPRECIATE
THE PAYROLL
SAVINGS PLAN.
JUST ASK THE
PEOPLE AT
GEORGIA-PACIFIC.
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Savings Bonds is an
efficient way to save
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the Treasury, Washington, DC
20226.
US. SAVINGS BOND5%_
Paying BetterThan Ever '
A public service of this publication.
The Upjohn Company
Kalamazoo, Michigan 49001 USA
© 1985 The Llpjohn Company
J-5491 June 1985
Consider the
causative organisms. . .
cefaclor
250-mg Pulvules" t.i.d.
offers effectiveness against
the major causes of bacterial bronchitis
H. influenzae, H. influenzae, S. pneumoniae, S. pyogenes
(ampicillin-susceptible) (ampicillin-resistant)
Brief Summary Consult the package literature for prescribing
information
Indications and Usage Ceclor’ (cetaclor. Lilly) is indicated in the
treatment of the following Infections when caused by susceptible
strains of the designated microorganisms
Lower tesoiraiotv inlection$. including pneumonia caused by
Streptococcus pneumoniae iDiplococcus pneumoniae I Haemoph
ilus intiuemae. and 5 pyogenes (group A beta-hemolytic
streptococci)
Appropriate culture and susceptibility studies should be
performed to determine susceptibility ot the causative organism
to Ceclor
Contraindication Ceclor is contraindicated in patients with known
allergy to the cephalosporin group ot antibiotics
Warnings IN PENICILLIN-SENSITIVE PATIENTS. CEPHALO-
SPORIN ANTIBIOTICS SHOULD BE ADMINISTERED CAUTIOUSLY
THERE IS CLINICAL AND LABORATORY EVIDENCE OF PARTIAL
CROSS-ALLERGENICITY OF THE PENICILLINS AND THE
CEPHALOSPORINS. AND THERE ARE INSTANCES IN WHICH
PATIENTS HAVE HAD REACTIONS, INCLUDING ANAPHYLAXIS.
TO BOTH DRUG CLASSES
Antibiotics, including Ceclor. should be administered cautiously
to any patient who has demonstrated some form ot allergy,
particularly to drugs
Pseudomembranous colitis has been reported with virtually ail
broad-spectrum antibiotics (Including macrolides. semisynthetic
penicillins and cephalosporins), therefore, it is important to
consider its diagnosis in patients who develop diarrhea in
association with the use of antibiotics Such colitis may range in
seventy from mild to life-threatening
Treatment with broad-spectrum antibiotics alters the normal
flora of the colon and may permit overgrowth of Clostridia Studies
indicate that a toxin produced by ClosinOium difficile is one
primary cause of antibiotic-associated colitis
Mild cases of pseudomembranous colitis usually respond to
drug discontinuance alone In moderate to severe cases, manage-
ment should include sigmoidoscopy, appropriate bactenologic
studies, and fluid, electrolyte, and protein supplementation
When the colitis does not improve after the drug has been
discontinued, or when it is severe, oral vancomycin is the drug
of choice lor antibiotic-associated pseudomembranous colitis
produced by C difficile Other causes of colitis should be
ruled out
Precautions: General Precautions - If an allergic reaction to
Ceclor ' (cefaclor. Lilly) occurs, the drug should be discontinued,
and. if necessary, the patient should be treated with appropriate
agents, e g . pressor amines, antihistamines, or corticosteroids
Prolonged use ot Ceclor may result in the overgrowth ot
nonsusceptible organisms Careful observation of the patient is
essential If superinfeclion occurs during therapy, appropriate
measures should be taken
Positive direct Coombs' tests have been reported during treat-
ment with the cephalosporin antibiotics In hematologic studies
or in transfusion cross-matching procedures when antiglobulin
tests are performed on the minor side or in Coombs' testing of
newborns whose mothers have received cephalosporin antibiotics
before parturition, it should be recognized that a positive
Coombs' test may be due to the drug
Ceclor should be administered with caution in the presence of
markedly impaired renal function Under such conditions, careful
clinical observation and laboratory studies should be made
because sate dosage may be lower than that usually recommended
As a result of administration of Ceclor. a false-positive reaction
for glucose in the urine may occur This has been observed with
Benedict's and Fehling s solutions and also with Cfinitest*
tablets but not with Tes-Tape" (Glucose Enzymatic Test Strip.
USP. Lilly)
Broad-spectrum antibiotics should be prescribed with caution m
individuals with a history of gastrointestinal disease, particularly
colitis
Usage in Pregnancy - Pregnancy Category B - Reproduction
studies have been performed m mice and rats at doses up to 12
times the human dose and in ferrets given three times the maximum
human dose and have revealed no evidence of impaired fertility
or harm to the fetus due to Ceclor* (cetaclor, Lilly). There are,
however, no adequate and well-controlled studies in pregnant
women Because antmal reproduction studies are not always
predictive of human response, this drug should be used during
pregnancy only if clearly needed
Nursing Mothers - Small amounts ot Ceclor have been detected
in mother s milk following administration of single 500-mg doses
Average levels were 0 18. 0 20, 0 21 . and 0 1o mcg/ml at two.
three, lour, and five hours respectively Trace amounts were
detected at one hour The effect on nursing infants is not known
Caution should be exercised when Ceclor is-admintsiered to a
nursing woman
Usage in Children - Safety and effectiveness ot this product lor
use in infants less than one month of age have not been established
Adverse Reactions: Adverse effects considered related to therapy
with Ceclor are uncommon and are listed below
Gastrointestinal symptoms occur in about 2 5 percent of
patients and include diarrhea (1 in 70)
Symptoms of pseudomembranous colitis may appear either
during or after antibiotic treatment Nausea and vomiting have
been reported rarely
Hypersensiliyity teacims have been reported in about 1 5
percent of patients and include morbiliform eruptions |1 in 100)
Pruritus, urticaria, and positive Coombs' tests each occur in less
than 1 in 200 patients Cases ot serum-sickness-like reactions
(erythema mufttforme or the above skin manifestations accompanied
by arthritis/arthralgia and. frequently, lever) have been reported
These reactions are apparently due to hypersensitivity and have
usually occurred during or following a second course of therapy
with Ceclor Such reactions have been reported more frequently
in children than in adults Signs and symptoms usually occur a few
days after initiation of therapy and subside within a tew days
after cessation ot therapy No serious sequelae have been reported
Antihistamines and corticosteroids appear to enhance resolution
ot the syndrome
Cases ot anaphylaxis have been reported, half of which have
occurred in patients with a history of penicillin allergy
Other effects considered related to therapy included
eosinophilia |1 in 50 patients) and genital pruritus or vaginitis
(less than 1 in 100 patients)
Causal Relationship Uncertain- Transitory abnormalities in
clinical laboratory test results have been reported Although they
were of uncertain etiology, they are listed below to serve as
alerting information tor the physician
Hepatic - S\\Qh\ elevations in SCOT, SGPT, or alkaline
phosphatase values (1 in 40)
Hematopoietic - transient fluctuations in leukocyte count,
predominantly lymphocytosis occurring in infants and young
children (1 in 40)
Pena/ - Slight elevations in BUN or serum creatinine (less than
1 in 500) or abnormal urinalysis (less than 1 in 200)
I061782R)
Note Ceclor* (cefaclor, Lilly) is contraindicated in patients
with known allergy to the cephalosporins and should be given
cautiously to penicillin-allergic patients
Penicillin is the usual drug of choice in the treatment and
prevention ot streptococcal infections, including the prophylaxis
of rheumatic fever See prescribing information
© 1984. ELI LILLY AND COMPANY
Additional information avar/aO/e to
the profession on request from
Ell Lilly and Cwnpany.
Indianapolis. Indiana 46285
Ell Lilly Industries. Inc
Carolina. Puerto Rico (X>630
BALANCED
CALCIUM C
BJ
Low incidence of side effects
CAEDIZEM® (diltiazem HCl)
produces an incidence of adverse
reactions not greater than that
reported with placebo therapy,
thus contributing to the patient’s
sense of well-being.
‘Cardlzem Is Indicated In the treatment of angina pectoris due to
coronary artery spasm and in the management of chronic stable
angina (classic effortrassociated angina) in patients who cannot
tolerate therapy with beta-blockers and/or nitrates or who remain
^^ptomatic despite adequate doses of these agents.
References:
1. Strauss WE, McIntyre KM, Parisi AE, et al: Safety and efficacy
of diltiazem hydrochloride for the treatment of stable angina
pectoris: Report of a cooperative clinical trial. Am J Cardiol
49:560-566, 1982.
2. Pool PE, Seagren SC, Bonarmo JA, et al; The treatment of exercise-
inducible chronic stable angina with diltiazem: Effect on treadmill
exercise. Chest 78 (July suppl): 234-238, 1980.
Reduces angina attack frequency*
42% to 46% decrease reported in
multicenter study
Increases exercise tolerance*
In Bruce exercise test,^ control
patients averaged 8.0 minutes to
onset of pain; Cardizem patients
averaged 9.8 minutes (P<.005).
CARDIZEM
CdilkLazem HCl)
THE BALANCED
CALCIUM CHAHNEL BLOCKER
Please see full prescribing information on following page.
2/84
PROFESSIONAL USE INFORMATION
cordlzem.
(diltiazem HCI)
AO mfi and 60 mg (ahlets
DESCRIPTION
CARDIZEM*' Idlltiazem hydrochloride) is a calcium ion inllux
inhibitor (slow channel blocker or calcium antagonist). Chemically,
diltiazem hydrochloride Is 1,5-Benzothiazepin-4(5H)one.3-(acetyloxy)
-5-[2-(dimethylamino)ethyl]-2,3-dlhydro-2-(4-methoxyphenyl)-,
monohydrochloride,|+) -cis- The chemical structure is:
CHpCHpNICHjIj
Diltiazem hydrochloride is a white to otf-white crystalline powder
with a bitter taste It Is soluble in water, methanol, and chlorolorm
It has a molecular weight ol 450.98, Each tablet ol CARDIZEM
contains either 30 mg or 60 mg diltiazem hydrochloride lor oral
administration
CLINICAL PHARMACOLOGY
The therapeutic benelits achieved with CARDIZEM ate believed
to be related to its ability to Inhibit the inllux of calcium ions
during membrane depolarization ol cardiac and vascular smooth
muscle
Mechanisms ol Action. Although precise mechanisms of its
antlanginal actions ate still being delineated, CARDIZEM is believed
to act in the following ways
1 Angina Due fo Coronary Artery Spasm CARDIZEM has been
shown to be a potent dilator of coronary arteries both epicatdial
and subendocardial. Spontaneous and ergonovine-induced cor-
onary artery spasm are inhibited by CARDIZEM
2 Exertional Angina: CARDIZEM has been shown to produce
increases in exercise tolerance, probably due to its ability to
reduce myocardial oxygen demand. This is accomplished via
reductions in heart rate and systemic blood pressure at submaximal
and maximal exercise work loads.
In animal models, diltiazem interferes with the slow inward
(depolarizing) current in excitable tissue. It causes excitation-contraction
uncoupling in various myocardial tissues without changes in the
configuration of the action potential, Diltiazem produces relaxation
of coronary vascular smoofh muscle and dilation of both large and
small coronary arteries at drug levels which cause little or no
negative inotropic effect The resultant Increases in coronary blood
flow (epicardial and subendocardial) occur in Ischemic and nonischemic
models and are accompanied by dose-dependent decreases in sys-
temic blood pressure and decreases in peripheral resistance
Hemodynamic and Electrophysiologic Effects. Like other
calcium antagonists, diltiazem decreases sinoatrial and atrioventricu-
lar conduction in isolated tissues and has a negative inotropic effect
in Isolated preparations. In the intact animal, prolongation of fhe AH
inferval can be seen at higher doses.
In man, diltiazem prevents spontaneous and ergonovine-provoked
coronary artery spasm. It causes a decrease in peripheral vascular
resistance and a modest fall in blood pressure and, in exercise
tolerance studies in patients with ischemic heart disease, reduces
the heart rate-blood pressure product for any given work load
Studies to date, primarily in patients with good ventricular function,
have not revealed evidence of a negative inotropic effect, cardiac
output, ejection fraction, and left ventricular end diastolic pressure
have not been affected. There are as yet few data on the interaction
of diltiazem and beta-blockers Resting heart rate Is usually unchanged
or slightly reduced by diltiazem
Intravenous diltiazem in doses of 20 mg prolongs AH conduction
time and AV node functional and effective refractory periods approxi-
mately 20%, In a study involving single oral doses of 300 mg of
CARDIZEM in six normal volunteers, the average maximum PR
prolongation was 14% with no instances of greater than first-degree
AV block, Diltiazem-associated prolongation of the AH interval is not
more pronounced in patients with first-degree heart block. In patients
with sick sinus syndrome, diltiazem significantly prolongs sinus
cycle length (up to 50% in some cases).
Chronic oral administration of CARDIZEM in doses of up to 240
mg/day has resulted in small increases in PR Interval, but has not
usually produced abnormal prolongation. There were, however, three
instances of second-degree AV block and one instance of fhird-
degree AV block in a group of 959 chronically freated patients.
Pharmacokinetics and Metabolism. Diltiazem is absorbed
from fhe tablet formulation to about 80% of a reference capsule and
is subiecf to an extensive first-pass effect, giving an absolute
bioavallablllty (compared to intravenous dosing) of about 40%. CARDIZEM
undergoes extensive hepatic metabolism in which 2% to 4% ol the
unchanged drug appears in the urine In vitro binding studies show
CARDIZEM is 70% to 80% bound to plasma proteins. Competitive
ligand binding studies have also shown CARDIZEM binding is not
altered by therapeutic concentrations of digoxin, hydrochlorothiazide,
phenylbutazone, propranolol, salicylic acid, or warfarin. Single oral
doses of 30 to 120 mg of CARDIZEM result in detectable plasma
levels within 30 to 60 minutes and peak plasma levels two to three
hours after drug administration The plasma elimination half-life
following single or multiple drug administration is approximately 3.5
hours Desacetyl diltiazem is also present in the plasma at levels of
10% to 20% of fhe parent drug and is 25% to 50% as potent a
coronary vasodilator as diltiazem Therapeutic blood levels of
CARDIZEM appear to be in the range of 50 to 200 ng/ml There is a
departure from dose-linearity when single doses above 60 mg are
given; a 120-mg dose gave blood levels three times that ol the 60-mg
dose. There is no information about the effect of renal or hepallc
impairment on excretion or metabolism ol diltiazem.
INDICATIONS AND USAGE
1 Angina Pectoris Due to Coronary Artery Spasm. CARDIZEM
is indicated in the treatment of angina pectoris due to coronary
artery spasm, CARDIZEM has been shown effective in the
treatment of spontaneous coronary artery spasm presenting as
Prinzmetal's variant angina (resting angina with ST-segment
elevation occurring during attacks)
2 Chronic Stable Angina (Classic Eflort-Assoclated Angina).
CARDIZEM is indicated in the management of chronic stable
angina. CARDIZEM has been effective in controlled trials in
reducing angina frequency and increasing exercise tolerance.
There are no controlled studies ol the effectiveness of the concomi-
tant use of diltiazem and beta-blockers or of the safety of this
combination in patients with impaired ventricular function or conduc-
tion abnormalities.
CONTRAINDICATIONS
CARDIZEM is contraindicated in (1) patients with sick sinus
syndrome except in the presence of a functioning ventricular pacemaker,
(2) patients with second- or third-degree AV block except in the
presence of a functioning ventricular pacemaker, and (3) patients
with hypotension (less than 9D mm Hg systolic)
WARNINGS
1 Cardiac Conduction. CARDIZEM prolongs AV node refrac-
tory periods without significantly prolonging sinus node recov-
ery time, except in patients with sick sinus syndrome This
effect may rarely result in abnormally slow heart rates (particularly
in patients with sick sinus syndrome) or second- or third-degree
AV block (six of 1243 patients tor 0 48%) Concomitant use of
diltiazem with beta-blockers or digitalis may result in additive
effects on cardiac conduction A patient with Prinzmetal's
angina developed periods of asystole (2 to 5 seconds) after a
single dose of 60 mg of diltiazem
2 Congestive Heart Failure. Although diltiazem has a negative
inotropic effect in isolated animal tissue preparations, hemot^namic
studies In humans with normal ventricular function have not
shown a reduction in cardiac index nor consistent negative
effects on contractility (dp/dt) Experience with the use of
CARDIZEM alone or in combination with beta-blockers in patients
with impaired ventricular function is very limited Caution should
be exercised when using the drug in such patients.
3 Hypotension. Decreases in blood pressure associated with
CARDIZEM therapy may occasionally result in symptomatic
hypotension
4 Acute Hepatic Injury. In rare instances, patients receiving
CARDIZEM have exhibited reversible acute hepatic injury as
evidenced by moderate to extreme elevations of liver enzymes
(See PRECAUTIONS and ADVERSE REACTIONS.)
PRECAUTIONS
General. CARDIZEM (diltiazem hydrochloride) is extensively metab-
olized by the liver and excreted by the kidneys and in bile. As with any
new drug given over prolonged periods, laboratory parameters should
be monitored at regular intervals The drug should be used with
caution in patients with impaired renal or hepatic function. In sub-
acute and chronic dog and rat studies designed to produce toxicity,
high doses of diltiazem were associated with hepatic damage In
special subacute hepatic studies, oral doses of 125 mg/kg and
higher In rats were associated with histological changes in the liver
which were reversible when the drug was discontinued. In dogs,
doses of 20 mg/kg were also associated with hepatic changes;
however, these changes were reversible with continued dosing
Drug Interaction. Pharmacologic studies indicate that there
may be additive effects In prolonging AV conduction when using
beta-blockers or digitalis concomitantly with CARDIZEM. (See
WARNINGS),
Controlled and uncontrolled domestic studies suggest that con-
comitant use of CARDIZEM and beta-blockers or digitalis is usually
well tolerated. Available data are not sufficient, however, to predict
the effects of concomitant treatment, particularly in patients with left
ventricular dysfunction or cardiac conduction abnormalities In healthy
volunteers, diltiazem has been shown to increase serum digoxin
levels up to 20%,
Carcinogenesis, Mutagenesis, Impairment ol Fertility. A
24-month study in rats and a 21-month study in mice showed no
evidence of carcinogenicity There was also no mutagenic response
In in vitro bacterial tests No intrinsic effect on fertility was observed
in rats.
Pregnancy. Category C Reproduction studies have been con-
ducted in mice, rats, and rabbits. Administration of doses ranging
from five to ten times greater (on a mg/kg basis) than the daily
recommended therapeutic dose has resulted in embryo and fetal
lethality. These doses, in some studies, have been reported to cause
skeletal abnormalities, in the perinatal/postnatal studies, there was
some reduction in early individual pup weights and sunrival rates.
There was an increased incidence of stillbirths at doses ol 20 times
the human dose or greater.
There are no well-controlled studies in pregnant women; therefore,
use CARDIZEM in pregnant women only if the potential benefit
justifies the potential risk to the fetus
Nursing Mothers. It is not known whether this drug is excreted
in human milk. Because many drugs are excreted in human milk,
exercise caution when CARDIZEM is administered to a nursing
woman If the drug's benefits are thought to outweigh its potential
risks in this situation
Pediatric Use. Safety and effectiveness in children have not
been established,
ADVERSE REACTIONS
Serious adverse reactions have been tare in studies carried out to
date, but it should be recognized that patients with impaired ventricu-
lar function and cardiac conduction abnormalities have usually been
excluded
In domestic placebo-controlled trials, the incidence of adverse
reactions reported during CARDIZEM therapy was not greater than
that reported during placebo therapy
The following represent occurrences observed in clinical studies
which can be at least reasonably associated with the pharmacology
of calcium influx inhibition In many cases, the relationsh'o to
CARDIZEM has not been established. The most common occurrences,
as well as their frequency of presentation, are edema (2.4%),
headache (2.1%). nausea (1,9%), dizziness (1.5%), rash (1.3%),
asthenia (1,2%), AV block (1.1%). In addition, the following events
were reported infrequently (less than 1%) with the order of presenta-
fion corresponding to the relative frequency of occurrence.
Cardiovascular
Nervous System
Gastrointestinal
Dermatologic
Other;
Flushing, arrhythmia, hypotension, bradycar-
dia. palpitations, congestive heart failure,
syncope.
Paresthesia, nervousness, somnolence,
tremor, insomnia, hallucinations, and amnesia.
Constipation, dyspepsia, diarrhea, vomiting,
mild elevations of alkaline phosphatase. SCOT,
SGPT, and LDH,
Pruritus, petechiae, urticaria, photosensitivity.
Polyuria, nocturia.
The following additional experiences have been noted;
A patient with Prinzmetal's angina experiencing episodes of
vasospastic angina developed periods ol transieni asymptomatic
asystole approximately five hours alfer receiving a single 60-mg
dose of CARDIZEM.
The following postmarketing events have been reported infre-
quently in patients receiving CARDIZEM; erythema multiforme; leu-
kopenia; and extreme elevations of alkaline phosphatase, SCOT,
SGPT, LDH, and GPK. However, a definitive cause and effect between
these events and CARDIZEM therapy is yet to be established.
OVERDOSAGE OR EXAGGERATED RESPONSE
Overdosage experience with oral diltiazem has been limited.
Single oral doses of 300 mg of CARDIZEM have been well tolerated
by healthy volunteers. In the event ol overdosage or exaggerated
response, appropriate supportive measures should be employed in
addition to gastric lavage The following measures may be considered;
Bradycardia
High-Degree AV
Block
Cardiac Failure
Hypotension
Administer atropine (0.60 to 1.0 mg). If there
is no response to vagal blockade, administer
isoproterenol cautiously
Treat as for bradycardia above. Fixed high-
degree AV block should be treated with car-
diac pacing
Administer inotropic agents (isoproterenol,
dopamine, or dobutamine) and diuretics.
Vasopressors (eg, dopamine or levarterenol
bitartrate).
Actual treatment and dosage should depend on the severity of the
clinical situation and the judgment and experience of fhe treating
physician.
The oral/LDso's in mice and rats range from 415 to 740 mg/kg
and from 560 to 810 mg/kg, respectively The intravenous LD^'s in
these species were 60 and 38 mg/kg. respectively. The oral LD5„ in
dogs is considered to be in excess of 50 mg/kg, while lethality was
seen in monkeys at 360 mg/kg The toxic dose in man is not known,
but blood levels in excess of 800 ng/ml have not been associated
with toxicity.
DOSAGE AND ADMINISTRATION
Exertional Angina Pectoris Due to Atherosclerotic Coro-
nary Artery Disease or Angina Pectoris at Rest Due to Coro-
nary Artery Spasm. Dosage must be adjusted to each patient's
needs. Starting with 30 mg four times daily, before meals and at
bedtime, dosage should be increased gradually (given in divided
doses three or (our times daily) at one- to two-day intervals until
optimum response is obtained. Although individual patients may
respond to any dosage level, the average optimum dosage range
appears to be 180 to 240 mg/day. There are no available data concern-
ing dosage requirements in patients with Impaired renal or hepatic
function. If the drug must be used In such patients, titration should be
carried out with particular caution.
Concomitant Use With Other Antlanginal Agents:
1 Sublingual NTG may be taken as required to abort acute
anginal attacks during CARDIZEM therapy.
2 Prophylactic Nitrate Therapy -CARDIZEM may be safely
coadministered with short- and long-acting nitrates, but there
have been no controlled studies to evaluate the antlanginal
effectiveness of this combination.
3. Beta-hlockers. (See WARNINGS and PRECAUTIONS )
HOW SUPPLIED
Cardizem 30-mg tablets are supplied in bottles of 100 (NOG
0088-1771-47) and in Unit Dose Identification Paks of 100 (NDC
0088-1771-49). Each green tablet is engraved with MARION on one
side and 1771 engraved on the other. CARDIZEM 60-mg scored
tablets are supplied in bottles of 100 (NDC 0088-1 772-47) and in Unit
Dose Identification Paks of 100 (NOG 0088-1772-49). Each yellow
tablet is engraved with MARION on one side and 1772 on the other.
Issued 4/1/84
Another patient benefit product from
PHARMACEUTICAL DIVISION
MARION
LABORATORIES, INC
KANSAS CITY, MISSOURI 64137
Turn of the century
trephine forcranial surgery
and tonsillotome for
removing tonsils.
We’ve been defending
doctors since
these were the
state of the art.
These instriiiments were the best available at
the turn of the century. So was our professional
liability coverage for doctors. In fact, we
pioneered tfie concept of professional
protection in 1899 and have been providing
this important service exclusively to doctors
ever since.
You can be sure we’ll always offer the most
complete professional liability coverage you
can carry. Plus the personal attention and
claims prevention assistance you deserve.
For more information about Medical
Protective coverage, contact your Medical
Protective Company general agent.
\'!i f M M t.' ^ iitys si i' t >/ w
Jerome E. Kronsnoble, William E. Herte, 850 North Elm Grove Road, Elm Grove, WI 53122, (414) 784-3780
SOCIOECONOMICS
Hearing held on PT practice without referral
The Senate Agriculture, Health
and Human Services Committee
in September held a hearing on a
bill which would authorize physi-
cal therapists to evaluate and
treat patients without referral.
Senate Bill 233, introduced by
that Committee, removes from
the law the requirement that
physical therapists may practice
only upon the written referral of
a physician, dentist, or podiatrist.
The bill is primarily promoted by
physical therapists who are prac-
ticing independently from medi-
cal clinic settings.
In the last legislative session
this same group of physical thera-
pists tried to pass legislation to
bar physician service corpora-
tions from employing physical
therapists. When that was re-
jected in Committee, the practice
without referral bill was intro-
duced.
Michael C Reineck, MD, a
West Bend orthopedic surgeon,
testified on the Medical Society's
behalf against the bill. He re-
minded the Committee that
physical therapy is just one form
of therapy, and one form of ther-
apy is not enough for many
patients.
While complimentary to the PT
profession. Doctor Reineck noted
their training has not prepared
them to take on the responsibility
as managers in evaluation and
treatment.
A few weeks prior to this hear-
ing a public hearing was held on a
companion bill. Assembly Bill
256. Tai J Park, MD, Neenah;
Neal Taylor, MD, La Crosse; and
Daniel Halpern, MD, Madison,
testified on behalf of the Medical
Society in opposition to AB 256.
Physician contacts are needed
to block Committee approval of
both SB 233 and AB 256. Either
bill would allow physical thera-
pists to receive patients without
confirmed diagnoses.
The SMS Physicians Alliance
Division and its field consultants
can provide a list of the members
of the Senate Agriculture, Health
and Human Services Committee
and the Assembly Health Com-
mittee. See contact information
elsewhere in this section.*
C E S
Foundation
of the State Medical
Society of Wisconsin
The Charitable, Educational and
Scientific Foundation of the
State Medical Society of Wis-
consin recognizes the generosity
of the following individuals and
organizations who have made
contributions during the month
of August 1985.
AUGUST
VOLUNTARY
CONTRIBUTIONS
Stephen W Hargarten, MD
Ravikant Maski, MD
Leland R Mayer, MD
Gregory S Milleville, MD
BARBARA SCOTT
MARONEY FUND
HB Maroney, II
POMAINVILLE FUND
Mary Virginia Brageau
BROWN COUNTY LOAN
FUND
Marion S Hart
James R Mattson, MD
BEAUMONT 500 CLUB
1985 Staff of the State
Medical Society of
Wisconsin
MEMORIALS
Kristin L Bjurstrom
Mrs Sally Bloediker, RN
Mary Virginia Brageau
Mr and Mrs Jerry Buechner
Fond du Lac County Medical
Society
Mrs Dianne Janorske
HB Maroney, II
State Medical Society of
Wisconsin
Mr and Mrs Donald
Steinberger
Mr and Mrs Earl R Thayer
MUSEUM ENDOWMENT
FUND
Karver Puestow, MD
MEMORIALIZED
Francis E Gehin, MD
Earl A Hatleberg, MD
Adolph M Hotter, Jr, MD
Eric Allen Masterson
Raymond Murphy
Margaret Pom/ainville
Michael Ries, MD
Sherwood Slate
Robert E Sweeney*
44
WISCONSIN MEDICAL JOURNAL, OCTOBER 1985: VOL. 84
•v^LAs:
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WlUXESHA
DISTRICT 1
DISTRICT 2
Lois Riley
(414/271-4328)
Lanny Hardy
(608/257-6781)
County medical
societies
County medical
societies
Milwaukee
Waukesha
Ozaukee
Washington
Sheboygan
Kenosha
Racine
Walworth
Columbia-Marquette
Adams
Green Lake-
Waushara
Lafayette
Richland
Jefferson Dane
Green Dodge
Iowa Juneau
Grant Sauk
Rock
DISTRICT 3
Deborah Bowen Wilke
(414/964-5046)
County medical
Door-Kewaunee
societies
Calumet
Oneida-Vilas
Oconto
Lincoln
Marathon
Marinette-Florence
Wood
Forest
Portage
Langlade
Waupaca
Shawano
Winnebago
Outagamie
Fond du Lac
Brown
Manitowoc
DISTRICT 4
County medical
societies
Ashland-Bayfield-
Iron
Douglas
Barron-Washburn-
Burnett
Sawyer
Polk
Pierce-St Croix
Chippewa
La Crosse
Monroe
Eau Claire-Dunn-
Pepin
Trempealeau-
Jackson-Buffalo
Vernon
Crawford
Price-Taylor
Rusk
Clark
1985
Physicians
Alliance
Districts
and
Field Consultants
Physicians Alliance is a socio-
economic-leg islative-govern-
mental division of the State
Medical Society of Wisconsin
and is under the direction of the
Physicians Alliance Commis-
sion.
««A W
RACINE '
_J KCNQShA I
OS/ER 66,000
FAMILY PHYSICIANS
READ THIS
JOURNAL
the
physician
and
spjoiMfcsmedicine
Profile of Youth Soccer Injuries
Hov I uuul u> Ainreies
Heart Rale arvl Dunrtg Exercise
Current Status d Meriscus Surgery
Practical information
on the medical aspects of
fitness and exercise.
Tennis elbow: Joint resolution by
conservative treatment.
Hypertrophic cardiomyopathy
and the athlete.
Effects of sunscreen use during
exercise In the heat.
Overuse Injuries to the knee in
runners.
How I manage ingrown toenails.
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SOCIOECONOMICS
SMS physicians testify for additional
mental commitment standard
The Assembly Judiciary Com-
mitee held a public hearing in
mid-September on a State Medi-
cal Society-requested bill to
create a "fifth standard" for in-
voluntary civil commitment
under the Mental Health Act.
Assembly Bill 311, introduced by
Representative John Medinger,
(D-La Crosse) would, with exist-
ing due process, authorize treat-
ment for individuals who are
obviously mentally ill, but due to
the mental illness, are not ca-
pable of understanding their need
for treatment.
Darold A Treffert, MD, a psy-
chiatrist from Fond du Lac and
chairman of the SMS Board of
Directors, testified on behalf of
the Society in support of AB 311.
He refuted claims that passage of
the bill would be invalidated on
constitutional grounds by empha-
sizing the bill maintained all ex-
isting due process. "It is not to
make commitment easier, it only
allows patients to be treated at
the proper time," Doctor Treffert
told the Committee.
Pauline M Jackson, MD, a La
Crosse psychiatrist who also
serves on the SMS Board of
Directors and the Mental Health
Committee, also testified on be-
half of the Medical Society. She
likened the mental health treat-
ment system of the past and pres-
ent as a pendulum swing that was
too short on due process and free-
dom from unwarranted restraint
at one extreme to one that is too
short on a sick person's right to
treatment on the other. "AB 311
would bring the pendulum back
toward the center" Doctor Jack-
son said.
Critics of the bill say that a
court challenge is a virtual cer-
tainty should it become law. The
Wisconsin Civil Liberties Union
indicated that it would assist in
underwriting the case.
The constitutional issue arises
based on a landmark 1972 Wis-
consin case in Lessard vs Schmidt.
The court's interpretation of Wis-
consin's 1972 vague and loosely-
defined mental commitment
statute was construed as implying
a standard of dangerousness.
Some now believe that commit-
ment standards may only be
based on dangerousness.
The Medical Society's strong
opinion is that the court did not
preempt a more carefully formu-
The Assembly Financial Insti-
tutions and Insurance Committee
last month voted to kill a bill
which waived insurance com-
panies' obligations to pay interest
on overdue insurance claims if
the amount of interest due was
less than $5.
Assembly Bill 246, introduced
by Rep John Robinson (D-
Wausau), amended an existing
law which requires insurers to
pay an annual rate of 12% simple
interest unless claims are paid
within 30 days of receipt. The
existing law is applicable to
health insurance reimbursement
paid directly to physicians, hospi-
tals, and clinics.
The bill was promoted mainly
by Blue Cross and WPS to al-
legedly end the practice of issuing
miniscule separate interest
checks.
Many legislators received com-
munications from constituents
complaining about the waste in
receiving a separate interest
check for as little as one cent.
Suspicions arose at the hearing
on AB 246 when it was pointed
out that almost every insurance
lated need-for-treatment stan-
dard.
The Judiciary Committee also
heard testimony on a Joint Reso-
lution calling for a study to rec-
ommend changes to the mental
health treatment system. At the
time of this hearing it appeared
as if the Committee chairman
would not move AB 311 but in-
stead would go with the study
proposal.
Physicians are urged to contact
their legislators in support of
AB 311 and encourage them to do
all they can to move the bill from
Committee.*
company had the technology in
place to add the amount of in-
terest to the claim check. Because
the bill also extended the time
limit before a claim was overdue
from 30 days to 30 business days,
it was obvious to the Committee
that the bill's only aim was for in-
surers to keep their money longer
to increase profit margins.
The Medical Society voiced
strong opposition to the bill. Rep-
resentatives voting to kill the bill
were Carpenter, Tesmer, Craw-
ford, Antaramian, Black, Fergus,
Huelsman, Ladwig, and Schneid-
ers. Voting in support were Hauke
and John Young.*
Persons interested in the Im-
paired Physician Program
may call 608/257-6781 or
toll-free in Wisconsin: 1-800-
362-9080 and explain their
concern to Mr John LaBis-
soniere or Mr H B Maroney
of the State Medical Society
staff. The caller's identity
will be kept in complete
confidence.
Bill waiving interest on overdue
insurance claims rejected
WISCONSIN MEDICAL JOURNAL, OCTOBER 1985: VOL. 84
47
OBITUARIES
Charles Francis Foley, MD, 91,
died May 3, 1985 in Sparta. Born
May 14, 1893 in Kingston, Doctor
Foley graduated from Marquette
University School of Medicine,
Milwaukee, in 1916. He served in
the United States Navy during
World War I. He was a physician
at Soldiers Grove, Wilton, and at
the Veterans Administration Hos-
pital, Tomah, before retiring.
Surviving are his widow, Car-
oline; two sons, Charles, Shell
Lake; Gregory, Janesville; and a
daughter, Alice Robertson of
Chicago, 111.
Lucy A Vernetti, MD, Phoenix,
Ariz, died May 3, 1985 in Phoe-
nix. Born in Italy and raised in
Hurley, Wis, Doctor Vernetti
graduated from the University of
Wisconsin Medical School in
Madison. She served her intern-
ship in Phoenix and practiced
medicine there until 1979. She
was preceded in death by her
husband, Fred McLellan. Surviv-
ing are two brothers, Garfield
Vernetti, Shatter, Calif, and Gene
Vernetti of Canoga Park, Calif.
house of
BIDWELL, inc.
7954 West Harwood
and Watertown Plank Road
Milwaukee, Wisconsin 53213
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1-414-774-6250
Francis E Gehin, MD, 66, Stevens
Point, died July 12, 1985 in
Stevens Point. Born Jan 28, 1919
in Belleville, Doctor Gehin grad-
uated from the University of Wis-
consin Medical School, Madison,
and served his internship in New
Orleans, La. Doctor Gehin be-
gan his practice in 1947 in
Stevens Point and practiced
medicine until his retirement in
1984. He was a member of the
Portage County Medical Society,
the State Medical Society of Wis-
consin, and the American
Medical Association. Surviving
are his widow, JoAnne; six sons,
Paul, Stevens Point; Bruce,
Rudolph; Phillip, Reno, Nev;
Gregory, Ottawa, 111, and Mark
and David of Stevens Point.
Raymond J Murphy, MD, 48,
Green Bay, died July 17, 1985 in
Green Bay. Born Aug 15, 1936 in
Appleton, Doctor Murphy gradu-
ated from the University of Wis-
consin Medical School, Madison,
and served his residency at the
Medical College of Wisconsin in
Milwaukee. Doctor Murphy
served in the United States Navy
from 1963-65. He was chief of the
Department of OB/GYN at
St Vincent Hospital and was a
past member of the board at Bei-
lin Memorial Hospital in Green
Bay. He was a member of the
American College of OB/GYN;
the Northeastern Wisconsin Peri-
natal Association; the Wisconsin
Society of Obstetrics and Gyne-
cology; the Brown County Medi-
cal Society; the State Medical
Society of Wisconsin and the
American Medical Association.
Surviving are his widow, Bever-
ly; two sons, Patrick and Sean,
and two daughters, Molly and
Kelly, all at home.
Lester E Haushalter, MD, 76,
Brookfield, died Aug 8, 1985 in
Wauwatosa. Born June 5, 1909 in
Milwaukee. Born June 5, 1909 in
graduated from Marquette Uni-
versity School of Medicine, Mil-
waukee, and served his intern-
ship at St Joseph's Hospital,
Milwaukee. He served in the
United States Army Medical
Corps during World War II and
received a Bronze Star and Purple
Heart. Doctor Haushalter prac-
ticed medicine in the Milwaukee
area for 43 years before retiring
in 1977. He was a member of The
Medical Society of Milwaukee
County, the State Medical Society
of Wisconsin, and the American
Medical Association. Surviving
are his widow, Marilyn; two
daughters, Mary Eldridge, Sims-
bury, Conn; Judith Melino,
Rochester, New York; three sons,
Jerry, Los Angeles, Calif; Navy
Capt William, San Pedro, Calif;
and Dr Robert of Elm Grove.
Other survivors include his step-
children, Jaclyn Lemke, Stuart,
VA; James Lees, Brookfield; Jill
Kumlien, Brookfield; and Mary
Lynn Allen of Wautoma.
Ruth E Church, MD, 80, White-
water, died Aug 11, 1985 in
Waukesha. Born Aug 8, 1905 in
Walworth, Doctor Church grad-
uated from the University of Wis-
consin Medical School, Madison,
in 1937. She was a member of the
Wisconsin Department of Public
Health from 1937-1939; Iowa
Department of Public Health
from 1939-1945; and was director
of the Illinois Department of Pub-
lic Health from 1945-1951. Doc-
tor Church served in the United
States Army Medical Corps from
1953-1955 during the Korean
Conflict. She was director of the
Waukesha County Public Health
Department from 1961-1967. She
was a member of the Waukesha
County Medical Society, the State
Medical Society of Wisconsin,
and the American Medical Asso-
ciation.*
48
WISCONSIN MEDICAL JOURNAL, OCTOBER 1985: VOL. 84
•physician members of the State Medical Society of Wisconsin
PHYSICIAN BRIEFS
Robert Jacobson, MD, has joined
the Iron County Clinic, Hurley,
in association with Bruce Gordon,
MD. Doctor Jacobson graduated
from the University of Wisconsin
Medical School, Madison and
completed his family practice resi-
dency at the University of Colo-
rado Health Science Center,
Pueblo, Colo.
Mark Villwock, MD, recently be-
came associated with the Deck-
ner Clinic in Green Bay. Doctor
Villwock graduated from the
Medical College of Wisconsin,
Milwaukee, and completed his
family practice residency at Good
Samaritan Medical Center, Mil-
waukee.
Harry Bayron, MD, Marshfield,
has joined the medical staff of the
Marshfield Clinic. Doctor Bayron
graduated from the University of
Puerto Rico School of Medicine.
His residency was completed at
the University of Connecticut
School of Medicine followed by
a fellowship at the University of
Miami /Jackson Memorial Hospi-
tal Medical Center.
Young K Lee, MD, La Crosse, has
been named as recipient of the
Distinguished Teaching Award of
the University of Wisconsin-
Madison Medical Alumni Associ-
ation. Doctor Lee is a graduate
from Seoul National University
School of Medicine in Korea and
served his residency at the Uni-
versity of Wisconsin-Madison. A
member of the medical staff of
the Gundersen Clinic Ltd since
1974, Doctor Lee is president-
elect of the Wisconsin Society of
Anesthesiologists.
V Jill K Kempthorne, MD, Madi-
son, has joined the Department of
Pediatrics at the Jackson Clinic's
East Towne office. Doctor Kemp-
thorne graduated from the Uni-
versity of Washington School of
Medicine in Seattle. She com-
pleted her residency at the
Children's Orthopedic Hospital
and Medical Center, Seattle. Prior
to joining the Jackson Clinic, Doc-
tor Kempthorne held positions as
house physician. Department of
Pediatrics, Carney Hospital, Bos-
ton; pediatrician and medical
director, Codman Square Health
Center, Dorchester, Mass; and as
clinical instructor at the Tufts
University School of Medicine.
Graham D Avery, MD, has be-
come a member of the medical
staff of the Marshfield Clinic.
Doctor Avery graduated from the
University of Texas Medical
Branch in Galveston. Following
a year of research at the Univer-
sity of Texas Health Science
Center in Houston, Doctor Avery
also completed his residency at
the Center. A fellowship was
completed at Washington
University-Barnes Hospital in
St Louis.
George H Handy, MD,* Madison,
Chief Medical Consultant of the
Bureau of Social Security Disabil-
ity Insurance of the Department
of Health and Social Services, re-
tired this month. Doctor Handy
graduated from Rush Medical
College, Chicago, and served his
internship at King County Hospi-
tal System in Seattle. Licensed to
practice medicine in Wisconsin in
1947, he was in private practice
in Wisconsin until 1964. In 1965
he received his master's degree
in Public Health at the University
of Minnesota and in 1967 joined
the State Division of Health and
served as State Health Officer
from 1971-1976. In 1976 he be-
came Medical Director of the
CUNA Mutual Insurance Group
in Madison, and in 1982 became
the Chief Medical Consultant for
the BSSDI.
Theodore A Praxel, MD, * Wis-
consin Rapids, has become a
member of the medical staff of
Doctor's Clinic. A native of Mil-
waukee, Doctor Praxel graduated
from the Medical College of Wis-
consin and completed his resi-
dency at St Joseph's Hospital and
the Marshfield Clinic in Marsh-
field.
Arnold J Aguilera, MD, has joined
the medical staff of the Gunder-
sen Clinic, Ltd in La Crosse. Doc-
tor Aguilera graduated from the
University of Iowa College of
Medicine and completed his in-
ternship at the University of
Rochester School of Medicine
and Dentistry, Rochester, NY.
His residency was completed at
the University of New Mexico
School of Medicine in Albu-
querque. He most recently com-
pleted a fellowship at the Univer-
sity of Colorado Health Sciences
Center in Denver.
Doctor Handy Doctor Thorpe
Robert F Thorpe, MD, * Mani-
towoc, who was the original
physician when the Manitowoc
Clinic opened in 1950, has retired
from his medical practice. Doctor
Thorpe graduated from the Uni-
versity of Illinois in Champaign,
111, and served his internship and
residency at Cook County Hospi-
tal in Chicago. Doctor Thorpe
was a member of the Memorial
Hospital medical staff and had
served as president of the medi-
cal staff in 1966 and 1968.
WISCONSIN MEDICAL JOURNAL, OCTOBER 1985:VOL. 84
49
PHYSICIAN BRIEFS
JohnJ Maher, MD, Beloit, recent-
ly joined the medical staff of the
Beloit Memorial Hospital in the
Emergency Department. Doctor
Maher graduated from Eastern
Virginia Medical School and com-
pleted his residency at Akron
General Medical Center, Ohio.
Mark W Francis, MD, Beloit, has
become a member of the medical
staff of the Beloit Memorial Hos-
pital in the Emergency Depart-
ment. Doctor Francis graduated
from the University of Rochester
School of Medicine and Den-
tistry, New York, and completed
his residency at the Medical Col-
lege of Pennsylvania.
Kevin G Derus, MD, Beloit, a
graduate from the Medical Col-
lege of Wisconsin, Milwaukee,
has joined the medical staff of the
Beloit Memorial Hospital in the
Emergency Department. Doctor
Derus completed his residency at
the Akron General Medical
Center in Ohio.
Doctor Maher Doctor Francis
Annette Z Stormont, MD, Mon-
roe, recently became associated
with The Monroe Clinic. Doctor
Stormont graduated from the
Medical College of Wisconsin in
Milwaukee, and served her in-
ternship at St Joseph's Hospital in
Milwaukee. Her residency was
completed at the Mayo Graduate
School of Medicine in Rochester,
Minn, where she also served as
chief resident in the Department
of Ophthalmology. Her husband,
Daniel M Stormont, MD recently
became associated with the De-
partment of Orthopedic Surgery
at The Monroe Clinic.
William R O'Shields, MD, Chip-
pewa Falls, recently joined the
medical staff of St Joseph's Hos-
pital in Chippewa Falls. Doctor
O'Shields graduated from the
University of Minnesota School
of Medicine and served his in-
ternship at the State University
of New York-Stony Brook, and
completed his residency at
St Paul Ramsey Medical Center
in Minnesota.
Charles J Gehring, MD, Sheboy-
gan, recently became a member
of the Department of Anesthesi-
ology at Sheboygan Memorial
Hospital. Doctor Gehring gradu-
ated from the University of Wis-
consin Medical School, Madison,
and completed his internship and
residency at the University of
Wisconsin Hospital and Clinics
in Madison.
Alayne J Van Erem, MD, has
joined the medical staff of the
Marshfield Clinic. Doctor Van
Erem graduated from the Uni-
versity of North Dakota in Grand
Forks and served an internship at
Milwaukee Children's Hospital.
Her residency was completed at
Georgetown University in Wash-
ington, DC. Doctor Van Erem
was in private practice in War-
rentown, VA; was on the medical
staff at Kaiser Permanente in
Walnut Creek, Calif, and was in
group practice in Pleasant Hill,
Calif, before coming to Marsh-
field.
Albert J Motzel Jr, MD, Wauke-
sha, closed his surgical practice
on July 31 after 27 years of prac-
tice in the Waukesha area. On
August 1 he assumed a new posi-
tion as vice president for medical
affairs with the Waukesha Me-
morial Hospital. In announcing
the change Doctor Motzel noted
that his increasing involvement
with medical staff activities, qual-
ity assurance, continuing medical
education and planning at the
hospital, and the changes occur-
ring in health care today were
becoming so overwhelming that
he could no longer continue as an
individual practitioner. However,
he hopes that in his new role he
can contribute significantly to the
advancement of high quality, ef-
fective care in the Waukesha
community.
Bradley C Fry, MD, Sheboygan,
has joined the Department of
Anesthesiology at Sheboygan
Memorial Hospital. Doctor Fry
graduated from the University of
Wisconsin Medical School, Madi-
son, and completed his residency
at University Hospital in Cleve-
land.
Gary F Steele, MD, Brownsville,
has joined the medical staff at the
Brownsville Family Center. He is
a graduate of the West Virginia
School of Medicine and served
his internship at the Charleston
Area Medical Center in West
Virginia. After completing a tour
of duty with the United States
Navy, Doctor Steele completed
a family practice residency at
the Regional Medical Center in
Charleston.
Doctor Derus
50
WISCONSIN MEDICAL JOURNAL, OCTOBER 1985: VOL. 84
PHYSICIAN BRIEFS
Stephen M Endres, MD, Eau
Claire, has joined the medical
staff at Eau Claire Anesthesiolo-
gists Ltd. Doctor Endres gradu-
ated from the University of
Minnesota Medical School and
completed his residency at the
Mayo Clinic in Rochester, Minn.
Douglas Cowgill, MD, Marsh-
field, recently became associated
with the Marshfield Clinic. He
graduated from the University of
Southern California School of
Medicine, Los Angeles, and com-
pleted an internship at Los An-
geles County-USC Medical
Center. Doctor Cowgill practiced
medicine with the Indian Health
Service in Bethel, Alaska, for four
years and then returned to Los
Angeles County USC to complete
his residency in surgery. He also
completed a fellowship at the
Baylor School of Medicine, Hous-
ton, Texas. Prior to joining the
Marshfield Clinic, Doctor Cow-
gill completed a residency at the
University of Colorado Health
Sciences Center in Denver.
Donald T Bishop, MD, Beloit,
recently became a member of the
medical staff of Beloit Clinic, SC.
Doctor Bishop graduated from
the University of Colorado Medi-
cal School and completed his
residency at Santa Clara Valley
Medical Center in San Jose, Calif.
He also completed a fellowship at
the University of Wisconsin Hos-
pital and Clinics and currently
is a clinical assistant professor at
the UW Hospital and Clinics.
He previously served as director
of the ICU/CCU at the Veterans
Administration Medical Center in
Boise, Idaho.
John Pirsch, MD, Madison,
recently joined the Department
of Internal .Medicine at the East
Towne office of the Jackson
Clinic. Doctor Pirsch graduated
from the University of Minnesota
Medical School, and completed
his internship and residency at
the University of Wisconsin Hos-
pital and Clinics, Madison. Prior
to joining the Clinic, Doctor
Pirsch was an admitting officer at
the Veterans Administration Hos-
pital, Madison, and was Director
of Emergency Rooms in Stough-
ton and Edgerton.H
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WISCONSIN MEDICAL JOURNAL, OCTOBER 1985: VOL. 84
51
For professional liability insurance, the stakes are too
high to depend on anyone else.
That's why the State Medical Society has endorsed a
professional liability plan which has been developed
especially for Wisconsin physicians.
Available only to members of the SPIS— and offered
through SMS Services, Inc.— this medical malpractice policy
has superior features including:
• Consent of the physician is required before settlement of
any claim.
• Availability of legal counsel, experienced in defendant
medical liability.
• All members of claims and underwriting committees are
Wisconsin physicians.
• Occurrence coverage provided for claims arising during
the policy period, even if claim is reported at a later
time.
For the best in professional liability coverage, contact
SMS Services, Inc. at (608) 257-6781 or toll-free 1-800-362-9080
\Me know how vital it is to safeguard the present...
and to protect the future.
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MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
Internal Medicine; BC/BE. Established
50-doctor multispecialty group practice
located in the Milwaukee, Wisconsin
metropolitan area. Expanding practice
needs two internists. Competitive salary
and excellent fringe benefits. Address in-
quiries and CV to Medical Director, PO
Box 427, Menomonee Falls, WI 53051.
plO-11/85
Primary Care. Seeking primary care
physician interested in diagnostic chal-
lenges, both inpatient and outpatient,
and providing primary care for individu-
als with mental retardation (all ages). In
addition, the health of group home cli-
ents from the Eastern half of the US is to
be monitored. Bethesda Lutheran Home
is located on the banks of the Rock River
in South Central Wisconsin. Come join a
progressive staff interested in meeting
the challenges presented by our clients.
Send resume to: John C Heffelfinger,
MD, Medical Director, Bethesda Luther-
an Home, 700 Hoffman Dr, Watertown,
Wl 53094. 10/85
Family practice opportunity— very
busy five-physician practice being cov-
ered by four physicians. Pleasant South
Central Wisconsin community of 15,000;
close to Milwaukee and Madison. Excel-
lent recreational area. First-year guaran-
teed salary. Excellent benefits. Contact:
C Burchardt, Medical Associates, 1200 N
Center, Beaver Dam, WI 53916; ph 414/
887-7101. lOtfn/85
General Internist. Board certified/
board eligible. Opening established prac-
tice with large multispecialty clinic, Mad-
ison. Competitive salary, excellent fringe
benefits. Send curriculum vitae and ref-
erences to Dept 568 in care of the
Journal. plO- 11/85
Rheumatologist. Will complete training
in a University rheumatology fellowship
7/ 86. Interested in a practice opportunity
in Wisconsin or elsewhere in Midwest.
Please contact Dept 564 in care of the
Journal. plO/85
RATES: 50<t per word, with a minimum
charge of $20.00 per ad. BOXED AD
RATES: $25.00 per column inch.
DEADLINE: Copy must be received by the
15th of the month preceding month of issue:
e.g., copy for the August issue is due July 15.
Send copy to: Wisconsin Medical Journal,
Box 1109, Madison, Wisconsin 53701; or
phone (area code 608) 257-6781; or toll-free
in Wisconsin: 800/362-9080.
Wanted Board Certified Otolaryngol-
ogist. Head and neck surgeon. Join active
one-man practice. General otolaryngol-
ogy, head and neck surgery, facial plastic
surgery, nasal allergy. Computerized of-
fice with x-ray, audiologist, and hearing
aid dispensing. Northern Wisconsin near
Apostle Islands National Lakeshore. Con-
tact James A Hamp, MD, ENT Profes-
sional Associates, SC, 2101 Beaser Ave,
Suite 1, Ashland, WI 54806; ph 715/682-
9311. 10-12/85:1-3/86
Family Practice. Third family practice
physician needed to join multispecialty
group of 17 in Hartford, WL Two branch
locations. All facilities modern and well
equipped. Guaranteed first year nego-
tiable salary: usual fringe benefits. Con-
tact: Murlin Bernd, Clinic Manager, 1004
E Sumner St, Hartford, WI 53027;
ph 414/673-5745. 10-11/85
Pediatrician. BC/BE to join busy four-
member Pediatric Department within a
23-member multispecialty group. Excel-
lent benefits and competitive salary. Call
or write: W J Mommaerts, Administrator,
West Side Clinic, sc, 1551 Dousman St,
Green Bay, WI 54303; ph 414/494-5611.
10-11/85:1-2/86
Physician interested in purchasing In-
ternal Medicine General Practice in Mil-
waukee. Please send information in-
cluding type of practice, total number of
patients, and total number of active files.
Contact Dept 569 in care of the Journal.
10/85
Appleton, Wisconsin— seeking physi-
cian for weekend coverage at family
practice clinic affiliated with local hospi-
tal. Flexible hours and attractive compen-
sation. Submit resume to Emergency
Consultants, Inc, 2240 South Airport Rd,
Traverse City, MI 49684; 1-800/253-1795
orin Michigan 1-800/632-3496. plO/85
West Bend, Wisconsin, General Clin-
ic, a (18) physician multispecialty group,
is seeking physicians in the specialties of
Internal Medicine, Family Practice, OB/
GYN, and Pediatrics. First-year salary
guaranteed. Corporate membership pos-
sible after one year. Excellent fringe
benefits. Located in scenic, recreational
area with close proximity to Milwaukee.
Please contact Hans W Schmelzling, Ad-
ministrator, General Clinic, 279 S 17th
Ave, West Bend, WI 53095; ph 414/338-
1123. 6tfn/85
Radiologist-Board certified, available for
part-time position for clinics in Mil-
waukee and neighboring counties. Con-
tact Dept 567 in care of the Journal.
10-11/85
Excellent opportunity for a Board cer-
tified or eligible internist to practice
in conjunction with an 8-member Inter-
nal Medicine Department of a 26-mem-
ber multispecialty group. The group is
located in southeastern Wisconsin, in a
city of 100,000 between two major
metropolitan areas of greater than one
million. If interested, please send CV to:
Stephen L Wagner, Kurten Medical
Group, 2405 Northwestern Ave, Racine,
WI 53404. All inquiries will be kept
confidential. 6tfn/85
Family Practitioner needed to join two
FPs at the Ellsworth, Wisconsin office
of a progressive eleven-physician group.
Liberal fringes and financial package.
Forty miles from metropolitan Min-
neapolis/St Paul. Contact R M Hammer,
MD, River FaUs, WI 54022; ph 715/425-
6701 or 612/436-8809. 4tfn/85
Wanted— Board qualified— board cer-
tified obstetrician-gynecologist as an
associate. Modern well equipped facility.
Excellent starting salary and benefits in-
cluding profit sharing plan. Please contact
Elizabeth Allen Steffen, MD, 734 Lake
Ave, Racine, Wis 54303. 9tfn/83
OB/GYN: BC/BE to join three OB-GYNs
in 31 -physician multispecialty group.
Beautiful lakefront community of 90,000
located between Milwaukee and
Chicago offers a wealth of cultural, edu-
cational, and recreational opportunities.
Well-equipped clinic and two local
hospitals; salary guarantee with in-
centive bonus; excellent fringe benefits
and early partnership. Send curriculum
vitae to: R D Lacock, Administrator,
Racine Medical Clinic, 5625 Washington
Ave, Racine, WI 53406. 9tfn/85
General and surgical solo practice for
sale. Gross in excess of $300,000. Grow-
ing desirable midwestern university
city with population 25,000. One very
well-equipped hospital in county of
60,000 a few blocks away. Owner will
remain to introduce. Contact Dept 563 in
care of the Journal. 9tfn/85
Orthopedic Surgeon sought by state-
of-the-art multispecialty group in Mil-
waukee, Wisconsin. Board certified/
eligible physician to join 3 other ortho-
pedists in the performance of indepen-
dent orthpedic evaluations for the pur-
pose of determining appropriate
treatment or disability. No weekends,
no call, no surgery. Competitive salary
and fringe benefits. Please submit CV
to Dept 566 in care of the Journal.
plO-11/85
WISCONSIN MEDICAL JOURNAL, OCTOBER 1985: VOL. 84
53
MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
continued
Family Practice: Thirty-one physician
multispecialty group conveniently lo-
cated between Chicago and Milwaukee.
Well-equipped clinic offering salary
gaurantee with incentive bonus; excel-
lent fringe benefits and early ownership.
Please send curriculum vitae to: R D
Lacock, Administrator, Racine Medical
Clinic, 5625 Washington Ave, Racine,
WI 53406. 9tfn/85
Emergency Physician. Seeking third
full-time associate for modern, well-
equipped emergency outpatient depart-
ment. Lower volume ER. Thirty-five
miles north of Green Bay. Board eligible,
ATLS, ACLS certification desirable.
Beautiful rural Wisconsin. Send inquiries
with CV to Administrator, Community
Memorial Hospital, 855 S Main St, Ocon-
to Falls, WI 54154 or call 414/846-3444.
10-11/85
Internist-Infectious Disease Phy-
sician. The Racine Medical Clinic, a pro-
gressive cluster corporation of 32 phy-
sicians, is currently seeking an Internist-
Infectious Disease physician. Full bene-
fits, unlimited earnings and a full and
exciting practice are offered. Please con-
tact; Roger D Lacock, Administrator,
Racine Medical Clinic, 5625 Washington
Ave, Racine, WI 53406; ph 414/886-
5000. 6tfn/85
MESA is on the MOVE
in
Northern Illinois, Wisconsin
and the Chicagoland Area
We are seeking Board Certified/
eligible and Emergency Trained
Physicians to join our growing
organization.
• Compensation/Benefit Packages
are highly competitive with adminis-
trative and educational support
services.
• Management and Staff positions
for Emergency Departments and
Ambulatory Care Centers.
• Excellent communication skills
and the desire to excel in Emergency
Medicine is a necessity.
MESA Medical Emergency Service
Associates, SC over 20 years of
excellence in Emergency Medicine.
Contact: Ms Debbie Carsky, Director
of Recruitment, 312/459-7304 (collect)
or write to 15 South McHenry Road,
Buffalo Grove, IL 60090. 10/85
Family Practitioner needed to join
established Family Practice group in East
Central Wisconsin city of 50,000 on
beautiful Lake Winnebago. Competitive
salary, fringes, excellent recreation area.
Send CV to MS Knier, MD, 555 S Wash-
burn, Oshkosh, Wis 54901; 414/426-0265.
lOtfn/84
Second Family Practitioner needed to
staff a satellite of a 38-physician multi-
specialty group in Kiel, a beautiful small
community in East Central Wisconsin. At-
tractive income arrangements, association
membership possible after one year, pen-
sion and profit sharing, extensive fringe
benefits. Contact R B Windsor, MD, 1011
North 8 St, Sheboygan, WI 53081; ph 414/
457-4461. c2tfn/85
Board Eligible Orthopedic Surgeon to
join established orthopedic practice in
East Central Wisconsin. Contact Dept 553
in care of the Journal. 2tfn/85
Versatile Surgeon wanted to comple-
ment aggressive family practice group in
rural northeastern Minnesota resort com-
munity. Well-equipped 40-bed hospital
with proven surgical practice volume.
Outstanding outdoor recreational op-
portunities with time off to enjoy it.
Reply with CV to E Johnson, Ely Medical
Center, Ltd, 224 East Chapman Street,
Ely, Mn 55731; ph 218/365-3151. 6tfn/85
Internist /Cardiologist for multi-
specialty group practice in Milwaukee,
Wisconsin. Extremely well-equipped
modern facility with stress thallium,
echo, holter, etc. Applicant should be
Board certified /eligible in cardiology
but must be willing to do general medi-
cine also. Please forward CV to Dept
565 in care of the Journal. plO/85
FAMILY PRACTITIONERS
INTERNISTS, OB/GYN
The UW Office of Rural Health is seek-
ing primary care specialists for more
than 50 communities throughout Wis-
consin. Opportunities are available
throughout Wisconsin for Board certi-
fied physicians trained in US medical
schools and residencies.
CONTACT:
Laurie Glowac or Fred Moskol
New Physicians for Wisconsin
University of Wisconsin
Department of Family Medicine
777 S Mills St, Madison, WI 53715
Phone 608/263-4095 7/85-6/86
Primary care physicians— Family Prac-
tice, General Practice, or ER experience
desirable. To staff clinics for industrial,
walk-in, after hours and satellite medi-
cine. Excellent opportunity— guaranteed
salary, profit-sharing, great fringes.
Send CV to: Administrator, Manitowoc
Clinic, PO Box 3008, Manitowoc, WI
54220. 9-12/85
We are seeking three (3) Board certi-
fied/eligible family practice physicians
for a new Ambulatory Care Center in the
Milwaukee area; attractive work hours
and financial package. Please send CV or
call: Ms Debbie Carsky, Director of Re-
cruitment, MESA (Medical Emergency
Service Associates), 15 S McHenry Rd,
Buffalo Grove, IL 60089; 312/459-7304.
10/85
Ophthalmologist. Board certified /Board
eligible, to join one other Board certified
ophthalmologist in rapidly expanding
40-member multispecialty group with high
level ophthalmic pathology. Immediate
drawing area 100,000. Located on Lake
Michigan with excellent recreational activ-
ities. First-year salary. Association after one
year with income based solely on produc-
tion with superb benefits package. Contact
D K Aymond, MD, The Sheboygan Clinic,
1011 North 8 Street, Sheboygan, WI 53081;
ph 414/457-4461. 9tfn/85
Pediatrics/Neonatology: Thirty-one
physician multispecialty group con-
veniently located between Chicago and
Milwaukee. Well-equipped clinic offer-
ing salary guarantee with incentive
bonus: excellent fringe benefits, and
early ownership. Neonatology skills
needed for Level II Nursery. Please send
curriculum vitae to R D Lacock, Admin-
istrator, Racine Medical Clinic, 5625
Washington Ave, Racine, WI 53406.
9tfn/85
Internist or Family Practitioner to join
two Internists and General Surgeon in
growing, established. Green Bay area
practice. Send CV to John Brusky, MD,
1203 South Military Ave, Green Bay, WI
53404. 7tfn/84
Physicians needed full or part-time to
perform light physicals. Milwaukee area.
Professional liability provided. Phone
414/344-2100, Ms Jenkins. lOtfn/84
Wisconsin: Pediatrician with sub-
specialty interest to join multispecialty
clinic that includes general pediatricians,
pediatric hematologist, oncologist and
neonatologist in city of 150,000. Send
CV to Dept 561 in care of the Journal.
8tfn/85
54
WISCONSIN MEDICAL JOURNAL, OCTOBER 1985: VOL. 84
MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
continued
General Internist. Marshfield Clinic,
one of the nation's largest multispecialty
private groups, is seeking several Board
certified/Board eligible General Internal
Medicine specialists to join its expanding
16-member section. Internal Medicine
Residency Program, University af-
filiation, Research Foundation, and large
regional referral base contributes to a
very stimulating environment. Unique
big city medicine opportunity in a
family-oriented rural setting. Please
send curriculum vitae to: John P Folz,
Assistant Director, Marshfield Clinic,
1000 North Oak Ave, Marshfield, WI
54449 or call collect at 715/387-5181.
9-11/85
Internist with or without subspecialty
interest. Board Certified or eligible, to
join six other internists in a well-estab-
lished, 23-man expanding multispecialty
group in prosperous lakeside south-
eastern Wisconsin city of 36,000. The
Internal Medicine Department currently
has subspecialties in cardiology, pul-
monary medicine, and medical on-
cology. Liberal fringe benefits. Initial
salary plus percentage as associate.
Full status in service corporation, with
incentive-oriented formula after first
year. Contact] F Kuglitsch, MD, Fond du
Lac Clinic, SC, 80 Sheboygan St, Fond
du Lac, Wis 54935; ph 414/923-7420
collect. 5tfn/85
Ophthalmologist, subspecialty pediatrics
or glaucoma helpful but not required.
Board certified/Board eligible, to join one
other Board certified ophthalmologist in
rapidly expanding 40-member multi-
specialty group with high level ophthalmic
pathology. Must be willing to do general
ophthalmology. Immediate drawing area
100,000 with unopposed subspecialty re-
ferral area much higher. Located on Lake
Michigan with excellent recreational ac-
tivities. Optometric support available. First-
year salary. Association after one year with
income based solely on production with
superb benefits package. Contact D K Ay-
mond, MD, The Sheboygan Clinic, 1011
North 8 Street, Sheboygan, Wl 53081; ph
414/457-4461. 9tfn/85
Family practice physician, internist
and OB/GYN physicians needed to join
a multispecialty clinic in NE Wisconsin.
Excellent starting salary, full benefits,
partnership one year, HMO affiliated.
Contact Stephen C Caselton, MD, 2152
Riverside Ave, Marinette, Wis 54143;
ph 715/732-2211. p8- 10/85
MEDICAL FACILITIES
Office for rent January 1986. Now used
for orthopedic surgeon. 32' x 50', includ-
ing waiting room, business office, two
large exam rooms, cast room, and office.
Free parking. Baraboo, Wisconsin. Phone
608/356-6644. 10/85
MISCELLANEOUS
Physicians. Ultrasonography Service in
your office. Milwaukee Ultrasonography
Service offers to bring realtime ultraso-
nography to your personal office. Service
now available in southeastern Wisconsin.
For information, please call Nancy Schil-
ler at 414/933-8795. 10-11/85
Physicians Signature Loans to
$50,000. Up to 7 years to repay. Com-
petitive fixed rate, with no points, fees,
or charges of any kind. No prepayment
penalties. Prompt, courteous service.
Physicians Service Assn, Atlanta, GA.
Toll-Free (800)241-6905. lOeom/83
MEDICAL MEETINGS-
CONTINUING MEDICAL
EDUCATION
WISCONSIN
NOVEMBER 16, 1985: Wisconsin
Society of Pathologists, American Club,
Kohler. g9- 10/85
NOVEMBER 18-21, 1985 (Louisiana);
A Primary Care Update, the 70th Scientific
Assembly of Interstate Postgraduate
Medical Association. Accredited by ACC-
ME and eligible for 24 hours of Category
1 and 4 hours of Category 5 credit of the
AMA/PRA. Acceptable for 24 prescribed
hours credit by American Academy of
Family Physicians and 24 hours by the
College of Family Physicians of Canada.
Info: IPMANA, PO Box 1109, Madison,
WI 53701 g9-10/85
DECEMBER 6-7, 1985: 5th Annual Con-
ference on Heart Diseases: Imaging Comes
to Cardiology. Wisconsin Center, Madi-
son. Sponsored by Department of Medi-
cine, Cardiology Section, and Depart-
ment of Radiology, and Continuing
Medical Education, University of Wis-
consin Medical School; with University
of Wisconsin Hospital and Clinics. AMA
Category 1 and University of Wisconsin
CEUs— both 12 hours. AAFP Prescribed
and AOA Category 2-D— both 9Vz hours.
Contact: Sarah Aslakson, Continuing
Medical Education, 610 Walnut St, 465B
Madison, Wisconsin 53705; ph 608/263-
2856. 10/85
OTHERS
OCTOBER 1985 (Minnesota): Continu-
ing medical education programs, University
of Minnesota Medical School, Minnea-
polis. See details in full-page ad elsewhere
in this section. glO/85
NOVEMBER 1985 (Minnesota): Con-
tinuing medical education programs. Uni-
versity of Minnesota Medical School, Min-
neapolis. See details in full-page ad else-
where in this section. glO/ 85
NOVEMBER 14-16, 1985 (Minnesota);
Clinical Strategies In Primary Care Medi-
cine, Radisson Plaza Hotel, St Paul. Info:
Bonnie Young, CME, St Paul-Ramsey
Medical Center, 640 Jackson St, St Paul,
MN 55101; ph 612/221-3977. g6-10/85
DECEMBER 4-6, 1985: (Illinois);
Neurology for the Non-Neurologist, The
Westin Hotel, Chicago. Contact; Uni-
versity Office of Continuing Education,
Rush University, 600 S Paulina, Chicago,
IL 60612; ph 312/942-7095. p9-ll/85
DECEMBER 5-7, 1985 (Minnesota):
Coronary Heart Disease: A Comprehensive
Review of Principles and Practice, Sheraton
THIS LISTING is compiled by the State
Medical Society of Wisconsin in coopera-
tion with others who wish to maintain a
centralized schedule of meetings and
courses of interest to Wisconsin physicians
and to avoid scheduling programs in conflict
with others. Hospitals, Clinics, Specialty
Societies, and Medical Schools are par-
ticularly invited to utilize this listing service.
There is a nominal charge for listing of Con-
tinuing Medical Education courses at the
following rates: 50« per word, with a mini-
mum charge of $20.00 per listing.
BOXED LISTINGS: $25.00 per column
inch. Listings of other scientific meetings
will be included at the discretion of the
editors.
COPY DEADLINE tor listings is 15th of the
month preceding the month of publication;
e.g., copy for the August issue is due by July
15. Address communications to: Wisconsin
Medical Journal, Box 1109, Madison, Wis-
consin 53701; or phone (area code 608)
257-6781; or toll-free in Wisconsin: 800/
362-9080.
FOR LISTING of other meetings see the
January 4. 1985 issue of the Journal of the
American Medical Association: Continuing
Education Opportunities for Physicians for
period January 1985 through December
1985.
WISCONSIN MEDICAL JOURNAL, OCTOBER 1985: VOL. 84
55
MEDICAL YELLOW PAGES
MEDICAL MEETINGS-
CONTINUING MEDICAL
EDUCATION
continued
Wisconsin Society
Medical Assistants
An affiliate of the American
Association of Medical
Assistants, Inc
is sponsoring
Professional Development
and Advancement Seminar
Saturday, November 9
Marshfield Clinic
Marshfield
• Infertility
Bruce A Wineman, DO
Obstetrics & Gynecology
• AIDS
Ray C Haselby, DO
Infectious Disease
• Aspects of Plastic Surgery
Molly Pearce, RN, PA
Plastic Surgery
• Changing Economics in
Health Care, Business,
and Insurance Trends
Don Nystrom, Business
Office Manager
.6 CEUs applied for
Registration fee: $6.00 (members
and students); $18.00 (non-
members)
Doctors: Please consider sending
your staff for this day of education.
The registration fee is tax-
deductible
For more information contact:
Laura Hillman
Education Chairman
Rt 1, Box 389
Fox Lake, WI 53933
414/885-5576
Corrine M Boushon, CMA
Cochairman
1007 Sawyer Drive
Marshfield, WI 54449
715/384-4129
Sylvia Neumann, CMA
Financial Chairman
400 North Street
Beaver Dam, WI 53916
414/885-6077 glO/85
Midway Hotel, St Paul. Info: Bonnie
Young, CME, St Paul-Ramsey Medical
Center, 640 Jackson St, St Paul, MN
55101; ph 612/221-3977. g6-ll/85
FEBRUARY 13-14, 1986 (Michigan):
Tenth Annual Winter Pediatric Confer-
ence at Powderhorn Ski Area, Ironwood,
Michigan. Guest speaker is James A
Stockman, III, MD. Info: Marshfield
Medical Education Department or H
James Nickerson, MD, Marshfield Clinic,
1000 North Oak Ave, Marshfield, Wis-
consin 54449. 9-12/85; 1-86
WEEKLY SEMINARS
Most major ski areas. Club Med,
Disney World, Cruising aboard
Sailboats in the Virgin Islands or a
Mississippi Paddlewheeler. Topic:
Medical-legal issues. Accredited
Category 2 by AMA.
Current Concept Seminars, Inc
(since 1980). 3301 Johnson St,
Hollywood, FL 33021; ph 800/
428-6069. $175. p9-12/85; 1-2/86
Wisconsin Specialty
Society Meetings 1985-1986
• Wisconsin Society of Radiation
Oncology, Oct 18-19, 1985,
Concourse Hotel, Madison
• Wisconsin Dermatological
Society, Oct 26, 1985, Froederdt
Memorial Lutheran Hospital,
Milwaukee
• Wisconsin Orthopaedic Society,
Nov 1, 1985, The Olympia
Resort, Oconomowoc
• Wisconsin Society of
Pathologists, Nov 16, 1985,
American Club, Kohler
• Wisconsin Chapter American
College of Surgeons, Dec 7,
1985, Marc Plaza Hotel,
Milwaukee
• Wisconsin Urological Society,
Apr 11-12, 1986, Edgewater
Hotel, Madison
• Wisconsin Academy of Family
Physicians, June 11-14, 1986,
Telemark Lodge, Cable
• Wisconsin Society of Obstetrics
& Gynecology, July 17-19, 1986,
Embassy Suites, Green Bay
• Wisconsin Dermatological
Society, Aug 1-3, 1986, The
Abbey, Lake Geneva
1986 CME CRUISE /CONFERENCES
ON SELECTED MEDICAL TOPICS-
Caribbean, Mexican, Hawaiian, Alaskan,
Mediterranean. 7-12 days year-round.
Approved for 20-24 CME Category 1
credits (AMA/PRA) & AAFP prescribed
credits. Distinguished professors. FLY
ROUND-TRIP FREE ON CARIBBEAN,
MEXICAN, & ALASKAN CRUISES. Ex-
cellent group fares on finest ships. Reg-
istration limited. Prescheduled in com-
pliance with present IRS requirements.
Information: International Conferences,
189 Lodge Ave, Huntington Station, NY
11746; ph 516/549-0869. plO-12/85
AMA
DECEMBER 8-11, 1985; Interim AMA
House of Delegates, Washington, DC.
JUNE 15-19, 1986: Annual AMA House
of Delegates, Chicago, IL.B
ADVERTISERS
Abbott Northwestern 8, 9
Acme Laboratories 51
Advanced Technology Associates,
Inc 4
Medical Computer Systems
Air Force Medicine 7
American Physicians Life 14
Dista Products Co (Div of Eli
Lilly & Co) 40
Ceclor®
Dorsey Pharmaceuticals (Div
of Sandoz, Inc) 29, 30
Hydergine® LC
Gaarder Miller Milwaukee
Ltd 33
House of Bidwell 48
Knoll Pharmaceuticals
Company 36, 37, 38
Isoptin®
Marion Laboratories 41, 42
Cardizem®
Medical Protective Company 43
Minnesota, University of 57
Continuing Medical Education
Navy Medicine 30
PBBS Equipment 10
Peppino's 46
Physician and Sportsmedicine,
The 46
Professionals Insurance
Company, The 52
Roche Laboratories 59, BC
Dalmane®
SK&F Company 35
Dy azide®
S&L Signal Company 51
SMS Services, Inc 34
Upjohn Company, The 39
Motrin®m
56
WISCONSIN MEDICAL JOURNAL, OCTOBER 1985: VOL. 84
2nd-3rd
9th-l2th
16th-18th
18th-19th
25th
OCTOBER, 1985
Tenth International Symposium on intestinal Microecology
Principles of Colon and Rectal Surgery
Annual internal Medicine Review
Practical Ophthalmology ih Primary Care
Current Concepts in Endocrine Pathology
7th-9th
8th-9th
NOVEMBER, 1985
Geriatric Medicine for Faculty of Family Practice Residencies
The 2nd Nutrition in the 80's Update:
Current issues and New Directions
15th-16th
Advanced Endourology:
Changing Options in the Management of Urinary Calculi
22nd-23rd
Laser Surgery with the Carbon Dioxide Laser
FEBRUARY
26th-27th
JANUARY- JULY, 1986
(selected courses)
Topics in Geriatric Medicine: Drug Therapy Symposium vii
APRIL
14th-15th
APRIL 28th-
MAY 2nd
Current Concepts in Refractive Surgery
Family Practice Review: Update '86
MAY
7th-9th
7th-9th
20th
2lst-23rd
WorldMed '86: international Health Care Congress
(sponsored by Minnesota Trade Office and Medical Alley Association)
43rd Annual Course in Allergy and Clinical immunology
Symposium on Gynecologic Oncology
Current Concepts in Radiation Therapy
JUNE
6th-7th
18th-21st
25th-27th
15th Annual Workshops on Clinical Hypnosis -
Introductory and Advanced
50th Annual Surgery Course - Advances in Trauma and Critical Care
Topics and Advances in Pediatrics
JULY
7th-9th
Orthopaedic Surgery: Shoulder
Box 293 Mayo, 420 Delaware Street S.E., Minneapolis, MN 55455 (612) 373-8012
NEWS YOU CAN USE
CHANGES MADE IN UNPROEESSIONAL CONDUCT DEFINITION. As published in the Wisconsin Adminis-
trative Register, September 30, 1985, the Wisconsin Administrative Code definition of unprofessional con-
duct (Chapter Med 10) has been changed to include one new provision and expand another. Under the new
code, former 10.02(2)(o) which prohibited solicitation, now reads:
[unprofessional conduct is defined to mean and include] engaging in uninvited, in-person solicitation
of actual or potential patients who, because of their particular circumstances, are vulnerable to undue
influence; or engaging in false, misleading or deceptive advertising.
In addition, the Code includes as unprofessional conduct:
(t) Aiding or abetting the unlicensed practice of medicine or representing that unlicensed persons prac-
ticing under supervision, including unlicensed M.D.'s and D.O.'s, are licensed, by failing to identify
the individuals clearly as unlicensed physicians or delegates.
It should be remembered that this section defining unprofessional conduct is not intended to be exclusive—
the Medical Examining Board is not limited to examining only those complaints charging conduct listed in
this Code section. For the original definition of unprofessional conduct, see the June 1985 WMJ, page 92. ■
PRESIDENT REAGAN'S TAX REFORM PLAN would lower the top tax rate by broadening the tax base, reports
the September 4 AMA Newsletter. While the AMA generally supports the proposal's objectives, it ex-
pressed strong opposition to provisions that would change accounting methods for medical practices and
might lessen the value of physicians' retirement savings. The plan, which was unveiled May 28, would
eliminate numerous tax credits, deductions, and exclusions, and lower the tax rates for both individuals and
corporations. It would replace 14 current individual income tax rates— ranging from 11% to 50%— with three
rates of 15%, 25%, and 35%. Corporate rates would drop from a maximum of 46% to 33%. In a statement, the
AMA told the Senate Finance Committee and the House Ways and Means Committee that it strongly opposed
a plan to limit the use of the cash method of accounting and mandate the use of the accrual method. The As-
sociation also opposed a plan to require that accounts receivable be taxed during the same year they were
generated. The latter requirement would cause cash flow problems for many medical practices, especially
where collections are difficult. 'Treasury II,' as the President's plan is called, would impose undesirable re-
strictions on qualified retirement plans and discourage people from saving for retirement. 'We believe that
government policy should encourage retirement savings,' the Association said.B
FUTURE PARTICIPATION RATES in Medicare will depend to a large extent on federal marketing efforts for
participating physicians and the impact of the fee freeze on nonparticipating physicians, the AMA Center for
Health Policy Research said. The center reached its conclusion after a study of economic factors in physicians'
decisions last year about whether to sign up for the Medicare participating physician program. In a sample of
476 nonfederal patient care physicians, the center found that the physicians who were more likely to partici-
pate last year were those who had previously assigned a larger percentage of patients or whose usual fees
were relatively close to the Medicare prevailing fee (a high ratio). The higher the past assignment rate, the
more likely the physician was to participate. A 1% increase in past assignment rates increased the probability
of participation by a little more than one-half percent. As expected, the more the physician's usual fee was
covered by the prevailing charge, the more likely he was to participate. A 1% increase in the ratio of the Medi-
care prevailing fee to the physician's usual fee increased the probability of participating by one-tenth of one
percent. Overall, the likelihood that any physician would participate last year was a little more than one-third,
with urban and non-board-certified physicians nearly twice as likely to participate as their rural or board-certi-
fied colleagues. The more heavily urbanized northeast and north central regions of the United States had
larger participation rates than the more rural south and west. Internists, psychiatrists, anesthesiologists,
radiologists, and pathologists had the highest participation rates. Surprisingly, one-fifth of those physicians
who assigned no patients in the past decided to participate, and nearly one-fourth of those who previously had
assigned all patients decided not to participate.*
58
WISCONSIN MEDICAL JOURNAL, OCTOBER 1985:VOL. 84
EXCERPTS FROM A SYMPOSIUM
"THE TREATMENT OF SLEEP DISORDERS"^
. highly effective
for both sleep induction and
sleep maintenance ff
Sleep Laboratory Investigator
Pennsylvania
. . onset of action is
rapid. . .provides sleep with
no rebound effect to agitate the
patient the following day A A
Psychiatrist
California
1 . . appears to have
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benzodiazepines ff
of the
Psychiatrist
California
After 15 years, the experts still concur about the
continuing value of Dolmone (flurozepom HCI/
Roche). It provides sleep that satisfies patients. . .
and the wide margin of safety that satisfies you.
The recommended dose in elderly or debilitated
patients is 15 mg. Contraindicated in pregnancy
DALMANE
flurazepam HCI/Roche ®
sleep that satisfies
15-mg/30-mg
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References: 1. Kales J, etal. Clin Pharmacol Ther 12 691 -
697, Jul-Aug 1971 2. Kales A, etal: Clin Pharmacol Ther
;g 356-363, Sep 1975 3. Kales A, etal Clin Pharmacol
Ther 19 576-583, May 1976 4. Kales A, etal: Clin Pharma-
col Ther 32 T8I-788, Dec 1982 5. Frost JD Jr, DeLucchi
MR. J Am Geriatr Sac 27:5A]-546, Dec 1979 6. Dement
WC, etal: BehavMed, pp 25-31, Oct 1978 7. Kales A,
Kales JD: JCIIn Psychopharmacol 3 140-150, Apr 1983
8. Tennant FS, etal: Symposium on the Treatment of Sleep
Disorders, Teleconterence, Oct 16, 1984 9. Greenblatt DJ,
Allen MD, Shoder Rl: Clin Pharmacol Ther 21 385-361,
Mar 1977
flurazepam HCI/Roche(w
Before prescribing, please consult complete product
information, a summary of which follows;
Indications: Etfective in all types ot insomnia characterized
by difficulty in tailing asleep, frequent nocturnal awakenings
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situations requiring resttui sleep Objective sleep laboratory
data have shown effectiveness for at least 28 consecutive
nights of administrafion Since insomnia is often transient
and intermittent, prolonged administration is generally not
necessary or recommended Repeated therapy should only
be undertaken with appropriate patient evaluation
Contraindications: Known hypersensitivity to tiurazepam FICI,
pregnancy Benzodiazepines may cause tetal damage when
administered during pregnancy Several studies suggest an
increased risk ot congenital malformotions associated with
benzodiazepine use during the tirst trimester Warn patients
ot the potential risks to the tetus should the possibility of be-
coming pregnanf exisf while receiving flurazepam Instrucf
patients to discontinue drug prior to becoming pregnant Con-
sider the possibility of pregnancy prior to instituting therapy
Warnings: Caution patients about possible combined effects
with alcohol and other CNS depressants An additive effect
may occur it alcohol is consumed the day following use for
nighttime sedation This potential may exist for several days
following disconfinuation Caution against hazardous occu-
pations requiring complete mental alertness {eg . operating
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such acfivifies may occur fhe day following ingesfion Not
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Withdrawal symptoms rarely reported, abrupt discontinuation
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patients on medication for a prolonged period of time Use
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those who might increase dosage
Precautions: In elderly and debilitated patients, it is recom-
mended that the dosage be limited to 15 mg to reduce risk of
oversedation, dizziness, confusion and/or ataxia Consider
potential additive effects with other hypnotics or CNS depres-
sants Employ usual precautions in severely depressed
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cies, or in those with impaired renal or hepatic function
Adverse Reocfions: Dizziness, drowsiness, lightheadedness,
staggering, ataxia and falling have occurred, particulorly in
elderly or debilitated patients Severe sedation, lethargy dis-
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heartburn, upset stomach, nouseo, vomiting, diarrhea, con-
stipation, Gl pain, nervousness, talkativeness, apprehension,
irritability, weakness, palpitations, chest pains, body and joint
pains and GU complaints There have also been rare occur-
rences of leukopenia, granulocytopenia, sweating, flushes,
difficuify in focusing, blurred vision, burning eyes, faintness,
hypotension, shortness of breoth, prurifus, skin rash, dry
mouth, bitter taste, excessive salivation, anorexia, euphoria,
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and alkaline phosphatase, and paradoxical reactions, eg .
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Dosage: Individualize tor maximum beneficial effect Adults
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DALMANE
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Co^ytighf © 1985 by Roche Producfs Inc All righfs reserved
>*•* sOC'fl-i. V
<■ t'' V
WISCONSIN
MEDICAL JOURNAL
LIBRARY or THE
COLLEGE OF PHYSICIANS
OF philadblphiAM
0EC4-
T
SB 328 and medical malpractice
President Scott in his President's Page reiterates what Dr William
Listwan told a Senate committee at a recent hearing on SB 328:
"Skyrocketing costs of medical malpractice insurance do not represent
merely a 'pocketbook' issue for physicians. It is a matter of escalating
expenses for the consumer with the potential for creating a further crisis
in the availability and affordability of healthcare." (See page 5)
Gratifying response
Medical Editor Falk in the Editorials section expresses the views of the
medical community generally when he states: "It was a gratifying
response to the Society's Physicians Alliance when on October 9
approximately 800 physicians from all over the state attended a recep-
tion for the entire Wisconsin State Legislature . . . The legislators should
have been impressed by the sheer number of physicians present and
their unusual unity as well as their sincerity and concern relative to
the malpractice problem at the grass roots level. (See page 6)
In vitro fertilization and embryo transfer
A group of Waukesha physicians report their initial results of the in
vitro fertilization program at their hospital. In the initial series of 20
patients, a pregnancy rate of 35% per embryo transfer was achieved.
New methods are described to decrease the loss of concept! following
embryo transfer. (See page 9)
WISCONSIN
MEDICAL JOURNAL
£
CONTENTS
1
November 1985
ISSN 0043-6542 /Established 1903
Owned and published by
State Medical Society of Wisconsin
Medical Editor
Victor S Falk MD, Edgerton
Editorial Board
Victor S Falk MD, Edgerton Chairman
Melvin F Hath MD, Baraboo
M C F Lindert MD, Milwaukee
Andrew B Crummy Jr MD, Madison
Richard D Sautter MD, Marshfield
Dean M Connors MD, Madison
George VJ Kindschi MD, Monroe
Charles H Raine MD, Racine
Darrell L Witt MD, Wausau
Garrett A Cooper MD, Madison Emeritus
Editorial Director
Wayne J Boulanger MD, Milwaukee
Editorial Associates
R Buckland Thomas MD. Monroe
Russell F Lewis MD, Marshfield
Raymond A McCormick MD, Green Bay
Victor S Falk MD, Edgerton
Medical Editor
Staff
Earl R Thayer, Madison
Secretary-General Manager
State Medical Society of Wisconsin
H B Maroney II, Madison
Assistant Secretary-Corporate Counsel
State Medical Society of Wisconsin
Mrs Mary Angell, Madison
Managing Editor
Mrs Marjorie Stafford, Madison
Publications Assistant
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TIVE; State Medical Journal Advertising
Bureau, Inc, 711 South Blvd, Oak Park, 111
60302, Ph 312/383-8800,
LOCAL IWISCONSIN) ADVERTISING: Con-
tact: Mrs Mary Angell, Wisconsin Medical
Journal, Box 1109, Madison, Wis 53701. Ph
608/257-6781.
SUBSCRIPTION RATES: Members, $12.50
per year (included in dues); nonmembers,
$25.00. Single copy: current year, $2.00; pre-
vious years, $3.00. SPECIAL RATES: Foreign
and Canada. $30.00. Blue Book issue, $8.00.
Membership Directory issue, $15.00.
SECOND CLASS POSTAGE PAID at
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PUBLISHED MONTHLY. "Acceptance for
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Street. Mailing address; Box 1109, Madison,
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POSTMASTER: Send address changes to
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Madison, Wis 53701,
COPYRIGHT 1985
State Medical Society of Wisconsin
SPECIAL FEATURES
President's Page
5 SB 328 and medical
malpractice
John K Scott, MD
Madison
Editorials
6 Gratifying response
Victor S Falk, MD
Edgerton
6 It made me sick
Victor S Falk, MD
Edgerton
6 Never, never, never
Victor S Falk, MD
Edgerton
6 Noble work recognized
7 Non-nurse midwives
Victor S Falk, MD
Edgerton
Socioeconomics
42 SMS Liability Task Force
chairman testifies
42 Spotlight on SB 328: Ten
statewide press conferences
in two days
43 Medicare participating
physician program clarified
Pidilic Health
44 Traveler's Diarrhea
Miscellaneous
44 Blue Book Update
46 AMA Physician's Recogni-
tion Award Recipients
News you can use
56 Effects of an extended fee
freeze
56 CME credit deadline
approaching
56 Insurance rates higher for
some Michigan physicians
56 Quack cures
56 Volunteer relief activities
in Mexico City
56 Physician service oppor-
tunities overseas
SCIENTIFIC MEDICINE
9 In vitro fertilization and
embryo transfer
K Paul Katayama, MD, PhD;
Mark Roesler, MS; Cindy
Gunnarson, RN; Gloria M
Halverson, MD; and
Matthew A Meyer, MD,
Waukesha
1 1 Severe bullous emphysema
and contralateral broncho-
genic carcinoma . . . Suc-
cessful management with
staged bilateral
thoracotomy
Kevin T Johnson, MD and
Akira Funahashi, MD, PhD
Milwaukee
14 Abstract: Farm accidents
in children
Thomas H Cogbill, MD,
Henry M Busch Jr, MD, and
Gary R Stiers, MD
La Crosse
WISCONSIN MEDICAL JOURNAL (ISSN 0043-6542) is the official publication of the State Medical
Society of Wisconsin, devoted to the interests of the medical profession and health care in Wisconsin.
Its affairs are handled by the Editorial Board, subject to policy direction of the Society's Board of
Directors. The Managing Editor is responsible for the production, business operation, and coor-
dination of contents as well as the final responsibility of the entire publication. The Editorial Director
IS responsible for Editorials. Unsigned Editorials express views consistent with the policies of the
State Medical Society of Wisconsin. Signed Editorials express personal views of the author for which
the Society takes no responsibility. Neither the Editors nor the State Medical Society will accept
responsibility for statements made or opinions expressed in the pages of the Journal. Indexed in
("Index Medicus," "Hospital Literature Index," and "Cambridge Scientific Abstracts."
Vol. 84 No. 11
CONTENTS
14 Abstract: The incidence of
rebleeding in traumatic
hyphema
George J Witteman, MD,
Stephen J Brubaker, MD,
Max Johnson, MD, and
Ronald Marks, PhD
Wausau, La Crosse, and
Marshfield, Wisconsin and
University of Florida
15 Malignant posttraumatic
hypermetabolic syndrome
associated with brain injury
Philip J Dahlberg, MD;
Thomas H Cogbill, MD;
Byron L Annis, MD; and
William M Deering, MD
La Crosse
ORGANIZATIONAL
21 Reception brings 800
physicians and 100 legisla-
tors together
21 SMS Annual Meeting plans
underway
21 New Communications
Coordinator named
22 1984 Membership Survey:
Members want greater
emphasis on public image
of profession
24 Membership encouraged
for residents and students
24 Dues payment options
available
25 Reduced Practice or
Retired membership
classifications
25 Spouse physicians take
note
25 Wisconsin Association of
Senior Physicians met
November 9
26 Membership facts
30 Membership Directory-
Update
46 CES Foundation: Contri-
butions during September
1985
DEPARTMENTS
45 Physician Briefs
49 Specialty Societies:
American Congress of
Rehabilitation Medicine,
American College of
Radiology, American Col-
lege of Physicians, Wiscon-
sin Society of Internal
Medicine, Council of the
American College of Sur-
geons-Wisconsin Chapter,
American College of Physi-
cians, and Milwaukee
Ophthalmological Society
50 County Societies: Adams-
Marquette-Columbia . . .
Brown . . . Rusk . . .
Winnebago
51 Medical Yellow Pages:
Physicians exchange . . .
Medical facilities . . . Mis-
cellaneous . . . Medical
meetings/ Continuing
Medical Education . . .
Books received . . . Adver-
tisersH
THE state medical SOCIETY OF WISCONSIN, created by the Territorial Legislature in 1841,
represents over 6200 member physicians in Wisconsin, comprising 55 county medical societies
and 26 medical specialty sections. The purpose of the Society is to "bring together the physicians
of the State of Wisconsin to advance the science and art of medicine and the better health of the
people of Wisconsin, and to secure the enactment and enforcement of just medical laws, " The
major activities of the Society include continuing medical education, peer review, legislation,
community health education, scientific affairs, socioeconomics, health planning, services for
physicians, operation of a Charitable, Educational and Scientific Foundation, and publication of
the Wisconsin Medical Journal.
STATE MEDICAL
SOCIETY
OF WISCONSIN
Officers
PREStDENT: John K Scott. MD, Madison
President-Elect: Charles W Landis,
MD, Milwaukee
Secretary-General Manager:
Earl R Thayer. Madison
Treasurer: John J Foley, MD
Menomonee Falls
Board of Directors
CHAtRMAN: Darold A Treffert, MD
Fond du Lac
Vice Chairman: Roger L
von Heimburg, MD, Green Bay
First District
Jerome W Fans Jr, MD, Cudahy
Carl S Eisenberg, MD, Milwaukee
Thomas A Hofbauer, MD.
Menomonee Falls
Wayne H Konetzki. MD, Waukesha
Fredrick Wood Jr, MD, Kenosha
William L Treacy. MD, Milwaukee
Richard D Fritz, MD, Milwaukee
William J Listwan, MD, West Bend
Glenn H Franke, MD, Milwaukee
Lucille B Glicklich, MD, Milwaukee
Second District
J D Kabler, MD, Madison
Cyril M Hetsko, MD. Madison
James J Tydrich, MD, Richland Center
Alwin E Schultz, MD. Madison
Kenneth I Gold, MD, Beloit
Third District
Pauline M Jackson, MD, La Crosse
Fourth District
John J Kief, MD, Rhinelander
Jung K Park. MD, Wisconsin Rapids
IV George Locher, MD. Wausau
Fifth District
Darold A Treffert. MD, Fond du Lac
Kenneth M Viste Jr, MD. Oshkosh
C William Freeby, MD. Appleton
Sixth District
Roger L von Heimburg, MD, Green Bay
Joseph C DiRaimondo. MD, Manitowoc
Seventh District
Marwood E Wegner, MD, St Croix Falls
Philip J Happe, MD. Eau Claire
Eighth District
Joseph M Jauquet, MD. Ashland
President: Doctor Scott
President-Elect: Doctor Landis
I. Past President: Timothy T Flaherty,
I AID, Neenah
Speaker: Duane W Taebel, MD.
La Crosse
Vice Speaker: Vernon M Griffin, MD,
Mansion
A /
American Physicians Life's comprehensive and competi-
tively priced line of insurance products is now being
offered exclusively through SMS Services Inc., to State
Medical Society members.
APL is a majority-owned subsidiary of Physicians
Insurance Company of Ohio (PICO) and a sister com-
pany of The Professionals Insurance Company, the
carrier of the SMS-endorsed Professional Liability
Insurance Plan.
APL coverages available to you through SMS Services
Inc., and its authorized insurance representatives
include:
• Innovative Universal Life coverages
• Low Cost Graded Premium Whole Life plan
• Yearly Renewable and Convertible Term Life protection
• Non-cancellable Disability Income programs
• Single and Flexible Premium Annuities
• Comprehensive Office Overhead Expense protection
Why not contact SMS Services Inc., today to find out
how American Physicians Life can solve all your life
insurance needs.
CONTACT:
SMS SERVICES INC.
330 EAST LAKESIDE STREET
P.O. BOX 1109
MADISON, WISCONSIN 53701
(608) 257-6781 OR TOLL FREE
1-800-362-9080
PRESIDENT'S PAGE
SB 328 and medical malpractice
Skyrocketing costs of medical malpractice insurance do not represent merely a
"pocketbook" issue for physicians.
It is a matter of escalating expenses for the consumer with the potential for creating
a further crisis in the availability and affordability of healthcare.
This was the gist of a statement by William Listwan, MD, West Bend, in testimony
before the State Senate Committee on Labor, Business, Veterans Affairs and In-
surance. Doctor Listwan spoke for the Society's Liability Task Force in support of
proposed Senate Bill 328 which addresses several aspects of the medical malpractice
issue including placing a cap on malpractice awards. SB 328 also:
—imposes toughter sanctions on doctors:
—strengthens the peer review system for physicians;
—imposes tougher sanctions on doctors;
—strengthens the peer review system for
physicians;
—requires itemized damages in verdicts in
malpractice cases; and
—provides a clear and complete definition of
medical expenses.
SB 328 proposes a $3.3 million cap on all mal-
practice awards. The State Medical Society's propos-
ed amendment seeks a $1 million cap on "non-
medical" components of those awards but allows for
unlimited payment of medical expenses incurred by
patients who succeed in proving claims against
physicians.
"Nonmedical" expenses are typically understood to
include such components as: pain and suffering; loss
of society and companionship; and future earnings.
The purpose of the proposed $ 1 million award limit
on nonmedical payments is to begin to find a means
to hold the line on medical malpractice insurance pre-
mium costs which increased nearly 100 percent in 1985
alone. By imposing no limits on medical expense pay-
ments, the proposal ensures patients will receive due
compensation for all injuries.
The Physicians Alliance Commission and the Lia-
bility Task Force of the State Medical Society have
been very active in dialogue on SB 328. The diagram
at the right shows the anticipated route of SB 328
through the Legislature and to the Governor's desk to
be signed into law in an acceptable form. "The mills of
justice grind slowly, but they grind exceedingly fine."
Tremendous expenditures of time and effort on
behalf of the State Medical Society members and Aux-
iliary are necessary to bring SB 328 through the
legislative process. You know your immediate task:
to contact your State Senator and State Representative
to explain why they should support the Society's posi-
tion on medical liability. Let's all pull together now,
and in the future, as calls come from our Society. ■
John K Scott, MD
SENATE BILL 328: Developed by Legislative Council Special
Committee on Medical Malpractice — August 1984-May 1985.
(Chairman: Senator Jerome Van Sistine)
Reported to: Legislative Council — voted to introduce SB 328
in June 1985.
Referred to: Senate Committee on Labor, Business, Veterans
Affairs and Insurance (Chairman; Senator Jerome Van Sistine)—
public hearing held Oct 2, 1985
October 18, 1985: Floor period ended.
—Additional public hearing may be held.
—Committee meets in executive session to vote on recom-
mending passage of bill; may consider and recommend
amendments.
Referred to: Joint Committee on Finance (Cochairs; Senator
Gary George and Representative Marlin Schneider)
—Committee meets in executive session to vote on recommend-
ing passage of bill; may recommend amendments.
Referred to: Senate Organization Committee (Five mem-
bers, Democratic and Republican leadership)
—Committee schedules bill for floor action in Senate.
January 28, 1986: Floor period begins.
Full Senate action: If Senate adopts SB 328, with or without
amendments, the bill as passed by the Senate is sent to the
Assembly.
Referred to: Assembly Committee on Financial Institutions
and Insurance (Chair: Representative Tom Hauke)
—Committee may hold public hearings
—Committee takes executive action on the bill, if the chairman
schedules the bill for executive session.
—Committee recommends passage of bill and amendments.
Referred to: Assembly Rules Committee
—Committee schedules bill for floor action in Assembly.
Full Assembly Action: Reconciliation of Assembly and
Senate versions
—If different, either house may concur in the other house's
changes: or, the bill may be sent to a conference committee.
Governor signs bill into law
March 26, 1986: 1985 Legislature adjourns.
January 1987: 1987 Legislature convenes.
EDITORIALS
V
Wayne J Boulanger, MD, Editorial Director
Unsigned editorials express views consistent with the policies of the State Medical Society of Wisconsin.
Signed editorials express personal views of the author for which the Society takes no responsibility.
Gratifying response
It was a gratifying response to the
Society's Physicians Alliance
when on October 9 approximately
800 Wisconsin physicians from all
over the state attended a reception
for the entire Wisconsin State
Legislature. This was an oppor-
tunity to informally meet with the
state legislators in regard to the
malpractice situation.
One physician who was present
indicated that he had opted for
early retirement when he re-
ceived his bill for $24,000 for cov-
erage as a general surgeon. An-
other pessimistic physician who
did not attend stated that he did
not anticipate any progress "until
the whole system collapsed."
The legislators should have
been impressed by the sheer num-
ber of physicians present and their
unusual unity as well as their
sincerity and concern relative to
the malpractice problem at the
grass roots level.
— Victor S Falk, MD, Edgerton
It made me sick
Recently I talked with a 15-year-
old high school freshman. He had
been dropped from the football
squad just the day before for drug
abuse and had sought help of his
own volition.
He stated that he had begun
using marijuana while in second
grade. I questioned him about the
source and he said it was readily
available from older people
around the schoolyard. This really
sickened me.
He said he financed the pur-
chase of marijuana by taking
money from his mother's purse
and she never noticed the missing
money. He also started drinking
beer on weekends to the point of
intoxication beginning in 7th
grade. Initially he would have an
older person procure the beer for
him. Since he was now 15, he
could buy it over the counter him-
self. In addition he smokes a pack
of cigarettes daily.
The whole story is distressing,
but the availability of drugs to
children in the lower grades
seems particularly disgraceful.
This pleasant, outgoing young
man's parents had no idea that he
was involved with either mari-
juana or beer until he turned him-
self in. I'm sure there must be
someone observant enough
around the grade school environ-
ment to detect the low form of
animal life that pushes drugs onto
children.
— Victor S Falk, MD, Edgerton
Never, never, never
Supreme Court Chief Justice
Burger periodically comes down
rather hard on the legal profes-
sion. He particularly dislikes
lawyer advertising and calls it
"sheer shysterism."
He is quoted as saying "I will
say never— my advice to the
public is— never, never, never
under any circumstances engage
the services of a lawyer who
advertises." The Chief Justice
would certainly take a dim view
of the morning and evening TV
lawyers' commercials here in
Wisconsin.
But what would he think of
advertising physicians? Con-
fronted with full-page newspaper
ads, billboards, and radio and TV
spots all touting competing HMO
plans, he might have trouble find-
ing medical care in Wisconsin that
has not been commercialized by
some form of advertising.
— Victor S Falk, MD, Edgerton
Noble work
recognized
Since the Nobel Prize for peace
was established in 1901, it has
been awarded only six times to or-
ganizations. This past month the
prize went to the International
Physicians for the Prevention of
Nuclear War.
With it came well deserved rec-
ognition of those physicians of the
world who by their unique and
persistent concern for humanity
have made seminal contributions
to the world's understanding and
perception of the life and health
consequences of nuclear explo-
sion. Many, even among the med-
ical profession, realize that the
prime activist group within the
IPPNW is the organization known
as the Physicians for Social Re-
sponsibility (PSR).
In Wisconsin this group num-
bers several hundreds of mem-
bers. In 1982 they carried their
concerns to the State Medical
Society's House of Delegates and
won an official commitment by
the Society to educate physicians
and the public to the public health
consequences of nuclear explo-
sion. There is now an ongoing
committee of the Society dedi-
cated to this task. It has sponsored
lectures and seminars. It helped
bring a delegation of Society phy-
sicians to Wisconsin to dialogue
with government officials, physi-
cians, and others. The Society
hosted an overflow crowd for din-
ner and talks with their Russian
counterparts.
It is more than interesting to
note that the State Medical Society
of Wisconsin is alone among the
hundreds of county, state, and na-
tional medical groups comprising
so-called "organized medicine" to
join this unusual and highly suc-
cessful peace movement. Equally
VVl.SCONSIN MKDIC/U. JOl RN.AI,, NO\’E.\lBER 198.5 :\ OI.. 89
NOBLE WORK RECOGNIZED
EDITOKIAl.S
notable is the fact that the Soci-
ety's current President John K
Scott, MD, Madison, was the van-
guard for the Society's involve-
ment. At the time he took on this
task of leadership there were hints
of suspicion a la Joe McCarthy.
Support came reluctantly. But
persistence and dedication paid
off. It is a cause which humanity
must not deny.
Thank you, Doctor Scott, for
your insight and courage. Similar
appreciation goes to your col-
leagues in the PSR, whether SMS
member or no. Perhaps now your
efforts will speak with a louder
voice to be heard and listened to
by an ever widening audience.
Non-nurse
midwives
Many specialists in the field of
obstetrics and gynecology have
recently limited their practices to
gynecology alone and have dis-
continued obstetrics. The obvious
reason for this is the high cost of
premiums for obstetrical coverage
for so-called malpractice. In the
Miami, Florida area for example,
the annual premium for obstetri-
cians is $123,000. It is under-
standable why this would prove
overwhelming for many obstetri-
cians.
Now a bill has been proposed in
the Wisconsin Senate to license
non-physician, non-nurse mid-
wives. The low level criteria for
licensure include only high school
graduation or equivalent, being
age 18 or over, completing a
course of study and passing an
examination established by the
Department of Regulation and
Licensing. There are also some
very limited requirements for
physician backup or supervision.
There is a strong lobbying cam-
paign in support of the bill that
stresses the concept of women's
right to choose their method of
delivery.
On the basis of previous experi-
ence with unlicensed midwives il-
legally functioning within a few
miles of our state capital, there
will inevitably be some outcomes
affecting both the mother and the
infant that are less than desirable.
The past experience has been that
these previously unlicensed mid-
wives resented and resisted medi-
cal help even in emergencies.
One wonders what sort of mal-
practice insurance coverage these
lay midwives would have if the
proposed bill would unfortunately
pass the Senate. Perhaps the
women seeking this type of care
might be more sympathetic to lay
midwives than to "wealthy doc-
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Victor S Falk, MD, Medical Editor
SCIENTIFIC MEDICINE
In vitro fertilization and embryo transfer
K Paul Katayama, MD, PhD; Mark Roesler, MS; Cindy Gunnarson, RN; Gloria M Plalverson, MD;
and Matthew A Meyer, MD, Waukesha, Wisconsin
ABSTRACT. Initial results of the in
vitro fertilization program at Wau-
kesha Memorial Hospital are pre-
sented. In the initial series of 20 pa-
tients, a pregnancy rate of 35% per
embryo transfer was achieved. New
methods are described to decrease
the loss of concepti following embryo
transfer.
Key words: In vitro fertilization; Embryo
transfer; Ritodrine
Since the first in vitro child
was born in England in 1978, in
vitro fertilization (IVF) programs
have been initiated in many in-
stitutions throughout the world.
The first program in America was
started in Norfolk, Virginia in
1980.
In 1984 the first IVF program in
Southeastern Wisconsin was
established at Waukesha Memor-
ial Hospital. We report here on the
initial results of this program.
Indication for IVF. The incidence
of infertility has increased in re-
cent years. As a result of this and
of the lack of availability of infants
for adoption, there is an increased
need for infertility therapy. In
some instances IVF is the only
therapy which can be offered to
an infertile couple. At this hospital
we have been able to help a num-
ber of these couples.
The indications for IVF at lead-
ing institutions around the world^
From Waukesha Memorial Hospital,
Waukesha. Reprint requests to: K Paul
Katayama, MD, Waukesha Memorial
Hospital, 725 American Ave, Waukesha,
Wis 53188 (ph 414/ 544-2722). Copyright
1 985 by the State Medical Society of Wis-
consin.
and in our program include:
1. absent or irreparably dam-
aged fallopian tubes;
2. oligoasthenospermia;
3. endometriosis refractory to
conventional therapy; and
4. idiopathic infertility of long
duration.
Materials and methods. Patients
for the IVF program were se-
lected, following a comprehensive
infertility workup, on the basis of
the above indications, and after
review by the IVF Committee,
which consists of obstetrician-
gynecologists and is directed by a
Board-certified reproductive
endocrinologist. Twenty patients
have been accepted for the IVF
program.
Each patient received two to
three ampules of human post-
menopausal gonadotropins (Per-
gonal® ) intramuscularly starting
on the third day of the menstrual
cycle. Patients were monitored by
hormonal assays, ultrasound ex-
aminations of follicular develop-
ment, and examination of uterine
cervical mucous changes in re-
sponse to rising estrogen. After
proper follicular stimulation was
accomplished using Pergonal® ,
each patient received 10,000 lU of
human chorionic gonadotropin
(hCG) intramuscularly. Thirty-six
hours later, oocyte retrieval was
accomplished by laparoscopic
procedure.
The oocytes were placed in cul-
ture media consisting of Ham's
F-10 supplemented by human
serum. Sperm obtained from the
patient's husband were capaci-
tated by a washing process which
involved suspension in Ham's
F-10 solution and repeated centri-
fugation. Insemination was car-
ried out four to eight hours after
egg retrieval. Two days later all of
the concepti were transferred by
a thin transfer catheter through
the cervix to the patient's uterus.
The patients were divided into
two series. Patients in Series I re-
ceived no premedication prior to
transfer and were discharged four
hours after transfer. In Series II,
patients received 10 mg of rito-
drine orally, and 50 mg of meperi-
dine and 10 mg of diazepam, intra-
muscularly, one hour prior to
transfer. Patients in the second
series were kept in bed for 24
hours following transfer and were
instructed to remain in bed for
four days following discharge.
Results. Series I. Egg retrieval was
successful in six out of seven pa-
tients in this series. One to four
Table 1 —Results of the IVF Program at Waukesha Memorial Hospital
Pregnancy
rate (%j
Number of (pregnancy
Number of embryo Number of per embryo
patients transfers pregnancies transfer!
Series I
7
6
0
0
Series II
13
11
6
54
TOTAL
20
17
6
35
WISCONSIN MKOICAI |Ol KNAI., NOVKMBKR l983:\OI . 84
9
SCIENTIFIC MEDICINE
IN VITRO FERTILIZATION-Katayama et al
fertilized and cleaved eggs were
transferred in each of these six pa-
tients. There were no pregnancies
in this group (Table 1).
Series II. In Series II, there were
13 patients. Egg retrieval was suc-
cessful in 1 1 of these patients. One
to four concepti were transferred
in each of these 1 1 patients. In this
group of 11, there were two bio-
chemical pregnancies and four
clinical pregnancies which are on-
going (Table 1).
Case history. A 28-year-old mar-
ried, white female, para 0, was re-
ferred for her primary infertility of
four years' duration. She con-
sented to this publication of her
case history. Complete evaluation
of infertility disclosed obstruction
of fallopian tubes. In April 1984
the patient had undergone an ex-
ploratory laparotomy which dis-
closed large hydrosalpinx on the
left and torsion of the right hydro-
salpinx. Restoration of functional
fallopian tubes was thought to be
impossible, and bilateral sal-
pingectomy was carried out. The
ovaries were suspended to the
sides of the uterus by the referring
physician to facilitate future in
vitro fertilization attempts.
Table 2— Pregnancy rate per embryo
transfer
IVF Center Percentage
Sendai, Japan^
10
Uppsala, Sweden^
11
Vienna, Austria'*
17
Melbourne, Australia
(Trouson, et al)^
19
Los Angeles, California, USA
(Marrs, et all**
19
Melbourne, Australia
(Lopata)^
20
New Haven, Connecticut,
USAS
20
Clamart, France’
21
Adelaide, Australia*’
21
Houston, Texas, USA“
21
Norfolk, Virginia, USA*s
26
Bourn Hall, UK*s
29
Waukesha, Wisconsin, USA
(Series II)
54
On the third day of her men-
strual cycle in January 1985, the
patient received two ampules of
Pergonal® intramuscularly. By
the 13th day of her menstrual cy-
cle, follicular size had reached
15 mm in diameter. Her estradiol
value was 928 pg/ml. At that time
she was given 10,000 units of hu-
man chorionic gonadotropin
(hCG) intramuscularly. Thirty-six
hours later laparoscopy was car-
ried out under general anesthesia
and three eggs were retrieved.
Two eggs were fertilized and
cleaved. Two days later embryo
transfer was carried out. Singleton
pregnancy has been established,
and the patient is due in October
1985.
Discussion. In well-established
clinics around the world fertiliza-
tion and embryo transfer occur in
about 80% of patients subjected to
laparoscopy. Our results are con-
sistent with those figures.
However, all published results
reflect a significant loss of con-
cepti following embryo transfer.
Currently the rate of pregnancy as
a percentage of transfers at major
IVF centers ranges from 10% to
29% (Table 2).2
In our second series we utilized
new and hitherto unreported ap-
proaches in an effort to decrease
the loss of concepti following
transfer. To minimize the uterine
contractions, which are con-
stantly occurring in females of re-
productive age, we administered
a B2 receptor agonist, ritodrine, to
impede the biochemical processes
contributing to uterine contrac-
tions.
Since implantation of a fertilized
egg does not occur in the human
female until seven days following
conception, we modified our pro-
tocol so as to keep patients as
much as possible at rest during the
pre-nidation period. Patients were
kept in the hospital for 24 hours
following transfer and instructed
to get as much bed rest as possible
following discharge. They were
also instructed to remain as much
as possible in a position whereby
gravity might assist the uterus in
retaining the concepti. In other
words, patients whose uteri were
anteverted were instructed to re-
main on their abdomens. Patients
whose uteri were retroverted
were instructed to rest in a dorsal
position.
The pregnancy rate as a per-
centage of transfers in our second
series compares very well with
that of programs worldwide
(Table 2). Since our second series
is small, the pregnancy rate may
change as the series grows. Never-
theless, we believe that the meth-
odologies described here may play
some part in the achievement of
that pregnancy rate.
Addendum. On September 22,
1985 the patient referred to in the
text delivered a normal male in-
fant.
Acknowledgment We gratefully ac-
knowledge the support of Donald Fund-
ingsland, Edward Olson, Anne M Riendl,
MD, Jill Krueger, Shari Croegaert, Mary
Anne Meyers, RN, Elaine Pfeifer, RN,
Mary Anne Earner, RN, Linda Oddan, and
the anesthesiologists of Waukesha Me-
morial Hospital; and a special thank you
to Dr Harold I Borkowf and other refer-
ring physicians.
REFERENCES
1. Mahadevan MM, Trounson AO, LeetonJF:
The relationship of tubal blockage, infer-
tility of unknown cause, suspected male in-
fertility and endometriosis to success of in
vitro fertilization and embryo transfer. Fer-
til Steril 1983; 40:755-762.
2. Suzuki M, Hoshiai H, Hoshi K, et al: In vitro
fertilization and embryo transfer at Tohoku
University, Sendai, japan./ In Vitro Fertil &
Embryo Transfer 1984 (March); 1:82.
3. Sundstrom P, Wramsby H, Leidholm P, et
al: Some clinical results of in vitro fertiliza-
tion by the Malmo Group, Sweden. / In
Vitro Fertil & Embryo Transfer 1984 (March);
1:48-50.
4. Feichtinger W, Kemeter P: Organization
and computerized analysis of in vitro fertili-
zation and embryo transfer programs. / In
Vitro Fertil & Embryo Transfer 1984 (March);
1:34-41.
5. Trounson A, Wood C: In vitro fertilization
results, 1979-1982, at Monash University,
Queen Victoria, and Epworth Medical Cen-
tres./ In Vitro Fertil & Embryo Transfer 1984
(March): 1:42-47.
6. Marrs RP, Vargyas JM, Gibbons WE, et al:
A modified technique of human in vitro fer-
tilization and embryo transfer. Am J Obstet
Gynecol 1983; 147; 3:318-322.
It)
WISCONSIN MEDICAL JOCRNAI , NOVEMBER 1985: VOL. 84
IN VITRO FERTILIZATION-Katayama et al
SCIENTIFIC MEDICINE
7. Lopata A: Concepts in human in vitro fertili-
zation and embryo transfer. FertilSleril 1983
(Septl: 40;289-301.
8. Laufer N, Decherney AH, Haseltine F, et al:
Human in vitro fertilization employing in-
dividualized ovulation induction by human
menopausal gonadotropins./ /n Vitro Fertil
& Embryo Transfer 1984 (March); 1:56-62.
9. Belaisch-Allart JC, Frydman R, Testart J. et
al: In vitro fertilization and embryo transfer
program in Clamart, France./ In Vitro Fer-
til & Embryo Transfer 1984 (March); 1:51-55.
10. Kerin JF, Warnes GM, Quinn P, et al: In
vitro fertilization and embryo transfer pro-
gram, Department of Obstetrics and Gyne-
cology, University of Adelaide at The
Queen Elizabeth Hospital, Woodville, South
Australia./ In Vitro Fertil & Embryo Transfer
1984 (March): 1:63-71.
1 1 . Quigley MM, Wolf DP: Human in vitro fer-
tilization and embryo transfer at the Univer-
sity of Texas, Houston,/ In Vitro Fertil & Em-
bryo Transfer 1984 (March); 1:29-33.
12. Garcia J, Acosta A, Andrews MC, et al: In
vitro fertilization in Norfolk, Virginia,
1980-1983./ /n Vitro Fertil & Embryo Trans-
fer 1984 (March): 1:24-28.
13. Edwards RG, Fishel SB, Cohen J, et al: Fac-
tors influencing the success of in vitro fer-
tilization for alleviating human infertility./
In Vitro Fertil & Embryo Transfer 1984
(March): 1:3-23. ■
Severe bullous emphysema and contralateral
bronchogenic carcinoma . . . Successful management
with staged bilateral thoracotomy
Kevin T Johnson, MD and Akira Funahashi, MD, PhD, Milwaukee, Wisconsin
ABSTRACT. There is an increased
incidence of bronchogenic car-
cinoma among the patients who
have pulmonary bullous disease. A
case is presented in which a large
bullous lesion and a bronchogenic
carcinoma occurred simultaneously
in the opposite lungs. The patient
was successfully treated by bilateral
thoracotomy.
Key words: Bronchogenic carcinoma;
Pulmonary bullous disease; Emphysema
Large pulmonary bullae
usually occur in association with
chronic obstructive lung disease
and a bullectomy is an accepted
method of treatment for selected
cases. Patients who have pulmon-
ary bullous disease also appear to
have an increased incidence of
bronchogenic carcinoma. In
these patients resectional surgery
for bronchogenic carcinoma is
From the Department of Medicine, Vet-
erans Administration Medical Center,
Milwaukee (Wood), and the Medical Col-
lege of Wisconsin, Milwaukee. Doctor
Johnson is a Fellow in pulmonary dis-
eases: Doctor Funahashi is a Professor of
Medicine. Publication support provided.
Reprint requests to: A Funahashi. MD,
1 1 IE, VA Medical Center, 5000 West Na-
tional Ave, Milwaukee, Wis 53193 (ph
414/384-2000). Copyright 1985 by the
State Medical Society of Wisconsin.
often difficult because of the
limited pulmonary reserve. When
a carcinoma is contiguous to an
area of bullous disease, a resection
of the tumor together with bullous
tissue may be performed; and this
has been described previously. ^ ^
We report a case with a large bul-
lous lesion associated with a bron-
chogenic carcinoma in the contra-
lateral lung. The patient was
successfully treated by a bullec-
tomy followed by resection of the
carcinoma. To our knowledge this
is the first case in which a giant
bulla and bronchogenic car-
cinoma occurred simultaneously
in opposite lungs and were treated
by bilateral thoracotomy.
Case report. A 51-year-old male
presented to the Veterans Admin-
istration Medical Center in Mil-
waukee, Wisconsin on Nov 22,
1980 with a one-year history of
progressive dyspnea, a four-
month history of a cough produc-
tive of blood-tinged sputum, a
25-pound weight loss, and an in-
termittent achy left-sided chest
pain. His medical history was re-
markable for alcohol abuse and
chronic obstructive pulmonary
disease (COPD). He had smoked
one to two packages of cigarettes
daily for 35 years. History was re-
markable for significant occupa-
tional asbestos exposure from
1966 to 1980. Physical examina-
tion was remarkable for finger
clubbing, localized wheezing in
the left lower posterior thorax,
and decreased breath sounds with
hyperresonance to percussion in
the upper two-thirds of the right
hemithorax. Admission labora-
tory examination was normal ex-
cept for minimal elevation of
alkaline phosphatase and gamma-
glutamyl transpeptidase. Repeat
liver function studies and liver-
spleen scan one week later were
normal. The admission chest ro-
entgenogram (Fig 1-A) revealed a
large bullous lesion occupying
80% of the right hemithorax with
compression of the residual right
lung and a left-sided retrocardiac
density. Tomograms of the left hi-
lum confirmed the presence of a
left retrocardiac mass. Cytologic
examination of expectorated spu-
tum was negative for malignant
cells.
Flexible fiberoptic bronchos-
copy demonstrated a vascular,
polypoid mass occluding the su-
perior segment bronchus of the
left lower lobe, and a biopsy re-
vealed squamous cell carcinoma.
Pulmonary function studies dem-
onstrated moderate obstructive
1 1
\VISC ().\Sr\ MKDICAI.JOl KNAI , NOVEMBER 1985 :VOE. 84
SCIEXTIFIC MEDICINE
SEVERE BULLOUS EMPHYSEMA-Johnson & Funahashi
Figure 1 [A)— Admission posteroanterior chest roentgenogram Figure 1 [B)—Posteroanterior chest roentgenogram after right up-
demonstrating a large bullous lesion occupying 80 percent of the per bullectomy demonstrating significant reexpansion of the right
right hemithorax with compression of the residual right lung and lung,
a left-sided retrocardiac density.
Figure 2 [A]— Preoperative pulmonary perfusion scan with tech- Figure 2 [B]— Perfusion scan after right upper lobe bullectomy.
netium^^ macroaggravated albumin.
12
WISCONSIN' MEDICAL JOCRNAI., NO\ E,MBER 1983 :\ OL. 84
SEVERE BULLOUS EMPHYSEMA-Johnson & Funahashi
SCIENTIFIC MEUICINE
ventilatory impairment with a
forced vital capacity (FVC) of
2.91 L (71%) and a forced ex-
piratory volume at 1 second
(FEVi) of 1.79 L (58%). Pulmonary
perfusion scan with 4 mCi techne-
tium®® macroaggregated albumin
(Fig 2-A) demonstrated marked
decrease in perfusion of the right
lung field, except for the base, and
a perfusion defect in the left mid-
lung zone. Pulmonary ventilation
scan with inhalation of 16 mCi ze-
noni3^ radioactive gas revealed de-
creased ventilation of the right
lower lung field with air trapping
in the entire right lung in the
washout phase and a delayed ven-
tilation in the left middle lung
zone. These studies indicated a
limited contribution of the right
lung to his overall pulmonary
function and that the patient
would not be able to tolerate a left
lower lobectomy without im-
provement of the right lung
function.
On Dec 11, 1980, the patient
underwent a right thoracotomy.
The right lung bulla was stapled
and excised. The residual two-
thirds of the right upper lobe ap-
peared normal and remained in-
tact. The patient experienced
dramatic symptomatic relief post-
operatively, and the postoperative
course was uneventful. Postbul-
lectomy chest roentgenogram
(Fig TB) revealed significant reex-
pansion of the right lung. Repeat
pulmonary function studies dem-
onstrated significant improvement
of the FEVi, which had increased
from 1.79 to 2.46 liters. Ventila-
tion and perfusion scans after the
bullectomy also showed a consid-
erable improvement in the right
lung function. (Fig 2-B).
On Dec 30, 1980 a left lower lo-
bectomy was performed. The re-
sected bronchial margin was free
of tumor, but two of seven lobar
lymph nodes demonstrated me-
tastases. The patient subsequently
received radiation therapy to the
mediastinum with 5,760 rads. Pul-
monary function studies obtained
on May 10, 1983 showed a mod-
erate reduction in FVC (2.60 L)
and FEVi (1.86 L), which was pri-
marily attributable to the lobec-
tomy. He died in Eebruary 1984
from acute liver failure at another
hospital. An autopsy revealed no
residual or metastatic carcinoma
despite lobar lymph node metas-
tases at the time of lobectomy.
Discussion. In spite of recent ad-
vancement of radiation treatment
and chemotherapy, surgical re-
section still offers the greatest po-
tential cure for primary nonsmall
cell bronchogenic carcinoma. Un-
fortunately a significant propor-
tion of patients is denied surgical
resection at the time of diagnosis,
because of poor pulmonary re-
serve. An obstructive impairment
secondary to chronic obstructive
airways disease is the most com-
mon cause of poor pulmonary re-
serve. In patients with pulmonary
emphysema, the airway obstruc-
tion is usually irreversible. Occa-
sionally, however, in selected pa-
tients with airway obstruction
improvement in pulmonary func-
tion may result from surgical
treatment. Surgical correction of
tracheal strictures with upper air-
way obstruction is a well-estab-
lished procedure. A severe airway
obstruction due to compression of
the left mainstem bronchus by an
aneurysm also has been reported.'*
In this case a surgical resection of
the aneurysm resulted in a dra-
matic clinical and functional im-
provement. Surgical removal of a
giant pulmonary bulla, with com-
pression of functional remaining
lung tissue, also may result in sig-
nificant improvement in pulmo-
nary function. Selection of the
cases, however, is not an easy task
due to difficulty of assessing the
degree of underlying generalized
pulmonary emphysema. Many
guidelines have been proposed for
this purpose.^®
The apparent association of bul-
lous emphysema and broncho-
genic carcinoma has been de-
scribed previously.' ^ Stoloff et al
reported an incidence rate of lung
carcinoma in men with bullous
emphysema to be 6.1% compared
to a 1.9% without bullous emphy-
sema.^ Goldstein et al found 16
cases, or a 3.9% incidence, of
"giant bullous disease" in a total
of 41 1 patients with bronchogenic
carcinoma, while control groups
showed an incidence of 1.7%.' As
to the relationship of tumor and
bullous lesion, there are conflict-
ing reports. Stoloff found that in 6
(23%) of his 26 cases the tumor
arose from within the bulla, while
in 20 (77%), there was no special
relationship to the bulla. Gold-
stein, however, found that in 15
out of 18, or 83.3%, of his cases
the carcinoma was contiguous to
an area of bullous disease.
Surgical resection of broncho-
genic carcinoma in patients with
bullous disease is difficult because
of generally poor pulmonary func-
tion. In Goldstein's series there
were 18 patients who had both
bullous disease and bronchogenic
carcinoma.' Only seven of those
18 cases had thoracotomies. Of
the seven patients who under-
went thoracotomies only two had
resectional surgery. One died of
metastasis and the other was lost
to followup. Aronberg et aF
reported three patients, under the
age of 40, who had both bullous
disease and bronchogenic car-
cinoma. Two patients had resec-
tional surgery. In one of Gold-
stein's cases and two of
Aronberg's cases the carcinoma
was in the side where bullous
changes were present. In Gold-
stein's other case the bullous
change was described as
"throughout" in both lungs. This
patient had a right upper lobec-
tomy. In the present case the
squamous cell carcinoma devel-
oped in the opposite lung necessi-
tating a bilateral thoracotomy.
In the present case a large bul-
lous lesion was thought to be the
WISCONSIN MKDICAI jOCKNAI,, NO\ LMBFR 19«5;\ OI . «4
13
SCIENTIFIC MEDICINE
SEVERE BULLOUS EMPHYSEMA— Johnson & Funahashi
major reason of his pulmonary
dysfunction. A bullectomy in the
right side with significant im-
provement of pulmonary function
allowed the patient to have left
lower lobectomy for curative re-
section of the carcinoma. His car-
cinoma was cured in spite of me-
tastasis to lymph nodes at the time
of surgery, and there was no
residual tumor at autopsy when
the patient died from acute liver
failure over three years after
thoracotomy.
Although bullous change itself
has been postulated as a cause of
carcinoma in cases where car-
cinoma occurred in contiguous
area of bullous disease, cigarette
smoking and an asbestos dust ex-
posure in our patient probably
played a major role in the develop-
ment of his carcinoma. This case
illustrates the importance of rec-
ognizing a potentially correctable
cause of pulmonary dysfunction
before denying a patient for cura-
tive surgery for bronchogenic
carcinoma.
REFERENCES
1 . Goldstein MJ, Snider GL, el al: Bronchogenic
carcinoma and giant bullous disease. Am Rev
RespDis 1968: 97:1062-1070,
2. Stoloff IL, Kanofsky P, Magilner L: The risk
of lung cancer in males with bullous diseases
of the lung. Arch Environ Health 1971:
22:163-167.
3. Aronberg DJ, Sagel SS, LeFrak S, et al: Lung
carcinoma associated with bullous lung dis-
ease in young men. Am J Resp Dis 1980:
134:249-252.
4. Varkey B, Tristani FE: Compression of
pulmonary artery and bronchus by descend-
ing thoracic aneurysm. Am J Cardiol 1974:
34:610-614.
5. Iwa T, Watanabe Y, Fukatani G: Simultane-
ous bilateral operations for bullous em-
physema by median sternotomy. yCard/ouas
Surg 1981: 81:732-737.
6. Potgieter PD, Benater SR, et al; Surgical treat-
ment of bullous lung disease. Thorax 1981;
36:885-890. ■
ABSTRACTS
The incidence of rebleeding
in traumatic hyphema
GEORGE J WITTEMAN, MD: STEPHEN J BRUBAKER,
MD: MAX JOHNSON, MD: and RONALD MARKS, PhD,
The Eye Clinic of Wausau (GJW|, Wausau, Wis; Gundersen
Clinic Ltd (SJB), La Crosse, Wis: Marshfield Clinic (MJ),
Marshfield, Wis; and The Biostatistics Unit (RM|, Univer-
sity of Florida, Gainesville, Fla. Ann Ophthalmol 1985 (Sept):
17:525-529.
A collaborative, retrospective study of 371
consecutive hyphema patients reveals an overall
3.5% incidence of rebleeding without the use of
antifibrinolytic agents. This is the single largest
study of hyphema patients published. The re-
bleed rate is significantly lower than the
20%-33% rate of rehemorrhage reported in pre-
vious American studies. Numerous factors were
reviewed on each patient, including age, sex,
race, grade of hyphema, disposition, and the use
of topical or systemic medications. Thirty per-
cent of the patients were treated on an outpatient
basis. The low incidence of rebleeding, particu-
larly in less severe hyphemas (less than half the
anterior chamber volume), does not support the
routine use of systemic antifibrinolytics or
corticosteroids. ■
Farm accidents in children
THOMAS H COGBILL, MD: HENRY M BUSCH JR, MD:
and GARY R STIERS, MD, Departments of Surgery and
Pediatrics, Gundersen Clinic Ltd /La Crosse Lutheran
Hospital, La Crosse, Wis. Pediatrics 1985 (Oct): 76:562-566.
During a six and one-half year period, 105
children were admitted to the hospital as the
result of trauma that occurred on farms. The
mechanism of injury was animal related in 42
(40%), tractor or wagon accident in 28 (26%),
farm machinery in 21 (20%), fall from farm
building in six (6%), and miscellaneous in eight
(8%). Injury Severity Score was calculated for
each patient. An Injury Severity Score of greater
than or equal to 25 was determined for 1 1 chil-
dren (11%). Life-threatening injuries, therefore,
are frequently the result of childhood activities
that take place in agricultural environments. The
most common injuries were orthopedic, neuro-
logic, thoracoabdominal, and maxillofacial.
There was one death in the series, and only one
survivor sustained major long-term disability.
Such injuries are managed with optimal out-
come in a regional trauma center. Educational
programs with an emphasis on prevention and
safety measures may reduce the incidence of
farm accidents. ■
14
WISCONSIN MEDICAI |Ol RNAl . NO\ E.MBER 198.i : VOl . 84
SCIENTIFIC MEDICINE
Malignant posttraumatic hypermetabolic syndrome
associated with brain injury
Philip J Dahlberg, MD; Thomas H Cogbill, MD; Byron L Annis, MD; and William M Deering, MD, La Crosse, Wisconsin
ABSTRACT. Malignant post-
traumatic hypermetabolic syn-
drome (MPHSI developed in seven
brain-injured patients. A character-
istic constellation of symptoms in-
cluded severe muscle rigidity, dia-
phoresis, tachycardia, tachypnea,
and fever. Complications of the syn-
drome were marked weight loss, vol-
ume depletion, hypernatremia,
renal failure, orthopedic injuries,
and death. The entire symptom
complex could be reversed with pan-
curonium bromide or diazepam ad-
ministration. The clinical features
and response to muscle relaxants
closely resemble other disorders in
which muscle contracture is a dom-
inant feature. These include malig-
nant hyperthermia, tetanus, strych-
nine poisoning, and the neuroleptic
malignant syndrome. This suggests
that intense prolonged muscle con-
tracture is of pathogenetic impor-
tance and should be addressed in
the management of the syndrome.
Key words: Malignant posttraumatic
hypermetabolic syndrome; Brain injury:
Vegetative syndromes
VARIETY OF vegetative syn-
dromes have been described fol-
lowing severe brain injury. In the
acute phase these include fronto-
basal syndrome, diencephalic
crisis, and acute, secondary mid-
brain syndrome. These are char-
acterized by profound neurologic
From the Departments of internal
Medicine, Surgery, Neurology and Neuro-
surgery, Gundersen Clinic Ltd, La Crosse.
The authors gratefully acknowledge the
support of the Gundersen Medical Foun-
dation. Reprint requests to: Philip J Dahl-
berg, MD, Gundersen Clinic Ltd, 1836
South Ave, La Crosse, Wis 54601 (ph
608/782-7300). Copyright 1985 by the
State Medical Society of Wisconsin.
deficits, decerebrate or decorticate
rigidity plus paroxysms of exten-
sor spasms, diaphoresis, tachy-
cardia, tachypnea, hyperthermia,
and hypertension. Metabolic ab-
normalities include increased
catecholamine excretion, oxygen
consumption, and a markedly
negative nitrogen balance.^ ^ Sur-
vival of the acute phase may be
followed by a transitional period.
In this stage paroxysms become
less frequent, less intense, and
may only occur after external
stimulation. 2
Hyperthermia has been at-
tributed to hypothalamic injury,
loss of heat dissipation mechan-
isms, or stimulation of heat pro-
duction. The cardiovascular and
respiratory changes seen in these
syndromes may be partially due to
a combination of increased cate-
cholamine excretion and loss of
vegetative inhibition from dis-
turbed diencephalic function. ^
The hemodynamic response to
severe head injury was recently
reevaluated by Clifton et al."^ They
found increases in cardiac output,
blood pressure, pulse, and oxygen
consumption all correlated with
increased catecholamine excre-
tion. Beta-blocking agents were
successful in normalizing these
hemodynamic changes.
Our experience with seven
brain-injured patients suggests
that hypothalamic injury and in-
creased catecholamine excretion
are not adequate explanations for
all of the physiologic changes seen
after brain injury. This report
describes seven patients with a
syndrome of severe muscle con-
tracture, fever, tachycardia, and
tachypnea. Response to muscle
relaxants suggests that intense,
sustained muscle contracture is of
major pathogenetic importance.
Because of the dramatic and po-
tentially fatal nature of this syn-
drome, we have elected to call it
the malignant posttraumatic hy-
permetabolic syndrome (MPHS).
Case reports. Seven case reports
are summarized in Table 1. Two
representative case reports are
described below.
Case 4. A 19-year-old male was
involved in a motor vehicle acci-
dent sustaining rib fractures and
pneumothorax on the left side,
pulmonary contusion, and severe
head injury with decorticate pos-
turing. A computerized tomo-
graphic (CT) scan showed thal-
amic hemorrhage on the left side.
A chest tube on the left side and
intracranial pressure monitor
were placed. Episodes of intense
rigidity, decerebrate posturing,
diaphoresis, tachycardia, tachyp-
nea, and a temperature to 38.8 C
developed two hours after admis-
sion. The patient was paralyzed
with pancuronium bromide and
placed on a ventilator with com-
plete resolution of the syndrome.
Two subsequent attempts at dis-
continuing pancuronium bromide
led to an immediate recurrence of
the syndrome (Fig 1).
Two weeks after admission
pancuronium bromide and ven-
tilation were discontinued. In-
creasing rigidity and posturing
recurred followed by diaphoresis,
fever (39-40 C), tachycardia, and
tachypnea. Profound diaphoresis
was associated with large in-
VVISC()\SIN .VII DICAl. |Ol RNAI., NOVE.VIBEK 198,5 :VOI.. 84
15
SCIENTIFIC MEDICINE
MALIGNANT POSTTRAUMATIC-Dahlberg et al
Tabic 1—ClinicaI features of malignant posttraumatic hypermetaboUc syndrome
Cases
1 2 3 4 5 6
Age /Sex
Hypothalamic or
thalamic injury
Rigidity
Diaphoresis
Tachycardia
Fever
Flushing
Creatine phosphokinase
(units/ liter)
Urine urea nitrogen
(Gm/24 hours)
Complications
Weight loss (Kg)
Volume depletion
Hypernatremia
Azotemia
Orthopedic
Death
Response to diazepam
15/F
17/M
24/M
19/M
-
-
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
ND
ND
ND
ND*
13
15
ND
15
9.5
0
11.6
17.2
-
-
+
+
-
-
+
+
-
-
-
+
ND
ND
+
ND
+
ND*
16/M
30/M
16/M
+
-
+
+
+
+
+
+
+
+
+
+
+
+
+
-
-
+
1142
850
505
ND
27
19.8
8.2
7.6
5.4
+
:
+
-
-
iVD = not done
* = responded to pancuronium bromide
+ + +
sensible fluid losses (estimated at
3 to 4 liters daily), hypernatremia
(serum sodium 158 mM/liter) and
prerenal azotemia (blood urea
nitrogen 96 mg/dL). Urine urea
nitrogen ranged from 15 to 20
Gm. During the 40-day hospitali-
zation his weight fell 17.2 kg de-
spite 3000 to 3600 kcal of enteral
feedings daily.
Hypernatremia and azotemia
initially responded to aggressive
fluid and electrolyte replacement.
The syndrome, however, was un-
relenting and the patient died with
serum sodium of 159 mM/liter
and blood urea nitrogen of 120
mg/dL.
Case 6. A 30-year-old mentally
retarded male was struck by an
automobile and brought to the
emergency room complaining of
head pain. After arrival he sud-
denly lost consciousness, dilated
both pupils, and developed de-
cerebrate posturing. A CT scan
showed a left frontotemporal ex-
tracerebral hematoma and an
acute epidural hematoma which
was immediately drained in the
operating room. On the second
postoperative day intracranial
pressure rose to 30 torr and
neurologic status deteriorated.
Thirty ml of clot was evacuated on
reexploration of the head.
Following the second operation
the patient was decerebrate and
had bilateral Babinski signs. Two
days later he began having parox-
ysms of intense decerebrate ri-
gidity, fever, diaphoresis, tachy-
cardia, and tachypnea. Creatine
phosphokinase was 850 units per
liter, urine creatinine 2256 mg per
24 hours, and urine nitrogen
27 Gm per 24 hours. Intracranial
pressures remained less than 20
torr. Diazepam, 5 mg intrave-
nously every 6 hours, was given,
with resolution of rigidity, pa-
roxysms and normalization of
creatine phosphokinase by the
fifth day of treatment (Fig 2). Mod-
erate rigidity recurred as diaze-
pam dosage was tapered but there
were no further paroxysms of di-
aphoresis, tachycardia or tachyp-
nea, and creatine phosphokinase
levels remained normal.
During the first month of hospi-
talization, weight decreased 7.6 kg
despite 2400 kcal intake daily. He
was discharged at four months
with severe spastic quadraparesis.
Discussion. Malignant posttrau-
matic hypermetaboUc syndrome
(MPHS) occurring in seven brain-
injured patients is described
(Table 1). The onset within days
after the initial insult is character-
ized by intense rigidity, posturing,
diaphoresis, tachypnea, fever, and
occasionally flushing. It is usually
episodic and paroxysms are often
precipitated by external stimuli.
These episodes can be aborted
and prevented with pancuronium
bromide or large doses of diaze-
pam. The natural history is vari-
able. In some cases episodes spon-
taneously diminished and in
others progression to a crisis-like
state resulted in death.
Laboratory abnormalities as-
sociated with MPHS include mod-
estly elevated creatine phospho-
kinase and marked increases in
urine urea nitrogen. These are
probably caused by intense mus-
cle rigidity, muscle breakdown,
and hypermetabolism. Creatine
phosphokinase may prove useful
in distinguishing MPHS from
other hypermetaboUc states (sep-
sis, meningitis) and may provide
a means to assess therapy.
Complications observed in our
patients included volume deple-
tion, hypernatremia, and azo-
temia from large insensible fluid
losses. Orthopedic injuries de-
veloped in two patients from in-
tense, sustained muscle rigidity.
Two deaths attributed to the syn-
drome—one from severe fluid
losses leading to hypernatremia
and renal failure and the other to
severe hyperthermia.
Four other syndromes clinically
resemble the MPHS (Table 2).
These include malignant hyper-
thermia, tetanus, strychnine poi-
soning and the neuroleptic malig-
16
WISCONSIN MEUICAI. JOl'RNAL, NOVEMBER 1985:\'OI.. 84
MALIGNANT POSTTRAUMATIC-Dahlberg et al
SCIENTIFIC MEDICINE
nant syndrome. Although they
have widely different pathogen-
eses, each is characterized by
muscle rigidity, fever, diaph-
oresis, and tachycardia. This sug-
gests that sustained muscle con-
tracture plays a role in generating
the other manifestations of these
syndromes including fever, in-
creased oxygen consumption,
muscle necrosis, renal failure, and
bone and joint injuries. Muscle re-
laxants have a beneficial effect on
these syndromes, regardless of
whether muscle rigidity is cen-
trally or peripherally mediated.
Malignant hyperthermia is an
inherited disorder of muscle
metabolism. Extreme muscle hy-
permetabolism is precipitated by
exposure to volatile anesthetic
agents or succinylcholine. The ful-
minant syndrome is characterized
by muscle rigidity, fever, tachy-
cardia, tachypnea, increased oxy-
gen consumption, and lactic
Table 2— Disorders similar to the malignant posttraumatic hypermetabolic
syndrome jMPHSI
Neuroleptic
Malignant
hyperthermia
Tetanus
Strychnine
poisoning
malignant
syndrome
MPHS
Clinical
Rigidity
+
+
4-
+
+
Fever
+
4-
+
+
Diaphoresis
+
4-
4-
+
Tachycardia
+
+
+
4-
Laboratory
Elevated CPK +
+
4-
+
-b
Increased VO2 + +
+
+
ND
+
+
Lactic acidosis
4-
+
+
4-
-
Complications
Renal failure
+
+
+
+
+
Hypernatremia
-
+
+
4-
Orthopedic
-
4-
-
-
4-
Response to treatment
Pancuronium
-
+
4-
4-
Diazepam
-
+
+
+
Dantrolene
+
4-
4-
Amantadine
+
Bromocriptine
-
+ = Creatine phosphokinase
+ + = Oxygen consumption
ND = Not done
Figure I— Serial vital signs in Case 4 demonstrating increased
pulse, respirations, and temperature when pancuronium bromide
was discontinued. Recurrent posturing and diaphoresis occurred
simultaneously.
Figure 2— Serial vital signs and creating phosphokinase (CPKj
measurements in Case 6 showing resolution of MPHS and
elevated CPK during treatment with diazepam.
WISCONSIN MI DICAI.JOI RNAI , NO\ KMBER 1985: VOL. 84
17
SCIENTIFIC MEDICINE
MALIGNANT POSTTRAUMATIC-Dahlberg et al
acidosis. Complications may in-
clude rhabdomyolysis, hyperka-
lemia, cardiac arrhythmias,
disseminated intravascular coagu-
lation, neurologic disorders, and
acute renal failure. The skeletal
muscle relaxant, dantrolene, is ef-
fective in treatment of the
disorder.^
The clinical manifestations of
tetanus are caused by the toxin
tetanospasmin which interferes
with neuromuscular transmission
at the nerve terminal. Autonomic
involvement may lead to diaph-
oresis, fluctuating hypertension,
episodic tachycardia and cardiac
arrhythmias even during neuro-
muscular blockade. “ This phe-
nomenon makes comparison to
MPHS difficult. The major mani-
festations of the disease, how-
ever, are secondary to severe sus-
tained muscle contracture. Fever,
tachycardia, and increased oxy-
gen consumption are consistent
features. The increased oxygen
consumption decreases after
diazepam therapy.*^ Complica-
tions of tetanus include: lactic
acidosis, rhabdomyolysis, acute
renal failure, fractures, and dis-
locations.
Strychnine blocks glycine up-
take, disinhibiting the motorneu-
ron. Strychnine poisoning is
characterized by powerful exten-
sor muscle spasms, hyperpyrexia,
tachycardia, and tachypnea. It is
complicated by lactic acidosis,
rhabdomyolysis, and acute renal
failure. The syndrome is effec-
tively treated with diazepam or
pancuronium and respiratory
support. 2123
The neuroleptic malignant syn-
drome is a rare idiosyncratic reac-
tion to major tranquilizers. Fol-
lowing drug exposure severe
extrapyramidal muscle rigidity is
followed by hyperpyrexia, tachy-
cardia, tachypnea, diaphoresis
and labile hypertension. 2^ 26
syndrome can be effectively
treated with centrally acting dopa-
mine agonists (amantadine or bro-
mocriptine) which suggests a
pathogenetic role for dopamine
receptor blockade. 222s Peripher-
ally acting muscle relaxants (dan-
trolene sodium) are also effec-
tive.2^20 Complications may in-
clude rhabdomyolysis and acute
renal failure. 21 Although the syn-
drome is centrally mediated, oxy-
gen consumption decreases after
dantrolene therapy. 29 This implies
that fever and hypermetabolic
state are due to the sustained mus-
cle contracture.
A variety of other clinical cir-
cumstances including status epi-
lepticus and phencyclidine intoxi-
cation may lead to a similar, but
less severe, constellation of symp-
toms and complications. 22 23 Wg
would suggest that the patho-
physiology is similar.
Although beta blocking drugs
are effective in blocking the cate-
cholamine-induced hemody-
namic alterations following head
injury, we would recommend
caution using these drugs in pa-
tients with MPHS. Bradycardia
and vasoconstriction induced by
these drugs could interfere with
heat dissipation and aggravate hy-
perthermia. These patients should
be treated with diazepam or pan-
curonium and monitored care-
fully for complications. Aggres-
sive nutritional support must be
emphasized. Our patients lost
large amounts of body weight de-
spite receiving greater than 2400
kcalories daily. Since hypermetab-
olism may be aggravated by large
carbohydrate loads, a high pro-
tein, high fat enteral formula may
be preferable. 2^^
MPHS is initiated by severe
brain injury leading to intense de-
corticate or decerebrate posturing.
Fever, diaphoresis, flushing,
tachycardia, and tachypnea likely
represent physiologic responses to
excessive heat generation and
oxygen consumption from the rig-
id muscles. Hypothalamic injury
and increased catecholamine ex-
cretion may contribute to the syn-
drome by interfering with central
heat and hemodynamic regula-
tion. The concept of hypermeta-
bolic complications arising from
sustained muscle contracture has
significant implications on patient
management. This syndrome
should be considered in any brain-
injured patient with dispropor-
tionate or otherwise unexplained
fever, tachypnea, and tachycar-
dia. These findings should not
always be attributed to nonspe-
cific hypothalamic dysfunction,
autonomic nervous system insta-
bility, or excessive catecholamine
excretion. Therapy with muscle
relaxants is specific and effective.
REFERENCES 1-34 available upon re-
quest to the authors. ■
i«
WISCONSIN .VIEDICAI JOI RNAI.. NOX F.MBER 1985 :VOI,. 84
BALANCED
CALCIUM
BJ
Low incidence of side effects
CARDIZEM® (diltiazem HCl)
produces an incidence of adverse
reactions not greater than that
reported with placebo therapy,
thus contributing to the patient’s
sense of well-being.
‘Cardlzem is Indicated in the treatment of angina pectoris due to
coronary arteiy spasm and in the management of chronic stable
angina (classic effortrassociated angina) in patients who cannot
tolerate therapy with beta-blockers and/or nitrates or who remain
symptomatic despite adequate doses of these agents.
Heferences:
1. Strauss WE, McIntyre KM, Paris! AF, et al: Safety and efficacy
of diltiazem hydrochloride for the treatment of stable angina
pectoris: Report of a cooperative clinical trial. Am J Cardiol
49:560-566, 1982. ^
2. Pool PE, Seagren SC, Bonanno JA, et al: The treatment of exercise-
inducible chronic stable angina with diltiazem: Effect on treadmill
exercise. Chest 78 ( J\dy suppl):234-238, 1980.
Reduces angina attack frequency*
42% to 46% decrease reported in
multicenter study
Increases exercise tolerance*
In Bruce exercise test,^ control
patients averaged 8.0 minutes to
onset of pain; Cardizem patients
averaged 9.8 minutes (P<.005).
CARDIZEM
CdilUazem HCO
THE BALANCED
CALCIUM CHANNEL BLOCKER
I
Please see full prescribing information on following page.
2/84
PROFESSIONAL USE INFORMATION
cordizem.
(dilhazem HCI)
30 m(t and 60 mg (ahleLs
DESCRIPTION
CARDIZEM'^ (dlltlazem hydrochloride) Is a calcium ion inllux
inhibitor (slow channel blocker or calcium antagonist). Chemically,
dlltlazem hydrochloride is l,5-Benzothiazepin-4(5H)one,3-(acetyloxy)
•5-[2-(dimethylamlno)ethyl]-2,3-dihydro-2-(4-methoxyphenyl)-,
monohydrochloride.(+)-cis-,The chemical structure is:
CHjCHjNICHjIj
Dlltlazem hydrochloride is a white to oll-white crystalline powder
with a bitter taste. It is soluble in water, methanol, and chloroform.
It has a molecular weight ol 450 98 Each tablet of CARDIZEM
contains either 30 mg or 60 mg diltiazem hydrochloride lor oral
administration,
CLINICAL PHARMACOLOGY
The therapeutic benefits achieved with CARDIZEM are believed
to be related to its ability to inhibit the Inllux of calcium ions
during membrane depolarization of cardiac and vascular smooth
muscle
Mechanisms of Action. Although precise mechanisms of its
antianginal actions are still being delineated, CARDIZEM is believed
to act in the following ways
1 Angina Due to Coronary Artery Spasm; CARDIZEM has been
shown to be a potent dilator of coronary arteries both epicardial
and subendocardial. Spontaneous and ergonovine-mduced cor-
onary artery spasm are inhibited by CARDIZEM.
2. Exertional Angina: CARDIZEM has been shown to produce
increases in exercise tolerance, probably due lo its ability to
reduce myocardial oxygen demand. This is accomplished via
reductions in heart rate and systemic blood pressure at submaximal
and maximal exercise work loads.
In animal models, diltiazem interferes with the slow inward
(depolarizing) cunent In excitable tissue. It causes excitation-contraction
uncoupling in various myocardial tissues without changes in the
configuration of the action potential. Diltiazem produces relaxation
of coronary vascular smooth muscle and dilation of both large and
small coronary arteries at drug levels which cause little or no
negative inotropic effect. The resultant increases In coronary blood
flow (epicardial and subendocardial) occur in Ischemic and nonischemic
models and are accompanied by dose-dependent decreases in sys-
temic blood pressure and decreases in peripheral resistance
Hemodynamic and Electrophyslologic Effects. Like other
calcium antagonists, diltiazem decreases sinoatrial and atrioventricu-
lar conduction in isolated tissues and has a negative inotropic effect
in Isolated preparations. In the intact animal, prolongation ol the AH
interval can be seen at higher doses.
In man, diltiazem prevents spontaneous and ergonovine-provoked
coronary artery spasm. It causes a decrease in peripheral vascular
resistance and a modest tall In blood pressure and, in exercise
tolerance studies in patients with ischemic heart disease, reduces
the heart rate-blood pressure product for any given work load.
Studies to date, primarily in patients with good ventricular function,
have not revealed evidence of a negative inotropic effect; cardiac
output, election fraction, and left ventricular end diastolic pressure
have not been affected. There are as yet few data on the interaction
of diltiazem and beta-blockers Resting heart rate Is usually unchanged
or slightly reduced by diltiazem
Intravenous diltiazem in doses ol 20 mg prolongs AH conduction
time and AV node functional and effective refractory periods approxi-
mately 20%, In a study involving single oral doses of 300 mg of
CARDIZEM in six normal volunteers, the average maximum PR
prolongation was 14% with no Instances of greater than first-degree
AV block, Diltiazem-associated prolongation of the AH Interval Is not
more pronounced in patients with first-degree heart block. In patients
with sick sinus syndrome, diltiazem significantly prolongs sinus
cycle length (up to 50% in some cases).
Chronic oral administration of CARDIZEM in doses of up to 240
mg/day has resulted in small Increases in PR interval, but has not
usually produced abnormal prolongation. There were, however, three
instances of second-degree AV block and one instance of third-
degree AV block in a group of 959 chronically treated patients.
Pharmacokinetics and Metaboiism. Diltiazem is absorbed
from the tablet formulation to about 80% of a reference capsule and
is subject to an extensive first-pass effect, giving an absolute
bioavailability (compared to inbavenous dosing) of about 40%. CARDIZEM
undergoes extensive hepatic metabolism in which 2% to 4% of fhe
unchanged drug appears in the urine. In vitro binding studies show
CARDIZEM is 70% to 80% bound to plasma proteins Competitive
ligand binding studies have also shown CARDIZEM binding is not
altered by therapeutic concentrations ol digoxin, hydrochlorothiazide,
phenylbutazone, propranolol, salicylic acid, or warfarin. Single oral
doses ol 30 to 120 mg of CARDIZEM result in detectable plasma
levels within 30 lo 60 minutes and peak plasma levels two lo three
hours after drug administration. The plasma elimination half-life
following single or multiple drug administration is approximately 3,5
hours, Desacetyl diltiazem is also present in the plasma at levels of
10% to 20% of the parent drug and is 25% to 50% as potent a
coronary vasodilator as diltiazem. Therapeutic blood levels of
CARDIZEM appear to be in the range of 50 lo 200 ng/ml. There is a
departure from dose-linearity when single doses above 60 mg are
given; a 120-mg dose gave blood levels three times that of the 60-mg
dose. There is no information about the effect of renal or hepatic
impairment on excretion or metabolism of diltiazem.
INDICATIONS AND USAGE
1 Angina Pectoris Due to Coronary Artery Spasm. CARDIZEM
is indicated in the treatment of angina pectoris due to coronary
artery spasm. CARDIZEM has been shown effective in the
treatment of spontaneous coronary artery spasm presenting as
Prinzmetal's variant angina (resting angina with ST-segment
elevation occurring during attacks)
2 Chronic Stable Angina (Classic Effort-Associated Angina).
CARDIZEM is indicated in the management of chronic stable
angina CARDIZEM has been effective in controlled trials in
reducing angina frequency and increasing exercise tolerance
There are no controlled studies of the effectiveness of the concomi-
tant use of diltiazem and beta-blockers or of the safety of this
combination in patients with impaired ventricular function or conduc-
tion abnormalities.
CONTRAINDICATIONS
CARDIZEM is contraindicated in (1) patients with sick sinus
syndrome except in the presence of a functioning ventricular pacemaker,
(2) patients with second- or third-degree AV block except in the
presence of a funcfioning ventricular pacemaker, and (3) patients
with hypotension (less than 90 mm Hg systolic)
WARNINGS
1 Cardiac Conduction. CARDIZEM prolongs AV node refrac-
tory periods without significantly prolonging sinus node recov-
ery time, except in patients with sick sinus syndrome. This
effect may rarely result in abnormally slow heart rates (particularly
in patients with sick sinus syndrome) or second- or third-degree
AV block (six of 1243 patients for 0,48%). Concomitant use of
diltiazem with beta-blockers or digitalis may result in additive
effects on cardiac conduction A patient with Prinzmetal's
angina developed periods of asystole (2 lo 5 seconds) after a
single dose of 60 mg of diltiazem.
2 Congestive Heart Failure. Although diltiazem has a negative
inotropic effect In isolated animal bssue preparations, hemodynamic
studies in humans with normal ventricular function have not
shown a reduction in cardiac index nor consistent negative
effects on contractility (dp/dt). Experience with the use of
CARDIZEM alone or in combination with beta-blockers in patients
with impaired ventricular function is very limited. Caution should
be exercised when using the drug in such patients
3 Hypotension. Decreases in blood pressure associated with
CARDIZEM therapy may occasionally result in symptomatic
hypotension.
4 Acute Hepatic Injury. In rare Instances, patients receiving
CARDIZEM have exhibited reversible acute hepatic injury as
evidenced by moderate to extreme elevations of liver enzymes,
(See PRECAUTIDNS and ADVERSE REACTIONS.)
PRECAUTIONS
General. CARDIZEM (diltiazem hydrochloride) is extensively metab-
olized by the liver and excreted by the kidneys and m bile. As with any
new drug given over prolonged periods, laboratory parameters should
be monitored at regular intervals. The drug should be used with
caution in patients with impaired renal or hepatic function. In sub-
acute and chronic dog and rat studies designed to produce toxicity,
high doses of diltiazem were associated with hepatic damage In
special subacute hepatic studies, oral doses of 125 mg/kg and
higher in rats were associated with histological changes in the liver
which were reversible when the drug was discontinued. In dogs,
doses of 20 mg/kg were also associated with hepatic changes;
however, these changes were reversible with continued dosing
Drug Interaction. Pharmacologic studies indicate that there
may be additive effects in prolonging AV conduction when using
beta-blockers or digitalis concomitantly with CARDIZEM (See
WARNINGS),
Controlled and uncontrolled domestic studies suggest that con-
comitant use of CARDIZEM and beta-blockers or digitalis is usually
well tolerated Available data are not sufficient, however, to predict
the effects of concomitant treatment, particularly In patients with left
ventricular dysfunction or cardiac conduction abnormalities. In healthy
volunteers, diltiazem has been shown to increase serum digoxin
levels up to 20%,
Carcinogenesis, Mutagenesis, Impairment of Fertility. A
24-month study in rats and a 21 -month study in mice showed no
evidence of carcinogenicify. There was also no mutagenic response
in In vitro bacterial tests. No intrinsic effect on fertility was observed
in rats.
Pregnancy. Category C, Reproduction studies have been con-
ducted in mice, rats, and rabbits Administration of doses ranging
from five to ten times greater (on a mg/kg basis) than the daily
recommended therapeutic dose has resulted in embryo and fetal
lethality. These doses, in some studies, have been reported to cause
skeletal abnormalities. In the perinatal/postnatal studies, there was
some reduction in early individual pup weights and survival rates.
There was an increased Incidence of stillbirths at doses of 20 times
the human dose or greater.
There are no well-controlled studies in pregnant women; therefore,
use CARDIZEM in pregnant women only if the potential benefit
justifies the potential risk to the fetus.
Nursing Mothers. It is not known whether this drug is excreted
in human milk Because many drugs are excreted in human milk,
exercise caution when CARDIZEM is administered to a nursing
woman if the drug's benefits are thought to outweigh its potential
risks in this situation.
Pediatric Use. Safety and effectiveness in children have not
been established
ADVERSE REACTIONS
Serious adverse reactions have been rare in studies carried out to
date, but it should be recognized that patients with impaired ventricu-
lar function and cardiac conduction abnormalities have usually been
excluded
In domestic placebo-controlled trials, the incidence of adverse
reactions reported during CARDIZEM therapy was not greater than
that reported during placebo therapy.
The following represent occurrences observed in clinical studies
which can be at least reasonably associated with the pharmacology
of calcium influx inhibition. In many cases, the relationshm to
CARDIZEM has not been established The most common occurrences,
as well as their frequency of presentation, are; edema (2,4%),
headache (2.1%), nausea (1.9%), dizziness (1.5%), rash (1.3%),
asthenia (1.2%), AV block (1.1%). In addition, the following events
were reported infrequently (less than 1%) with the order of presenta-
tion corresponding to the relative frequency of occurrence.
Cardiovascular:
Nervous System;
Gastrointestinal;
Dermatologic:
Other:
Flushing, arrhythmia, hypotension, bradycar-
dia. palpitations, congestive heart failure,
syncope
Paresthesia, nervousness, somnolence,
tremor, insomnia, hallucinations, and amnesia.
Constipation, dyspepsia, diarrhea, vomiting,
mild elevations of alkaline phosphatase. SCOT,
SGPT, and LDH.
Pruritus, petechiae, urticaria, photosensitivity.
Polyuria, nocturia.
The following additional experiences have been noted:
A patient with Prinzmetal's angina experiencing episodes of
vasospastic angina developed periods ol transient asymptomatic
asystole approximately five hours after receiving a single 60-mg
dose of CARDIZEM
The following postmarketing events have been reported infre-
quently in patients receiving CARDIZEM erythema multiforme; leu-
kopenia; and extreme elevations of alkaline phosphatase. SCOT,
SGPT, LDH, and GPK. However, a definitive cause and effect between
these events and CARDIZEM therapy is yet to be established.
OVERDOSAGE OR EXAGGERATED RESPONSE
Overdosage experience with oral diltiazem has been limited.
Single oral doses of 300 mg of CARDIZEM have been well tolerated
by healthy volunteers. In the event of overdosage or exaggerated
response, appropriate supportive measures should be employed in
addition to gastric lavage, The following measures may be considered:
Bradycardia
High-Degree AV
Block
Cardiac Failure
Hypotension
Administer atropine (0.60 to 10 mg). If there
is no response to vagal blockade, administer
isoproterenol cautiously.
Treat as for bradycardia above. Fixed high-
degree AV block should be treated with car-
diac pacing.
Administer inotropic agents (isoproterenol,
dopamine, or dobutamine) and diuretics.
Vasopressors (eg, dopamine or levarterenol
bitartrate).
Actual treatment and dosage should depend on the severity of the
clinical situation and the judgment and experience of the treating
physician
The oral/LDso's in mice and rats range from 415 to 740 mg/kg
and from 560 to 810 mg/kg, respectively. The intravenous LDJs in
these species were 60 and 38 mg/kg, respectively The oral LDsj In
dogs is considered to be in excess of 50 mg/kg. while lethality was
seen In monkeys at 360 mg/kg. The toxic dose in man is not known,
but blood levels in excess of 800 ng/ml have not been associated
with toxicity.
DOSAGE AND ADMINISTRATION
Exertional Angina Pectoris Due to Atherosclerotic Coro-
nary Artery Disease or Angina Poctorls at Rest Due to Coro-
nary Artery Spasm. Dosage must be adjusted to each patient's
needs Starting with 30 mg four times daily, before meals and at
bedtime, dosage should be increased gradually (given in divided
doses three or four times daily) at one- to two-day intervals until
optimum response is obtained Although individual patients may
respond to any dosage level, the average optimum dosage range
appears to be 180 lo 240 mg/riay There are no available data concern-
ing dosage requirements in patients with impaired renal or hepatic
function. If the drug must be used in such patients, titration should be
carried out with particular caution.
Concomitant Use With Other Antianginal Agents:
1 Sublingual NTG may be taken as required lo abort acute
anginal attacks during CARDIZEM therapy.
2 Prophirlactic Nitrate Therapy -CARDIZEM may be safely
coadministered with short- and long-acting nitrates, but there
have been no controlled studies to evaluate the antianginal
effectiveness of this combination
3. Beta-blockers. (See WARNINGS and PRECAUTIONS.)
HOW SUPPLIED
Cardizem 30-mg tablets are supplied in bottles of 100 (NDC
0088-1771-47) and in Unit Dose Identification Paks of 100 (NDC
0088-1771-49) Each green tablet is engraved with MARION on one
side and 1771 engraved on the other CARDIZEM 60-mg scored
tablets are supplied in bottles of 100 (NDC 0088-1772-47) and in Unit
Dose Identification Paks of 100 (NDC 0088-1772-49). Each yellow
tablet is engraved with MARION on one side and 1772 on the other.
Issued 4/1/84
Another patient benefit product from
PHARMACEUTICAL DIVISION
MARION
LABORATORIES, INC
KANSAS city, MISSOURI 64137
ORGANIZATIONAL
Reception brings 800 physicians
and 100 legislators together
On October 9 SMS members
backed their leadership solidly
with a turn-out of more than 800
physicians at a legislative recep-
tion in Madison. More than 100
legislators accepted the SMS invi-
tation to join them.
The goal of providing a forum
for physicians to acquaint them-
selves with legislators and express
their individual concerns and per-
spectives on the medical liability
issue was more than met, accord-
ing to the SMS's Physicians Alli-
ance Division director, Brian Jen-
sen.
"The reception was an ex-
tremely gratifying outpouring of
physician support for the SMS ef-
fort to obtain some meaningful re-
SMS Annual
Meeting plans
underway
Scheduled for April 17-19, 1986
at MECCA in Milwaukee, the
theme for the Annual Meeting is
entitled "Cost-Effective Care of
the Pediatric Population." The
1986 scientific program commit-
tee consists of Kenneth I Gold,
MD, Beloit, and Kay Heggestad,
MD, Madison.
Tentative panel topics include
"Public health consequences of
nuclear armaments;" "What's
new and important in socioeco-
nomics ; " " Pediatric-perinatology ; ' '
"Genetics;" "Value of routine
check-ups;" "Teenagers;" "Areas
of oversell . . . Overtreatment . . .
overuse;" "Areas that might be
modified due to cost considera-
tions;" and "Areas in which more
efforts in prevention might be
cheaper than treatment."*
forms," Mr Jensen said. "I was
overwhelmed by the sheer num-
bers of both physicians and legis-
lators who attended. Perhaps it
should be done during every legis-
lative session."*
New Communications
Coordinator named
Mary A Kane joined the State
Medical Society staff September
12 as Communications Coordi-
nator, succeeding Diane Upton
who resigned to become a full-
time homemaker.
Ms Kane has 10 years' experi-
ence as a journalist, seven of them
with The Northwestern, an Osh-
kosh daily newspaper. While on
The Northwestern's staff, Ms Kane
was a reporter and chief of the
paper's Ripon Bureau which cov-
ers Fond du Lac County and the
surrounding area.
Ms Kane worked this summer
as a part-time, temporary copy
editor at The Wisconsin State
Journal.
Prior to joining The Northwest-
ern, she worked on the reporting
staffs of The Ripon Commonwealth
Press and The Fond du Lac Re-
porter.
Ms Kane is a recipient of numer-
ous awards in the annual Wiscon-
sin Press Women Communica-
tions Contest, including the 1982
competition in which she was the
overall winner, receiving five first
place citations.
Prior to moving to Madison, Ms
Kane was a Ripon resident for 10
years following -
her 1974 gradua-
tion from Ripon
College. She
earned a degree
in French, with a
minor in English.
While in Ri-
pon, Ms Kane
was active in
several civic and
professional
groups, including
Wisconsin Press Women in which
she held a variety of offices; the
League of Women Voters; the
American Association of Univer-
sity Women; the Educational Club
of Ripon; the Wau-Bun Girl Scout
Council's ad hoc nominating com-
mittee; the Ripon Child Care
Center board of directors, and St
Wenceslaus Catholic Church.*
More than 1,000 students, teachers
attend SMS Workshop on Health
More than 1,000 students and teachers from 171 high schools around
the State attended the October 2 annual Workshop on Health at Osh-
kosh.
Carol Cassell, PhD of Albuquerque, NM, past president of the Ameri-
can Association of Sex Educators, Counselors, and Therapists, talked
about "Love Versus Sex" in a keynote address followed by two series
of workshops.
This year's workshop theme was "Awareness is the Answer: Teen-
age Sexuality /Teenage Pregnancy."
This was the 23rd event of its kind jointly sponsored by the State Med-
ical Society of Wisconsin and its Auxiliary.*
WISCONSIN MF.niCAL JOURNAL, NOVEMBER 1985; VOL. 84
21
ORGANIZATIONAL
1984 MEMBERSHIP SURVEY
Members want greater emphasis
on public image of profession
The State Medical Society of
Wisconsin, in conjuction with
the Department of Survey Design
and Analysis of the American
Medical Association, designed a
1984 survey of SMS members.
The purposes of the survey were
to assess SMS performance on a
number of programs and activi-
ties, ascertain the perceptions of
members as to their reasons for
belonging to the Society, and col-
lect important demographic data
from the members. The informa-
tion obtained is being used by the
Task Force on Medical Care, vari-
ous commissions and committees
of SMS, and by the Board of Di-
rectors in establishing issue pri-
orities, planning budgets and pro-
grams, and developing legislative
strategies.
Survey design
Licensed physicians practicing
at least part-time who belong to
the State Medical Society of Wis-
consin received a mail survey in
November 1984. Retired physi-
cians and candidate members
were not surveyed. By the cutoff
date, nearly 60 percent of the
4,588 questionnaires were re-
turned. These 2,641 respondents
were representative of the sample
on major background variables:
major professional activity, spe-
cialty, sex, age, and county size.
This representativeness was de-
termined by comparison of data
available on the computerized
AMA Physician Masterfile for the
sample.
Physicians' level of involvement
in organized medicine
• The majority of respondents
consider themselves active in
hospital medical staff (88.7%),
state (51.5%), county (59.6%),
and specialty (61.9%) societies.
However, only one-third define
themselves as active in the
AMA.
• Equal numbers of members of
SMS define themselves as inac-
tive members (47.7%) or active
members (47.4%). Four percent
are active leaders.
• Nearly 9 in 10 SMS members
take an active role in hospital
medical staff organizations (ac-
tive leader, 27.7%; active mem-
ber, 61.0%).
• The largest percentage of active
leaders in SMS are in the age
categories of 50-54 years of age
(8.3%) and 45-49 years of age
(6.1%). Approximately half of
each age group define them-
selves as active members of
SMS, with the exception of
members in their thirties (30-34
years, 39.2%; 35-39 years,
42.6%).
• Active leaders and members
rated programs more highly
than inactive members. For ex-
ample, 69 percent of the active
members and 59.4 percent of
the inactive members rated
WISPAC as excellent or good.
Membership priorities
• Three-fourths (75.6%) of the re-
spondents called for greater em-
phasis on the public image of
the profession.
• Seventy percent of the respond-
ents favored greater attention to
professional liability and mal-
practice issues.
• Approximately half of the re-
spondents said more emphasis
should be given to the following
issues: state/federal govern-
ment involvement in Wisconsin
healthcare (49.8%); relationship
with third-party payors (49.6%);
and costs of healthcare (49.6%).
• The majority of SMS members
(62.5%) describe themselves as
somewhat informed about SMS
activities. One-fifth (20.1%) are
"very well informed."
Readership patterns
• Of the three SMS publications,
Wisconsin Medical Journal, Med-
igram, and Capitol Week, Medi-
gram is read most regularly. For
all three publications, active
SMS members are more regular
readers than others. Older phy-
sicians tend to read WMJ and
Medigram more frequently than
younger physicians.
• Almost half (48.0%) of the SMS
members read the Wisconsin
Medical Journal regularly and
more than one-third (35.6%)
read it occasionally.
• More than two-thirds (69.3%) of
the respondents read Medigram
regularly and an additional 22.5
percent read it occasionally.
• Among the one-third who re-
ceive Capitol Week, 39.3 percent
read it regularly and 32.4 per-
cent read it occasionally.
State Medical Society of
Wisconsin Programs
• Representation of medicine's
views to legislators and com-
munication of medicine's con-
cerns and accomplishments to
the general public were rated as
important reasons for member-
ship by more than 90 percent of
the respondents.
• Three-fourths of the respond-
ents consider Medigram and the
Wisconsin Medical Journal as im-
portant reasons for their mem-
bership.
• More than 50 percent of re-
spondents cited exchanging
views with other professionals
and political candidate support
through WISPAC important for
their membership decision.
• Peer pressure and direct bene-
fits [eg, insurance programs, dis-
22
WISCONSIN MKmCAI.JOCRNAI., NO\'EMBER 1985 :\ OE. 84
MEMBERSHIP SURVEY
ORGANIZATIONAI.
count plans) were considered
important reasons by fewer
than half the members.
• Overall, members gave the
highest performance ratings to
"communication with the pro-
fession (excellent 24.7%; good
58.2%) and to the Society's
legislative activity (excellent
23.6%; good 49.1%).
Practice characteristics
• The median number of hours
worked per week is 53 hours.
Almost two-thirds (60.8%) of the
physicians work 46-60 hours
per week, and 5.9 percent work
more than 70 hours. Physicians
in small cities or towns (5,000-
25,000 population) work shghtly
more hours than physicians in
other locations.
• Partnership or group practice is
the most common type of prac-
tice among the respondents. For
the period of the last five years,
solo practice was the second
most common type of practice.
• The most dramatic change is in
terms of participation in pre-
ferred provider organizations
(PPOs). Participation in PPOs is
expected to increase from 3.3
percent of the respondents five
years ago and 7.9 percent cur-
rently, to 13.5 percent during
the next five years.
• Participation in health mainten-
ance organizations (HMOs) has
increased from 16.0 percent
during the past five years to 29.3
percent during the current year.
With respect to the next five
years, HMO participation is ex-
pected to remain constant at
29.2 percent.
• Participation in independent
practice associations (IPAs) has
increased from 8.2 percent dur-
ing the past five years to 15.0
percent during the current year.
Slightly more than 16 percent of
the membership indicated IPA
participation in the next five
years.
• Participation in freestanding
surgery centers and ambulatory
care centers is expected to in-
crease. Respondents predicted
that the percentage of physicians
practicing in hospital outpatient
departments and community
health centers will decline.
• Of the respondents who stated
they have been in solo practice
for the past five years, about
one-half (55.6%) are only in solo
practice today, 2.8 percent are
only in group practice and 41.6
percent are in some other prac-
tice arrangements (including
participation in a group or solo
practice along with some other
activity.
• Of the respondents specifying
only group practice during the
past five years, two thirds
(63.5%) are in a group practice
only, 1.7 percent are in solo
practice only, and 34.8 percent
are in some other arrangements.
• Among respondents currently
in solo practice only, 70.3 per-
cent expect to be in solo practice
only in the next five years.
Another 3.0 percent expect to be
in group practice only, and 26.7
percent expect to be working in
some other arrangement (in-
cluding participation in a group
or solo practice along with some
other activity).
• Of those respondents who cur-
rently are in group practice
only, 0.6 percent expect to be in
solo practice only and almost
one-quarter (24.4%) expect to be
in some other arrangements
during the next five years.
• Many physicians practicing in
HMOs also participate in some
other form of medical practice.
More than three-quarters
(77.2%) specified partnership or
group practice also, IPAs were
specified by almost one-third
(31.8%) of respondents, hospital
outpatient departments by 19.1
percent, and PPOs by 18.5 per-
cent. Solo practice was specified
by 19.0 percent of the respond-
ents in HMOs.
• The most common practice
location is outside of the central
business district of a city
(31.9%).
• Nearly three-quarters (73.4%)
specified that their medical
practice is incorporated.
• The average number of physi-
cians in a group practice is 15.
Group, HMO, and IPA physicians
• Among those who have joined
an HMO/IPA, more than half
(58.0%) first joined during 1983
or 1984 and 13.6 percent joined
during 1982.
• Among HMO/IPA physicians,
the average number of HMOs/
IPAs that they participate in is
one. Respondents were more
likely to belong to more than
one HMO than to more than
one IPA.
• Of eight possible factors moti-
vating physicians to join an
HMO/IPA, the most frequently
checked factors were retention
of patients (87.3%), the ability to
compete with alternative health-
care systems (83.9%), and in-
creased patient base (64.9%).
• Two-thirds of the HMO/IPA
physicians specified that a
change in their practice arrange-
ment has not increased or de-
creased their income. Of the re-
spondents commenting on this
question, most specified that it
was too early to know the effect
on their income.
Compensation
• Over one-third of the physicians
derive 100 percent of their com-
pensation from fee-for-service
while only 29.7 percent derive
none of their income from fee-
for-service. Capitation was least
likely to be the form of compen-
sation. A salary accounted for
100 percent of the medical prac-
tice income of 15.8 percent of
the respondents, while 62.9 per-
cent received no salary at all.
WISCONSIN MKmCAI. JOl RNAI„ NOVEMBER 1985 :\ OE. 84
23
ORGAN IZATIONAI.
MEMBERSHIP SURVEY
• Typically one-quarter of the pa-
tient load is reimbursed by Med-
icare. Responses ranged from 0
to 100 percent.
• The median percent of a patient
load reimbursed by Medicaid is
10 percent. Medicaid patient
load ranged from 0 to 100 per-
cent.
Importance of healthcare issues
in Wisconsin
• When presented with six health-
care issues, 85 to 90 percent of
the respondents rated each issue
at least somewhat important.
• The ranking of the importance
accorded the issues is: cost of
healthcare, federal government
regulations, state government
regulations, the distribution of
healthcare providers, the supply
of healthcare providers, and the
availability /accessibility of care.
Cost of healthcare
• Respondents were abnost evenly
split between indicating that the
cost of healthcare today is too
high (45.6%) and that the cost is
about right (48.5%).
• Older age groups and those
physicians in primary care spe-
cialties (family practice, general
practice, pediatrics, internal
medicine) and in psychiatry ap-
pear more concerned about high
costs.
Income from medical practice
• Almost two-thirds of the re-
spondents indicated that their
Note: The mean income is the sum of
the incomes divided by the total number
of physicians reporting an income. The
median income is the middle income; if
the incomes were ranked, half would be
above the median and half would be
below the median. Generally, incomes are
not evenly distributed, with a few ex-
tremely high incomes. The mean, which
as a balance point is sensitive to extreme
cases, will be high, but the median—
always the middle— will be lower and
therefore more typical of the entire
distribution. Thus, although one often
thinks of the mean as the average, the me-
dian is the preferred measure of average
income.
annual net taxable income from
medical practice and related
activities for 1983 was between
$50,000 and $125,000 ($50,000-
$74,999, 23.4%; $75,000-
$99,999, 24.6%; $100,000-
$124,999, 15.8%).
• Among those responding, 60.6
percent had net taxable incomes
under $100,000.
• Over 71 percent of physicians in
rural areas had incomes be-
tween $25,000-$ 100,000. Medi-
an income for rural practitioners
was $62,500 as opposed to
$87,500 for physicians in all
other locations.
• Median income, by specialty,
ranged from $62,500 for family
practice /general practice, pedi-
atrics, and psychiatry to
$137,500 for radiology.
• Male physicians overall earned
$25,000 to $30,000 more than
female practitioners.
• Median net taxable income of all
member physicians in 1983 was
$87,500. ■
Membership encouraged for residents and students
The State Medical Society of
Wisconsin is encouraging medical
students and resident physicians
to join organized medicine early in
their careers.
Dues are waived for freshman
medical students while upper
classmen and postgraduate ones
pay only $10.00. Resident physi-
cian membership dues for 1986
are $45.50, just 10 percent of reg-
ular dues.
Physicians elected to SMS mem-
bership within six months of com-
pleting residency, fellowship, or
fulfillment of government obli-
gation enjoy a dues reduction of
50 percent for the first year and 25
percent the second year.
The AMA has a very low dues
structure for the Student Member
and Resident Member as well. In
addition, to attract new members
the AMA has a reduction of dues
for the new practitioner of 50 per-
cent for the first year and 25 per-
cent the second year.
Physicians are urged to seri-
ously consider joining organized
medicine as early as possible to
take advantage of these special
membership rates.
State Medical Society members
have several options when paying
membership dues in organized
medicine. These programs are de-
signed to provide SMS members
with a plan most convenient for
them.
Members classified as "regu-
lar," "part-time practice," and
To begin the membership pro-
cess, if your practice is or will be
located in Wisconsin, or if you
have any questions, you may con-
tact your local county society or
call the Membership and Com-
munications Division of the State
Medical Society: 1-800-362-9080
(Madison area number: 257-6781.)
"over age 70" may take advantage
of the installment payment op-
tion. This plan allows members to
pay one-half of the total dues
amount prior to January 1, with
the balance due on or before May
15. Members should note that
they will continue to receive
continued on next page
Dues payment options available
24
WISCONSIN MhmCAI JOl RNAI . NOVEMBHR 1985: VOI.. 84
DUES PAYMENT OPTIONS
ORGAMZATIONAl.
Continued from preceding page
monthly statements indicating the
outstanding balance.
New members should be aware
that AMA publications which
they will receive as an AMA mem-
ber will be sent only after the full
AMA dues are received by the As-
sociation.
A second option allows mem-
bers to pay dues using their
Mastercard or VISA credit cards.
The membership dues statement
will include an easy-to-use form if
members select the credit card
plan.
Of course, members may opt to
pay their dues by check in one
lump sum. This method avoids
any delays in receiving publi-
cations and other "tangible" bene-
fits. As with the options listed
above, SMS collects county soci-
ety and AMA dues and distributes
them to the appropriate organiza-
tion.
If you have any questions re-
garding these payment alter-
natives, please contact the State
Medical Society toll-free 1-800-
362-9080. ■
Reduced Practice or Retired
membership classifications
The State Medical Society re-
minds physicians who have re-
duced their practice to 1,000
hours or less during the calendar
year, but do not qualify for Re-
tired status, that they may apply
for a "Part-time Practice" classifi-
cation which waives 50 percent of
the regular membership dues.
Physicians who have reached
age 70, but are still practicing,
qualify for "Over Age 70" classi-
fication, and receive a 50 percent
reduction of regular SMS dues as
well.
These special membership clas-
sifications must be applied for
through the physician's county or
state society. The changes will be-
come effective January 1 follow-
ing approval or the year after the
physician reaches the age of 70
and cannot be made retroactive.
Other classifications which may
be requested for which dues ex-
emptions may apply are:
Associate: Financial hardship
due to illness or disability
Retired: Works less than 240
hours per year
Military Service: Temporary
service in the Armed Forces or
National Health Service
Some county societies and the
AMA have reduced or waived
dues for the same classifications as
SMS. Physicians who are retired
or will be retiring should advise
their county or state society of
their present or future status so
that a change in classifications can
be arranged.*
Spouse physicians
take note
Did you know that two-physi-
cian families are eligible for dues
reduction in SMS membership?
Under a plan approved by the
SMS Board of Directors, one
member of two-physician families
is entitled to a dues break of $50.
The other member pays full dues.
The members themselves would
identify which one receives the
discounted rate.
The Society requests that such
two-physician families use the
home address for mailings so as to
assure equal access to the Soci-
ety's communications. The reduc-
tion of dues is supported by elim-
inating duplication of Society
mailings, including the Wisconsin
Medical Journal and Medigram.
Spouse physicians are urged to
identify themselves as two-physi-
cian families and request the dues
reduction of $50 for one member
of the family.*
Wisconsin Association
of Senior Physicians
met November 9
Members of the Wisconsin As-
sociation of Senior Physicians met
Saturday, November 9 at the
Madison Club in Madison with
Kenneth Carter, MD, Beloit,
presiding president.
The major topic for discussion
was Estate Planning: The New Wis-
consin Marital Property Reform
Law, which was presented by
Robert Webster, assistant vice-
president of the First Wisconsin
National Bank Trust Department,
Madison.
A report on the Charitable, Edu-
cational and Scientific Foundation
of the State Medical Society, What
It Is and Who Needs It, was pre-
sented along with a slide show.
SMS President John K Scott,
MD, addressed the group on Med-
icine: 1985 and Beyond.
A Norwegian travelogue. Land
of the Midnight Sun, was presented
by Eugene J Nordby, MD of Madi-
son.
A short business meeting with
election of officers was held. Elec-
tion results will appear in the De-
cember issue.*
house of
BIDWELL, inc.
7954 West Harwood
and Watertown Plank Road
Milwaukee, Wisconsin 53213
ORTHOTIC
AND
PROSTHETIC
SERVICES
1-414-774-6250
WISCOWSIN .MKDIC'Al JOl RNAI , NOVKMBER l9S,'5:VOI . S4
2,5
ORGANIZATIONAL
Membership facts
Whether you're just starting medical school, maintaining a
full-time practice, or retiring, SMS has a membership classi-
fication to fit your individual needs. Election to membership
by the County Medical Society in which your principal place
of practice is located carries with it membership in the State
Medical Society of Wisconsin and, if you wish, the American
Medical Association. If you qualify for resident membership
at the time of your election, your membership dues are
greatly reduced. This may also qualify you for reduced dues
the first two years of your practice. In addition, two-physician
families may be eligible for a $50 discount on total SMS
membership dues. Dues for regular membership in 1986 are
$455 for SMS, $375 for AMA, and county society dues vary.
A more detailed listing of SMS membership classifications
and their corresponding dues follows:
State Medical Society of Wisconsin
DESCRIPTION OF MEMBERSHIP
CLASSIFICATIONS
Regular: Member in active practice. • First year in
practice — physicians elected to SMS membership within six
months of completing residency, fellowship, or fulfillment
of government obligation enjoy a dues reduction of 50 per-
cent for the first year. • Second year in practice — physicians
who quality by meeting the above criteria enjoy a 25 per-
cent dues reduction during their second year of practice.
• Two-physician family — one member (spouse) of a two-
physician family is entitled to a dues reduction of $50 or the
amount of their State Society dues whichever is less.
Resident: Physician who at January 1 of dues year is in an
approved training program as a hospital resident or research
fellow who is licensed to practice medicine and surgery in
Wisconsin.
Military Service: Members who are serving in the U.S.
armed forces (generally not to exceed five years).
Associate: Member whose dues are waived because of fi-
nancial hardship due to illness or disability. This classifica-
tion is temporary and is reviewed on an annual basis.
Life: Member who has held membership in a state medical
society for 50 years or is a Past President of the State Med-
ical Society of Wisconsin.
Honorary: Member who was named by the Board of Direc-
tors in recognition of long and distinguished service to the
cause of medicine.
Retired: Member who has completely retired from practice
(works less than 240 hours per year). All dues are waived
Your membership in organized medicine will help in-
sure the continued "safety" of your practice and quality
care for all patients. Your voice will be heard through par-
ticipation. Membership in the State Medical Society of Wis-
consin also requires membership in the county medical
society (AMA membership is optional but encouraged). For
Regular, Part-time Practice, or Over Age 70 membership
classifications, dues may be paid in one lump sum or in two
equal installments: one-half of the total payable by January
1, the other half not later than May 15, 1986 which is the
removal date for those members who have not completed
payment. You are urged to renew your membership.
unless county society indicates they wish to charge county
dues.
Part-time Practice: Physician, regardless of age, who prac-
tices 1,000 hours or less during the calendar year but does
not qualify for retired membership.
Over Age 70: Member in active practice who is over 70
years of age as of January 1.
Candidate: Member attending a medical school in Wiscon-
sin or fulfilling a postgraduate obligation prior to eligibility
for licensure.
Scientific Fellow: The Board of Directors may by invitation
and unanimous consent confer upon any person engaged in
teaching of or research in one or more of the basic sciences
at an accredited college or university, and not holding the
degree of Doctor of Medicine or Osteopathy, the status of
Scientific Fellow.
Emeritus: Retired members who have chosen not to renew
their license.
1986 DUES AMOUNTS FOR THESE
CLASSIFICATIONS
SMS
AMA
COUNTY
Regular
$455.00
$375.00
Normal County Dues
1st Year in Practice
$227.50
$187.00
Normal County Dues
2nd Year in Practice
$341,25
$281.00
Normal County Dues
Two Physician Family
$405.00
$375.00
Normal County Dues
Part-Time Practice
$227.50
$375.00/-0-’
Normal County Dues
Part-Time— Over Age 70
$227.50
$187.00*
Normal County Dues
Resident
$ 45.50
$ 45.00
Varies
Military Service
-0-
$250.00/$ 45.00 -0-
Associate
-0-
-0-
-0-
Retired
-0-
$375.00/-0-*
-0-
Retired— Over Age 70
-0-
-0-
-0-
Life
-0-
$375.00/-0-*
-0-
Honorary
-0-
$375.00/0-*
-0-
Over Age 70
$227.50
$375.00/-0 *
Normal County Dues
Candidate-
Freshman Year
Medical Student
-0-
$ 20.00
Varies
Sophomore and
Succeeding Medical
Student Years
$ 10.00
$ 20.00
Varies
Postgraduate— One
$ 10.00
$ 45.00
Varies
Scientific Fellow
-0-
-0-
-0-
Emeritus
-0-
-0-
-0-
* Physicians in these categories may be eligible for exemption from paying AMA dues
under the grandfather clause:
AMA dues-exempt members who were granted exemption before 1986 based on pre-
viously established criteria, with the exception of financial hardship or disability, will
automatically be dues-exempt in 1986 and beyond under the grandfather clause.
Under new AMA policy, only the following two categories of physicians will qualify
for new dues exemption:
(1) Financial hardship and/or disability.
(2) 70 years of age or older and fully retired
State Society dues are prorated on a monthly basis for
those elected to membership July 1 through September 30.
Those elected after September 30 have no dues payable for
the balance of the year in which they are elected. AMA dues
follow the same pattern except prorating is on a semiannual
basis rather than monthly basis.
To begin the membership process, if your practice is or
will be located in Wisconsin, or you have any questions, you
may contact your local county society or call the Member-
ship and Communications Division of the State Medical
Society, if in Wisconsin: 1-800-362-9080 (Madison area num-
ber: 257-6781). ■
26
WISCONSIN .MEmCALJOCRNAl., NOVEMBER 1985: VOL. 84
ALZHEIMER’S DEMENTIA
Cure of the disease is still out of reach.
In as devastating a condition as this,
even the most modest relief of
symptoms — or for that matter keeping
them from getting worse or merely
slowing their intensification — is a
great contribution to patient and family.
HYDERGINE® LC (ergoloid mesylates) is
indicated for patients over age sixty
who manifest signs and symptoms of
idiopathic mental decline. It appears
that individuals who respond to
HYDERGINE LC therapy are those who
would be considered to suffer from
some ill-defined process related to
aging or to suffer from some
underlying condition such as
Alzheimer’s dementia.
Before prescribing HYDERGINE therapy, the possibility that the patient’s signs and
symptoms arise from a potentially reversible and treatable condition should be
excluded. In addition, because the presenting clinical picture may evolve to suggest
an alternative treatment, the decision to use HYDERGINE therapy
should be continually reviewed.
HYDERGINE* LC
(ergoloid mesylates)
liquid capsules, 1 mg
THE ONLY PRODUCT INDICATED FOR ALZHEIMER’S DEMENTIA.
® 1985 Sandoz, Inc.
HYD-1085-13
For Brief Summary, please see following page.
HYDERGMElfi
)[QOll]l
liquid capsules
1 1U9
Indications: Symptomatic relief of signs and
symptoms of idiopathic decline in mental capacity
(i.e., cognitive and interpersonal skills, mood, self-
care, apparent motivation) in patients over sixty.
It appears that individuals who respond
to HYDERGINE therapy are those who would
be considered clinically to suffer from some
ill-defined process related to aging or to have some
underlying dementing condition, such as primary
progressive dementia, Alzheimer's dementia, senile
onset, or multi-infarct dementia. Before pre-
scribing HYDERGINE'® (ergoloid mesylates), the
physician should exclude the possibility that signs
and symptoms arise from a potentially reversible
and treatable condition, particularly delirium and
dementiform illness secondary to systemic disease,
primary neurological disease, or primary
disturbance of mood. Not indicated for acute or
chronic psychosis regardless of etiology (see
Contraindications).
Use of HYDERGINE therapy should be continually
reviewed, since presenting clinical picture may
evolve to allow specific diagnosis and specific alter-
native treatment, and to determine whether any
initial benefit persists. Modest but statistically
significant changes observed at the end of twelve
weeks of therapy include: mental alertness, confu-
sion, recent memory, orientation, emotional labil-
ity, self-care, depression, anxiety/fears, cooperation,
sociability, appetite, dizziness, fatigue, bother-
some(ness), and overall impression of clinical
status.
Contraindications: Hypersensitivity to the drug:
psychosis, acute or chronic, regardless of etiology.
Precautions: Because the target symptoms are of
unknown etiology, careful diagnosis should be
al tempted before prescribing H)’DERGINE (ergo-
loid mesylales) preparations.
Adverse Reactions: Serious side effects have not
been found. Some transient nausea and gastric
disturbances have been reported, and sublingual
irritation with the sublingual tablets.
Dosage and Administration: 1 mg three times daily.
Alleviation of symptoms is usually gradual and
results may not be observed for 3-4 weeks.
How Supplied: HYDERGINE LC (liquid capsules);
1 mg, oblong, off-white, branded “HYDERGINE LC
1 mg" on one side. "A" other side. Packages of 100
and 500. (Encapsulated by R. R Scherer, N.A.,
Clearwater, Florida 33518).
HYDERGINE (ergoloid mesylates) tablets (for
oral use); 1 mg, round, white, embossed
"HYDERGINE 1" on one side, “A" other side.
Packages of 100 and 500.
Each liquid capsule or tablet contains ergoloid
mesylates USP as follows; dihydroergocornine
mesylate 0.333 mg, dihydroergocristine mesylate
0.333 mg, and dihydroergocryptine (dihydro-
alpha-ergocryptine and dihydro-beta-ergocryptine
in the proportion of 2;1) mesylate 0.333 mg, repre-
senting a total of 1 mg.
Also available: HYDERGINE sublingual tablets;
1 mg, oval, white, embossed "HYDERGINE” on one
side, “78-77" other side. Packages of 100 and 1000.
0.5 mg, round. white, embossed "HYDERGINE 0.5"
on one side. "A" other side. Packages of 100 and
1000.
HYDERGINE liquid; 1 mg/ml. Bottles of 100 mg
with an accompanying dropper graduated to deliver
1 mg. IHYD-ZZ24-6 15 84I
Before prescribing, see package circular for full
product information. hyd-io85-i3
DORSEY PHARMACEUTICALS
Division of Sandoz. Inc • East Hanover, NJ 07936
A SANDOZ COMPANY
Practice management workshops
The AMA's Department of Practice
Management is planning 1986 workshops for
physicians and medical office staff in approx-
imately 50 different locations throughout the
country. This expansion of the Department's
efforts will bring AMA workshops to many
more physicians than in the past. Final sched-
ules for January through June 1986 will be
available soon. For further information contact
Suzanne Fraker, Director, Dept of Practice
Management, AMA Headquarters, Chicago.
The telephone number is (312) 645-4792. ■
U.S. Postal Service STATEMENT OF OWNERSHIP, MAN-
AGEMENT AND CIRCULATION of the ^^isconsin Medical
Journal, issued monthly.
PUBLISHER: State Medical Society of Wisconsin, 330 East
Lakeside Street, Madison, Wisconsin 53715
MEDICAL EDITOR: V S. Falk, MD, 5 West Rollin Street,
Edgerton, Wisconsin
MANAGING EDITOR: Mary Angell, 330 East Lakeside
Street, Madison, Wisconsin
OWqsiER: Same as publisher above.
KNOWN BONDHOLDERS, MORTGAGEES, AND OTHER
SECURITY HOLDERS OWNING OR HOLDING I PER-
CENT OR MORE OF TOTAL AMOUNT OF BONDS,
MORTGAGESOR OTHER SECURITIES: None.
THE PURPOSE, FUNCTION, AND NONPROFIT STATUS
OF THIS ORGANIZATION AND THE EXEMPT STATUS
FOR FEDERAL INCOME TAX PURPOSES have not
changed during the preceding 1 2 months.
EXTENT AND NATURE OF CIRCULATION
AVERAGE
ACTUAL
NUMBER
NUMBER
COPIES EACH
OF COPIES OF
ISSUE DURING
SINGLE ISSUE
PRECEDING 12
PUBLISHED
MONTHS
NEAREST TO
FILING DATE
Total number copies primed
(net press run)
6304
6300
Paid circulation (mail sub-
scriptions)
6148
6165
Total paid circulation
6148
6165
Free distribution by mail, carri-
er or other means (samples,
complimentary, and other
free copies)
80
35
Total distribution
6248
6200
Office use. left-over, un-
accounted spoiled after print-
mg
56
100
TOTAL
6304
6300
I cerlify ihai Ihe slalcmenis made by me are correct and complete.
/s/MARY ANGELL
Managing Editor
Date of filing: Sept 27, 1985
PS Form 3526, modified above for purposes of
prinimg.
For professional liability insurance, the stakes are too
high to depend on anyone else.
That's why the State Medical Society has endorsed a
professional liability plan which has been developed
especially for Wisconsin physicians.
Available only to members of the SMS— and offered
through SMS Services, Inc.— this medical malpractice policy
has superior features including:
• Consent of the physician is required before settlement of
any claim.
• Availability of legal counsel, experienced in defendant
medical liability.
• All members of claims and underwriting committees are
Wisconsin physicians.
• Occurrence coverage provided for claims arising during
the policy period, even if claim is reported at a later
time.
for the best in professional liability coverage, contact
SMS Services, Inc. at (608) 257-6781 or toll-free 1-800-362-9080
know how vital it is to safeguard the present...
and to protect the future.
Endorsed by the
State Medical Society
of Wisconsin
Underwritten by: ROFESSIONALS
INbUI^ANCE COMPANY
A respected leader in coverage for preferred markets.
ORGANIZATIONAL
Membership Directory— Update
The following information is being provided from Membership reports and from individual members for updating the
1985 Membership Directory as published in the July 1985 issue of the Wisconsin Medical Journal. Because of space limi-
tations address changes and phone numbers will not be included in this Update; however, they will be changed in
Membership records. County transfers will be included when processing has been completed by the Membership
Department.
Changes in practice specialties (as used by the AMA|
and changes in Board-certified specialties as listed by
the American Board of Medical Specialties.
(changes only with member's name; practice specialties appear
before the slash {/) and Board-certified specialties appear after
the slash. I
BARRON /WASHBURN/
BURNETT
DR IM / IM
Gary A Johnson MD
1030 Yorkshire Ave
Rice Lake WI 54868
FP / FP
Rodney G Olson MD
40 West Newton
Rice Lake WI 54868
FP / FP
Gary U Stelzer MD
40 West Newton
Rice Lake WI 54868
CHIPPEWA
Charles A Kemper MD
727 Maple St
PO Box 699
Chippewa Falls WI 54729
DANE
Brian G Bertha
2329 Sommers Ave, #2
Madison WI 53705
J M B Bloodworth Jr MD
2500 Overlook Terr
Madison WI 53705
PD HEM / PD
Jonathan L Finlay MD
606 Blue Ridge Pkwy
Madison WI 53705
AP
Anthony llejka MD
6317 Century Ave
Middleton WI 53562
IM
Jeffrey Kowitz MD
6120 Century Ave #101
Middleton WI 53562
GE IM
Mark L Lloyd MD
221 W Lakeside St
Madison WI 53715
IM
Brad Pohlman MD
6710-D Park Ridge Dr
Madison WI 53719
R / R
O Arthur Stiennon III MD
3575 Swoboda
Verona WI 53593
Nancy E Thorn MD
2653 Chamberlain Ave
Madison WI 53705
OPH / OPH
Joel M Weinstein MD
600 Highland Ave
Madison WI 53792
Eric C Westman
2635 Chamberlain Ave
Madison WI 53705
DOUGLAS
Robert R Mataezynski MD
1514 Ogden Ave
Superior WI 54880
OBG / OBG
Douglas R Meyer, MD
FOND DU LAC
FP / FP
Jean EJohnson MD
669 Thorne St
Ripon WI 54971
IM
Mariano L Rosales Jr MD
14 Beaver Dam St
Waupun WI 53963
FP / FP
Christal R Sakrison MD
669 Thorne St
Ripon WI 54971
KENOSHA
Nazario R Cruz MD
723 58th St
Kenosha WI 53140
LA CROSSE
IM
Steven L Benton MD
1410 State St, #3
La Crosse WI 54601
FP
William D Beyer MD
632 N 23rd St
La Crosse WI 54601
FP
Keven J Boyle MD
700 West Ave South
La Crosse WI 54601
Edward Cardona MD
1836 South Ave
La Crosse WI 54601
FP / FP
Thomas G Frisby MD
700 West Ave South
La Crosse WI 54601
NPM PD
Kim N Gelke MD
700 West Ave South
La Crosse WI 54601
EM
Kenyon R Gilbert MD
Rte 1, Box 143
Blair WI 54616
David E Goodnough MD
1836 South Ave
La Crosse WI 54601
FP
Karla R Grenz MD
700 West Ave South
La Crosse WI 54601
PD NPM / PD
John H Gunkel MD
224 South 21st St
La Crosse WI 54601
FP
Christopher M Fluiras MD
700 West Ave South
La Crosse WI 54601
END IM/IM
Gregory B Pehling MD
1836 South Ave
La Crosse WI 54601
FP
Scott Rysdahl MD
700 West Ave South
La Crosse WI 54601
MARINETTE/FLORENCE
Junji S Flashimoto MD
1510 Main St
Marinette WI 54143
MILWAUKEE
IM GE/IM
John D Agayoff Jr MD
3003 W Good Hope Rd
Milwaukee WI 53217
William G Anderson MD
5210 N 54th St
Milwaukee WI 53218
AN GS/AN
Senen S Arcilla MD
16525 Nancy Lane
Brookfield WI 53005
AN
Robert C Arfman MD
11712 Watertown Plank Rd
Milwaukee WI 53226
PD / PD
Cedor B Aronow MD
3003 W Good Hope Rd
Milwaukee WI 53217
Susan P Bass
1252 North 68th St
Wauwatosa WI 53213
PD / PD
Bonnie-Jo G Bates MD
3003 W Good Hope Rd
Milwaukee WI 53217
EM
Cynthia A W Bauer MD
3318 S 119th St
West Allis WI 53227
30
WISCONSIN MEOICAI. JOURNAL, NOVKMBER 1985: VOL. 84
ORGANIZATIONAL
MILWAUKEE continued
ORS
Mark M Benson MD
2040 W Wisconsin Ave, #452
Milwaukee WI 53233
IM j ID / IM
Barry Bernstein MD
3003 W Good Hope Rd
Milwaukee Wl 53217
CD IM / IM
Paul S Bernstein MD
3003 W Good Hope Rd
Milwaukee WI 53217
IM / IM
U Michael Blaschke MD
12011 W North Ave
Wauwatosa WI 53226
Dragan Bogunovic MD
3238 South 16th St
Milwaukee Wl 53215
D
Anthony Bonfiglio MD
777 West Glencoe PI
Milwaukee WI 53217
Terre Borkovec MD
3240 N Cambridge St
Milwaukee WI 53211
RHU IM / IM
Joseph A Bretza MD
8233 N Gray Log Lane
Fox Point WI 53217
IM / IM
John M Bryant MD
3003 W Good Hope Rd
Milwaukee Wl 53217
PD / PD
James S Bruce MD
3070 North 51st St
Milwaukee WI 53210
IM./ IM
Raymond S Brumblay MD
3003 W Good Hope Rd
Milwaukee WI 53217
OTO A/OTO
Richard K Brunelle DO
9900 W Bluemound Rd
Milwaukee WI 53226
PD / PD
Kathleen K Burchby MD
3003 W Good Hope Rd
Milwaukee Wl 53217
OBG / OBG
Paul D Burstein MD
1218 West Kilbourn
Milwaukee WI 53233
ORS
Jeffrey J Butler MD
4890 Langlade Dr
Milwaukee WI 53151
PTH
Marcia Jo Campbell MD
8700 W Wisconsin Ave
Milwaukee Wl 53226
A1 RHU/AI
Bruce L Charous MD
3003 W Good Hope Rd
Milwaukee Wl 53217
A PD / PD
Meenakshi Chintapalli MD
OTO HNS /OTO
Robert H Ciralsky MD
3003 W Good Hope Rd
Milwaukee Wl 53217
EM FP / FP
James W Cope Jr MD
2544 North 41st St
Milwaukee WI 53210
OBG
Renee R Coulter MD
1823 North 69th
Wauwatosa Wl 53213
P / PN
Maximo L Cueto Jr MD
2745 W Layton Ave
Milwaukee WI 53221
IM
Larry B Dean MD
3003 W Good Hope Rd
Milwaukee Wl 53217
IM HEM / IM
William L Deardorff MD
7400 Harwood
Wauwatosa Wl 53213
IM ID / IM
Thomas H Dee MD
1011 N Mayfair Rd, #209
Wauwatosa WI 53226
EM / EM
Arthur R Derse MD
5000 West Burleigh
Milwaukee Wl 53210
GS CDS / GS
William R Deshur MD
3070 North 51st St, #405
Milwaukee WI 53210
OBG
Frederick T Dickinson DO
9900 W Bluemound Rd
Wauwatosa WI 53226
GS
Brian L Dodds MD
2230 A N 56th St
Milwaukee Wl 53208
GP
Daniel J Donovan DO
7123 South 76th St
Franklin Wl 53132
ID IM / IM
Gerald J Dorff MD
12011 North Avenue
Milwaukee Wl 53226
END IM / IM
Elaine C Drobny MD
3003 W Good Hope Rd
Milwaukee Wl 53217
IM GE / IM
Drew M Elgin MD
3003 W Good Hope Rd
Milwaukee Wl 53217
IM
Richard L Erdman MD
3827 North 82nd St
Milwaukee WI 53222
GS/GS
Julian W Falecki MD
10125 W North Ave
Wauwatosa Wl 53226
PTH
Mary C Fieber MD
4620 West Medford
Milwaukee Wl 53216
IM / IM
Brenton H Field ]r MD
3003 W Good Hope Rd
Milwaukee Wl 53217
AN / AN
Paul J Fitzpatrick MD
101 Cardiff Rd
Wales WI 53183
IM / IM
Janies R Fonk MD
7400 Harwood Ave
Wauwatosa WI 53213
PD ID /PD
George T Frommeli MD
3003 W Good Hope Rd
Milwaukee WI 53217
IM
David E Fumo MD
821 East Oklahoma
Milwaukee Wl 53207
GP
William L Gerard DO
W161 N11629 Church St
Germantown WI 53022
IM
Daniel T Gerber MD
1737 North 47th St
Milwaukee WI 53208
FP
Beth L Gillis MD
PO Box 187
Tigerton WI 54486
GPM / GPM
Alfred S Gima MD
3003 W Good Hope Rd
Milwaukee WI 53217
GP
Mark J Giovanelli DO
8531 W Capitol Dr
Milwaukee Wl 53222
P
Erol F Giray MD
1220 Dewey Ave
Milwaukee Wl 53213
OTO A/OTO
Dean E Goblirsch DO
9900 W Bluemound Rd
Milwaukee WI 53226
PD / PD
Howard J Gollop MD
4747 N Idlewild Ave
Whitefish Bay WI 53211
OTO
Joseph H Graboyes MD
3003 W Good Hope Rd
PO Box 17300
Milwaukee Wl 53217
IM
Neil R Guenther MD
12655 Meadow Dr
Elm Grove Wl 53122
IM END / IM
Hayes H Hatfield MD
7400 Harwood Ave
Milwaukee WI 53213
IM PUD / IM
Richard G Harbecke MD
3003 W Good Hope Rd
Milwaukee WI 53217
AN / AN
Robert J Hlavac MD
3338 South Whitnall, #8
Milwaukee WI 53207
GE IM / IM
Samuel E Hoke MD
12011 W North Ave
Wauwatosa WI 53226
ORS / ORS
Norman W Hoover MD
3003 W Good Hope Rd
Milwaukee Wl 53217
DR
Lindsey W Inouye MD
2956 North 70th St
Milwaukee WI 53210
GP
D Sue Jennings DO
2040 W Wisconsin Ave, #770
Milwaukee WI 53233
IM
Timothy M Jest MD
12011 W North Ave
Wauwatosa WI 53226
WISCONSIN MEDICAL JOURNAL, NOVEMBER 1985: VOL. 84
31
ORGANIZATIONAL
MILWAUKEE continued
ORS
R / R
IM / IM
John F Lesko MD
Carol C Pohl MD
Ann R Selzer MD
IM
3003 W Good Hope Rd
3003 W Good Hope Rd
3003 W Good Hope Rd
Kenneth E Johnson MD
Milwaukee WI 53217
Milwaukee WI 53217
Milwaukee WI 53217
1123 Glenview Ave
Wauwatosa W1 53213
OBG / OBG
IM DIA / IM
CD IM/IM
Paul Lucca MD
Maynard D Poland MD
Suhas K Shelgikar MD
PD / PD
3003 W Good Hope Rd
3003 W Good Hope Rd
3124 South 27th St
Kenneth O Johnson MD
Milwaukee Wl 53217
PO Box 17300
Milwaukee WI 53215
3003 W Good Hope Rd
Milwaukee W1 53217
EM
Milwaukee Wl 53217
AI PD / AI
David R Madenberg DO
ORS / ORS
Brock V' Sherman MD
GS CDS/GS
5000 West Chambers
John T Propsom MD
3003 W Good Hope Rd
Steven K Kappes MD
Milwaukee Wl 53210
3070 N 51st St
Milwaukee WI 53217
3003 W Good Hope Rd
Milwaukee W1 53217
IM
Milwaukee WI 53210
GP
Michael Martinez MD
IM
Eugene W Skrzypek DO
IM END/IM
310 West Wisconsin
Leonard C Rauen MD
2572 South 76th St
Hak joong Kim MD
Milwaukee Wl 53202
3003 W Good Hope Rd
West Allis WI 53219
8500 W Capitol Dr
Milwaukee W1 53222
ORS
Milwaukee Wl 53217
Kenneth M Solis MD
Leland R Mayer MD
IM
4232 W Highland Ave, #307
OTO
1 1909 Diane Dr
Luke E Rehrauer MD
Milwaukee WI 53208
Mark S Kitz MD
Wauwatosa WI 53226
5625 W Brown Deer Rd, #214
2516 N 124th St, ^164
Brown Deer WI 53233
P
Wauwatosa W1 53226
FP
Brian T Steinhaus MD
Richard E Meyerchak MD
IM
409 E Silver Spring Dr
ORS
5306 N Port Washington Rd
Manuel A Rivera MD
Milwaukee WI 53217
Charles A Klein MD
Milwaukee Wl 53217
5623 W Washington Blvd
PD PUD
3007 North 70th St
Milwaukee WI 53208
Milwaukee W1 53210
IM /IM
John C Stevens MD
Gerald J McCarthy MD
IM / IM
3003 W Good Hope Rd
N
4936 North Diversey
Donald'G Roach MD
Milwaukee WI 53217
Kevin M Klein MD
Milwaukee WI 53217
7400 Harwood Ave
ORS
1612 North 50th St
Wauwatosa WI 53213
Milwaukee WI 53208
Gerald T Mclnerney MD
James E Stoll Jr MD
2400 South 90th St
GS CDS/GS
3003 W Good Hope Rd
ORS
West Allis WI 53227
Richard E Rodgers MD
Milwaukee Wl 53217
Philip D Konkel MD
2110 Glenview Ave
OBG
2040 W Wisconsin Ave, #503
Milwaukee Wl 53233
IM NEP/IM
Wauwatosa Wl 53213
Joanne E Metoff MD
Winfred H Stringer MD
10010 W Edgerton Ave
IM
12011 West North Ave
HNS PS / OTO
Hales Corners WI 53130
Leon B Rose MD
Wauwatosa WI 53226
Anthony S Krausen MD
3003 W Good Hope Rd
FP EM
8225 N 52nd St
Brown Deer WI 53233
Robert R Stumpf
Milwaukee Wl 53217
Suresh K Misra MD
545 North 106
3201 South 16th St
DR R / R
Wauwatosa WI 53226
IM
Milwaukee WI 53215
Robert S Ruggero MD
GP CD
Kathryn C Kricg MD
PD / PD
3003 W Good Hope Rd
3003 W Good Hope Rd
Milwaukee WI 53217
Alfred R Talens MD
Milwaukee WI 53217
Mark J Mitchell MD
2745 W Layton Ave
3003 W Good Hope Rd
AN
Milwaukee WI 53221
PD
Milwaukee WI 53217
Richard L Rusch MD
CD IM / IM
Ann M Larew MD
IM / IM
2977 North 50th St
201 1 W North Ave
Milwaukee WI 53210
Melish A Thompson Jr MD
Milwaukee WI 53226
Michael B Mosleth MD
3003 W Good Hope Rd
3003 W Good Hope Rd
Ezzeldin M Salaina MD
Milwaukee WI 53217
IM
Milwaukee WI 53217
2350 North Lake Dr, #504
Richard E B Larew MD
Milwaukee WI 53211
Richard D Turcott MD
7400 Harwood Ave
N IM / IM
PO Box 13064
Wauwatosa WI 53213
MareJ Novom MD
IM
Wauwatosa Wl 53213
FP / FP
3003 W Good Hope Rd
Milwaukee WI 53217
Robert J Santilli MD
3003 W Good Hope Rd
OBG / OBG
Steven R Lasater MD
Milwaukee Wl 53217
Gerald L Vitamvas MD
3921 South 76th St
GP
3003 W Good Hope Rd
Milwaukee WI 53220
Thomas P Pelino DO
FP
Milwaukee WI 53217
AN / AN
8651 West North Ave
Wauwatosa, WI 53226
Kenneth M Saydcl DO
2572 South 76th St
GS CDS/GS
Thomas E Lass MD
West Allis WI 53219
Michael J V'olkert MD
6300 N Port Washington Rd
IM
ON IM / MON IM
1201 1 W North Ave
Milwaukee WI 53217
Paul A Peterson
Wauwatosa Wl 53226
3009 North Frederick
Milwaukee WI 53211
Michael W Schuetz MD
3003 W Good Hope Rd
Milwaukee WI 53217
32
WISCONSIN MKDICAI JOl RNAL, NO\ KMBFR 1985 :\Ol. 84
MEMBERSHIP DIRECTORY-UPDATE
ORGANIZATIONAL
MILWAllKEE continued
Sally Vrana
2814 North 47th St
Milwaukee WI 53210
GS / GS
Alonzo P Walker MD
424 East Racine
Mequon WI 53092
Peter P Wisniewski MD
5164 S Mallard Circle
Milwaukee WI 53221
GP
H Harpster Wonder DO
2572 South 76th St
West Allis WI 53219
PD / PD
Linda S Woodward MD
3070 North 51st St, Rm 304
Milwaukee WI 53201
AN
Michael P Woods MD
5000 W National Ave
Wood WI 53192
AN / AN
Alan R Zarkower DO
5310 W Capitol Dr
Milwaukee WI 53216
PD
Mary Jo Zimmer MD
3003 W Good Hope Rd
Milwaukee WI 53217
OZAUKEE
Richard W Bunting MD
326 West Pierre Lane
Port Washington WI 53074
PD / PD
Kalapurackal J Chako MD
10620 North Ivy Ct
Mequon WI 53092
PD / PD
Thomas B Chatton MD
1707 Willow Lane
Grafton WI 53024
IM / IM
William A Ehinger MD
10414 N Bittersweet Ct
Mequon WI 53092
PD / PD
John N Goetz MD
326 West Pierre Lane
Port Washington WI 53074
IM / IM
Kevin J Goniu MD
215 W Washington St
Grafton WI 53024
IM / IM
Thomas J James MD
W62 N536 Washington Ave
Cedarburg WI 53012
PD ADL / PD
Edwin G Montgomery Jr MD
215 W Washington St
Grafton WI 53024
GS
Gwenn K Pavlovitz MD
215 W Washington St
Grafton WI 53024
RACINE
GS CDS
Peter J Bartzen Jr MD
5625 Washington Ave
Racine WI 53406
Howard H Johnson MD
5516 Acorn Trail
Racine WI 53402
ORS
Robert Laing MD
5625 Washington Ave
Racine WI 53406
ROCK
GS CDS/GS GVS
Mayer Katz MDB
Doctors! Watch your mail for the
1986 membership dues statement
scheduled to arrive in mid-Novem-
ber. See page 26 of this issue for
further details.
Are you ready
future?
are exp^s of
ISgIng the business aspect of medical
practices. Our prote^onai coni^itants wilt .
tailor solutions to ycxir special needs , . > , '
solutions that result in increased pro-
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maximized income for today — and
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Your time is valuable.
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Turn of the century
trephine forcranial surgery
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removing tonsils.
We’ve been defending
doctors since
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These instruments were the best available at
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New
Motrin 800rf^
ibuprofen
/ Once-daily INDERAL LA
(propranolol HCI) for
smooth blood pressure
control without the
potassium problems
of diuretics
( )iK ('-daily INDI RAl 1 A ([tropr.inolol I IC'D
.tvoids th(' risk ol diiirc'tic -indtit c'd I ('( 1 .ih-
norm<iliti('s diit’ to hvpokalt'iiiia.' ’ In addi-
tion, INDI KAl I A ftrc'sc'ivc's [totassiiini
balaiK (' without additivo a^t'nts or siip[)k'-
nu'nts v\ hik' [)ro\ idini; siniftk', W('ll-tok'rat('d
tlu'ia[A with broad c ardiovasailar Ix'iiolits.
Once-daily INDERAL LA
for the cardiovascular
benefits of the world's
leading beta blocker
Siniftiv start with 80 mg ont o daily. Dosago
may Ix' int rtMstxl to 1 JO mg to IhO mg onc e
daily as notxkxl to at hioye additional control
I iko fonyontional INDERAL tablets,
INDERAl. l.A should not bo used in tho
txt'sonc o ot c'ongostiyo heart tailuro, sinus
Ixadyoardia, heart Itkx k greater than first
(k'gree, and Ixonchial asthnia.
Tilt’ appe.v.vice ot these capsu es
IS a reciisiereP traciemarK
ot Aversi Laporatohes
80 ma 120 mci 100 mg
Please see bnet summar\ ot proscribing iniormation
on the next page tor tutther details
For beta-1/ beta-2
blockade
Once-daily
INDERALLA
(PROPRANOLOL HCI)
LONG ACTING
CAPSULES
BRIEF SUMMARY (FOR FULL PRESCRIBING INFORMATION. SEE PACKAGE CIRCULAR )
INDERAL’ LA brand of propranolol hydrochloride (Long Acting Capsules)
DESCRIPTION. Inderal LA is formulated to provide a sustained release ol propranolol
hydrochloride Inderal LA is available as 80 mg. 120 mg, and 160 mg capsules
CLINICAL PHARMACOLOGY. INDERAL is a nonseleclive beta-adrenergic receptor
blocking agent possessing no other autonomic nervous system activity It specifically com-
petes with beta-adrenergic receptor stimulating agents for available receptor sites When
access to beta-receptor sites is blocked by INDERAL. the chronotropic, inotropic, and
vasodilator responses to beta-adrenergic stimulation are decreased proportionately
INDERAL LA Capsules (80, 120. and 160 mg) release propranolol HCI at a controlled and
predictable rale Peak blood levels following dosing with INDERAL LA occur al about 6 hours
and the apparent plasma half-life is about 10 hours When measured at steady stale over a 24-
hour period the areas under the propranolol plasma concentration-time curve (AUCs) for the
capsules are approximately 60% to 65% of the AUCs for a comparable divided daily dose of
INDERAL tablets The lower AUCs for the capsules are due to grealer hepatic metabolism of
propranolol, resulting from the slower rale of absorption ol propranolol Over a twenty-four (24)
hour period, blood levels are fairly conslant lor about twelve (12) hours then decline
exponenlially
INDERAL LA should not be considered a simple mg for mg subslitute for conventional
propranolol and the blood levels achieved do not match (are lower than) those of two to four
times daily dosing with the same dose When changing to INDERAL LA from conventional
propranolol, a possible need for retitration upwards should be considered especially to
maintain effectiveness at the end of the dosing interval In most clinical settings, however,
such as hypertension or angina where there is little correlation between plasma levels and
clinical effect. INDERAL LA has been therapeutically equivalent to the same mg dose of
conventional INDERAL as assessed by 24-hour effects on blood pressure and on 24-hour
exercise responses ol heart rate, systolic pressure and rale pressure product INDERAL LA
can provide effective beta blockade for a 24-hour period
The mechanism of the anlihyperlensive effect of INDERAL has not been established
Among the factors that may be involved in contributing to the antihypertensive action are (1)
decreased cardiac output, (2) inhibition of renin release by the kidneys, and (3) diminution ol
tonic sympathetic nerve outflow from vasomotor centers in the brain Although total peripheral
resistance may increase initially, it readjusts to or below the pretreatment level with chronic
use Effects on plasma volume appear to be minor and somewhat variable INDERAL has
been shown to cause a small increase in serum polassium concentration when used in the
treatment of hypertensive patients
In angina pectoris, propranolol generally reduces the oxygen requirement of the heart at
any given level of effort by blocking the catecholamine-induced increases in the hear! rate,
systolic blood pressure, and the velocity and extent ol myocardial contraction Propranolol
may increase oxygen requirements by increasing left ventricular liber length, end diastolic
pressure and systolic ejection period The net physiologic effect of beta-adrenergic blockade
IS usually advantageous and is manifested during exercise by delayed onset of pain and
increased work capacity
In dosages greater than required for beta blockade, INDERAL also exerts a quinidine-like
or anesthetic-like membrane action which affects the cardiac action potential The signifi-
cance of fhe membrane action in the treatment of arrhythmias is uncertain
The mechanism of the antimigraine effect of propranolol has not been established Beta-
adrenergic receptors have been demonstrated in the pial vessels of the brain
Beta receptor blockade can be useful in conditions in which, because of pathologic or
functional changes, sympathetic activity is detrimental to the patient But there are also
situations in which sympathetic stimulation is vital. For example, in patients with severely
damaged hearts, adequate ventricular function is maintained by virtue of sympathetic drive
which should be preserved In the presence of AV block, grealer than first degree, beta
blockade may prevent the necessary facilitating effect ol symoathelic activity on conduction
Beta blockade results in bronchial constriction by interfering with adrenergic bronchodilator
activity which should be preserved in patients subject to bronchospasm
Propranolol is not significantly dialyzable
INDICATIONS AND USAGE. Hypertension: INDERAL LA is indicated in the manage-
ment of hypertension, it may be used alone or used in combination with other antihypertensive
agents, particularly a thiazide diuretic INDERAL L.A is not indicaled in the management of
hypertensive emergencies
Angina Pectoris Due to Coronary Atherosclerosis: INDERAL LA is indicaled
for the long-term management of patients with angina pectoris
Migraine: INDERAL LA is indicated for fhe prophylaxis of common migraine headache
The efficacy of propranolol in the treatment of a migraine attack that has started has not been
established and propranolol is not indicated for such use
Hypertrophic Subaortic Stenosis: INDERAL LA is useful in the management of
hypertrophic subaortic stenosis, especially tor treatment of exertional or other stress-induced
angina, palpitations, and syncope INDERAL LA also improves exercise pertormance The
effectiveness of propranolol hydrochloride in this disease appears to be due to a reduction of
the elevated outflow pressure gradient which is exacerbated by beta-receptor stimulation
Clinical improvement may be temporary
CONTRAINDICATIONS. INDERAL IS contraindicated in 1) cardiogenic shock, 2) sinus
bradycardia and greater than first degree block. 3) bronchial asthma, 4) congestive heart
failure (see WARNINGS) unless the failure is secondary to a tachyarrhythmia treatable with
INDERAL
WARNINGS. CARDIAC FAILURE* Sympathelic stimulation may be a vital component sup-
porting circulatory function in patients with congestive heart failure, and its inhibition by beta
blockade may precipitate more severe failure Although beta blockers should be avoided in
overt congestive heart failure, if necessary, they can be used with close follow-up in patients
with a history of failure who are well compensated and are receiving digitalis and diuretics
Beta-adrenergic blocking agents do not abolish the inotropic action of digitalis on heart
muscle
IN PATIENTS WITHOUT A HISTORY OF HEART FAILURE, conlinued use of beta blockers
can. in some cases, lead to cardiac failure Therefore, at the first sign or symptom of heart
failure, the patient should be digitalized and/or treated with diuretics, and the response
observed closely, or INDERAL should be discontinued (gradually, if possible).
IN PATIENTS WITH ANGINA PECTORIS, there have been reports of exacerbation of
angina and, in some cases, myocardial infarction, following abrupl discontinuance of
INDERAL therapy Therefore, when discontinuance of INDERAL is planned the dosage
should be gradually reduced over al least a few weeks, and the patient should be
cautioned against interruption or cessation of therajDy without the physicians advice If
INDERAL theraiw is interrupted and exacerbation of angina occurs, it usually is advis-
able to reinstitute INDERAL therapy and take other measures appropriate lor the man-
agement of unstable angina pectoris Since coronary artery disease may be
unrecognized, it may be prudent to follow fhe above advice in patients considered at risk
of having occult atherosclerotic heart disease who are given propranolol for other
indications
Nonallergic Bronchospasm (e.g., chronic bronchitis, emphysema) —
PATIENTS WITH BRONCHOSPASTIC DISEASES SHOULD IN GENERAL NOT RECEIVE BETA
BLOCKERS INDERAL should be administered with caution since it may block bronchodila-
lion produced by endogenous and exogenous catecholamine stimulalion of beta receptors
MAJOR SURGERY The necessity or desirability of withdrawal of beta-blocking therapy
prior to major surgery is controversial It should be noted, however, that the impaired ability ol
the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthe-
sia and surgical procedures
The appearance of these capsules
IS a registered trademark
of Ayerst Laboratories
INDERAL (propranolol HCI). like other beta blockers, is a competitive inhibitor of beta-
receptor agonists and its effects can be reversed by administration of such agents, e g
dobutamine or isoproterenol However, such patients may be subject to protracted severe
hypotension Difficulty in starting and maintaining the heartbeat has also been reported with
beta blockers
DIABETES AND HYPOGLYCEMIA Beta-adrenergic blockade may prevent the ap-
pearance ol certain premonitory signs and symptoms (pulse rate and pressure changes) of
acute hypoglycemia in labile insulin-dependent diabetes In these patients, it may be more
difficult to adjust the dosage of insulin
THYROTOXICOSIS Beta blockade may mask certain clinical signs of hyperthyroidism
Therefore, abrupl withdrawal of propranolol may be followed by an exacerbation of symptoms
of hyperthyroidism, including thyroid storm Propranolol does not distort thyroid function tests
IN PATIENTS WITH WOLFF-PARKINSON-WHITE SYNDROME, several cases have been
reported in which, after propranolol, the tachycardia was replaced by a severe bradycardia
requiring a demand pacemaker In one case this resulted after an initial dose of 5 mq
propranqiol
PRECAUTIONS. General Propranolol should be used wilh caution in patients with impaired
hepatic or renal function INDERAL (propranolol HCI) is not indicated tor the treatment of
hypertensive emergencies
Beta adrenoreceptor blockade can cause reduction of intraocular pressure Patients
should be told that INDERAL may interfere with the glaucoma screening test Withdrawal may
lead to a return ol increased iniraocular pressure
Clinical Laboratory Tests Elevated blood urea levels in patients with severe heart disease
elevated serum transaminase, alkaline phosphatase, lactate dehydrogenase
DRUG INTERACTIONS Palients receiving calecholamine-depleting drugs such as reser-
pine should be closely observed if INDERAL is administered The added catecholamine-
blocking action may produce an excessive reduction of resting sympathetic nervous activity
which may result in hypotension, marked bradycardia, vertigo, syncopal attacks or orthostatic
hypotension
Carcinogenesis. Mutagenesis. Impairment o! Fertility Long-term studies in animals have
been conducted to evaluate toxic effects and carcinogenic potential In 18-month studies in
both rats and mice, employing doses up to 150mg/kg/day. there was ho evidence of significant
drug-induced toxicity There were no drug-related tumorigenic effects at any of the dosage
levels Reproductive studies in animals did not show any impairment ol fertility that was
attributable to the drug
Pregnancy Pregnancy Category C INDERAL has been shown to be embryotoxic in
animal studies at doses about 10 times greater than the maximum recommended human dose
There are no adequate and well-controlled studies in pregnant women INDERAL should
be used during pregnancy only if the potential benefit justifies the potential risk to the fetus
Nursing Mothers: INDERAL is excreted in human milk Caution should be exercised when
INDERAL IS administered to a nursing woman
Pediatric Use Safety and effectiveness In children have not been established
ADVERSE REACTIONS. Most adverse effects have been mild and transient and have
rarely required the withdrawal of therapy
Cardiovascular bradycardia, congestive heart failure, intensification of AV block, hypo-
tension, paresthesia of hands, thrombocytopenic purpura, arterial insufficiency, usually of the
Raynaud type
Central Nervous System lightheadedness, mental depression manifested by insomnia,
lassitude, weakness, fatigue, reversible mental depression progressing to catatonia, visual
disturbances, hallucinations, an acute reversible syndrome characterized by disorientation for
fime and place, short-term memory loss, emotional lability, slightly clouded sensorium, and
decreased pertormance on neuropsychometrics
Gastrointestinal nausea, vomiting, epigastric distress, abdominal cramping, diarrhea,
constipation, mesenteric arterial thrombosis, ischemic colitis
Allergic pharyngitis and agranulocytosis, erythematous rash, fever combined with aching
and sore throat, laryngospasm and respiratory distress
Respiratory bronchospasm
Hematologic agranulocytosis, nonthrombocytopenic purpura, thrombocytopenic
purpura
Auto-Immune In extremely rare instances, systemic lupus erythematosus has been
reported
Miscellaneous alopecia. LE-like reactions, psoriasiform rashes, dry eyes, male impo-
tence. and Peyronies disease have been reported rarely Oculomucocutaneous reactions
involving the skin, serous membranes and conjunctivae reported for a beta blocker (practolol)
have not been associated with propranqiol
DOSAGE AND ADMINISTRATION. INDERAL LA provides propranolol hydrochloride in a
sustained-release capsule for administration once daily If patients are switched from INDERAL
tablets to INDERAL LA capsules, care should be taken to assure that the desired therapeutic
effect IS maintained INDERAL LA should not be considered a simple mg for mg substitute for
INDERAL INDERAL LA has dilferent kinelics and produces lower blood levels Retitration may
be necessary especially to maintain effectiveness at the end of the 24-hour dosing interval
HYPERTENSION — Dosage must be individualized. The usual initial dosage is 80 mg
INDERAL LA once daily, whether used alone or added to a diuretic The dosage may be
increased to 120 mg once daily or higher until adequate blood pressure control is achieved
The usual maintenance dosage is 120 to 160 mg once daily In some instances a dosage of 640
mg may be required The fime needed for full hypertensive response to a given dosage is
variable and may range Irom a few days to several weeks
ANGINA PECTORIS — Dosage must be individualized Starting with 80 mg INDERAL 1_A
once daily, dosage should be gradually increased at three to seven day intervals until optimum
response is obtained Although individual patients may respond at any dosage level, the
average optimum dosage appears to be 160 mg once daily In angina pectoris, the value and
safety of dosage exceeding 320 mg per day have not been established
If freatment is to be discontinued, reduce dosage gradually over a period of a few weeks
(see WARNINGS)
MIGRAINE — Dosage must be individualized The initial oral dose is 80 mg INDERAL LA
once daily The usual effective dose range is 160-240 mg once daily The dosage may be
increased gradually to achieve optimum migraine prophylaxis If a satisfactory response is not
obtained within four to six weeks after reaching the maximum dose. INDERAL 1_A therapy
should be discontinued It may be advisable to withdraw the drug gradually over a period of
S6V0r3l W66kS
HYPERTROPHIC SUBAORTIC STENOSIS— 80-160 mg INDERAL LA once daily
PEDIATRIC DOSAGE — At this time the data on the use of the drug in this age group are too
limited to permit adequate directions for use
REFERENCES
1. Holland OB, Nixon JV, Kuhnert L: Diuretic-induced ventricular ectopic
activity. Am J Med 1981;70:762-768. 2. Holme I, Helgeland A, Hjermann
I, et al: Treatment of mild hypertension with diuretics. The importance of ECG
abnormalities in the Oslo study and in MRFIT. JAMA 1984.251.1298-1299.
Ayersfe
AYERST LABORATORIES
New York. NY 10017
9411/1184
Copyright © 1984 AYERST LABORATORIES
Division of AMERICAN HOME PRODUCTS CORPORATION
HDX Clinical Hanagenent Systen
6) Appointnent Scheduling
7) Medical History
who IS number 1
in medical
olFice computer
systems m
Wisconsin?
1) Financial Accounting
2) Insurance Clain Tracking
J H I in ITTFinS N Rl
Not IBM nor Apple nor any other nationally-known
computer name. The answer is Advanced Technology
Associates. Number 1 means the most complete systems; the
most logical match of hardware, software and services. ATA is
the source for total packages — computers, terminals, printers,
special medical programs, careful installation, training for
your people and after-sale support.
Considering the scope of our Wisconsin experience, it
should not surprise you that ATA is endorsed by the State
Medical Society.
May we send you information listing your benefits from
a strictly medical office computer system? Call or write.
Advanced Technology Associates
4710 W. North Avenue, Milwaukee, Wl 53208
(414) 445-4280
In Wisconsin call toll free 1-800-242-4280.
-• SI!
Endorsed by SMS Services, Inc For members of the State Medical Society of Wisconsin.
SOCIOECONOMICS
SMS Liability Task Force chairman testifies
The State Medical Society was
well-represented October 2 by
Dr William] Listwan, West Bend,
in his testimony before the state
Senate's Committee on Labor,
Business, Veterans Affairs, and
Insurance.
As chairman of the SMS Task
Force on Medical Liability, Doctor
Listwan spoke in support of those
elements of Senate Bill 328 which
would:
—help stabilize medical malprac-
tice premiums and reduce the
Patients Compensation Fund
deficit;
—provide for a wider range of
sanctions against physicians
found negligent;
—strengthen peer review and the
Medical Examining Board's
role; and
—allow institution of surcharges
on insurance premiums for
those physicians who have
claims paid on their behalf.
Doctor Listwan's testimony
urged a $1 million cap on non-
medical, components of awards
and unlimited payments on medi-
cal damages which are outlined
comprehensively in SB 328.
Joining Doctor Listwan in sup-
port of SB 328 were:
—Frank Thatcher, a member of
the Fund board of governors
who served on the Legislative
Council's special subcommittee
which drafted SB 328;_
—Gladys Voegtli of Senior Health-
care, a consumer advocacy
group;
—Mari Nahn, an attorney on the
staff of the Wisconsin Hospital
Association;
—Thomas Fox, state insurance
commissioner;
—Bill Klouthis, Wisconsin Rapids,
a representative of the Wiscon-
sin Association of Manufac-
turers and Commerce's (WMC)
task force on healthcare cost
containment; and
—Fred Shaffer, WMC's legislative
counsel.
Testifying against the bill were
representatives of the Wisconsin
Academy of Trial Lawyers and
some of its members' selected
clients.
SB 328 is expected to work its
way through the legislative pro-
cess to the Governor's desk for en-
actment March 26, 1986. Further
information on SB 328 can be
found in the President's Page else-
where in this issue.*
SPOTLIGHT ON SB 328
Ten statewide press conferences in two days
Medical malpractice from the
physician's perspective was the
focus of 10 press conferences
around the state September 25-26.
The tour was part of SMS's con-
tinuing REACH program. SMS
President Dr John K Scott and
SMS Task Eorce on Medical Lia-
bility Chairman Dr William J List-
wan met with more than 40 re-
porters in the series of conferences
held largely at airports to ensure
maximum coverage in the allotted
time.
The press conferences were
scheduled to take place exactly
one week before state Senate Bill
328 goes to hearing before the
Senate's Labor, Business, Vet-
erans Affairs and Insurance Com-
mittee chaired by Jerome Van Sis-
tine (D-Green Bay).
The emphasis in each meeting
with reporters was on the SMS's
proposed amendments to SB 328,
specifically that seeking to place a
$1 million cap on "nonmedical"
expense portions of the total
amount awarded in a case.
As Doctor Listwan and Doctor
Scott stressed, the purpose of the
SMS proposal is "to pay the medi-
cal expenses of an injured person
and to care for that individual in
the future" while at the same time
preserving the basic intent of the
Patients Compensation Fund.
Yet, without fail, at each press
conference location, at least one
journalist inquired as to whether
the malpractice issue isn't simply
one of "the doctors versus the
lawyers."
SMS representatives were aware
the Wisconsin Academy of Trial
Lawyers had its own response to
SB 328 in which, incidentally, it
agrees the draft legislation's pro-
posed absolute cap of $3.3 million
on all awards should be dropped.
It is clear. Doctor Listwan told re-
porters, that it is principally the
trial lawyers who stand to lose the
most should any cap be placed on
awards; but the SMS proposal
would ensure a patient suffering
medical losses would be compen-
sated to whatever extent required.
Two other themes running con-
sistently throughout the question-
ing in all 10 cities were:
—What about the "bad doctor":
should the profession be more
continued on next page
42
WISCONSIN MEDICAI JOl RNAI., NOVEMBER I985:VOL. «4
TEN STATEWIDE PRESS
SOCIOECONOMICS
Continued from preceding page
aggressive in its self-policing
measures?
—And, what kinds of cutbacks in
insurance costs can the average
individual expect if the SMS
proposal is enacted into law?
In response, the SMS said:
—There is no denying that both
the peer review system and the
Medical Examining Board need
to be strengthened. The SMS
fully endorses the components
of SB 328 which deal with
tougher sanctions on doctors.
—If caps are placed on malprac-
tice awards, physicians and the
public alike cannot expect to see
anything more than a holding of
the line on healthcare or mal-
practice insurance premium
costs as a direct result.
Several reporters expressed in-
terest in writing or broadcasting
additional series, features or edi-
torials on the medical liability is-
sue. To assist them, the SMS has
prepared a list of physician con-
tacts for reporters seeking to in-
terview members of the profes-
sion to "localize” the subject.
SMS will continue to work with
the media statewide to educate
and inform legislators and the
public about the need for reform
in the medical liability arena.*
Medicare participating physician program clarified
Due to the considerable confu-
sion that still exists concerning
physician reimbursement under
the Medicare program, HCFA
plans to send a letter of clarifica-
tion to all physicians serving Med-
icare patients as soon as possible.
Under the Emergency Extension
Act of 1985, the existing Medicare
fee and reimbursement freeze will
continue for at least 45 days,
through November 14.
The following points may clarify
physicians' particular concerns:
• Physicians who participated
10/ 84-9/ 85 and are participating
this year may increase their ac-
tual charges but, at least during
this extension, their Medicare
reimbursement levels will re-
main frozen.
• Physicians who participated
10/84-9/ 85 and have opted out
of the program as of 10/1/85
(they are now "non-participat-
ing”) must roll back their
NOTE: Physicians who fall in-
to this category are strongly
urged to request in writing, by
registered mail from WPS, a
complete record of their charge
levels in effect during the April-
June 30, 1984 base period. Fol-
lowing this record of charges
from 15-18 months ago will
serve to avoid inadvertent vio-
lations of the freeze.
charges to the levels that were in
effect during the April/May/
June quarter of the 1984 base
period.
• Physicians who did not partici-
pate from 10/84-9/85 and re-
main non-participating as of
10/ 1 / 85, must keep their fees to
Medicare patients frozen as they
have been since the inception of
the program. This means that
their charges must be held to the
base period levels, April 1-
June 30, 1984.
• Physicians who did not partici-
pate from 10/84-9/85 but who
have elected to participate as of
10/1/85, may increase their
charges to Medicare patients.
They will not be held to the
April 1-June 30, 1984 charge
levels but they must accept as-
signment on 100% of their Med-
icare patients.
For those non-participating
physicians who raised their fees
on October 1, 1985 before know-
ing the freeze extension, they
must return to the fee levels that
were in effect 10/84-9/85. (It is
still unclear at this writing if
HCFA will create penalties for any
increased fees during the early
days of October or if they will
overlook this because of the late
actions of Congress and subse-
quent tardy information sent to
physicians on this topic.)
Physicians are also reminded
that it is still very likely that Con-
gress may provide an opportunity
later in the year to change their
participating status for the period
ending September 30, 1986.
For more information contact
the Physicians Alliance Division at
SMS Headquarters in Madison:
1-800-362-9080 toll-free or (608)
257-6781.*
Medical malpractice
conference tapes
Requests for the audio cas-
sette tapes of the May 10-11
Medical Malpractice Confer-
ence are being processed as
rapidly as possible, with about
a three-week waiting period.
Because of the overwhelm-
ing response for these tapes
members who receive the
tapes are asked to make every
effort to return them to SMS
as soon as possible. Requests
are being handled on a first-
come, first-served basis.
Requests should be directed
to the SMS Physicians Alliance
Division: 1-800-362-9080 or
Madison 257-6781 (ext 162).
WISCONSIN MEDICAL JOURNAL, NOVEMBER 1985:VOL. 84
43
BLUE BOOK UPDATE
On page 1 13 of the June Blue Book issue, the fol-
lowing changes under Corporate Members Repre-
senting Component County Medical Societies of the
Charitable, Educational and Scientific Foundation
should be made.
Calumet: William E Hannon MD— 1988
Clark: Vangalla J Reddy MD— 1987
Fond du Lac: William G Sybesma, MD— 1987
Forest: Burton Rathert MD— 1988
Green Lake-Waushara: Barry L Rogers, MD— 1987
Lincoln: James Bigalow MD— 1987
Monroe: Carlos A Jaramillo MD— 1987
Racine: Dennis] Kontra MD— 1988
Rock: Arthur C Plautz Jr MD— 1986
Rusk: Joseph Bachir MD— 1988
On page 123 under the Committee on Environmen-
tal and Occupational Health, the subgroup-Ad Hoc
Committee on the Public Health Consequences of Nu-
clear Armaments is composed of:
Susan M Wester, MD, La Crosse
Marc Hensen, MD, Madison
Ben R Lawton, MD, Marshfield
Melvin S Blumenthal, MD, Monroe
Allen Meyer, MD, Eau Claire
William A Morgan, MD, La Crosse
Jeffrey Patterson, DO, Madison
On page 121 under the Section Representatives of
the Physicians Alliance Commission, the following ap-
pointments have been made.
Allergy Section: Robert J Kriz, MD, Madison
Dermatology Section: Kenneth J Pechman, MD, Racine
Emergency Medicine Section: Mark Olsky, MD, Madison
Internal Medicine Section (2nd representative]: Robert W
Ninneman, MD, West Bend
Neurology Section: Gamber F Tegtmeyer, MD, Madison
Preventive Medicine Section: Constantine Panagis, MD,
Milwaukee
On pp 132 and 133 change Raymond Zastrow's ad-
dress to 2400 West Villard Ave.a
[public health
National Institutes on Health
Consensus Development
Conference Statement
(Summary and conclusions)
Traveler's Diarrhea
Diarrhea is the major health
problem in travelers to develop-
ing countries. Travel to high-risk
areas in Latin America, Africa,
the Middle East, and Asia is asso-
ciated with diarrhea rates of 20 to
50 percent. The syndrome is
caused by an infection acquired
by ingesting fecally contaminated
food or beverages. Escherichia
coli, a common species of enteric
bacteria, is the leading pathogen,
although a host of other bacteria,
viruses, and protozoa have been
implicated in some cases.
Prudent dietary and hygienic
practices should be followed, and
— )
they will prevent some, but not
all, diarrhea. Antimicrobial
agents are not recommended for
prevention of TD. Such wide-
spread usage in millions of travel-
ers would cause many side ef-
fects, including some severe
ones, while preventing a disease
that has had no reported mortal-
ity. Instead of universal antimi-
crobial prophylaxis, a more sen-
sible approach is rapid institution
of effective treatment that can
shorten the disease to 30 hours or
less in most people. For mild diar-
rhea, an antimotility drug such
as diphenoxylate or lopera-
mide could be taken. Alter-
natively, bismuth subsalicylate,
which works somewhat slower,
can be used. For more severe
diarrhea, an antimicrobial drug
may be used for treatment, and
trimethoprim / sulfamethoxazole,
trimethoprim alone, and doxycy-
cline are among the choices.
These drugs could be carried by
the traveler for use in the event of
illness. Oral rehydration should
be instituted when necessary.
The millions of Americans who
travel annually to developing
countries and their physicians
must be warned of the potential
risks of prophylactic antimicro-
bial drugs, with the attendant
side effects in otherwise healthy
individuals, and should be in-
formed of the alternative method
of prompt, effective treatment for
diarrhea.
Free single copies of the con-
sensus statement on travelers'
diarrhea are available from:
Michael J Bernstein
Office of Medical Applications
of Research
National Institutes of Health
Building 1, Room 216
Bethesda, Maryland 20205b
WOMEN IN MEDICINE Project has compiled a resource packet on the work patterns, practice characteristics,
and income of female physicians. Copies of the 63-page document, titled 'In the Marketplace,' are available
from Women in Medicine Project, AMA headquarters, Chicago. The telephone number is (312) 645-4391. B
44
WISCONSIN MEDICAL JOURNAL, NOVEMBER 1985:VOL. 84
•Physician members of the State Medical Society of Wisconsin
PHYSICIAN BRIEFS
James Ostiguy, MD, Appleton, has
joined the medical staff of the
Carenow Convenience Clinic.
Doctor Ostiguy graduated from
the University of Massachusetts
Medical School and completed his
internship and residency at St
Francis Medical Center in Peoria,
111.
James E Burwitz, MD,* recently
became associated with the Care-
now Convenience Clinic in Apple-
ton. Doctor Burwitz graduated
from the University of Wisconsin
Medical School, Madison, and
served his family practice resi-
dency at the University of Wis-
consin-Wausau program. He
previously practiced in the New
Lisbon Community Clinic.
Rolf Poser, MD, Columbus, a
member of the Poser Clinic, re-
cently had a research paper pub-
lished in the American Heart
Journal. The article entitled "Ag-
gravation of Arrhythmia Induced
with Antiarrhythmic Drugs dur-
ing Electrophysiologic Testing" is
about commonly used heart medi-
cations which suppress extra and
sometimes dangerous heart beats.
Barry B Edelstein, MD, Marsh-
field, has joined the Department
of Radiology at the Marshfield
Clinic. Doctor Edelstein gradu-
ated from the State University of
New York-Downstate Medical
Center in Brooklyn. He served his
internship at the University of
Chicago Hospital where he also
completed his residency in radi-
ology. Doctor Edelstein previ-
ously had been in private practice
in Chicago.
James B Unger, MD, * recently be-
came associated with the Marsh-
field Clinic. Doctor Unger, who
had previously served on the
medical staff of the Clinic, gradu-
ated from the University of Il-
linois Abraham Lincoln School of
Medicine in Chicago. His resi-
dency in obstetrics and gynecol-
ogy was completed at the Univer-
sity of Mississippi in Jackson.
Doctor Unger previously had
practiced at the Carbondale Clinic
in Illinois.
Dennis D Ohlrogge, MD,* Hol-
men, has joined the medical staff
of the Skemp-Grandview Holmen
Clinic in Holmen. Doctor Ohl-
rogge graduated from the Univer-
sity of Minnesota School of Medi-
cine and completed his residency
at St Mary's Hospital in Mil-
waukee. He practiced from 1982-
1985 in Nome, Alaska.
David A Onsrud, DO,* has joined
the medical staff of the Skemp-
Grandview Clinic, La Crosse.
Doctor Onsrud graduated from
the College of Osteopathic Medi-
cine and Surgery, Des Moines,
Iowa. He completed his residency
at Good Samaritan Hospital, Mil-
waukee.
James Deming, MD, recently be-
came associated with the Skemp-
Grandview's Lake Tomah Clinic.
Doctor Deming graduated from
the University of Wisconsin Medi-
cal School and completed his
family practice residency at the
Cedar Rapids, Iowa Medical Edu-
cation Program.
Robert E Phillips, MD,* Marsh-
field, medical director of Bethel
Living Center in Arpin, has been
chosen Physician of the Year by
the Wisconsin Association of
Nursing Homes. For the past five
years. Doctor Phillips has been
the attending physician at Bethel
and for two and one-half years, he
has been medical director and pri-
mary physician for Bethel resi-
dents. Doctor Phillips also is a
member of the medical staff at the
Marshfield Clinic.
Jim Le Claire, MD, Washburn, re-
cently became associated with the
Bayfield County Hospital and
Clinic. Doctor Le Claire graduated
from the Mayo Medical School,
Rochester, Minn, and served his
internship at St Joseph's Hospital,
Milwaukee. His residency was
completed at the University of
Wisconsin, Madison.
Michael Woods, MD, Brookfield,
has been chosen one of the 10
Healthy American Fitness Leaders
for 1985. Doctor Woods, who was
a speed skating competitor in the
1984 Olympics, was chosen for
the time and talent he has donated
while serving as vice president of
the Wisconsin Olympic Ice Rink
Foundation.
Randall J Casper, MD, recently be-
came associated with the Midel-
fort Clinic in Eau Claire. Doctor
Casper graduated from the Uni-
versity of Minnesota School of
Medicine and served his resi-
dency at Hennepin County Medi-
cal Center in Minneapolis. He is in
the Department of Internal Medi-
cine.
Edward P Horvath, Jr, MD,*
Marshfield, recently resigned his
position in the Department of Oc-
cupational Medicine at the Marsh-
field Clinic to accept the position
as Corporate Director of Occupa-
tional Health for Standard Oil
Company in Cleveland, Ohio.
Doctor Horvath was a member of
the Committee on Environmental
and Occupational Health of the
State Medical Society.
James O Redmann, MD, has joined
the Department of Ophthalmol-
ogy at the Midelfort Clinic in Eau
Claire. Doctor Redmann gradu-
ated and also served his residency
at the Medical College of Wiscon-
sin in Milwaukee.
WISCONSI.\ MEDICAL JOURNAL, NOVEMBER 1985: VOL. 84
45
PHYSICIAN BRIEFS
Richard Lucas, MD, has joined the
Department of Psychiatry at the
Midelfort Clinic, Eau Claire. Doc-
tor Lucas graduated from the Uni-
versity of Pennsylvania School of
Medicine and completed his resi-
dency at the University of Cali-
fornia.
Michael R Diestelmeier, MD, re-
cently became associated with the
Midelfort Clinic in Eau Claire.
A CES
9 Foundation
(> of the State Medical
^ Society of Wisconsin
T
The Charitable, Educational
and Scientific Foundation of
the State Medical Society of
Wisconsin recognizes the gener-
osity of the following individuals
and organizations who have
made contributions during the
month of September 1985.
BROWN COUNTY LOAN
FUND
Dr and Mrs Loren E Hart
Mrs Merrill (Zelda) Roghoff
Dr and Mrs Herbert Sandmire
Dr and Mrs Robert Schmidt
MEMORIALIZED
Mrs Mary Burns
Adolph Hutter, Sr, MD
Vivian Romberg
Clarence Rothe, MD
MEMORIALS
Dane County Medical Society
Dr and Mrs Loren E Hart
Mrs Merrill (Zelda) Roghoff
Dr and Mrs Herbert Sandmire
Dr and Mrs Robert Schmidt
Winnebago County Medical
Society Auxiliary
WORK WEEK OF HEALTH
State Medical Society
of Wisconsin
Doctor Diestelmeier graduated
from the University of Iowa Medi-
cal School and completed his in-
ternship and residency, in derma-
tology, at Walter Reed Army
Medical Center, Washington, DC.
Thomas J Murphy, MD, recently
joined the Grafton Clinic. Doctor
Murphy graduated from St Louis
University School of Medicine
and completed his residency at
the Tufts University Medical
School Affiliated Hospitals in
Springfield, Mass, and the Yale
University Affiliated Hospital,
New Haven, Conn. From 1980-
82, Doctor Murphy served in the
United States Public Health Serv-
ice Corps.
Carrie Ware, MD, has joined the
medical staff of the Artwich Clinic
in Oconto Falls. She graduated
from the Oregon Health Sciences
University, Portland, and com-
pleted her residency at Oregon
Health Sciences University and
the Portland Veterans Administra-
tion Hospital.*
AMA Physician's Recognition
Award Recipients
Listed below are those physicians in Wisconsin who have earned the
AMA Physician's Recognition Award in recent months. The State
Medical Society of Wisconsin congratulates these physicians who have
distinguished themselves and their profession by their commitment to
continuing education:
AUGUST
* Arndt, George W, Neenah
* Beckes, Robert], Wauwatosa
* Berridge, Frank E, Milwaukee
* Bhore, Jayawant N, Milwaukee
Boehme, Larry R, Hillsboro
Cullen, Gerald M, Milwaukee
* Davila, Julio C, Wausau
* Dernlan, Robert L, Manitowoc
* Doyle, Thomas], Eau Claire
* Fink, Richard A, La Crosse
* Frechette, Paul F, Janesville
* Geist, Jack E, Milwaukee
* Goren, Carolyn, La Crosse
* Gromer, RexC, Neenah
* Hankey, Terry L, Wausau
Heckman, Margaret G, Wood
* Ibach, Harold F, Milwaukee
* Logan, Richard, Middleton
Lorenzen, Kraig E, Brookfield
Manning, Dennis P, Milwaukee
* Martens, William E, Wauwatosa
* Matzke, Robert F, Janesville
* Meeter, Urquhart L, Medford
* Mockert, Thomas, Sheboygan
* Nair, Velayudhan K, Monroe
* Przlomski, Andrew T, Kenosha
* Quackenbush, Steven R, Woodruff
Rahko, Peter S, Madison
’Members of the State Medical Society
of Wisconsin
Remeniuk, Eudokia, New Berlin
* Rose, Quentin F, Milwaukee
* Sneed, Robert], Ashland
* Stewart, Richard D, Racine
Sullivan, Richard L, Milwaukee
* Tang, Thomas T, Milwaukee
* Toohill, Robert], Milwaukee
* Travelli, Renato, La Crosse
Urtes, Mary-Ann, Madison
* Wex, Thomas E, West Bend
* Witt, Raymond W, Kenosha
SEPTEMBER 1985
Becker, Robert C, Milwaukee
‘Betlach, Eugene H, Janesville
*Cohen, Steven H, Milwaukee
‘Cooke, William T, Richland Center
*De Kraay, Warren H, Kenosha
*Diba, Ali-Akbar, Milwaukee
‘Drury, Colin J, New Richmond
‘Erchul, James W, Appleton
Frazier, Harold N, Milwaukee
Geissler, Mark S, Madison
‘Kjentvet, Roger A, Wild Rose
‘Knauf, James W, Chilton
‘Lament, Frederick J, Green Bay
‘Lang, Gordon E, Milwaukee
‘Laufenburg, Herbert F, Cedarburg
‘Me Wey, Patrick J, Wauwatosa
‘Schulgit, Ronald E, Cudahy
‘Wilkins, Terrence], Milwaukee
‘Wright, Warren K, Chippewa Falls*
46
WISCONSIN MEDICAL JOURNAL, NOVEMBER l985:VOL. 84
It Pays
(f :
TO BE A
Member
X’x
V X
SMS
SERVICES p]
INC.
SMS Services, Inc.
Authorized SMS Services, Inc Insurance Representatives
Districts
1.
Donald E Mulock. District Manager
SMS Services, Inc
PO Box 68
Cudahy, Wl 53110
414/747-0919
1.
Executive Marketing Services, Ltd
890 Elm Grove Road, Suite 003
Elm Grove, Wl 53122
414/785-9900
1.
American Ins Mgmt, Inc
901 N Grandview Blvd
PO Box 2208
Waukesha, Wl 53187
414/547-0411
1.
Heil Financial Group
260 Regency Court
PO Box 827
Brookfield. Wl 53005-0827
414/785-4341
2.
Charles Sitkiewitz, District Manager
SMS Services, Inc
PO Box 1109
Madison, Wl 53701
608/257-6781
or 800/362-9080
3.
Don F Jabas Associates, Inc
1000 North Lynndale Drive
PO Box 937
Appleton, Wl 54912
414/731-0400
3.
Murphy Insurance Division
Alexander & Alexander, Inc
701 Cherry Street
PO Box 1204
Green Bay. Wl 54305
414/437-7123
3.
Hierl Insurance
258 S Main Street
Fond du Lac, Wl 54935
414/921-5921
6.
Weber Insurance Agency
929 Michigan Avenue
Sheboygan, Wl 53081
414/452-3521
7.
American Insurance Services, Ltd
PO Box 247
615 Barstow Street
Eau Claire, Wl 54702
715/839-8004
8.
Bead le-Ewing Insurance
6th and State
La Crosse, Wl 54601
608/784-4854
9.
OOU6LAS
VILAS
SAWYCR
fOAtST
FLOACNCE
MlC£
ONEiOA
-L-AhCLAOl
OCONTO
ST CNOU
BUFFALO
rR£MP£AL£AU
MONROC
CROSSE
)ZAUK££
VASMtNCTON
JEFFERSON
WAUKESHA
lAACINE
«E^0Sha.
Donald F Peterson, Manager
Service Programs
SMS Services, Inc
PO Box 1109
Madison, Wl 53701
608/257-6781
or 800/362-9080
5.
Orth-Abbott Insurance Service, Inc
6939 Mariner Drive
Racine, Wl 53406
414/886-9555
5.
John P Braun Agency
625 57th Street, #800
Kenosha, Wl 53140
414/657-3193
4.
Manson Insurance
First American Center
PO Box 1907
Wausau, Wl 54401
715/845-4371
or 800/472-1544
P.O. BOX 1109, MADISON, Wl 53701 • PHONE 608/257-6781 OR TOLL-FREE 1-800-362-9080
PHOTO Meg Theno Madison Capital Times
When Saving Time Means Saving Lives.
Your patients . . . they rely on you— your training and
your judgment, any day and any time. But in a critical
situation who can you rely on? Med Flight, the critical
care transport service from University of Wisconsin Hospi-
tal and Clinics.
Med Flight, an integral part of the hospital’s complete
critical care system, carries a specially-trained physician
on every flight, certified and experienced in Advanced
Trauma Life Support and Advanced Cardiac Life Support,
and a registered nurse trained in critical care.
Med Flight— a direct link between you and specialized
critical care. Through Med Flight's communication net-
work, you will be in constant contact with a physician
before, during and after Med Flight's arrival.
Med Flight, with full life support equipment, carries
up to three patients and three medical professionals at
one time. With a 200-mile service area and a 160 mph
cruising speed, it flies quickly and directly, to you and
your patient.
MED FLIGHT. When your patient’s life depends on you, you can depend on us.
For more information about MED FLIGHT, or any of the other critical care services available at UW Hospital and Clinics,
call (608) 263-8010.
600 Highland Avenue
Madison, WI 53792
In state
Out of state
1-800-472-01 1 1
1-800-343-0111
UW Hospital & Clinics
"Physician members of the State Medical Society of Wisconsin
SPECIALTY SOCIETIES
American Congress of Rehabili-
tation Medicine has elected John
L Melvin, MD,* Milwaukee, as its
first vice president at the recent
62nd Annual Session. Doctor Mel-
vin graduated from Ohio State
University and currently serves as
professor and chairman of the
Department of Physical Medicine
and Rehabilitation at the Medical
College of Wisconsin, Milwaukee.
He has been a member of ACRM
since 1966 and was elected to its
Board of Governors in 1980. He
will become president of ACRM
in 1987.
American College of Radiology re-
cently elected James J Sherry,
MD, * Milwaukee, a fellow of the
College. Doctor Sherry graduated
from the University of Cincinnati
College of Medicine and is pres-
ently on the medical staff of Co-
lumbia Hospital in Milwaukee.
He was selected for this honor for
his outstanding work in the field
of medical radiology.
American College of Physicians
has announced that Philip J Dahl-
berg, MD,* La Crosse, was elected
to fellowship in the ACP. A 1972
graduate of the University of Iowa
College of Medicine, Doctor Dahl-
berg is associated with the Gun-
dersen Clinic Ltd and the La
Crosse Lutheran Hospital. He will
be honored at the College's An-
nual Session in San Francisco in
April 1986.
Wisconsin Society of Internal
Medicine at the 30th Annual
Meeting held at Oshkosh, in-
stalled James R Mattson, MD,*
Green Bay, as president. He suc-
ceeds Anthony P Ziebert, MD* of
Milwaukee. Other officers in-
clude Charles S Geiger, MD,*
president-elect. West Bend, and
Cyril M Hetsko, MD,* secretary-
treasurer.
Doctor Mattson was elected to
the WSIM Council in 1980 and
served as secretary-treasurer dur-
ing 1983-84. Doctor Geiger was
elected to the WSIM Council in
1980 and has served as secretary-
treasurer since 1984. Doctor Het-
sko was elected to the WSIM
Council in 1981.
Susan L Turner, MD,* Marsh-
field; Les Harrison, MD, Chippe-
wa Falls; and James L Algiers,
MD, * Hartford, were all elected to
three-year terms on the WSIM
Governing Council. Continuing
on the Council are MDs, Terrence
N Hart,* Brookfield; Thomas P
Lathrop,* La Crosse; William J
Listwan,* West Bend; and Robert
E Phillips,* Marshfield.
Edwin L Overholt, MD,* La
Crosse, was designated an ex of-
ficio member of the Council as the
American College of Physician's
Governor of Wisconsin.
Robert F Madden, MD,* Mil-
waukee, was named as the recipi-
ent of the Society's 1985 Addis
Costello Internist of the Year
Award and William L Treacy,
MD,* Milwaukee, was presented
the 1985 WSIM Distinguished In-
ternist Award. James A Means,
MD,* Milwaukee, received a
WSIM award of merit for his
many years of service to the soci-
ety as the membership chairman.
Doctor Means is retiring from his
post this year.
During 1984-85, over 80 new
members were accepted into the
organization.
Council of the American College
of Surgeons, Wisconsin Chapter,
held an interim meeting April 26
in La Crosse. Dr J David Lewis,*
West Bend, presented a listing of
ambulatory surgery procedures
which he had developed based on
a survey of Wisconsin surgeons
and hospitals. This listing of pro-
cedures normally performed on
an outpatient basis was to be cir-
culated among the specialty
groups for input and then distri-
buted to the members.
Concerns with credentially and
quality care at Wisconsin surgical
centers were expressed. It was de-
cided to meet with the Wisconsin
Hospital Association to discuss the
lack of regulations and control of
surgical centers.
The Council affirmed a recom-
mendation of Dr Sanford Mack-
man*, Madison, that the Wiscon-
sin Chapter publicize the hazard
of postsplenectomy sepsis and the
availability of pneumococcal vac-
cine.
The Council's annual meeting
will be held December 7 at the
Marc Plaza Hotel in Milwaukee.
—Roger L von Heimburg, MD, *
Green Bay
American College of Physicians
has announced that Andrea
Dlesk, MD,* Marshfield, was
elected to fellowship in the ACP.
Doctor Dlesk will be honored at
the College's Annual Session to be
held in San Francisco in April
1986. A 1976 graduate of Harvard
Medical School, Doctor Dlesk is a
member of the Marshfield Clinic
and an assistant clinical professor
at the University of Wisconsin in
Madison.
Milwaukee Ophthalmological So-
ciety officers for the year 1985-86
have been announced as follows:
Robert A Hyndiuk, MD,* Mil-
waukee, president; Robert W
Pointer, MD,* Sheboygan, vice
president; Jack L Hughes, MD,*
Milwaukee, secretary; and Greg-
ory P Kwasny, MD,* Milwaukee,
treasurer. ■
WISCONSIN MEDICAL JOURNAL, NOVEMBER 1985:VOL, 84
49
COUNTY SOCIETIES
C
‘Physician members of the State Medical Society of Wisconsin
ADAMS MARQUETTE COLUM
BIA: At the September meeting of
the Adams-Marquette-Columbia
County Medical Society, the fol-
lowing physicians were elected as
officers for 1986; MDs Richard E
Christianson,* Portage, president;
Renato R Baylon,* Oxford, presi-
dent-elect; Paul] Slavik,* Portage,
secretary-treasurer; Robert T
Cooney,* Portage, delegate; and
Martin L Janssen,* Friendship, al-
ternate delegate.
BROWN: Seventy-five members
and guests were present at the
September meeting of the Brown
County Medical Society. Guest
speakers included MDs Peri L
Aldrich,* Don J Gallagher,* and
John Stevens who spoke on the
"Overview of Current Proposals
on Alternative Delivery Systems."
Mrs Deborah Bowen-Wilke, field
consultant from the Physicians Al-
liance Division of the State Medi-
cal Society and Ms Sally Wencel,
staff attorney for the State Medi-
cal Society, also were present to
answer questions. New members
accepted in the Society are MDs
Marc H Anderson,* Green Bay;
John F Andrews,* Green Bay;
James Berner,* DePere; Steven A
Halsey,* Green Bay; Paul C
Hodges Jr,* Green Bay; James D
McGovern,* Green Bay; Michael
F Phillips,* DePere; Susan M
Piechowski,* Green Bay; Roger H
Strube,* Green Bay; Kevin P
Wienkers,* Green Bay; and Rob-
ert C Zimmerman,* Green Bay.
RUSK: Forty-five members and
guests were present at the Sep-
tember meeting of the Rusk Coun-
ty Medical Society to hear guest
speaker Morris Davidman, MD,
chief of the Department of Ne-
phrology and director of the Kid-
ney Disease Center at Hennepin
County Hospital, Minneapolis,
Minnesota speak on "Practical As-
pects of Hypertensive Therapy."
WINNEBAGO: At the September
meeting of the Winnebago County
Medical Society, thirty-three mem-
bers and two guests were present
to hear J D Kabler, MD,* Madi-
son, speak on "Headaches. "■
Acme
Laboratories, Inc.
Qualified, competent profe.s.sionals are the
trademark of Acme Laboratorie.s. For
years, our certified orthotists and prirsthetists
have earned a reputation for excellence,
helping people improve their lives.
Acme Laboratories serves Wisconsin from
offices in .Milwaukee. Green Bay. Fond du
Lae and Woodruff. We're pleased to be a
designated HMO facility for southeastern
Wisconsin. Acme L.aboratories accepts all
insurance, including Medicare and Medicaid.
10702 W. Burleigh St., Milwaukee, Wl 53222
414-259-1090
GREEN BAY ORTHOPEDIC
Division of Acme Laboratories, Inc.
428 S. Adams St., Green Bay, Wl 54301
414-435-1461
525 E. Division St., Fond du Lac, Wl 54935
414-923-6676
Affilioled with Northwoods Rehabilitation
Box LOA, Woodruff, Wl 54568
715-356-8000 Ext. 8872
Acme Laboratories — where quality of
life is our main concern
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• Low cost rental service — $14.00
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• Convenient mall order service
to the 48 states
For more Information, call or write:
S. & L. SIGNAL COMPANY
Helping Enuretic Clients
Since 1950
1142 Fleetwood A ve. Madison, Wl 53716
Phone: 608-222-7939
Accepted for advertising In the AMA Journal
50
WISCONSIN MEOICAI. JOI RN AL, NOV EMBER 1983: VOL. 84
MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
Internal Medicine: BC / BE. Established
50-doctor multispecialty group practice
located in the Milwaukee, Wisconsin
metropolitan area. Expanding practice
needs two internists. Competitive salary
and excellent fringe benefits. Address in-
quiries and CV to Medical Director, PO
Box 427, Menomonee Falls, WI 53051.
plO-11/85
Growing multispecialty clinic is look-
ing for two family practitioners. One to
staff a three-person Walk-In Department
and the other to function in a traditional
family practice setting located in North
Central Wisconsin. New facility situated
across the street from new hospital. Full
partnership in two years. Easy access to
lakes, woods, and mountains. Write in-
cluding CV to D K Aughenbaugh, MD,
Medical Director, Wausau Medical Cen-
ter, 2727 Plaza Dr, Wausau, WI 54401.
pll-12/85:l/86
Family Practitioner. River Valley Medi-
cal Center is seeking two family practice
Board eligible /certified physicians for its
multispecialty group of 16 physicians in
Northwest Wisconsin. Excellent starting
salary and comprehensive fringe benefit
package the first year with full group
membership after one year. Attached to
a progressive 90-bed hospital. We are
within 45 minutes of the St Paul-Minne-
apolis area. Please contact Dr Carl Han-
sen, Recruitment Chairman or Tom Hal-
verson, Clinic Manager, 208 Adams St,
South, St Croix Falls, WI 54024; ph 715/
483-3221. pll/85;12tfn/85
Women's OB/GYN Care, SC of Wauke-
sha, Wisconsin, is seeking a BE/BC OB/
GYN, including residents finishing '86-87,
in a private, fee-for-services practice. This
would add a fifth OB/GYN to our call
schedule. Salary is negotiable with first
year guarantee and early partnership. This
50,000 member community has solid sup-
port for patient centered OB/ GYN care.
Referrals from area general practitioners
allow the OB / GYN to spend the majority
of time practicing the specialty. Our nurse
practitioner provides excellent patient
RATES; 50t per word, with a minimum
charge of $20.00 per ad. BOXED AD
RATES: $25.00 per column inch.
DEADLINE: Copy must be received by the
15th of the month preceding month of issue;
e.g., copy for the August issue is due July 15.
Send copy to: Wisconsin Medical Journal,
Box 1109, Madison, Wisconsin 53701; or
phone (area code 608) 257-6781; or toll-free
in Wisconsin: 800/362-9080.
education and preventive self-care. Our
hospital is a Level #2 Obstetric facility
with excellent pediatric colleagues, three
of whom have neonatal experience. Wis-
consin provides a myriad of outdoor and
recreational activities and Milwaukee cul-
tural events are only '/a hour away. Send
CV to Dr Anne Riendl, PO Box 1907, Wau-
kesha, WI 53187-1907; ph 414/544-2801.
11-12/85
Resident in Thoracic & Cardiovascu-
lar Surgery wanted to perform surgery to
correct deformities, repair injuries, pre-
vent diseases, and improve function of the
heart and thoracic cavity under supervi-
sion of hospital staff. Requires MD in
medicine and one year experience as a res-
ident in thoracic and cardiovascular sur-
gery. $20,000 per year, 40 hours per week.
Send resumes to Ben Loomis, 819 N 6th
St, Milwaukee, WI 53202; ph 414/224-
4208, J O #0254665 "Employer Paid Ad."
11/85
Directorship position available in a new
ambulatory care center to open December
1985 in Milwaukee, Wisconsin. Board eli-
gible/certified in family practice, internal
medicine, or emergency medicine de-
sired. Attractive compensation and bene-
fit package. Contact: Ms Debbie Carsky,
Director of Recruitment, (MESA) Medical
Emergency Service Associates, SC, 15 S
McHenry Rd, Buffalo Grove, IL 60089; ph
312/459-7304. 11/85
Family Practitioner wanted to share ex-
isting practice and fully-equipped medical
office in Waushara County. Salary plus in-
centives and opportunity for eventual pur-
chase of practice. Excellent recreational
area, a great place to live and raise a fam-
ily. Send inquiries to Roy Grunwaldt, Ad-
ministrator, Wild Rose Hospital, PO Box
243, Wild Rose, WI 54984; ph 414/622-
3257, ext 212. 11/85
Emergency Department Physician.
South Central Wisconsin. Emergency
medicine physician sought for progressive
emergency department. Physician enjoys:
independent contractor status, paid mal-
practice, flexible scheduling, and other
significant benefits. Call Kim Dials toll-
free at 1-800/231-0342. pll/85
Wisconsin, South Central. Board eli-
gible/certified family physician sought for
satellite facility in rural community of
2,400 as third member of a group. Oppor-
tunity to practice full spectrum family
medicine. Facility within 15-minute drive
of 68-bed, full-service hospital. Competi-
tive first-year minimum guarantee, full
benefits. Write or call: Joe Scholl, Fox Hill
Associates, 250 Regency Ct, Waukesha,
WI 53186; 414/785-6500. 11/85
Fifty-eight-year-old general practitioner
seeking part or full-time work in outpatient
medical practice. Considerable experience
in student health work. Have Wisconsin
license. Available reasonably soon. Inter-
ested in small communities. Contact Dept
571 in care of the Journal. pll-12/85
Wisconsin— Family Practice, Internal
Medicine, and Urology physicians to work
in Northern Wisconsin multispecialty
clinics. Guaranteed first year salary plus
fringes. Future partnership available. Send
CV to R J Sloan, MD, Lakeland Medical
Associates, Ltd, PO Box 549, Woodruff, WI
54568. 11/85
Wisconsin, Southeast. Family physician
seeking Board eligible /certified partner.
Practice located in rural community of
5,700 less than a 15-minute drive from
127-bed acute care hospital facility. Vari-
ous recreational opportunities. Guarantee
plus production incentive, full benefits.
Write or call: Joe Scholl, Fox Hill Associ-
ates, 250 Regency Ct, Waukesha, WI
53186; ph 414/785-6500. 11/85
Surgeon wanted to solo in northeast
Iowa near Mississippi River. Scenic and
recreational area including hunting, fish-
ing, boating. Two small community hos-
pitals, 1 1 referring physicians, previously
supporting one surgeon. Strong com-
munity and physician commitment. Hos-
pital-based office practice. Interest in basic
surgical orthopedics desired, but not re-
quired. Contact Dept 570 in care of the
Journal. 11/85
Emergency physicians full or part-time.
Positions available in a moderate volume
emergency room in Beloit, Wis. Must
have an active interest in community re-
lations. ACLS required. ATLS desirable. If
interested, contact John Maher, MD, Di-
rector, Emergency Department, Beloit
Memorial Hospital, 1969 W Hart Rd,
Beloit, WI 53511. 11-12/85
General Internist. Marshfield Clinic,
one of the nation's largest multispecialty
private groups, is seeking several Board
certified/Board eligible General Internal
Medicine specialists to join its expanding
16-member section. Internal Medicine
Residency Program, University af-
filiation, Research Foundation, and large
regional referral base contributes to a
very stimulating environment. Unique
big city medicine opportunity in a
family-oriented rural setting. Please
send curriculum vitae to: John P Folz,
Assistant Director, Marshfield Clinic,
1000 North Oak Ave, Marshfield, WI
54449 or call collect at 715/387-5181.
9-11/85
WISCONSIN MI'DICAL JOURNAL, NOVEMBER 1985:VOL. 84
51
MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
continued
Internist with or without subspecialty
interest. Board Certified or eligible, to
join six other internists in a well-estab-
lished, 23-man expanding multispecialty
group in prosperous lakeside south-
eastern Wisconsin city of 36,000. The
Internal Medicine Department currently
has subspecialties in cardiology, pul-
monary medicine, and medical on-
cology. Liberal fringe benefits. Initial
salary plus percentage as associate.
Full status in service corporation, with
incentive-oriented formula after first
year. Contact] F Kuglitsch, MD, Fond du
Lac Clinic, SC, 80 Sheboygan St, Fond
du Lac, Wis 54935; ph 414/923-7420
collect. 5tfn/85
Ophthalmologist, subspecialty pediatrics
or glaucoma helpful but not required.
Board certified /Board eligible, to join one
other Board certified ophthalmologist in
rapidly expanding 40-member multi-
specialty group with high level ophthalmic
pathology. Must be willing to do general
ophthalmology. Immediate drawing area
100,000 with unopposed subspecialty re-
ferral area much higher. Located on Lake
Michigan with excellent recreational ac-
tivities. Optometric support available. First-
year salary. Association after one year with
income based solely on production with
superb benefits package. Contact D K Ay-
mond, MD, The Sheboygan Clinic, 1011
North 8 Street, Sheboygan, WI 53081; ph
414/457-4461. 9tfn/85
Radiologist-Board certified, available for
part-time position for clinics in Mil-
waukee and neighboring counties. Con-
tact Dept 567 in care of the Journal.
10-11/85
FAMILY PRACTITIONERS
INTERNISTS, OB/GYN
The UW Office of Rural Health is seek-
ing primary care specialists for more
than 50 communities throughout Wis-
consin. Opportunities are available
throughout Wisconsin for Board certi-
fied physicians trained in US medical
schools and residencies.
CONTACT:
Laurie Glowac or Fred Moskol
New Physicians for Wisconsin
University of Wisconsin
Department of Family Medicine
777 S Mills St, Madison, WI 53715
Phone 608/263-4095 7/85-6/86
Wanted Board Certified Otolaryngol-
ogist. Head and neck surgeon. Join active
one-man practice. General otolaryngol-
ogy, head and neck surgery, facial plastic
surgery, nasal allergy. Computerized of-
fice with x-ray, audiologist, and hearing
aid dispensing. Northern Wisconsin near
Apostle Islands National Lakeshore. Con-
tact James A Hamp, MD, ENT Profes-
sional Associates, SC, 2101 Beaser Ave,
Suite 1, Ashland, WI 54806; ph 715/682-
9311. 10-12/85:1-3/86
Family practice opportunity— very
busy five-physician practice being cov-
ered by four physicians. Pleasant South
Central Wisconsin community of 15,000;
close to Milwaukee and Madison. Excel-
lent recreational area. First-year guaran-
teed salary. Excellent benefits. Contact:
C Burchardt, Medical Associates, 1200 N
Center, Beaver Dam, WI 53916; ph 414/
887-7101. lOtfn/85
General Internist. Board certified/
board eligible. Opening established prac-
tice with large multispecialty clinic, Mad-
ison. Competitive salary, excellent fringe
benefits. Send curriculum vitae and ref-
erences to Dept 568 in care of the
Journal. plO-11/85
Family Practice: Thirty-one physician
multispecialty group conveniently lo-
cated between Chicago and Milwaukee.
Well-equipped clinic offering salary
gaurantee with incentive bonus; excel-
lent fringe benefits and early ownership.
Please send curriculum vitae to: R D
Lacock, Administrator, Racine Medical
Clinic, 5625 Washington Ave, Racine,
WI 53406. 9tfn/85
Emergency Physician. Seeking third
full-time associate for modern, well-
equipped emergency outpatient depart-
ment. Lower volume ER. Thirty-five
miles north of Green Bay. Board eligible,
ATLS, ACLS certification desirable.
Beautiful rural Wisconsin. Send inquiries
with CV to Administrator, Community
Memorial Hospital, 855 S Main St, Ocon-
to Falls, WI 54154 or call 414/846-3444.
10-11/85
Orthopedic Surgeon sought by state-
of-the-art multispecialty group in Mil-
waukee, Wisconsin. Board certified/
eligible physician to join 3 other ortho-
pedists in the performance of indepen-
dent orthpedic evaluations for the pur-
pose of determining appropriate
treatment or disability. No weekends,
no call, no surgery. Competitive salary
and fringe benefits. Please submit CV
to Dept 566 in care of the Journal.
plO-11/85
Ophthalmologist. Board certified /Board
eligible, to join one other Board certified
ophthalmologist in rapidly expanding
40-member multispecialty group with high
level ophthalmic pathology. Immediate
drawing area 100,000. Located on Lake
Michigan with excellent recreational activ-
ities. First-year salary. Association after one
year with income based solely on produc-
tion with superb benefits package. Contact
D K Aymond, MD, The Sheboygan Clinic,
1011 North 8 Street, Sheboygan, WI 53081;
ph 414/457-4461. 9tfn/85
Pediatrics/Neonatology: Thirty-one
physician multispecialty group con-
veniently located between Chicago and
Milwaukee. Well-equipped clinic offer-
ing salary guarantee with incentive
bonus: excellent fringe benefits, and
early ownership. Neonatology skills
needed for Level II Nursery. Please send
curriculum vitae to R D Lacock, Admin-
istrator, Racine Medical Clinic, 5625
Washington Ave, Racine, WI 53406.
9tfn/85
Internist or Family Practitioner to join
two Internists and General Surgeon in
growing, established. Green Bay area
practice. Send CV to John Brusky, MD,
1203 South Military Ave, Green Bay, WI
53404. 7tfn/84
Physicians needed full or part-time to
perform light physicals. Milwaukee area.
Professional liability provided. Phone
414/344-2100, Ms Jenkins. lOtfn/84
Wisconsin: Pediatrician with sub-
specialty interest to join multispecialty
clinic that includes general pediatricians,
pediatric hematologist, oncologist and
neonatologist in city of 150,000. Send
CV to Dept 561 in care of the Journal.
8tfn/85
Internist-Infectious Disease Phy-
sician. The Racine Medical Clinic, a pro-
gressive cluster corporation of 32 phy-
sicians, is currently seeking an Internist-
Infectious Disease physician. Full bene-
fits, unlimited earnings and a full and
exciting practice are offered. Please con-
tact: Roger D Lacock, Administrator,
Racine Medical Clinic, 5625 Washington
Ave, Racine, WI 53406; ph 414/886-
5000. 6tfn/85
Pediatrician. BC/BE to join busy four-
member Pediatric Department within a
23-member multispecialty group. Excel-
lent benefits and competitive salary. Call
or write: W J Mommaerts, Administrator,
West Side Clinic, sc, 1551 Dousman St,
Green Bay, WI 54303; ph 414/494-561 1.
10-12/85:1/86
52
WISCONSIN MEDICAL JOURNAL, NOVEMBER 1985: VOL. 84
MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
continued
Excellent opportunity for a Board cer-
tified or eligible internist to practice
in conjunction with an 8-member Inter-
nal Medicine Department of a 26-mem-
ber multispecialty group. The group is
located in southeastern Wisconsin, in a
city of 100,000 between two major
metropolitan areas of greater than one
million. If interested, please send CV to:
Stephen L Wagner, Kurten Medical
Group, 2405 Northwestern Ave, Racine,
WI 53404. All inquiries will be kept
confidential. 6tfn/85
Family Practitioner needed to join two
FPs at the Ellsworth, Wisconsin office
of a progressive eleven-physician group.
Liberal fringes and financial package.
Forty miles from metropolitan Min-
neapolis/St Paul. Contact R M Hammer,
MD, River Falls, WI 54022; ph 715/425-
670 1 or 6 1 2/436-8809 . 4tfn/85
Wanted— Board qualified— board cer-
tified obstetrician-gynecologist as an
associate. Modern well equipped facility.
Excellent starting salary and benefits in-
cluding profit sharing plan. Please contact
Elizabeth Allen Steffen, MD, 734 Lake
Ave, Racine, Wis 54303. 9tfn/83
OB/GYN: BC/BE to join three OB-GYNs
in 31-physician multispecialty group.
Beautiful lakefront community of 90,000
located between Milwaukee and
Chicago offers a wealth of cultural, edu-
cational, and recreational opportunities.
Well-equipped clinic and two local
hospitals; salary guarantee with in-
centive bonus; excellent fringe benefits
and early partnership. Send curriculum
vitae to; R D Lacock, Administrator,
Racine Medical Clinic, 5625 Washington
Ave, Racine, WI 53406. 9tfn/85
Primary care physicians— Family Prac-
tice, General Practice, or ER experience
desirable. To staff clinics for industrial,
walk-in, after hours and satellite medi-
cine. Excellent opportunity— guaranteed
salary, profit-sharing, great fringes.
Send CV to: Administrator, Manitowoc
Clinic, PO Box 3008, Manitowoc, WI
54220. 9-12/85
Family Practitioner needed to join
established Family Practice group in East
Central Wisconsin city of 50,000 on
beautiful Lake Winnebago. Competitive
salary, fringes, excellent recreation area.
Send CV to MS Knier, MD, 555 S Wash-
burn, Oshkosh, Wis 54901; 414/426-0265.
lOtfn/84
Family Practice. Third family practice
physician needed to join multispecialty
group of 17 in Hartford, WI. Two branch
locations. All facilities modern and well
equipped. Guaranteed first year nego-
tiable salary: usual fringe benefits. Con-
tact: Murlin Bernd, Clinic Manager, 1004
E Sumner St, Hartford, WI 53027;
ph 414/673-5745. 10-11/85
Second Family Practitioner needed to
staff a satellite of a 38-physician multi-
specialty group in Kiel, a beautiful small
community in East Central Wisconsin. At-
tractive income arrangements, association
membership possible after one year, pen-
sion and profit sharing, extensive fringe
benefits. Contact R B Windsor, MD, 1011
North 8 St, Sheboygan, WI 53081; ph 414/
457-4461. c2tfn/85
West Bend, Wisconsin, General Clin-
ic, a (18) physician multispecialty group,
is seeking physicians in the specialties of
Internal Medicine, Family Practice, OB/
GYN, and Pediatrics. First-year salary
guaranteed. Corporate membership pos-
sible after one year. Excellent fringe
benefits. Located in scenic, recreational
area with close proximity to Milwaukee.
Please contact Hans W Schmelzling, Ad-
ministrator, General Clinic, 279 S 17th
Ave, West Bend, WI 53095; ph 414/338-
1123. 6tfn/85
ORTHOPEDIC SURGEON
Mid-Michigan community seeks orthopedic
surgeon for service area of 90,000. Guaranteed first
year income $150,000. Office space available in
medical office building adjacent to the hospital.
214-bed hospital provides excellent diagnostic
capabilities and new surgical facilities. Excellent
opportunity for a physician seeking busy private
practice opportunity with guaranteed success. Con-
tact Vice
723-5211,
President of Professional Service— 517/
ext 1823. pll-12/85;l-2/86
WISCONSIN MEDICAL JOURNAL, NOVEMBER 1985 i VOL. 84
53
MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
continued
Versatile Surgeon wanted to comple-
ment aggressive family practice group in
rural northeastern Minnesota resort com-
munity. Well-equipped 40-bed hospital
with proven surgical practice volume.
Outstanding outdoor recreational op-
portunities with time off to enjoy it.
Reply with CV to E Johnson, Ely Medical
Center, Ltd, 224 East Chapman Street,
Ely, Mn 55731; ph 218/365-3151. 6tfn/85
Board Eligible Orthopedic Surgeon to
join established orthopedic practice in
East Central Wisconsin. Contact Dept 553
in care of the Journal. 2tfn/85
Family Practice physician, BE/BC, to
share fully equipped medical office in
southeast Wisconsin with busy Board cer-
tified family practitioner. Opportunity for
partnership. Near Milwaukee and Chi-
cago, rural atmosphere. Excellent recrea-
tional, educational, hospital, and civic ad-
vantages. Send curriculum vitae to F M
Zarbock, MD, Box 158, S89 W22915
Maple Ave, Big Bend, WI 53103.
11-12/85:1/86
MEDICAL FACILITIES
Office for rent January 1986. Now used
for orthopedic surgeon. 32' x 50', includ-
ing waiting room, business office, two
large exam rooms, cast room, and office.
Free parking. Baraboo, Wisconsin. Phone
608/356-6644. 11/85
Family Practice for Sale. Southeastern
Wisconsin. Fully-equipped medical build-
ing with additional land for expansion.
Physician wishes to retire in near future.
Will assist in financing. Contact Mark
Gorman, 4109-67th St, Kenosha, Wiscon-
sin 53142; ph 414/654-9166. 11/85
General and surgical solo practice for
sale. Gross in excess of $300,000. Grow-
ing desirable midwestern university
HOLTER MONITOR
Quality Scanning for reel or cas-
sette type recorders by qualified
technicians and certified cardiolo-
gists' interpretations, scan price
$35.00 with UPS speedy delivery.
Recorders loaned, leased, or pur-
chase new dual-channel Holter re-
corders, $1295.00, with one-year
warranty. For more information call
Advance Medical and Research
Center 1-800/552-6753. lltfn/85
city with population 25,000. One very
well-equipped hospital in county of
60,000 a few blocks away. Owner will
remain to introduce. Contact Dept 563 in
care of the Journal. 9tfn/85
MISCELLANEOUS
Physicians. Ultrasonography Service in
your office. Milwaukee Ultrasonography
Service offers to bring realtime ultraso-
nography to your personal office. Service
now available in southeastern Wisconsin.
For information, please call Nancy Schil-
ler al 414/933-8795. 10-11/85
MEDICAL MEETINGS-
CONTINUING MEDICAL
EDUCATION
WISCONSIN
DECEMBER 7, 1985: Wisconsin Chap-
ter American College of Surgeons, Marc
Plaza Hotel, Milwaukee. gll/85
JANUARY 19-22, 1986: New Therapeu-
tics VI: The Results of Recent Advances in
Medicine. Telemark Lodge, Cable, Wis.
Sponsored by University of Wisconsin
School of Medicine and Continuing Medi-
cal Education. AMA Category I credit 14
hours. Family Practice credit pending,
University of Wisconsin CEUs 1.4. Con-
tact: Ann Bailey, Continuing Medical Edu-
cation, 454 WARF Bldg, 610 Walnut St,
Madison, Wis 53705; ph 608/263-2854.
11-12/85
Wisconsin Specialty
Society Meetings 1985-1986
• Wisconsin Society of
Pathologists, Nov 16, 1985,
American Club, Kohler
• Wisconsin Chapter American
College of Surgeons, Dec 7,
1985, Marc Plaza Hotel,
Milwaukee
• Wisconsin Urological Society,
Apr 11-12, 1986, Edgewater
Hotel, Madison
• Wisconsin Academy of Family
Physicians, June 11-14, 1986,
Telemark Lodge, Cable
• Wisconsin Society of Obstetrics
& Gynecology, July 17-19, 1986,
Embassy Suites, Green Bay
• Wisconsin Dermatological
Society, Aug 1-3, 1986, The
Abbey, Lake Geneva
APRIL 1 1-12, 1986: Wisconsin Urolog-
ical Society, Edgewater Hotel, Madison.
gll-12/85;l-3/86
JUNE 11-14, 1986: Wisconsin Academy
of Family Physicians, Telemark Lodge,
Cable. gll-12/85;l-5/86
JULY 17-19, 1986: Wisconsin Society of
Obstetrics & Gynecology, Embassy Suites,
Green Bay. gll-12/85;l-6/86
AUGUST 1-3, 1986: Wisconsin Derma-
tological Society, The Abbey, Lake Gene-
va. gll-12/85;l-7/86
OTHERS
DECEMBER 4-6, 1985: (Illinois):
Neurology for the Non-Neurologist, The
Westin Hotel, Chicago. Contact: Uni-
versity Office of Continuing Education
Rush University, 600 S Paulina, Chicago,
IL 60612; ph 312/942-7095. p9- 11/85
DECEMBER 5-7, 1985 (Minnesota):
Coronary Heart Disease: A Comprehensive
Review of Principles and Practice, Sheraton
Midway Hotel, St Paul. Info: Bonnie
Young, CME, St Paul-Ramsey Medical
Center, 640 Jackson St, St Paul, MN
55101; ph 612/221-3977, g6-ll/85
THIS LISTING is compiled by the State
Medical Society of Wisconsin in coopera-
tion with others who wish to maintain a
centralized schedule of meetings and
courses of interest to Wisconsin physicians
and to avoid scheduling programs in conflict
with others. Hospitals, Clinics, Specialty
Societies, and Medical Schools are par-
ticularly invited to utilize this listing service.
There is a nominal charge for listing of Con-
tinuing Medical Education courses at the
following rates: 50c per word, with a mini-
mum charge of $20.00 per listing.
BOXED LISTINGS: $25.00 per column
inch. Listings of other scientific meetings
will be included at the discretion of the
editors.
COPY DEADLINE tor listings is 15th of the
month preceding the month of publication;
e.g., copy for the August issue is due by July
15. Address communications to: Wisconsin
Medical Journal, Box 1109, Madison, Wis-
consin 53701; or phone (area code 608)
257-6781; or toll-free in Wisconsin: 800/
362-9080.
FOR LISTING of other meetings see the
January 4, 1985 issue of the Journal of the
American Medical Association: Continuing
Education Opportunities for Physicians for
period January 1985 through December
1985.
54
WISCONSIN MEDICAL JOURNAL. NOVEMBER 1985: VOL. 84
MEDICAL YELLOW PAGES
MEDICAL MEETINGS-
CONTINUING MEDICAL
EDUCATION
continued
JANUARY-JULY 1986: (Minnesota):
Continuing medical education programs,
University of Minnesota Medical School,
Minneapolis. See details in full-page ad
elsewhere in this issue. glO/85
EEBRUARY 13-14, 1986 (Michigan):
Tenth Annual Winter Pediatric Confer-
ence at Powderhorn Ski Area, Ironwood,
Michigan. Guest speaker is James A
Stockman, 111, MD. Info: Marshfield
Medical Education Department or H
James Nickerson, MD, Marshfield Clinic,
1000 North Oak Ave, Marshfield, Wis-
consin 54449. 9-12/85; 1-86
1986 CME CRUISE/CONFERENCES
ON SELECTED MEDICAL TOPICS-
Caribbean, Mexican, Hawaiian, Alaskan,
Mediterranean. 7-12 days year-round.
Approved for 20-24 CME Category 1
credits (AMA/PRA) & AAFP prescribed
credits. Distinguished professors. FLY
ROUND-TRIP FREE ON CARIBBEAN,
MEXICAN, & ALASKAN CRUISES. Ex-
cellent group fares on finest ships. Reg-
istration limited. Prescheduled in com-
pliance with present IRS requirements.
Information: International Conferences,
189 Lodge Ave, Huntington Station, NY
11746: ph 516/549-0869. plO-12/85
WEEKLY SEMINARS
Most major ski areas. Club Med,
Disney World, Cruising aboard
Sailboats in the Virgin Islands or a
Mississippi Paddlewheeler. Topic:
Medical-legal issues. Accredited
Category 2 by AMA.
Current Concept Seminars, Inc
(since 1980). 3301 Johnson St,
Hollywood, FL 33021; ph 800/
428-6069. $175. p9-12/85; 1-2/86
This space available
BOXED: $37.50
(IV2 column inches)
AMA
DECEMBER 8-11, 1985: Interim AMA
House of Delegates, Washington, DC.
JUNE 15-19, 1986: Annual AMA House
of Delegates, Chicago, IL.I
DECEMBER 7-10, 1986: Interim AMA
House of Delegates, Las Vegas, NV.
JUNE 2 1-25, 1987: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 6-9, 1987: Interim AMA
House of Delegates, Atlanta, GA.
JUNE 26-30, 1988: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 4-7, 1988: Interim House
of Delegates, Dallas, TX. ■
This space available
BOXED; $25.00
(1 column inches)
State Medical Society
of Wisconsin
Dates and locations of
ANNUAL MEETINGS
1986-1992
All meetings will be held in Milwau-
kee at the Milwaukee Exposition and
Convention Center and Arena
(MECCA) and the new Hyatt Regency
as the headquarters hotel.
1986- April 17-19
1987- March 26-28
1988- April 28-30
1989- April 13-15
1990- April 26-28
1991- April 18-20
1992- April 23-25
Meeting days will be Thursday and
Eriday; the first session of the House
of Delegates will convene on Thurs-
day, the second and third on Friday.
Scientific programming will be on Fri-
day and Saturday.
Further information: Commission on
Continuing Medical Education, State
Medical Society of Wisconsin, Box
1109, Madison, Wis 53701. Local tele-
phone: 257-6781; toll-free in Wiscon-
sin: 1-800/362-9080.
BOOKS RECEIVED
New books received are acknowledged
in this section. From these books, selec-
tions will be made for reviews in the in-
terest of the readers and as space permits.
Reviews are written by members of the
faculty of the University of Wisconsin
Medical School and by others who are par-
ticularly qualified. Most books here listed
will be available on loan from the Medical
Library Service, 1305 Linden Drive,
Madison, Wisconsin 53706; tel. 608/262-
6594.
Too Tall, Too Small. By John S Gillis,
PhD. Institute for Personality and Ability
Testing, Inc, PO Box 188, Champaign,
IL 61820. 1982. Pages: 187. Price: $12.95.
Correlative Neuroanatoniy & Func-
tional Neurology. 19th edition. Edited
by Joseph G Chusid, MD. Lange Medi-
cal Publications, Drawer L, Los Altos,
CA 94022. 1985. Pages: 513. Price:
$19.50.B
ADVERTISERS
Acme Laboratories 50
Advanced Technology Associates,
Inc 41
Medical Computer Systems
American Physicians Life 4
Ayerst Laboratories 38, 39, 40
Inderal® LA
Dista Products Co (Div of Eli
Lilly & Co) 8
Keflex®
Dorsey Pharmaceuticals (Div
of Sandoz, Inc) 27, 28
Hydergine® LC
Gaarder Miller Milwaukee
Ltd 33
House of Bidwell 25
Marion Laboratories 19, 20
Cardizem®
Med Flight 48
Medical College of Wisconsin 35
Physician Resource Network
Medical Protective Company 36
Navy Medicine 7
PBBS Equipment 7
Peppino's 34
Professionals Insurance
Company, The 29
Roche Laboratories 57, BC
Dalmane®
S&L Signal Company 50
SMS Services, Inc 47
Upjohn Company, The 37
Motrin®
Wisconsin Clinic Credit
Managers Association 34B
WISCONSIN MliDICAl.JOCRNAL, NOVKMBEK 1985: V OL, 84
NEWS YOU CAN USE
EFFECTS OF AN EXTENDED FEE FREEZE. According to a recent article published in the September issue
of Medical Economics, members of the American Society of Internal Medicine indicated that a continued
Medicare fee freeze would harm more patients than it would help. Nearly nine out of ten internists currently
participating in Medicare say a continued freeze would force them to drop out which, in turn, would limit access
for the elderly and increase their out-of-pocket expenses. According to the internists surveyed, 31% indicated
another freeze will cause them to lay off employees or reduce their salaries/ hours; 30% said they would ac-
cept assignment less often; 28% said they would curtail services; 16% would shift costs to non-Medicare pa-
tients; 15% would refuse new Medicare patients, and 8% would take early retirement. ■
CME CREDIT DEADLINE APPROACHING. Continuing Medical Education credits for all physicians must be
completed by December 31, 1985 to assure license renewal for the coming biennium. Thirty (30) hours of
Category 1 credits approved through the AMA's Physician Recognition Award (PRA) program are required.
The process of requiring physicians to attest to their having completed the coursework begins in late November
and early December. More than 50 hospitals and 30 specialty societies are accredited by the State Medical
Society of Wisconsin as sources of obtaining the CME credits. These accrediting bodies are listed in the June
Blue Book issue of WMJ.m
INSURANCE RATES HIGHER FOR SOME MICHIGAN PHYSICIANS. Michigan's second largest physician
malpractice insurance company has increased its rates for some of its insured physicians participating in pre-
ferred provider organizations (PPOs) and independent practice associations (IPAs). The increase followed a
study by the company. Physicians Insurance Co of Michigan, that showed that physicians participating in
PPOs or IPA/HMOs were 20 to 35 percent more likely to lose their malpractice suits than physicians who do
not participate in these types of arrangements. Premium surcharges ranged from 25 to 100 percent of the 1985
premium, based primarily on whether the physicians had claims histories, licensing problems, or incidence of
drug or alcohol abuse. ■
QUACK CURES are exposed as fraudulent in information packets from the AMA Division of Library and In-
formation Management. Physicians, the federation, and the public may obtain information packets on un-
scientific nostrums ranging from colonic irrigation to hair analysis. The library's existing literature covers
nearly 80 subject areas, including alternative cancer and arthritis cures, allergy testing, and baldness
remedies. When the library does not have material to answer a query on a quack cure, the staff provides a
computerized literature search to help the caller. For more information, contact Micaela Sullivan, research as-
sociate, Division of Library and Information Management, AMA headquarters, Chicago. The telephone number
is (312) 645-4846. ■
VOLUNTEER RELIEF ACTIVITIES IN MEXICO CITY. The American Medical News is interested in contacting
physicians who have first-hand information about conditions in Mexico City or who are or have been involved
in volunteer relief activities in the aftermath of the earthquake in September. Physicians are asked to contact
Barbara Bolsen at AMA Headquarters: 3 12/ 645-4428. ■
PHYSICIAN SERVICE OPPORTUNITIES OVERSEAS. The Dec 14, 1984 issue of JAMA contained a directory,
entitled Physician Service Opportunities Overseas, which listed more than 170 organizations that recruit US physi-
cians for both long- and short-term assignments in a host of countries around the world. Included is a list of
factors that physicians must think about in considering overseas service. For further information physicians
may contact Kimberly Glasbrenner of the JAMA MEDICAL NEWS staff: 312/645-7145.B
56
WISCONSIN MEDICAL JOURNAL, NOVEMBER I985:VOL. 84
EXCERPTS FROM A SYMPOSIUM
"THE TREATMENT OF SLEEP DISORDERS"®
ii
\ . . highly effective
for both sleep induction and
sleep maintenance ff
Sleep Laboratory Investigator
Pennsylvania
. . onset of action is
rapid. . . provides sleep with
no rebound effect to agitate the
patient the following day A A
Psychiatrist
Calitornia
. . appears to have
the best safety record of any
of the benzodiazepines ff
Psychiatrist
Calitornia
After 15 years, the experts still concur about the
continuing value ot Dolmone (flurozepom HCI/
Roche). It provides sleep that sotisties patients. . .
and the wide margin ot satety that satisfies you.
The recommended dose in elderly or debilitated
patients is 15 mg. Contraindicated in pregnancy
DALMANE
flurazepam HCI/Roche (S
sleep that satisfies
15-mg/30-mg
capsules
References: 1. Kales J, etal Clin Pharmacol Ther /2 691-
697, Jul-Aug 1971 2. Kales A, etal Clin Pharmacol Ther
/(S, 356-363, Sep 1975 3. Kales A, etal: Clin Pharmacol
Ther 19 576-583, May 1976 4, KolesA, etal Clin Pharma-
col Ther 3278] -T&8, Dec 1982 5. FrostJDJr, DeLucchl
MR: J Am Geriatr Sac 27 5A]-5A6. Dec 1979 6. Dement
WC, eta! BehavMeO, pp 25-31, Oct 1978 7. Kales A,
Kales JD J Clin Psychopharmacol 3 AAO-lbO, Apr 1983
8. Tennant FS, etal Symposium on the Treatment ot Sleep
Disorders, Teleconference, Oct 16, 1984 9. Greenblatt DJ,
Allen MD, Shader Rl: Clin Pharmacol Ther 21 355-36],
Mor 1977
DALMANE"
flurazepam FICI/Roche(w
Before prescribing, please consult complete product
information, a summary ot which follows:
Indications: Effective in all types of insomnia characterized
by difficulty in falling asleep, frequent nocturnal awakenings
and/or early morning awakening, in patients with recurring
insomnia or poor sleeping habits, in acute or chronic medical
situations requiring restful sleep Objective sleep laboratory
data have shown effectiveness for at least 28 consecutive
nights of administration Since insomnia is often transient
and intermittent, prolonged administration is generally not
necessary or recommended Repeated therapy should only
be undertaken with appropriate patient evaluation
Contraindications: Known hypersensitivity to flurazepam FICI,
pregnancy Benzodiazepines may cause fetal damage when
administered during pregnancy Several studies suggest an
increased risk of congenital malformations associated with
benzodiazepine use during the first trimester Warn patients
of the potential risks to the fetus should the possibility of be-
coming pregnant exist while receiving flurazepam Instruct
patients to discontinue drug prior to becoming pregnant Con-
sider the possibility of pregnancy prior to instituting therapy
Warnings: Caution patients about possible combined etfects
with alcohol and other CNS depressants An additive effect
may occur if alcohol is consumed the day following use for
nighttime sedation This potential moy exist for several days
following discontinuation Caution against hazardous occu-
pations requiring complete mental alertness (e g . operating
machinery, driving) Potential impairment of performance of
such activities may occur the day following ingestion Not
recommended tor use in persons under 15 years ot age
Withdrawal symptoms rarely reported, abrupt discontinuation
should be avoided with gradual tapering of dosage for those
patients on medication for a prolonged period ot time Use
caution in administering to addiction-prone individuals or
those who might increase dosage
Precautions: In elderly ond debilitated potients, it is recom-
mended that the dosage be limited to 15 mg to reduce risk of
oversedation, dizziness, contusion and/or ataxia Consider
potential additive effects with other hypnotics or CNS depres-
sants Employ usual precautions in severely depressed
patients, or in those with latent depression or suicidal tenden-
cies, or in those with impaired renal or hepatic function
Adverse Reactions: Dizziness, drowsiness, lightheodedness,
staggering, ataxia and falling have occurred, particularly in
elderly or debilitated patients Severe sedation, lethargy, dis-
orientation and coma, probably indicative ot drug intolerance
or overdosage, have been reported Also reported headache,
heartburn, upset stomach, nausea, vomiting, diarrhea, con-
stipation, Gl pain, nervousness, talkativeness, apprehension,
irritability, weokness, palpitations, chest pains, body and joint
pains and GU complaints There have also been rare occur-
rences of leukopenia, granulocytopenia, sweating, flushes,
difficulty in focusing, blurred vision, burning eyes, tointness,
hypotension, shortness of breath, pruritus, skin rash, dry
mouth, bitter taste, excessive salivation, anorexia, euphoria,
depression, slurred speech, confusion, restlessness, halluci-
nations, and elevated SGOT, SGPT, total and direct bilirubins,
and alkoline phosphatase, and paradoxical reactions, eg
excitement, stimulation and hyperactivity
Dosage: Individualize for maximum beneficial effect Adults
30 mg usual dosage, 15 mg may suffice in some patients
Elderly or debilitated patients. 15 mg recommended initially
until response is determined
Supplied: Capsules containing 1 5 mg or 30 mg flurazepam
HCI
Roche Products Inc
Manati, Puerto Rico 00701
FOR SLEEP
After more than 1 5 years of use, ifs # 1 for sleep that satisfies.
Patients are satisfied because they fall asleep fast and stay
asleep till morning. ^ ® And you're satisfied by the exceptionally
wide margin of safety. As always, caution patients about
driving or drinking alcohol.
Please see references and summary of producf information on reverse side
DALMANE
flurazepam HCI/Roche ®
sleep that satisfies
pyright ■£ 1985 by Roche Products Inc All rights reserved
7
WISCONSIN
MEDICAL JOURNAL
Medicine: Trade or profession?
President Scott in his President's Page points out that the term "pro-
fession" can be interpreted as benign or highly charged depending on
one's point of view. He cites a 70-year-old definition of a profession
as an occupation with certain criteria and believes it is "valid today
and if adhered to would not lead to the present corruption of the term
'profession.' " (See page 5)
Medical liability not alone in ''crisis"
An editorial entitled "Telling testimony" points out the fact that there
is a serious crisis in medical liability in Wisconsin but the problem is
not limited to medical care. "The crisis in medical liability coverage
is reflected over and over in a whole host of areas where the threat
of a lawsuit and attendant liability threatens continuation and avail-
ability of a variety of necessary activities and endeavors." (See page 6)
'Required request' for organ transplantation?
Professor Peters of Stevens Point offers a practical proposal for
increasing the supply of cadaver organs for transplantation and urges
Wisconsin's Legislature to enact a 'required request' law similar to those
in the states of New York and Oregon. (See page 10)
SMS membership reaches new high
Record numbers of physicians have joined SMS and their county
medical societies in 1985. By mid-November total SMS membership
had reached 6,472, an increase of 12.5% over 1984 levels. (See page 31)
WISCONSIN
MEDICAL JOURNAL
£
CONTENTS
1
December 1985
ISSN 0043-6542 /Established 1903
Owned and published by
State Medical Society of Wisconsin
Medical Editor
Victor S Falk MD, Edgerton
Editorial Board
Victor S Falk MD, Edgerton Chairman
Melvin F Hath MD, Baraboo
M C F Lindert MD, Milwaukee
Andrew B Crummy Jr MD, Madison
Richard D Sautter MD, Marshfield
Dean M Connors MD, Madison
George W Kindschi MD, Monroe
Charles H Raine MD, Racine
Darrell L Witt MD, Wausau
Garrett A Cooper MD, Madison Emeritus
Editorial Director
Wayne J Boulanger MD, Milwaukee
Editorial Associates
R Buckland Thomas MD, Monroe
Russell F Lewis MD, Marshfield
Raymond A McCormick MD, Green Bay
Victor S Falk MD, Edgerton
Medical Editor
Staff
Earl R Thayer, Madison
Secretary-General Manager
State Medical Society of Wisconsin
H B Maroney II, Madison
Assistant Secretary-Corporate Counsel
State Medical Society of Wisconsin
Mrs Mary Angell, Madison
Managing Editor
Mrs Marjorie Stafford, Madison
Publications Assistant
NATIONAL ADVERTISING REPRESENTA-
TIVE: State Medical Journal Advertising
Bureau, Inc, 711 South Blvd, Oak Park, 111
60302, Ph 312/383-8800.
LOCAL jWISCONSINI ADVERTISING: Con-
tact: Mrs Mary Angell, Wisconsin Medical
Journal, Box 1109, Madison, Wis 53701. Ph
608/257-6781.
SUBSCRIPTION RATES: Members, $12.50
per year (included in dues): nonmembers,
$25.00. Single copy: current year, $2.00; pre-
vious years, $3.00. SPECIAL RATES: Foreign
and Canada, $30.00. Blue Book issue, $8.00.
Membership Directory issue, $15.00.
SECOND CLASS POSTAGE PAID at
Madison, Wisconsin, and at additional mail-
ing offices,
PUBLISHED MONTHLY. "Acceptance for
mailing at special rate of postage provided for
in Section 1103, Act of October 3. 1917,
Authorized August 7, 1918." Address all com-
munications to THE WISCONSIN MEDICAL
JOURNAL. Street address: 330 East Lakeside
Street. Mailing address: Box 1109, Madison,
Wis 53701.
POSTMASTER: Send address changes to
Wisconsin Medical Journal, PO Box 1109,
Madison. Wis 53701.
COPYRIGHT 1985
State Medical Society of Wisconsin
SPECIAL FEATURES
President's Page
5 Medicine: Trade or profes-
sion, by John K Scott, MD,
Madison
Editorials
6 Telling testimony
6 Long-wear contact lenses,
by Victor S Falk, MD,
Edgerton
7 My white hat, by Victor S
Falk, MD, Edgerton
Letters
7 New drugless healers?, by
William J Lajoie, MD, Wis-
consin Society of Physical
Medicine and Rehabilitation
8 Let's control our own
destiny, by William J
Maurer, MD, Marshfield
8 Milwaukee brace, by
Frederick G Gaenslen, MD,
Milwaukee
Special
10 Required request: A prac-
tical proposal for increas-
ing the supply of cadaver
organs for transplantation,
by David A Peters, PhD,
Stevens Point
13 Contact lenses: Boon or
bain?, by Frederick J Davis,
MD, Madison
57 Index: Wisconsin Medical
Journal, Vol 84, January
1985 through December
1985
Miscellaneous
15 AMA Physician's Recogni-
50
tion Award recipients
Blue Book update
Socioeconomics
43 State Medical Society
Legislative Status Report
46 AIDS bill becomes law
News you can use
72 Health prospects 1983/2003
survey reported
72 Council on ethical and
judicial affairs
72 JCAH announces new
quality review bulletin
72 AMA says Supreme Court
action on California mal-
practice law is 'significant'
WISCONSIN MEDICAL JOURNAL (ISSN 0043-6542) is the official publication of the State Medical
Society of Wisconsin, devoted to the interests of the medical profession and health care in Wisconsin.
Its affairs are handled by the Editorial Board, subject to policy direction of the Society's Board of
Directors. The Managing Editor is responsible for the production, business operation, and coor-
dination of contents as well as the final responsibilify of the entire publication. The Editorial Director
IS responsible for Editorials. Unsigned Editorials express views consistent with the policies of the
: State Medical Society of Wisconsin . Signed Editorials express personal views of the author for which
ithe Society takes no responsibility. Neither the Editors nor the State Medical Society will accept
responsibility for statements made or opinions expressed in the pages of the Journal. Indexed in
I'Tndex Medicus," "Hospital Literature Index," and "Cambridge Scientific Abstracts."
Vol. 84 No. 12
I
CONTENTS
fV-. :- STATE MEDICAL
f S- SOClliTY
!.% - J/J OF WISCONSIN
Officers
SCIENTIFIC MEDICINE
19 Review of the clinical
manifestations, laboratory
findings, and complications
of infectious mononucleo-
sis, by Lynn Rosen White,
MD and Peter S Karofsky,
MD, Madison
25 Clinical Cancer: New dis-
coveries in oncology:
Potential applications to
clinical practice, by Henry
C Pitot, PhD, Madison
(Number 1 of a series)
ORGANIZATIONAL
49 Obituaries:
George Colville Owen, MD
Milwaukee
Benjamin E Urdan, MD
Milwaukee
Moktar Najafzadeh, MD
Miami, Florida
(Twin Lakes)
Gerald J Bergmann, MD
Greenfield
James D Zeratsky, MD
Marinette
Anthony S Kult, MD
Milwaukee
66 CES Foundation: Contri-
butions during the month
of October 1985
President: John K Scott, MD, Madison
President-Elect: Charles W Landis,
MD, Milwaukee
Secretary-General Manager:
Earl R Thayer, Madison
Treasurer: John J Foley, MD
Menomonee Falls
Board of Directors
Chairman: Darold A Treffert, MD
Fond du Lac
Vice Chairman: Roger L
von Heimburg, MD, Green Bay
First District
Jerome W Eons Jr, MD, Cudahy
Carl S Eisenberg, MD, Milwaukee
Thomas A Hofbauer, MD,
Menomonee Falls
Wayne H Konetzki, MD, Waukesha
Fredrick Wood Jr, MD, Kenosha
William L Treacy, MD, Milwaukee
Richard D Fritz, MD, Milwaukee
William J Listwan, MD, West Bend
Glenn H Franke, MD, Milwaukee
Lucille B Glicklich, MD, Milwaukee
30 Membership facts
31 SMS membership reaches
new high
31 H/D Nominating Commit-
tee selects slate of candi-
dates
31 President-elect Landis will
not serve office
32 1985 Leadership Confer-
ence participants
33 Governor Earl addresses
SMS Leadership Conference
33 Dr Treffert named to state-
wide professional discipline
task force
34 Max Goodwin Physician-
Citizen of the Year
37 Membership Directory-
Update
DEPARTMENTS
48 County societies: Lincoln
(CMS offers free colorectal
screening) . . . Marinette-
Florence . . . Outagamie
. . . Sheboygan . . .
Winnebago
50 News highlights:
Columbus Community
Hospital . . . Marshfield
Clinic ... St Mary's
Medical Center
51 Physician briefs
67 Medical yellow pages:
Physicians exchange . . .
Medical facilities . . . Mis-
cellaneous . . . Medical
meetings/continuing
medical education . . .
Advertisers ■
the state medical society of WISCONSIN, created by the Territorial Legislature in 1841,
represents over 6200 member physicians in Wisconsin, comprising 55 county medical societies
and 26 medical specialty sections. The purpose of the Society is to "bring together the physicians
of the State of Wisconsin to advance the science and art of medicine and the better health of the
people of Wisconsin, and to secure the enactment and enforcement of just medical laws." The
major activities of the Society include continuing medical education, peer review, legislation,
community health education, scientific affairs, socioeconomics, health planning, services for
physicians, operation of a Charitable, Educational and Scientific Foundation, and publication of
the Wisconsin Medical Journal.
Second District
J D Kabler, MD, Madison
Cyril M Hetsko, MD, Madison
James J Tydrich, MD, Richland Center
Alwin E Schultz, MD, Madison
Kenneth I Gold, MD, Beloit
Third District
Pauline M Jackson, MD, La Crosse
Fourth District
John J Kief, MD, Rhinelander
Jung K Park, MD, Wisconsin Rapids
W George Looker, MD, Wausau
Fifth District
Darold A Treffert, MD, Fond du Lac
Kenneth M Viste Jr, MD, Oshkosh
C William Freeby, MD, Appleton
Sixth District
Roger L von Heimburg, MD, Green Bay
Joseph C DiRaimondo, MD, Manitowoc
Seventh District
Marwood E Wegner, MD, St Croix Falls
Philip J Happe, MD, Eau Claire
Eighth District
Joseph M Jauquet, MD. Ashland
President: Doctor Scott
President-Elect: Doctor Landis
Past President: Timothy T Flaherty,
MD, Neenah
Speaker: Duane W Taebel, MD,
La Crosse
Vice Speaker: Vernon M Griffin, MD,
Mauston
J
A,
A New Health Care Card is Born
FOR AMERICAN MOTORS EMPLOYEES
AND RETIREES
The Same High Quality
Health Care Coverage
ATTENTION PHYSICIANS AND HOSPITALS
This individual is enrolled In MEOVIEW. a private review program that requires
pre^ertitication lor all Non-Emergency admissions at health care facilities
Notification must be made of all Emergency admissions within 24 hours A
limited number of surgical procedures may require a second surgical opinion or
ambulatory surgery. Compliance with these procedures is required for full
payment of health care benefits
New Rules for Physicians
and Hospitals to Follow—
which are administered
by Medview, a private health
resource administrator
TO RECEIVE BENEFIT PAYMENTOR INFORMATION
THE AMERICAN MOTORS HEALTH PLAN
provides employees/retirees and the medical community
with some new guidelines—
1. Pre-certification of non-emergency
hospital admissions
2. 24 hour notification of emergency
hospital admissions
3. Mandatory second surgical opinions and
ambulatory surgery
4. Concurrent review of hospital stays
5. Expanded home health care
6. Broader drug and alcohol rehabilitation
program
Benefit Payments
administered by
Blue Cross &
Blue Shield United
of Wisconsin and
their Preferred
Service Center
PRESIDENT'S PAGE
Medicine: Trade or profession?
The term "profession" can be interpreted as benign or highly charged depending on
one's point of view. The Latin root, profiteri, conveys a sense of promise, confession,
or commitment. Over time the term has come to mean a public claim of special knowl-
edge or skill in some particular area.
Justice Brandeis once defined a profession as an occupation ( 1) for which the neces-
sary preliminary training is intellectual in character, involving knowledge and to some
extent learning as distinguished from mere skill; (2) is pursued largely for others and
not merely for one's self; and (3) in which the amount of financial return is not the
accepted measure of success.
Even though Brandeis stated his definition more than 70 years ago, it is valid to-
day and if adhered to would not lead to the present corruption of the term "profes-
sion."
The so-called "learned professions"— originally medicine, law, and divinity— demanded profound academic
study. The knowledge thereby acquired set the members apart from the laity who, lacking such knowledge,
depended on the statements and acts of the professional. Members of a profession thus found themselves in
a position of authority and service based on trust. This dual relationship imposed on members of the profes-
sions a particular moral obligation often made more explicit by a code of ethics. Certainly this has been true
of the medical profession.
The unselfish devotion attributed to physicians is, however, subject to disintegration as is the whole concept
of a profession as each is affected by the changing social and economic structure. Service, once the keystone
of a profession, is now everybody's activity. With that change has come the view that the rendering of special-
ized service alone constitutes professionalism.
Who today denies the name "professional" to the auto mechanic, the hairdresser, the watchmaker, the
investment counselor, the travel agent, or the airline hostess? At one time the activities they represent would
have been called "trades," meaning skilled work not requiring a high level of education and certainly distinct
from a profession. The intense competitiveness of the occupations combined with liberal advertising further
clouds the older sense of a "profession." Hence the query: Is medicine a trade or a profession?
Some suggest there is little difference between business, the trades, and the professions. To most of us, how-
ever, such a statement induces a nagging uneasiness. There is a tradition in medicine. There is an undying
sense of the older professionalism. Even though physicians are incorporated, business managers take over
our offices, and the term "industry" is applied to medical and health care, the tradition of the professional,
almost ghostlike, will not disappear.
Happily, most of us continue to believe that the needs of the patient should come first, that medical service
is not a commodity of the marketplace, that our profession involves scholarship and intellect above and beyond
mere skill, and that service rendered with an eye on the cash register is not really service but business.
F Scott Fitzgerald's observation on the importance of being able "to hold two opposed ideas in the mind
at the same time and still retain the ability to function" is relevant here. Physicians and indeed their regulators
must act in full awareness of medicine's dual nature: financial considerations can never be fully put aside,
but we function primarily as the servants of our patients' needs.
Medicine is certainly both a profession and a business and it no longer stands out from innumerable other
"professions.” Let us hope, however, that some of the old values will persist, unchanged. It will be a sad day
for America if physicians ever come to be seen as tradespeople. It will also be a sad day if physicians have
a higher image of themselves than the public has of physicians. Pious words will then have no effect. ■
WISCONSIN MEDICAL JOURNAL, DECEMBER 1985: VOL. 84
5
EDITORIALS
Wayne J Boulanger, MD, Editorial Director
Unsigned editorials express views consistent with the policies of the State Medical Society of Wisconsin.
Signed editorials express personal views of the author for which the Society takes no responsibility.
Telling testimony*
There is a serious crisis in medical
liability in Wisconsin. It is a crisis
of insurance affordability for phy-
sicians and patients, and it is rap-
idly also becoming a crisis of avail-
ability of care for some patients in
some areas of the state.
The problem is not limited to
medical care. The application of
the tort system to professional lia-
bility is generating a crisis in in-
surance availability and afforda-
bility for engineers, architects,
nurse midwives, municipal units
of government, and even attor-
neys themselves. The depth and
breadth of this problem is seri-
ous—so serious that a special ses-
sion of the Legislature had to be
held to attempt to resolve the prob-
lem for the dispensers of alcoholic
beverages. The solution was the
elimination of that liability expo-
sure.
The crisis in medical liability
coverage is reflected over and
over in a whole host of areas
where the threat of a lawsuit and
attendant liability threatens con-
tinuation and availability of a vari-
ety of necessary activities and en-
deavors. For example, why should
companies continue to produce
vaccines when lawsuits for prod-
uct liability cost those companies
200 times the profits from those
vaccines?
There is something dreadfully
wrong with a system that ulti-
mately sees less than 30 cents of
each dollar awarded to the victim
while the majority of that dollar
‘Excerpts from testimony before the Sen-
ate Committee on Labor, Business, Veter-
ans Affairs & Insurance, Green Bay, Wis-
consin, November 13, 1985 regarding
medical liability and SB 328, by Darold A
Treffert, MD, Fond du Lac, Chairman of
the State Medical Society's Board of Direc-
tors.
goes to the legal system and insur-
ance system supported by the vast
medical liability industry.
We are not opposed to compen-
sating victims for true medical neg-
ligence. We are opposed to a sys-
tem that rewards the advocates in
the industry more than it awards
the victims.
Medical negligence does occur.
In some instances this is by incom-
petent medical practitioners. Med-
icine continually strives to im-
prove the practice patterns of
physicians and to discipline physi-
cians who fail to meet high ethical
and clinical standards. The peer
review and discipline provisions
of Senate Bill 328— the "so-called
medical liability bill"— and the
1985 biennial budget bill provi-
sions are important steps toward
improving that system.
However, eliminating the few
physicians with multiple awards
or settlements is not the only solu-
tion. A much broader and more
complex problem is the public ex-
pectation that there should be pro-
tection not only against malprac-
tice but also what might be called
"maloccurrence."
In the minds of the public, and
in the minds of juries, tragic and
untoward maloccurrences become
confused with malpractice. Mal-
practice awards have often come
not to represent simply negligence,
but rather a system of compensa-
tion for persons visited by some
untoward outcome unavoidable
and unanticipated.
If malpractice has come to mean
something other than negligence,
and if claims equate to compensa-
tion, as Attorney Melvin Belli has
stated for example, then a major
restructuring of the tort system is
necessary to avoid chaos and bank-
ruptcy of any medical liability
plan.
The medical malpractice crisis
is the tip of the "let's sue" men-
tality that threatens to sink all of
society's activities— charitable,
professional and business— in a
paralyzing sea of inactivity under
threat of suit or actual bankruptcy
under cost of suit.
SB 328 is the first step on the
road to reform and the Society
commends Senator Jerome Van
Sistine and the Legislative Council
Special Committee for the devel-
opment of this proposal.
Long-wear contact
lenses
The Capital Times, a Madison
newspaper, recently published a
series of articles describing the
hazards of extended-wear soft
contact lenses. The subject was
thoroughly researched and ac-
curately reported.
On the basis of this series, the
Optometry Examining Board has
directed the State Department of
Regulation and Licensing to draw
up rules spelling out how the
warnings are to be presented.
It seemed appropriate for the
Wisconsin Medical Journal to in-
form Wisconsin physicians about
some of the problems resulting
from the poorly informed users of
extended-wear soft contact lenses.
Consequently, Dr Frederick J
Davis was asked to provide us
with such an article. Doctor Davis
recently retired after 35 years as
an ophthalmologist with the Davis-
Duehr Eye Associates of Madison.
He also is Emeritus Associate
Clinical Professor of Ophthalmol-
ogy at the University of Wiscon-
sin Medical School. Doctor Davis
was a pioneer in the field of con-
tact lenses. He has no axe to grind
since he is no longer in active
practice.
The Wisconsin Medical Journal is
appreciative of Doctor Davis's
6
WISCONSIN MEDICAL JOURNAL, DECEMBER 1985: VOL. 84
CONTACT LENSES
EDITORIALS
prompt and knowledgable re-
sponse. His article is published in
this issue.
— Victor S Falk, MD, Edgerton
My white hat
Last year after considerable
thought and discussion, I elected
not to sign up for the acceptance
of all Medicare claims. I would
continue to accept many of these
as I had always done, but not all.
This year after reviewing the in-
formation sent out by Medicare,
the AMA and our own state soci-
ety, I decided to become one of
the good guys with the white hats.
I signed the agreement to accept
all Medicare payments effective
October 1.
Our office manager very care-
fully submitted separate state-
ments to Medicare for services
rendered through September 30
and for those on or after October 1 .
What happened? Within days irate
patients began calling the office
stating that all of their Medicare
claims prior to October 1 had been
denied.
I became diffused in a patriotic
aura. My face was red, my white
hat turned to white heat, and the
air was blue as I gave vent to my
frustration.
Several calls to the Medicare of-
fice revealed that mistakes had
been made and attempts would be
made to try to correct them. The
computer, you know. Of course,
what comes out of a computer de-
pends entirely on what is fed into
it.
Without becoming patently par-
anoid, it seems that we just can't
win.
—Victor S Falk, MD, Edgerton ■
[ letters)
The Editors would like to encourage physicians to contribute to the LETTERS section where they can ventilate their frustrations as well as opinions. This feature is in-
tended to be lively and spirited as well as informative and educational. As with other material which is submitted for publication, all letters will be subject to the usual
editing. Address correspondence to: The Editor. Wisconsin Medical Journal. Box 1109. Madison, Wis 53701.
New drugless healers?
To THE Editor: A new bill. As-
sembly Bill 256, soon will be con-
sidered for a vote by our state leg-
islators. This bill is essentially a
product of the Wisconsin Physical
Therapy Association, Inc (WPTA).
The purpose of this bill is to allow
physical therapists to practice
without any referral from a physi-
cian; it would allow physical ther-
apists to evaluate and treat pa-
tients without any medical refer-
ral. In other words, they would be
allowed to practice in the same
way as chiropractors.
The WPTA takes the position
that they are, by training, perfectly
qualified to do this. They state,
"Today's physical therapists are
well qualified, both by education
and clinical training, to evaluate a
patient's physical condition, (editor-
ial emphasis added), assess his/her
physical therapy needs, and if ap-
propriate, safely and effectively
treat the patient." The WPTA
claims, "Because of the skill and
reputation of physical therapists,
increasing numbers of patients are
requesting physical therapy serv-
ices and are frustrated to find they
must first be seen by a referring
practitioner." (editorial emphasis
added) It is the intent of the WPTA
to have physical therapists decide
which of their patients should be
seen by a physician! The WPTA
states, "Furthermore, by elimi-
nating the referral requirement
(physician referral) the potential
for referral for profit would be re-
duced." (editorial emphasis added)
The WPTA further states, "Prac-
tice without referral would allow
physical therapists to treat pa-
tients with established diagnoses,
such as rheumatoid arthritis, mul-
tiple sclerosis, etc, without the pa-
tient having to incur the additional
expense of seeing a referring physi-
cian." (editorial emphasis added)
They state, "Practice without re-
ferral will allow physical thera-
pists to become an entry point into
the healthcare system."
It appears obvious from the
statements made by the WPTA
that if Assembly Bill 256 is passed,
we will have a new group of
"drugless healers ." Unless there
is a widespread opposition to this
bill by ALL Wisconsin physicians,
this bill will surely pass. The
WPTA is well organized and they
are making an all out effort to see
that this or some equivalent bill is
passed in the Legislature.
William J Lajoie, MD, President
Wisconsin Society of Physical
Medicine and Rehabilitation
continued next page
WISCONSIN MEDICAL JOURNAL, DECEMBER 1985: VOL. 84
LETTERS
Med student offers
perspective on
physical therapy
Editor's note: The following letter, writ-
ten by a fourth-year medical student at the
University of Nevada School of Medicine,
also offers a perspective on physical ther-
apy. It was published in the October 18,
1985 issue of American Medical News.
To AM News: Your article "Pri-
vate practice of physical therapy
on the increase" [AMN, Sept 13,
1985) demonstrated the difference
of opinion between the physician
and physical therapist concerning
treatment without referral by the
therapist. I believe I can offer an
additional insight in that I am both
a physical therapist and am pres-
ently completing medical school.
Prior to entering medical school
1 had a successful private practice
physical therapy office. As the
state legislative chairman, I
sought to change the state law
allowing a therapist to treat with-
out physician referral. I felt I could
better initially evaluate a patient
than a physician and wanted to
generate my own patient load,
thus having better control of my
practice.
During medical school 1 quickly
realized there is a vast amount of
pathology associated with muscu-
loskeletal pain or dysfunction,
which physical therapists have
not been exposed to. The master's
physical therapy program I at-
tended was excellent and the in-
formation covered was in-depth,
but the knowledge to enable a
therapist to adequately screen pa-
tients was grossly lacking. For a
therapy curriculum to adequately
train a therapist to initially evalu-
ate and diagnose, two additional
years would need to be added:
one year of pathology and phar-
macology, and one year of hospi-
tal clerkships rotating through the
basic areas.
There are two major problems
with therapists treating without
referral. The first is that they have
not been trained to recognize
many disease processes that will
result in harm to the patient or at
best waste their time and money.
Most low back pain, for instance,
is of a muscular-skeletal etiology
for which physical therapists will
treat effectively. But those few pa-
tients whose problem is of a dif-
ferent etiology, which will be
missed by therapists, makes the
whole concept of treatment with-
out referral a disservice to society.
The other problem is therapists
are unable to prescribe medica-
tions. The vast majority of therapy
patients seen as outpatients greatly
benefit from muscle relaxants, an-
algesics, or occasionally antibi-
otics. In fact, as seen in the past,
most therapy candidate patients
do well with these medications
and rest alone. In those states that
allow therapists to treat without
referral, the patient would not
have the benefit of medications
immediately and at best would
have to wait until he could be seen
by a physician.
The legislative momentum for
physical therapists to treat with-
out referral is increasing. Physical
therapy training is inadequate to
enable them to properly act as
medical screeners. If they wish to
do so, therapy curriculums must
be drastically enhanced or better
yet, apply to medical school.
— William S Muir
Las Vegas, Nevada
Milwaukee brace
To THE EDITOR: I wish to call your
attention to an error which I think
needs to be corrected. In your
comments "that made Milwaukee
famous" (August issue) you attrib-
ute the invention and design of the
Milwaukee brace to Dr Walter
Blount.
The truth of the matter is that
Dr Albert C Schmidt invented and
designed the brace and with the
collaboration of Doctor Blount
perfected it and popularized its
use.
I hope this information is used
to correct the situation.
—Frederick G Gaenslen MD
1031 North Astor St
Milwaukee WI 53202
Let's control our
own destiny
To THE Editor: The State Medical
Society of Wisconsin is composed
of and supported by physicians in
a wide variety of medical prac-
tices including private solo small
and large group, prepaid or HMO-
type, government service, and aca-
demic medicine.
Giving front page coverage to
unsubstantiated opinions such as
"There is great danger in this
(HMO movement)" and that "Phy-
sicians have some responsibility
to try to reverse this process” is
really reactionary and counterpro-
ductive.
Perhaps there is a great danger
in the movement when looking at
it from the long-term perspective
of physicians' reimbursement and/
or salaries, but to attack the pre-
paid medical care system on the
basis that to quote Doctor Rengel
"The patient's best hope for a com-
mitted relationship with his per-
sonal physician has been severely
compromised by this trend" is
overstating the case.
I believe it is readily apparent
that those familiar with prepaid
medical care as a financing mecha-
nism realize that we stress the tradi-
tional committed relationship be-
tween the personal physician and
his patient and that we are able to
practice the highest quality medi-
cal care with all its interpersonal
relationships within the frame-
work of an HMO.
continued next page
8
WISCONSIN MEDICAL JOURNAL, DECEMBER 1985: VOL. 84
LET'S CONTROL
LETTERS
Perhaps those physicians who
are the most knowledgable and
dedicated advocates of the patients
and who wish to retain the quality
of care should take charge of the
HMO movement and the medical
care financing and delivery sys-
tem. In doing so, they will be tak-
ing charge of their own destiny
and control the changes that occur
rather than reacting to the changes.
William J Maurer, MD, President
Marshfield Clinic
1000 North Oak Avenue
Marshfield, Wisconsin 54449 ■
ARMYPHYSKIANS
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endless insurance forms, malpractice
premiums, cash flow worries. And they
need not concern themselves with the
ability of the patient to pay.
Part of Army medical excellence is
prescribing the best possible care— not
the least care, nor most defensive care.
If you believe in this kind of compre-
hensive health care, you may wish to
explore the many exciting possibilities
Army Medicine has for you. We invite
your call:
Captain Scott Hendrickson
(312) 926-2040
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WISCONSIN MEDICAL JOURNAL, DECEMBER 1985: VOL. 84
9
SPECIAL
Required request: A practical proposal
for increasing the supply of cadaver
organs for transplantation
David A Peters, PhD, Stevens Point, Wisconsin
A.PPROXIMATELY 14,000 people
each year could benefit from heart
transplants.! Another 4,000-5,000
could be helped by liver trans-
plants.^ Close to 13,000 people
now await kidney transplants.^
The demand for organs vastly ex-
ceeds the supply.
State Uniform Anatomical Gift
Acts (UAGAs), which govern the
removal and transfer of organs
from cadavers for medical use, de-
clare that organs may be removed
from a deceased person only if
that person has given explicit prior
consent or his/her family permits
such taking immediately upon the
death of their relative.'*
Organ procurement agencies
and other interested organiza-
tions, such as the National Kidney
Foundation and the National
Liver Foundation, have long been
involved in public education pro-
grams designed to encourage peo-
ple to sign donor cards. These
groups also have contacted critical
care staff in hospitals and urged
them to be on the alert for poten-
tial donors dying in their institu-
tions. Despite these recruitment
efforts, few organs are retrieved
from cadavers. Of the 20,000 in-
dividuals dying each year under
Professor Peters is Adjunct Associate Pro-
fessor of Philosophy, University of Wis-
consin-Stevens Point, and Director, The
Institute for Health Policy and Law at
Stevens Point. Reprint requests to: David
A Peters, PhD, % Health Sciences Library,
St Michael's Hospital, 900 Illinois Ave,
Stevens Point, Wis 54481 (ph 715/346-
5092). Copyright 1985 by the State Medi-
cal Society of Wisconsin.
conditions conducive to organ
retrieval, organs are obtained
from less than 15%. ^
The nation's organ procure-
ment works poorly for several rea-
sons. First, transplant surgeons
uniformly refuse to remove or-
gans from brain-dead individuals
without family consent. They do
so irrespective of whether the de-
cedent has signed a donation docu-
ment. One reason why physicians
adhere to this practice is because
they fear being sued by distraught
families who resent not being con-
sulted about organ removal from
their loved ones or who explicitly
object to this procedure. While
state UAGAs authorize physicians
to remove organs and tissues from
brain-dead declared donors with-
out family consent, physicians are
simply not confident enough that
the law permits them to do this
purely on the strength of the de-
cedent's signed donor card.
Surgeons require family per-
mission also because they do not
wish to gain the reputation of be-
ing organ "vultures" who are in-
sensitive to the needs, emotions,
and values of the bereaved kin.
Many physicians believe as well
that it is simply unethical not to
ask the family, since the deceased
is of their own flesh and blood.®
Current surgical practice, then,
requires that the families of both
declared and undeclared brain-
dead potential donors be asked
about organ donation from such
patients before physicians take
the organs. But hospital personnel
(especially critical care staff) who
might ask families about organ re-
moval from deceased kin often do
not do so because
1. they feel it is too ghoulish a
request to make of a grief-
stricken family, or
2. they are not certain what
hospital policy is concerning
organ retrieval, or
3. they are not committed zeal-
ously enough to the organ
procurement effort.’’
This is the second major factor
contributing to the poor rate of or-
gan retrieval. Of course, if no one
makes the request, organs that
might have been obtained by fam-
ily consent are lost. When asked
about donating organs from dead
relatives, about 60%-80% of white
families consent.® Families who
agree to donate organs from rela-
tives almost invariably say later
that they appreciated being asked
because it gave them a chance to
bring some good out of a tragic
loss.^ It is reasonable to believe,
then, that if we don't routinely ask
families about organ removal
from deceased kin, not only are
we wasting many useful organs
but also we are denying families
an important therapeutic outlet.
Arthur Caplan of the Hastings
Center has recently proposed a
promising way of mitigating these
problems. Caplan calls it the pol-
icy of "required request. Under
this arrangement no hospital
could disconnect a brain-dead po-
tential donor from a respirator and
write a death certificate until
evidence were produced that
available next of kin had been
asked about the possibility of
organ donation from the de-
ceased. The chief virtue of the
policy is that it ensures that
families of qualified donors are
asked about organ donation. This
would presumably improve the
10
WISCONSIN MEDICAL JOURNAL, DECEMBER 1985: VOL. 84
REQUIRED REQUEST-Peters
SPECIAL
rate of organ retrieval and uni-
formly provide families the thera-
peutic benefits described above.
An additional advantage of the
Caplan policy is that once the
public realizes that a hospital will
automatically ask about organ do-
nation in such circumstances,
families will be prepared for the
request. The policy creates a salu-
tary pressure upon families to dis-
cuss organ donation before actu-
ally losing one of their members.
The policy also could resolve a
number of other practical
problems with organ retrieval.
In many cases a head-trauma vic-
tim's wallet or purse containing
his/her donor card gets separated
from the victim during rescue or
hospital admission procedures. If
the victim dies, the donor card is
frequently not sought or readily
producible. If it is found but not
signed, it is hard to know whether
the patient would have approved
of organ removal. The victim's
family is most likely to know the
answer to this question. Again,
routine family inquiry is indi-
cated.
Lastly, under the provisions of
Wisconsin's UAGA, the family
has the legal right to donate organs
from a deceased family member if
1. the latter has not signed a
donor card, or
2. a donor card cannot be
found, and
3. there is no evidence that
the decedent, while alive,
objected to postmortem or-
gan removal.^
If the family of a brain-dead po-
tential donor is not approached
about the possibility of organ re-
moval and transfer from their
loved one, they are not being
given an opportunity to exercise a
right which they possess under
law. The policy of required re-
quest, then, can be interpreted as
mandating that the family of a po-
tential donor be "read their
rights," as it were, so that they
may act upon them.
Suppose a hospital staff person
judges that a family is so emotion-
ally distraught as a result of the
unexpected death of their loved
one that they would be psycholog-
ically devastated by a donation re-
quest. Does the policy of required
request demand that the inquiry
be made irrespective of the likely
deleterious consequences to survi-
vors? No. Caplan suggests that in
this situation the hospital repre-
sentative be allowed to exercise
discretion and be permitted to
forego approaching the family if
he /she honestly believes that the
family would be harmed by such
a request. But in such a case, Cap-
lan insists, the hospital staff per-
son should be required to put into
writing the reasons why he/she
did not make the otherwise man-
dated inquiry. “ This restriction is
designed to discourage critical
care staff from shying away from
approaching families of potential
donors because they are psycho-
logically uncomfortable about do-
ing so.
Caplan also insists that the
physician who pronounces death
be prohibited from inquiring
about the donation. This restric-
tion is aimed at preventing or re-
ducing family suspicions that the
person making the request has
prematurely declared death in
order to quickly salvage the pa-
tient's usable organs. If this is a de-
fensible restriction, it raises the
question of whether the same con-
flict of interest issue arises in con-
nection with family inquiries
made by anyone directly con-
nected with the critical care of the
decedent. If this is a legitimate and
important problem, the option re-
mains of requiring that the person
who conducts the family inter-
view be someone who has been
not at all involved in the final
treatment of the patient; eg, a
member of the pastoral care team
or some other medically disinter-
ested party. Caplan recommends,
and I agree, that some agency in
the state [eg, the Department of
Health) be charged with setting
standards for the training of per-
sons who will be responsible for
requesting donation. Not every
person opportunely placed to
make the request has the back-
ground necessary to perform this
task in an informed and humane
manner.^
A third problem connected with
implementing Caplan's policy has
to do with protecting the auton-
omous choice of individuals who
have officially registered a deci-
sion to make their organs avail-
able after death by signing a dona-
tion document of some type; eg, a
driver's license donor card.
Wisconsin's UACA, like most
state UACAs, does not give a
family the right to veto the written
declaration of a deceased relative
to serve as a donor. The policy of
required request might be wrongly
interpreted as granting such au-
thority to the family. The UACA
gives paramount authority to the
individual to decide whether his/
her organs will be available for
medical use after death. Hospital
staff must therefore use a different
approach in speaking with fami-
lies of declared donors than they
use with families of potential do-
nors who have not signed dona-
tion documents.
The family of a declared donor
must be informed that the dece-
dent's signed card confers on the
institution or person functioning as
donee; ie, as recipient of the gift,
a legal right to take the decedent's
organs without family consent for
use in accordance with those pur-
poses specified by the donor, As
a matter of courtesy, the family
should of course be informed
about what the hospital is prepar-
ing to do to carry out the wishes
of their dead relative to serve as a
donor. Following standard inter-
view procedure, procurement
staff will attempt to answer those
WISCONSIN MEDICAL JOURNAL, DECEMBER 1985: VOL. 84
SPECIAL
REQUIRED REQUEST-Peters
questions most frequently asked
by lay persons about organ dona-
tion {eg, "Will it disfigure the body
and prevent open casket viewing?"
"What is meant by 'brain death'?"
"Will organ removal jeopardize
the possibility or quality of life in
the hereafter?").
In the unlikely event that the
family still opposes organ removal
from the declared donor dece-
dent, I suggest that the procure-
ment staff person ask the family,
as a matter of policy, to sign a brief
written declaration of dissent form.
This document will be a request to
the donee— ze, the person or insti-
tution authorized to receive the
anatomical gift (in most cases this
will be the attending physician)'"*
—to waive his/her right of access
to the gift for reasons cited by the
family on the dissent form. I call
this the "minimum burden of
proof requirement." While the
donee's waiver will be automatic,
requiring the dissenting family to
put into writing the substance of
their objection has a number of
important advantages.
First, it gives a more appropriate
degree of recognition to the para-
mount rights of declared donors
and donees under the UAGA than
is provided either by present pol-
icy (which usually never apprises
families of registered donors of
these rights) or a policy which
gives these rights mere token rec-
ognition. An example of the latter
would be a policy in which pro-
curement personnel inform fami-
lies of deceased designated donors
of the interlinked rights of the
decedents and donees, but then
deal with these families as if these
rights placed no constraints what-
ever on the families' behavior;
that is, after families are apprised
of these rights, procurement staff
straightaway ask these families
for permission to remove organs
from relatives who have person-
ally authorized this procedure be-
fore death.
The token recognition policy
would communicate to the family
the following message: "The dece-
dent and donee have these rights,
but we (procurement staff) don't
take them seriously, and we don't
expect you to either. So we ask
your consent to this procedure be-
fore giving effect to the decedent's
stated wishes." While this policy
is not a complete sellout of the
rights of registered donors and
donees (the rights are at least an-
nounced in the family interview),
these rights are not allowed to
qualify family authority in any
way.
The distinction between this
policy and current procurement
practice, which routinely ignores
the different legal topographies of
cases in which potential donors
have signed donation documents
and cases in which they have not,
is vanishingly small. The token
recognition policy is an almost
complete sellout of the rights of
declared donors and donees under
the UAGA. The policy I recom-
mend is less vulnerable to this
change.
Secondly, 1 doubt whether the
rights-acknowledging policy 1 am
proposing will estrange the public
from the organ procurement
movement and in this way jeopar-
dize the goal of maximizing the
number of organs obtained for
transfer to patients facing immi-
nent death from end-stage organ
diseases. The burden placed on an
objecting family to complete a dis-
sent form is not onerous, although
it is a significant exercise which
expressly acknowledges the rights
of donor and donee which are
paramount in the situation. The
family gets their way without hav-
ing to argue for their position in a
face-to-face interchange with the
donee and without having to go to
court (the donee's waiver is auto-
matic). The consciences of family
members must stand as the final
judge of the adequacy of their rea-
sons for requesting that organs not
be taken from the decedent as he/
she desired.
Thirdly, the policy makes it
clear to the family that they cannot
abort the retrieval procedure; only
the donee can do this by waiving
his/her legal right of access to the
gift.
Some might object that the min-
imum burden policy still permits
selling out the rights of declared
donors and donees in deference to
the contrary wishes of decedents'
families— which is strictly illegal
under the provisions of the UAGA.
However, is a policy of never
yielding to the objections of such
families (and being prepared to
defend the rights of donors and
donees in court if necessary)
worth its likely costs: alienation of
the public and so reducing the
number of organ donations made
by families in circumstances
where they are authorized by the
UAGA to decide whether organs
will be removed from a deceased
relative, in cases, namely, where
potential donors have not signed
donation documents and have not
registered prior objection to the
posthumous taking of their body
parts?
I suggest that since the public
currently has little personal com-
mitment to donating organs, the
policy of minimum burden of
proof achieves an acceptable bal-
ance between the two principal
competing interests at stake when
a deceased potential donor has
authorized posthumous donation:
(1) the rights of the donor and
donee generated by this formal
authorization, and (2) the long-
term success of the organ retrieval
effort.
In the past six months state leg-
islatures in New York and Oregon
have passed required request laws
based on the Caplan model.'®"’ I
urge that we enact similar legisla-
tion in Wisconsin. But whether
we retrieve organs under a re-
quired request policy or not, hos-
pital interviewers must bring the
rights of declared donors and the
corresponding rights of donees to
12
WISCONSIN MEDICAL JOURNAL, DECEMBER 1985:VOL. 84
REQUIRED REQUEST-Peters
SPECIAL
the attention of the surviving fam-
ilies of such donors. If they don't,
they defeat the important protec-
tions given to the autonomous
choice of declared donors under
the Uniform Anatomical Gift Act.
REFERENCES
1. Evans RW, et al: The National Heart Trans-
plantation Study: Final Report. (Seattle,
Washington: Battelle Human Affairs Re-
search Centers, 1984]: Executive Sum-
mary—29.
2. Wehr E: National health policy sought for
organ transplant surgery. Congressional
Quarterly Weekly Report 1984 (February 25|:
458.
3. Gapen P: Minority organ donors encouraged.
American Medical News 1984 (November 9):
19.
P RIOR TO 1947, the only indica-
tion for contact lenses was in an
attempt to give useful vision to the
unfortunate individual who had
corneal scarring, irregular astig-
matism or keratoconus, and who
could not achieve reasonable vi-
sion with glasses. These lenses
were moulded polymethylme-
thracrylate (PMMA) or blown-
Doctor Davis is Emeritus Associate Clin-
ical Professor of Ophthalmology, Univer-
sity of Wisconsin Medical School, Madi-
son. Copyright 1985 by the State Medical
Society of Wisconsin.
4. See Wisconsin Statutes Annotated. Sec.
155.06 (2(a), (b)). (West 1983).
5. Kolata G: Organ shortage clouds new trans-
plant era. Science 1983 (July 1); 221:32-33.
6. Overcast TD, et al: Problems in the identi-
fication of potential organ donors. JAMA
1984 (March 23/30; 251:1559-1562.
7. Sophie SR, et al: Intensive care nurses per-
ceptions of cadaver organ procurement.
Heart &Lung 1983 (May); 12:261-266; Stark
J, et al: Attitudes affecting organ donation
in the intensive care unit. Heart & Lung 1984
(July); 13:400-404.
8. Prottas J: Encouraging altruism: Public at-
titudes and the marketing of organ dona-
tion. Milbank Memorial Fund Quarterly:
Health & Society 1983 (Spring): 61:278-306.
9. David FD, Callanen V: The grieving family’s
reaction to organ donation. Washington
Hospital Center Organ Procurement De-
partment. Unpublished.
10. Caplan AL: Ethical and policy issues in the
procurement of cadaver organs for trans-
plantation. N Engl J Med 1984 (October 11);
311:981-983.
glass scleral lenses. They covered
the entire globe, had to be filled
with a buffered saline solution,
and could only be tolerated at best
for three to four hours at a time.
In 1947 the first corneal contact
lens was developed, and this
evolved to the point where mil-
lions of individuals throughout
the world have become more or
less enthusiastic contact lens
wearers in the past 38 years. The
early PMMA "hard" or rigid con-
tact lenses were very crude by to-
day's standards, and those of us
who fit them (largely on our wives
1 1 . Comments by Arthur Caplan at the confer-
ence, Organ Transplantation: Problems of
Procurement, Funding, & Rationing, held at
the University of Wisconsin, Stevens Point,
Wl, March 11, 1985.
12. Caplan AL: Organ procurement: It's not in
the cards. Hastings Center Report 1984 (Oc-
tober) 9-12.
13. See Oregon Donor Identification Manual.
Portland, Oregon: Oregon Donor Program
(1984): 17.
14. Wisconsin Statutes Annotated. Sec. 155.06
(4(c)).
15. "Poll: Not Many Donate Organs." Am Med
News, May 10, 1985; p 64
16. "N.Y. Hospitals Required to Ask About
Organ Donation." Am Med News, Sept 27,
1985; p 21.
17. "Oregon to Require Hospitals to Ask for
Transplant Organs." Wall Street Journal,
Sept 3, 1985; p 25. ■
or friends), had considerable mis-
givings as to what we were doing
to the cornea. The lenses were
large, thick, and fit flat so that the
apex of the cornea rubbed on the
back of the lens. This naturally
caused severe adaptation symp-
toms, namely foreign body sensa-
tion and tearing, and it was only
the most determined patient who
could get through the two to three
week adaptation period and
achieve reasonable six to eight
hour wearing time. We now know
that the patients who did well
with these early lenses developed
corneal anesthesia and had a high
pain threshold.
Largely through the impetus of
optometry, which was quick to
recognize a vast potential market,
there was rapid improvement in
lens design in the early 1950s. As
new lathes and manufacturing
techniques were developed, it be-
came possible to make the lenses
much smaller, thinner and steeper,
thus reducing adaptation time to
an acceptable seven to ten days,
and increasing safe wearing time
to a more realistic eight to 16
hours.
Contact lenses: Boon or bain?
Frederick J Davis, MD, Madison, Wisconsin
In the past several years the use of “extended wear" soft contact
lenses for “up to 30 days" correction of myopia has been highly pro-
moted and advertised by chain store and discount optical outlets.
Ophthalmologists are seeing an alarming increase in vision-threaten-
ing complications, most notably Pseudomonas corneal ulcers, secon-
dary to these lenses. The use of extended wear lenses, except for a
pressing visual or occupational need, and their prescription by med-
ically uneducated individuals, is to be strongly condemned.
WISCONSIN MEDICAL JOURNAL, DECEMBER 1985: VOL. 84
13
SPECIAL
CONTACT LENSES-Davis
In 1960 a group of about 20 oph-
thalmologists, recognizing the
need for more medically-oriented
direction in the contact lens field,
organized the Contact Lens As-
sociation of Ophthalmologists, a
group that now numbers over
1600 members representing every
state, who have been in the fore-
front of teaching and research in
contact lenses for the past 25
years.
From 1950 to 1970 millions of
patients were fit with "hard"
PMMA lenses, largely for cos-
metic purposes. The large major-
ity of these patients were young
myopic females. The primary
visual indication for contact lenses
was in the aphakic or postcataract
population. Spectacle vision for
these individuals is quite unsatis-
factory with marked restriction in
visual field and gross magnifica-
tion. With a contact lens, normal
vision is restored, and binocular
vision in monocular aphakia be-
comes possible. Over this 20-year
period, much was learned about
the long-term corneal complica-
tion of contact lens wear, and the
respiratory physiology of the cor-
nea.
It became common to see cor-
neal distortion, increasing astig-
matism, and in rare instances
peripheral corneal scarring or vas-
cularization in the 10-20 year con-
tact lens wearer. At first it was felt
that these changes were primarily
the result of mechanical pressure
and irritation from the lens edge.
However, it soon became apparent
that chronic oxygen deprivation
was the underlying cause. The
cornea, being avascular, normally
obtains the oxygen necessary for
its metabolism from the air.
PMMA is essentially impervious
to oxygen, and when an 8- 10 mm
lens covers most of the corneal
surface, the cornea must obtain its
oxygen from the small amount
that is dissolved in the tears that
flow behind the contact lens.
Some corneas withstand this de-
crease in oxygen better than
others, and this is why some pa-
tients' corneas tolerate contact
lenses only eight hours, while
others can adapt to 16-18 hours of
wear. In the old PMMA lenses,
this adaptation and regular wear-
ing time was critical. Every oph-
thalmologist and most family phy-
sicians are familiar with the 1:00
A.M. phone call from a contact
lens wearer who has left his/her
lenses in two to three hours longer
than average, and now has all the
symptoms of a corneal abrasion.
This overwear syndrome, caused
by acute oxygen deprivation, re-
sults in edema of the central cor-
neal epithelial cells, and punctate
keratitis. Fortunately, few of these
cases went on to frank corneal
abrasion, and corneal ulcers were
extremely rare in the hard lens
population.
All of this changed radically and
permanently in 1970 when soft
contact lenses first appeared in the
United States, and the FDA en-
tered the picture.
The first soft lens material was
developed in Czechoslovakia, and
Bausch and Lomb introduced soft
lenses to an eager public in 1970.
To their credit, Bausch and Lomb
required any ophthalmologist or
optometrist who wished to work
with the lens to attend a one-day
seminar in the care and fitting of
the lenses. They also required a
$5,000 investment in stock lenses,
purchase agreements, and the
like.
The FDA, worried about reports
from England and Canada of
infection with soft lenses, classi-
fied them as drugs and required
any new soft lens material to
undergo the same rigorous and ex-
pensive premarket testing as any
new drug. This limited the intro-
duction of competing soft lenses
to those companies who could af-
ford the several million dollars in
development costs. When this
restriction was lifted, many small
companies entered the soft con-
tact lens field, and there are now
about 50 competing brands on the
market.
In the first few years, the FDA
insisted that the lenses be heat
sterilized daily in freshly prepared
saline solution, and this worked
well with virtually no problems
with infections or complications
as long as the patient complied.
The sterilization process was cum-
bersome and time-consuming,
however, and patient compliance
declined rapidly. We were soon
seeing reports of pure culture of
Pseudomonas organisms taken
from dirty contact lens cases and
saline bottles. This prompted the
FDA to approve the use of pre-
served saline and cold chemical
sterilization techniques, which
were more effective but produced
a high incidence (20% or more) of
allergic conjunctivitis and super-
ficial punctate keratitis in daily
soft lens wearers.
The daily wear soft lens has
many advantages over the PMMA
hard lens. It is totally comfortable
with no adaptation symptoms. It
does not dislodge or become lost
easily, making it an excellent
athletic lens, and it rarely causes
corneal edema or overwear syn-
drome. It is an excellent part-time
wear lens as it does not distort the
cornea, making it easy for the pa-
tient to switch back and forth be-
tween glasses and contacts. This
was not true of PMMA hard
lenses. The soft lens, however, is
fit largely by trial and error, and
requires little skill or training by
the fitter. This fact opened Pan-
dora's box to the intensely com-
petitive, highly advertised situa-
tion we have today, with every
type of chain store and discount
optical house promoting and fit-
ting soft contact lenses. While this
practice has had the desired effect
of reducing prices, it has been at
the cost of many patients being
fitted with lenses they did not
need, or being improperly fitted,
with poor patient instruction, and
14
WISCONSIN MEDICAL JOURNAL, DECEMBER 1985: VOL. 84
CONTACT LENSES-Davis
SPECIAI.
very poor followup. All of this
would not have been so bad if the
lenses had continued on a daily-
wear basis. The patient who de-
veloped allergic or infection prob-
lems with these lenses would
simply stop wearing them and
seek medical help, and there was
rarely any irreversible corneal
damage.
For some strange reason, many
myopes are bothered by not being
able to see clearly on awakening
without taking the ten seconds to
put on their glasses or the five
minutes to insert their contacts, so
there developed an increasing de-
mand for a contact lens that could
be left in overnight and worn for
several days to several weeks at a
time. These "extended wear"
lenses had their first application in
the aphakic patient with some jus-
tification and fair success. As the
cataract patient ages, it becomes
more difficult to insert, remove
and care for a standard hard or
daily-wear soft lens, and the pa-
tient is so handicapped with
glasses that a soft contact lens that
can be left in a week or more at a
time is a real blessing. Since these
were all postsurgical patients, vir-
tually all of these early extended
wear lenses were fit by, or under
the close followup of, ophthalmol-
ogists or well-trained optom-
etrists. Complications such as cor-
neal edema, conjunctivitis, cor-
neal vascularization, and the like,
occurred but were promptly seen
and treated. Problems arose when
the FDA in its "wisdom" approved
extended wear lenses for purely
cosmetic purposes for the myopic
population. The chain stores and
discount centers promptly en-
tered the market with intense ad-
vertising, and the manufacturers
were only too glad to oblige as
they doubled the price of these
higher water content extended
wear lenses.
All of the problems of inade-
quate instruction, care, and fol-
lowup were now intensified as
corneal edema and epithelial ero-
sion became much more common
with the cornea operating in a de-
creased oxygen environment for
weeks at a time. The ever present
Pseudomonas organism plus cor-
neal abrasion equals a vision-
threatening corneal ulcer.
The upshot of all this is that
ophthalmologists are seeing an
alarming increase in corneal
ulcers secondary to extended
wear soft contact lenses with
many cases resulting in severe
corneal scarring necessitating
later corneal transplant and occa-
sional perforation and loss of the
globe. All this for the sake of not
having to insert contact lenses in
the morning!
The old PMMA material is now
disappearing and is being replaced
by new hard lens materials that
are much more oxygen permeable
than any prior lens, hard or soft.
Since these lenses do not cover the
entire cornea and provide an ex-
cellent oxygen environment to the
cornea even through the closed
lid, they will undoubtedly become
the "extended wear" lens of the
future.
The bottom line is that extended
wear lenses should only be worn
by those who have a real visual or
occupational need for them, and
should be fitted only under close
supervision and follow-up by a
well-trained optometric contact
lens specialist or ophthalmologist.
The patient must be very carefully
instructed in the signs and symp-
toms of lens complication, and
must have access to prompt medi-
cal eye care 24 hours a day, 365
days a year.H
AMA Physician's Recognition Award Recipients
Listed below are those physicians in Wisconsin who have earned the AMA Physician's Recognition Award in
recent months. The State Medical Society of Wisconsin congratulates these physicians who have distinguished
themselves and their profession by their commitment to continuing education:
OCTOBER 1985
‘Bender, William L, Viroqua
•Berg, Mary C, Madison
•Bernhardt, Louis C, Madison
•Bockelman, Henry W, Racine
•Boudry, Marshall O, Waupaca
Boys-Smith, John W, Marshfield
•Davis, Donald P, Milwaukee
•De Groot, Henry E, Racine
Di Liberti, Charles, Neenah
•Dudenhoefer, Paul A, Elm Grove
•Duffy, Michael A, Oshkosh
* Members of ihe Slate Medical Society of Wisconsin
•pinesilver, Alan G, Green Bay
•plickinger, Roger R, Waukesha
•Gladieux, John R, Milwaukee
•Handrich, Thomas A, Mequon
•Hendrickson, Robert L, Cornell
•Hirsch, Samuel R, Milwaukee
•Hizon, Josefina L, Sheboygan
Israelstam, David M, Madison
•Kempton, Leo V, La Crosse
•Klasinski, Clarence A, Stevens Point
•Knight, Margaret M, Wauwatosa
•Lasater, Steven R, Milwaukee
•Lewinnek, Walter, Merrill
•Lorenz, Albert A, Eau Claire
Manske, Brian R, La Crosse
Mark, Leighton P, Eau Claire
Me Sweeny, Austin J, Janesville
•Nielsen, William A, West Bend
•Patel, Munikumar H, Milwaukee
•Patel, Vasudev M, Monroe
•Pinkerton, John D, Marinette
•Rathbun, John M, Cumberland
•Reif, Lawrence J, Kenosha
•Richards, Marcia J S, Milwaukee
Roll, Byung L, New Berlin
•Rotter, Francis J, Milwaukee
•Stiehl, Charles W, Milwaukee
Tan, Lourdes R, Tomah
•Tarrant, Grace L, Menasha
•Tiu, Alfonso L, West Allis
•Tompkins, Douglas G, La Crosse
•Wilson, Janet A, Wisconsin Rapids
•Woods, James H, Milwaukee
•Zucker, Kenneth L, Green BayH
WLSCONSIN MEUICAI, JOURNAL, DECLMBER 1985 :VOI.. 84
15
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Victor S Falk, MD, Medical Editor
SCIENTIFIC MEDICINE
Review of the clinical manifestations, laboratory
findings, and complications of infectious mononucleosis
Lynn Rosen White, MD and Peter S Karofsky, MD, Madison, Wisconsin
ABSTRACT. Infectious mononucle-
osis is a viral illness with many clin-
ical manifestations. The diagnosis is
made in the laboratory using non-
specific tests like the white blood cell
count and specific tests which mea-
sure antibody levels to the Epstein-
Barr virus. Most patients with
mononucleosis require only support-
ive treatment and recover without
permanent mental or physical im-
pairment.
Key words: Mononucleosis; Infectious
mononucleosis; Epstein-Barr virus
Infectious mononucleosis
(IM) is a disorder caused by infec-
tion of B-lymphocytes with
Epstein-Barr virus (EBV). The
diagnosis is based on many clini-
cal manifestations including fever,
lymphadenopathy, and pharyn-
gitis. A lymphoproliferative re-
sponse to the infecting agent pro-
duces many of the characteristic
findings. The peripheral blood
smear is characterized by a mild
leukocytosis and a predominance
of mononuclear cells of which at
least 10-20% are atypical lympho-
cytes. All patients with IM will
have an elevation in EBV-specific
antibody titers, and most will
demonstrate a positive hetero-
phile antibody test.
From the Department of Pediatrics,
University of Wisconsin Hospital and
Clinics, Madison. Reprint requests to:
Peter S Karofsky, MD, Dept of Pediatrics,
H6/444, 600 Highland Ave, Madison, Wis
53792 (ph 608/263-8934). Copyright 1985
by the State Medical Society of Wisconsin.
Historical perspective. The clinical
syndrome of fever, lymphoid hy-
perplasia, pharyngitis, and multi-
system involvement in adoles-
cents and young adults was first
described as "Drusenfieber”
(glandular fever) by Pfeiffer^ in
1889. The specific clinical features
of this syndrome were outlined by
Sprunt and Evans^ in 1920 and re-
named "infectious mononucle-
osis." They also described "atypi-
cal lymphocytes" in the blood
smear of patients with infectious
mononucleosis. In 1923 Downey
and McKinlay^ further described
these cells, naming them "viro-
cytes” because of their association
with other viral illnesses.
In 1932 Paul and BunnelP pub-
lished their work on heterophile
antibodies in IM. Davidsohn,^ in
1937, refined the laboratory diag-
nosis of IM with the recognition of
differential absorption patterns of
heterophile antibodies with bo-
vine erythrocytes and with guinea
pig kidney cells.
The virus cultured from lym-
phoblastic cells was discovered by
Epstein, Barr, and Achong® during
their studies of Burkitt's lym-
phoma. Using electron micros-
copy, they demonstrated the pres-
ence of a new herpes-like
organism. Further study by Henle
and Henle^ in the 1960s led to a
description of the Epstein-Barr
virus and identification by new im-
munofluorescent antibody tech-
niques of several antibodies to the
virus. The antibodies were pres-
ent in subjects with the infectious
mononucleosis syndrome, and
the association between EBV and
IM was thus elicited by the
Henles.®
Niederman, Pearson, and Mil-
ler® studied mechanisms of trans-
mission of EBV. They showed
nasopharyngeal and salivary
shedding of the agent for pro-
longed periods following primary
infection. Sixbey et aP° dem-
onstrated EBV replication in oro-
pharyngeal epithelial cells from
patients with IM. This study sug-
gested the endogenous production
of EBV as a source of reinfection
of B cells.
Epidemiology. Epstein-Barr virus
is ubiquitous. In developing coun-
tries EBV infection is generally
asymptomatic and seropositivity
is greater than 90% by early child-
hood. Symptomatic disease ap-
pears to be more common in in-
dustrialized countries where
adolescents and young adults are
most severely affected. In the
more developed countries, sero-
positivity of greater than 90% is
not achieved until age 30, and a
higher prevalence of seroposi-
tivity among younger age groups
in the lower socioeconomic
groups is seen. Early acquisition of
the viral agent in this population
may be a result of crowded living
conditions.
The salivary glands appear to be
a major site of EBV latency and re-
activation. Most patients with IM
demonstrate oropharyngeal viral
excretion intermittently for
months following the acute phase
of the disease. In many infected
individuals viral excretion persists
a lifetime. It is postulated for
groups with a high incidence of
IM, such as young adults, that fre-
quent, intimate oral contact via
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INFECTIOUS MONONUCLEOSIS-White and Karofsky
kissing leads to transmission of
EBV.“ Infection also may be
spread iatrogenically through
blood products and bone marrow
transplantation.
Pathophysiology. Infection of B-
lymphocytes with EBV leads to
transformation of the cells with
subsequent intense proliferation.
Infected B cells express cell sur-
face membrane antigens capable
of stimulating a suppressor-lytic
T-cell response. The atypical lym-
phocytes associated with IM have
been identified as activated T-
lymphocytes.*^ Additionally, it is
proposed that interferon released
by infected B cells stimulates
natural killer cell activity. These
cell-mediated responses are prob-
ably responsible for the massive
mononuclear infiltrates in various
organs and tissues and may be
causally related to the multi-
system aberrations found in in-
fectious mononucleosis.*^
The acute phase of IM is char-
acterized by the presence of a
humoral response with produc-
tion of anti-viral capsid (anti-VCA)
IgM and IgG, which are detect-
able before the onset of symp-
toms, during the incubation
period. These antibodies, along
with the cell-mediated immune
response, may curtail infected B-
cell activity.
In convalescence, several spe-
cific antibodies develop, including
anti-EBV nuclear antigen (anti-
EBNA) antibodies and anti-early
antigen (anti-EA) antibodies. Addi-
tionally, memory T-cells and
helper T-cells monitor the anti-
body response. These activities
are felt to be responsible for con-
taining and preventing reactiva-
tion of latent EBV and for prevent-
ing the proliferation of potentially
malignant EBV-transformed B-
lymphoblasts.*®
Deficient host responses to EBV
infection can result in a chronic
mononucleosis syndrome, which
has been reported in individuals
with hypogammaglobulinemia. In
these patients there was per-
sistence of abnormal EBV-specific
etiologic response and clinical
manifestations of recurrent phar-
yngitis, chronic malaise, and fa-
tigue.*®
The host also may respond with
auto-antibody production which
may be secondary to B-cell acti-
vation (polyclonal) or transient T-
cell anergy. Activation of sup-
pressor/cytotoxic T-cells (to con-
trol the polyclonal B-cell prolifera-
tion) also can effect transient sup-
pression of cellular and humoral
immunity and cause decreased
immune responses to other con-
current infections and neoanti-
13.18,19.20
Clinical features. The familiar fea-
tures of infectious mononucleosis
can be thought of temporally in
the sequence of prodrome, syn-
drome, and convalescence. Before
the appearance of symptoms, a
30-50 day incubation precedes
this sequence.® The prodrome
generally lasts about 3-5 days and
is characterized by fever, malaise,
anorexia, myalgias, and headache.
The syndrome follows over the
next 5-15 days and may include
exudative pharyngitis, tonsillar
hypertrophy, palatal petechiae,
cervical lymphadenopathy, peri-
orbital and facial edema, conjunc-
tival inflammation, exanthems,
splenomegaly, and mild tender
hepatomegaly.
The convalescent phase, which
occurs from two to eight weeks
after the onset of the illness is
characterized by gradual resolu-
tion of the signs and symptoms.
Periods of waxing and waning are
not unusual.®*
Typical laboratory findings dur-
ing the acute phase of IM consist
of the following: (1) white blood
cell counts of 10,000-20,000/ mm®,
(2) an absolute lymphocytosis
(about 50% of total white blood
cell count), and (3) atypical lym-
phocytosis (at least 10-20% of total
white blood cell count). Transient
neutropenia, anemia, and throm-
bocytopenia have been found
early in the course of the illness.®®
Abnormal liver function tests
are common during the first three
weeks of the disease and are indic-
ative of a mild hepatitis. Values
for liver enzymes such as serum
glutamic oxaloacetic trans-
aminase, serum glutamic pyruvic
transaminase, and lactic dehy-
drogenase are often two to three
times normal. The bilirubin is
mildly elevated to 1-3 mg / 100 ml
but is rarely greater than 5 mg/
100 ml.®® Although the abnormal
liver function studies may persist
for extended periods during the
convalescent phase, it is unusual
to see a persistent or chronic ac-
tive hepatitis ensue.
One serologic test used to con-
firm the diagnosis of IM is the
heterophile antibody test. Hetero-
phile antibodies are IgM anti-
bodies, which react with antigens,
different from those which stim-
ulated their production. Some
heterophile antibodies cause ag-
glutination of sheep red blood
cells, while others are absorbed by
guinea pig kidney cells or beef
stroma. The Paul-Bunnell-David-
sohn test, of which the "spot”
tests are variations, is based upon
this principle. The heterophile
antibody in mononucleosis pa-
tients is absorbed by beef red
blood cells but not by guinea pig
kidney cells. Heterophile an-
tibody testing is done by diluting
a serum sample sequentially by
50% to achieve dilutions of 1:8,
1:16, 1:32 ... etc. Duplicate
samples of the serial dilutions are
then mixed with guinea pig kid-
ney cells or beef red blood cells.
The heterophile antibody (of IM),
when present in the patient's
serum, will be completely ab-
sorbed by beef red blood cells
(stroma), but minimally absorbed
by guinea pig kidney cells. Thus,
an assay to detect the heterophile
antibody after absorption by each
of the above two reagents, in the
case of a positive test, may show a
20
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INFECTIOUS MONONUCLEOSIS- White and Karofsky
SCIENTIFIC MEDICINE
Figure I— Antibody profile in infectious mononucleosis.
titer of at least 1:128, which is un-
changed, or not decreased by
more than one tube dilution fol-
lowing absorption with guinea pig
kidney cells. It is markedly de-
creased, however, by absorption
with beef red blood cells. The
term titer refers to the lowest se-
rum concentration at which the
antibody can be detected by the
assay. Thus, the differential ab-
sorption pattern is a specific way
in which the heterophile antibody
concentration can be measured.
An example of a positive test is
as follows: an adolescent with a
three-week history of fever,
malaise, pharyngitis, and lym-
phadenopathy is tested for hetero-
phile antibodies. He has a titer of
1:256; the titer is unchanged after
absorption with guinea pig kidney
cells, but absorption to beef red
blood cells yields a resultant titer
of less than 1:8 (ie, undetectable
even in relatively undiluted
serum).
In most cases of infectious
mononucleosis heterophile anti-
body tests will be positive by the
end of the third week (85-90%).
In young children with IM
heterophile antibodies are fre-
quently negative. In the 10-24
month old group only 27% have a
positive response. Seventy-six per-
cent of the 26-48 month group
have a positive response.
Specific antibody testing is
needed to establish the diagnosis
of IM in cases where several
features of IM are present and the
patient has a negative initial and
repeat heterophile test. The figure
shows the temporal sequence of
appearance of specific antibodies.
Acutely, during the incubation
period, there is a rise in titer of
anti-viral capsid antigen (anti-
VCA) IgM, which peaks during
the acute phase, then diminishes
rapidly over the next several
months to undetectable levels.
Anti-viral capsid antigen (anti-
VCA) IgG titers also rise rapidly,
paralleling the anti-VCA IgM titers
during the late incubation and
acute phases and will usually re-
main detectable for life.^'*^®
Approximately two to three
weeks after the onset of the ill-
ness, anti-early antigen antibodies
(anti-EA) appear. They rise in
titer, and then decline slowly over
several months. EA antibodies are
present as diffuse (D) and re-
stricted (R) components. Young
patients are more likely to have an
elevation of the restricted com-
ponent, while older patients show
a rise in the diffuse component.
Anti-EBV nuclear antigen (anti-
EBNA) antibodies appear later in
the convalescent period. These
antibodies, like the anti-VCA IgG
antibodies, persist and are de-
tectable life-long26 (Fig 1).
COMPLICATIONS. The complica-
tions of infectious mononucleosis
described below by systems in-
clude severe and life-threatening
sequelae of the syndrome as well
as relatively unusual but reported
effects associated with IM.
Ear, nose and throat. Airway ob-
struction secondary to marked
lymphoid hyperplasia in IM is
seen in both the younger and
older age groups. Patients experi-
encing this complication have
pharyngitis, often accompanied
by a thick membranous exudate
extending to the tonsils. They also
have tonsillar hypertrophy, lym-
phoid hyperplasia in Waldeyer's
ring (seen on lateral neck x-ray
films) and cervical lymphadenop-
athy. These patients develop
stridor and retractions and may
progress to frank respiratory
failure. Clinical improvement in
some patients with obstruction of
the upper respiratory tract secon-
dary to lymphoid hyperplasia has
been noted after the use of
steroids. 27
Concurrent infection with
group A beta-streptococcus has
been found in 3-30% of cases of
IM; appropriate antibiotic therapy
is recommended, with either pen-
icillin or erythromycin for 10 days
when cultures are positive. 2»
Peritonsillar abscess may pre-
sent with signs and symptoms of
peritonsillar swelling, purulent
exudate, dysphagia, and trismus.
Culture of abscess fluid (by aspira-
tion) usually yields typical oro-
pharyngeal and upper respiratory
tract flora (streptococci, staph-
ylococci, and sometimes anae-
robes). In one series of patients
hospitalized with IM, 1% devel-
oped peritonsillar abscess. Treat-
ment modalities include needle
aspiration, incision and drainage,
and immediate tonsillectomy.
Most treatment regimens also in-
clude systemic antibiotics.
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INFECTIOUS MONONUCLEOSIS-White and Karofsky
Reticuloendothelial system. Sple-
nic enlargement caused by a
mononuclear infiltration is a com-
mon finding in infectious mono-
nucleosis. Patients often experi-
ence mild to moderate left upper
quadrant discomfort and have an
enlarged spleen on examination.
Splenic rupture is a complication
in 0. 1-0.2% of cases with IM, with
days 4-21 of clinical illness (fol-
lowing the prodrome) being the
days of highest risk. Most rup-
tures are spontaneous but they
may occur following palpation,
bowel movements, or trauma.
Ninety percent occur in males.
The signs and symptoms include
left upper quadrant pain, general-
ized pain in the entire abdomen,
pain in the left shoulder, and in-
creasing pain with inspiration.
Hypovolemia may be present due
to hemorrhage. A leukocytosis
(white blood cell count of 15,000-
30,000/mm3) a left shift also
may be present. As physicians are
generally adept at recognizing this
entity, there have been no re-
ported fatalities in the past 18
years due to this complication. ^3
Eye. Complications which involve
the eye include conjunctivitis and
Parinaud's oculoglandular syn-
drome. Another common feature
of IM is periorbital (nonpitting)
edema, referred to as Hoagland's
sign. 31
The type of conjunctivitis com-
monly seen in IM involves one or
both eyes and may be a follicular
or membranous inflammatory
change. Conjunctivitis can occur
during any stage of the illness, but
it is most commonly seen during
the acute phase.
The oculoglandular syndrome
was first described by Parinaud^^
in 1889. This process consists of
unilateral granular conjunctivitis,
with preauricular and cervical
lymphadenopathy on the ipsilat-
eral side. The Epstein-Barr virus is
one of many infectious agents that
cause Parinaud's oculoglandular
syndrome. The conjunctivitis can
be severe and may be accompan-
ied by nodular discrete lesions on
the tarsal conjunctiva. The treat-
ment of Parinaud's oculoglandu-
lar syndrome is generally sympto-
matic (warm soaks to the eyelids),
but the granulations require ex-
cision. The specimens obtained
from this procedure characteris-
tically show large multinucleated
immunoblasts.^3
Cardiovascular. Myocarditis and
pericarditis are rare complications
of IM. The signs and symptoms
include dyspnea, orthopnea, gal-
lop rhythm, murmur, chest pain,
and pericardial friction rub.
The electrocardiographic find-
ings in myocarditis are T-wave in-
versions (V4, V5, Ve) and various
patterns of block. In pericarditis
nonspecific ST-T wave changes
are seen. 3334 Cardiac enzymes
(creatine phosphokinase, lactic
dehydrogenase, and serum glu-
tamic oxaloacetic transaminase)
may be elevated in acute myoperi-
carditis.^'*
In cases of IM where heart dis-
ease leads to death, pathologic
specimens demonstrate myofib-
rillar degeneration, interstitial
edema, and lymphocytic in-
filtration.3s
The treatment of heart disease
depends upon the particular pa-
thology and severity of the course.
In severe cases of pericarditis,
sedation, and analgesia, in addi-
tion to monitoring, are used. Sup-
portive care in the case of myo-
carditis includes telemetry mon-
itoring, inotropic regimens, and
pacemaker placement (in cases of
heart block). The use of steroids in
the treatment of carditis has been
advocated, following uncontrolled
trials. The results showed a dra-
matic improvement in signs,
symptoms, and electrocardio-
graphic findings within 48 hours
of initiation of therapy.
Pulmonary. Pneumonia is another
complication of IM. It is proposed
that the temporary immunosup-
pression induced by EBV infec-
tion allows for super-infection
with other organisms. Many pa-
tients with serologically proven
EBV infection exhibit simultane-
ous infection with other known
respiratory pathogens (viral, bac-
terial, and rickettsial). 36 There are
no pathognomonic findings in the
pneumonitis found in IM. Hilar
lymphadenopathy, shifting in-
filtrates, strand-like parenchymal
densities, and less frequently,
pleural effusions and nodular den-
sities may be present.
Pleuritis is also found in cases of
IM with pneumonia. Whether this
is due primarily to EBV infection
is unclear.
Therapy for pleuritis and/or
pneumonia is directed at the re-
sponsible pathogen.
Hematologic-oncologic. Severe he-
matologic complications in IM are
rare. Anemia is not generally a
part of the hematologic picture of
IM, and when present should
alert the physician to the presence
of a more serious process. The
acute onset of anemia suggests
blood loss, most often secondary
to splenic rupture. Hemolytic
anemia is rarely severe and is
present in almost 3% of patients. ^3
Mechanisms proposed for the red
blood cell hemolysis include anti-
erythrocyte antibodies (IgG), anti-i
cold agglutinins (IgM), and pos-
sibly, hypersplenism. The labora-
tory findings of hyperbilirubinem-
ia associated with reticulocytosis
will help to establish the diag-
nosis. Current therapy for severe
hemolytic anemia includes red
blood cell transfusions and the use
of corticosteroids. Aplastic anemia
associated with IM is thought to
be secondary to aberrations in im-
munologic response of the host to
EBV. 37
Pancytopenia which follows a
more insidious course may be
seen in IM. In one study, 3s the
mean time from onset of symp-
toms of pancytopenia to the nadir
of cell counts was 21.3 days (range
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INFECTIOUS MONONUCLEOSIS-White and Karofsky
SCIENTIFIC MEDICINE
7-49 days); the mean time from di-
agnosis of pancytopenia to bone
marrow recovery was 6.25 days
(range 4-8 days). In this report a
patient with pancytopenia associ-
ated with IM recovered shortly
after the initiation of steroid ther-
apy. The immediate response of
patients with pancytopenia to
steroids gives credence to the hy-
pothesis that this phenomenon
may occur secondary to an im-
munologic reaction.
Decreased platelet and neutro-
phil counts have been observed in
IM. Severe thrombocytopenia is
rare and is thought to be autoim-
mune in nature.23 Agranulocytosis
is also a rare complication. In one
report of two cases of agranulo-
cytosis, the onset was noted two
to six weeks after the onset of
symptoms of IM.^® Transient bone
marrow suppression secondary to
EBV infection may be responsible
for the mild cases of agranulocy-
tosis.
In addition to its association
with IM, EBV has also been as-
sociated with a number of malig-
nancies, including nasopharyn-
geal carcinoma, African Burkitt's
lymphoma, some American Bur-
kitt's lymphoma, and various
poorly differentiated lymphomas.
In the cases of Burkitt's lym-
phoma and nasopharyngeal car-
cinoma, it has been proposed that
there is a long latent period be-
tween primary infection with
EBV and detection of the malig-
nancy. Specific antibody titers to
EBV antigens are elevated with
the appearance of these malig-
nancies.'^®'**
Another form of a progressive,
fatal lymphoproliferative disease,
the X-linked lymphoproliferative
syndrome, is thought to be a result
of defective T-cell response to
EBV-associated antigens.
Neurologic and psychiatric. Neu-
rologic complications secondary
to IM are rare, occurring in
fewer than 1% of cases. They oc-
cur at any time during the course
of the illness. Any portion of the
peripheral or central nervous sys-
tem can be affected. Fatal out-
comes have been reported with
two neurologic complications,
meningoencephalitis and Guil-
lain-Barre syndrome with res-
piratory failure. Seizures have
been reported in patients with IM
who have meningoencephalitis
and who have atypical lympho-
cytes in their cerebrospinal
fluid. Status epilepticus as-
sociated with meningoencepha-
litis is a potentially fatal entity.
Many psychopathologic enti-
ties, including cognitive dis-
turbances, delirium, intellectual
deterioriation (acutely), disorien-
tation and various psychotic pre-
sentations including depression
have been described during the
course of EBV infections. Psy-
chosis in the form of perceptual
disturbances and visual halluci-
nations has been described as the
"Alice in Wonderland" syn-
drome.It is felt that many of
these presentations are consistent
with features of encephalitis, but
they also may be the psychologi-
cal responses of patients to the
debilitation experienced with IM.
Case reports describe a good re-
sponse to conventional pharmaco-
therapy and psychotherapy in
cases of acute psychosis.
Cranial nerve pathology has
been observed. Isolated cranial
nerve palsies, particularly Bell's
palsy, have been reported. A form
of ophthalmoplegia associated
with areflexia and ataxia has been
described as a postviral acute
polyneuritis syndrome in associ-
ation with IM.'‘®
Acute (reversible) bilateral and
unilateral sensorineural hearing
loss as well as vestibulitis have
been described during acute EBV
infection.
Acute cerebellar ataxia in the
form of pontocerebellitis can pre-
sent as acute limb and truncal
ataxia, incoordination, and dys-
arthria.
Other rare neurologic manifes-
tations of IM include transverse
myelitis and mononeuritis multi-
plex. The latter refers to inflam-
mation of multiple isolated pe-
ripheral nerves.
Integument. Rashes are a well-
known feature of the acute phase
of IM. Generalized eruptions are
macular, maculopapular, urticari-
al, or petechial. A morbilliform
rash is commonly seen following
therapy with ampicillin during the
acute phase of IM.
Papular acrodermatitis of child-
hood, or the Gianotti-Crosti syn-
drome, is manifested as a non-
pruritic brown-red papular erup-
tion of the face, buttocks, and
extensor portions of the extrem-
ities. It affects children from age
6 months to 12 years most often.
Although this is more commonly
associated with hepatitis B, EBV
also has been reported in associa-
tion with this entity.®®
Cold urticaria manifested by
hives on areas exposed to cold air
and cold surfaces or by ingestion
of cold foods is seen in patients
with IM. This reaction is thought
to be a result of mast cell degranu-
lation. It is not certain whether
this occurs as a result of cold-
activated factors (cryoglobulins
and cryofibrinogens), but these
were measured and were found to
be variably elevated in patients
with cold urticaria and IM. The
cold-activated factors are thought
to activate complement, which
leads to the degranulation of mast
cells.®"*®®
Cold-induced acrocyanosis is
another example of skin involve-
ment in IM mediated by immune
factors. Distal extremity cyanosis
in response to cold exposure can
be the presenting phenomenon in
IM. Cyanosis also can be observed
on the lips, the tongue, and the
nose. The proposed pathophysiol-
ogy of this phenomenon is that ag-
glutination of erythrocytes is
caused by the activation of cold-
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INFECTIOUS MONONUCLEOSIS-White and Karofsky
agglutinating autoantibodies,
which are then fixed by comple-
ment.
Gastrointestinal. Mild anicteric
hepatitis is a common feature of
IM. Liver function tests are tran-
siently elevated during the acute
phase of the disease and decrease
to normal levels later in the acute
and in the convalescent phases.
Profound jaundice (with total bili-
rubin greater than 10 mg/ 100 ml)
is very rare. The more serious
complications of submassive he-
patic necrosis and hepatic coma
also are very unusual. These lat-
ter entities may actually be due to
a Reye's syndrome and not to the
IM infiltrative process.
A transient malabsorption syn-
drome is observed in IM. Patients
develop crampy abdominal pain,
nausea, and vomiting and may be-
come dehydrated.
Proctitis, another condition seen
in association with IM, produces
abdominal pain, tenesmus,
bloody and mucoid rectal dis-
charge, inguinal adenopathy, and
rectal mucosal ulcerations.
Pancreatitis is another feature of
IM presenting as epigastric pain,
nausea, and vomiting. Patients
with pancreatitis have elevated
serum lipase and serum amylase
values (generally in the range of
100-600 units/dL).58
Miscellaneous complications.
Genitourinary complications as-
sociated with IM are very rare.
They include orchitis, nephro-
sis,and nephritis.
Kawasaki-like®^ disease and
Reye's syndrome®^ in association
with IM have been described.
THERAPY. In most cases of un-
complicated IM supportive care is
the only form of therapy required.
Analgesics are the most common
medications suggested for the dis-
comfort experienced during the
acute phase. Antipyretics may be
given for the initial febrile course.
Hydration is generally accom-
plished orally but may need to be
administered parenterally in cases
of dehydration following vomiting
or in cases of severe dysphagia or
odynophagia with pharyngitis and
severe prostration.
Airway management is impor-
tant, especially in the younger
child with symptomatic IM who
manifests airway compromise
secondary to inflammation of pha-
ryngeal, tonsillar, and lymph node
tissues. It is current practice to at-
tempt a short course of parenteral
corticosteroids equivalent to 1-
2 mg/kg (or 40-80 mg in young
adults and adolescents) of pred-
nisone on the first day, with rapid
tapering over 5-12 days.®® This is
begun early in impending airway
obstruction to avoid the necessity
of intubation or tracheostomy. If
airway obstruction is not relieved
following the initial doses of corti-
costeroids, the patient will require
an airway either via nasotracheal
intubation or tracheostomy. Care-
ful monitoring in an intensive care
unit setting for such time as the
acute swelling persists is generally
advisable.
Activity level during acute dis-
ease and convalescence is an indi-
vidual matter. In the past it was
conventional practice to prescribe
one to two weeks of bedrest dur-
ing the acute phase. There is no
basis for recommending bedrest
in uncomplicated IM, since the
symptomatic course usually
abates within five to seven days.
Physicians limit activity in pa-
tients with IM because they are
afraid of splenic rupture. In most
patients with an enlarged spleen,
mild activity, such as walking, is
probably not harmful. Recom-
mendations to athletes concerning
resumption of athletics remains
controversial. Maki and Reich^^
recommend that no athletics in-
volving bodily contact should be
attempted until splenomegaly and
splenic discomfort resolve. Ath-
letes involved in contact sports are
asked not to participate in their
sports for one month following
the onset of illness. If the athletes
do not have splenomegaly at that
time, they may resume their
sports. Whether an athlete has
splenomegaly needs to be care-
fully documented. If the physical
examination is negative or in-
conclusive, other examinations
should be used to confirm a nor-
mal spleen size in the athlete who
participates in contact sports. Di-
agnostic tests used include a flat
plate of the abdomen, ultrasound,
computerized axial tomography
and spleen scan.^® If there is evi-
dence of splenic enlargement by
these examinations, the tests
should be repeated at one to two
week intervals before resumption
of contact sports activity can be
advised. Stool softeners are some-
times prescribed for patients with
IM to decrease straining, which
also has been associated with
splenic rupture.
The use of corticosteroid ther-
apy in the routine management of
IM is a controversial issue. The
literature abounds with anecdotal
evidence of the efficacy of early
intervention with corticosteroids.
These articles suggest using ster-
oids for severe pharyngotonsillitis
with potential airway obstruc-
tion,®^ for potentially fatal neuro-
logic and for cardiac conditions.
While there are no controlled
studies of the effects of steroids on
the course of IM, reports of rapid
clinical improvement in patients
with complicated infectious mon-
onucleosis makes this an accepted
form of therapy in the doses cited
previously for treatment of im-
pending airway obstruction.
However, corticosteroids are not
routinely recommended for pa-
tients with an uncomplicated
course or for patients with mild
complications.
SUMMARY. Infectious mononu-
cleosis (IM) is a disorder caused by
Epstein-Barr virus (EBV) infection
of B-lymphocytes, which in turn
produces lymphoproliferation, of-
ten accompanied by transient sup-
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INFECTIOUS MONONUCLEOSIS- White and Karofsky
SCIENTIFIC MEDICINE
pression of cellular and humoral
immune responses. The individ-
ual host response to infection with
EBV determines the clinical ex-
pression of the disease. Generally,
IM is a self-limited transient ill-
ness with potential multisystem
involvement, presenting with
fever, pharyngitis, and lym-
phadenopathy. While corticoster-
oids have been used to treat
severe, life-threatening compli-
cations, in most cases of IM,
therapy is largely supportive.
Acknowledgment: The authors wish to
thank P Joan Chesney, MD for her review
of the manuscript and Kathy Wolenac for
her technical assistance and preparation
of the manuscript.
REFERENCES 1-65 are available upon re-
quest to the authors.*
CLINICAL CANCER: Number 1 of a series
New discoveries in oncology:
Potential applications to clinical practice
Henry C Pitot, MD, PhD Madison, Wisconsin
This is the first of a regular series
of articles on various topics on can-
cer. The series aims to offer brief and
practical digests of current percep-
tions and management approaches
to clinical cancer. The Professional
Education Committee of the Ameri-
can Cancer Society aims in choosing
topics to serve our audience of Wis-
consin primary physicians. We ex-
pect to offer in coming months dis-
cussions of colorectal cancer screen-
ing, skin cancer, acute leukemia,
mammography, chemoprevention,
and comment on newest research
advances as they may affect Wiscon-
sin physicians. Because of the pithy
nature of these articles, we espe-
cially want to encourage contact
with the authors if you wish to dis-
cuss these topics further or obtain
additional information. Your com-
ments or suggestions for topics
would be welcome.
Ernest C Borden, MD
Series Coordinator
From McArdle Laboratory for Cancer Re-
search, University of Wisconsin Medi-
cal School, Madison. Reprint requests
to: Henry C Pitot, MD, 1009A McArdle
Cancer Research, UW-Madison Medical
School, 450 N Randall Ave, Madison, Wis
53706 (ph 608/262-2177). Copyright 1985
by the State Medical Society of Wisconsin.
A.LTHOUGH IT IS not the leading
cause of death in developed coun-
tries throughout the world, cancer
is the most feared disease in mod-
ern civilizations. Even in most un-
developed countries of the Third
World, cancer is a leading cause of
death in adults, with cancer of the
stomach still exhibiting the highest
worldwide incidence in the
human population. In the United
States the major fatal cancer in
males is lung cancer, with 90% of
the cases directly related to smok-
ing habits. In the female, breast
cancer still exceeds all other fatal
cancers in incidence, although
lung cancer has just overtaken
breast cancer as the leading fatal
cancer in women of the United
States.
Few outside the medical profes-
sion realize the tremendous im-
pact on our society of the morbid-
ity of cancer, both in individual
suffering and in tangible costs to
this society. By a conservative es-
timate, the cost of cancer care in
our society is in excess of $25 bil-
lion per year. Although individ-
uals may have the legal right to in-
crease their risk of developing
cancer markedly through smok-
ing, excessive drinking, and over-
eating, the claim that society does
not have the right to regulate such
excesses in order to protect the
common good can hardly be justi-
fied.
Cancer prevention
More than 15 years ago the epi-
demiologic evidence strongly in-
dicated that the majority of hu-
man cancers are directly related
causally to environmental factors.
Many governments, including that
of the United States, sought to
place more stringent controls on
conditions of the workplace dur-
ing the production of industrial
chemicals and metals, as well as
in the monitoring of the carcino-
genicity of drugs produced by the
pharmaceutical industry, in an at-
tempt to eliminate potentially car-
Series Coordinator:
Ernest C Borden, MD, Madison
American Cancer Society Professor of
Clinical Oncology, University of Wis-
consin Clinical Cancer Center, 600
Highland Ave, Madison, Wisconsin
53792
Physicians are encouraged to con-
tact the authors if they wish to dis-
cuss these topics further or obtain
additional information. Comments
or suggestions for topics would be
welcome.
WISCONSIN MEDICAL JOURNAL, DECEMBER 1985: VOL. 84
25
SCIENTIFIC MEDICINE
NEW DISCOVERIES-Pitot
cinogenic environmental factors.
Almost all recent epidemiologic
studies of occupational cancer in-
dicate that industrial processes
and specific chemical products
may be directly related to sig-
nificantly less than 5% of human
cancers in our society. Moreover,
there is now substantial evidence
that 30% or more of potentially
fatal cancers in our society result
from the use and abuse of tobac-
co products for pleasure. Thus,
the elimination of the tobacco
habit in our society would de-
crease, within one or two decades,
cancer mortality by more than
one-fourth and the financial
burden to our society by billions
of dollars, not to mention the in-
estimable cost in human suffer-
ing.
A less well-defined, but still
equally important environmental
factor in the causation of human
cancer is diet. Food additives, as
well as artificial flavors and colors,
probably contribute little if any-
thing to the incidence of major hu-
man cancers, but dietary factors
such as the overall composition of
the diet and the amount consumed
are important. Epidemiologic evi-
dence that relates the fat content
of the diet to specific human neo-
plasms (especially carcinoma of
the breast, colon, and possibly
several others) is now well-docu-
mented. The proportion of fiber,
protein, and/or fat in the diet ap-
pears to be related to the increased
incidence of colon cancer in sev-
eral highly developed countries, al-
though the mechanism is not com-
pletely understood. Stomach and
esophageal cancer, which occur at
very high incidences especially in
South American and Eurasia, are
undoubtedly related to dietary fac-
tors, some of which appear to be
naturally occurring contaminants
such as nitrosamines.
That some factors in the diet
may actually protect against can-
cer has been shown both in ex-
perimental situations and in epide-
miologic studies. Vegetables such
as brussel sprouts, cauliflower,
cabbage, and related plants ap-
pear to contain such protective
factors. Whether specific vitamins
and minerals, such as retinoids
(vitamin A derivatives), vitamin C
or E, and/or selenium, inhibit or
prevent cancer development in
the human remains to be proven,
but their efficacy in cancer pre-
vention in experimental animals is
well-documented.
Until the last decade, the possi-
bility of an infectious or biological
cause of certain human cancers
was considered at best remote.
With the discovery of the causal
relationship between hepatitis B
viral infections and hepatomas,
especially in underdeveloped
countries; with the recent demon-
stration of the human T-cell lym-
phoma/leukemia virus (HTLV) in
the Far East and the West Indies;
and with the known causative as-
sociation of the Epstein-Barr virus
(EBV) with Burkitt's lymphoma
and nasopharyngeal carcinoma,
the viral causation of human can-
cer is now a significant environ-
mental factor. Prevention in the
form of vaccination is now feas-
ible and under trial for the hepa-
titis B virus, so that successful
worldwide vaccination, com-
parable to the smallpox vaccines,
could potentially eliminate most
hepatocellular carcinomas from
the world. As yet, similar preven-
tive actions for the HTLV, EBV,
and human papilloma viruses
(which may be causally related to
neoplasms of squamous epithe-
lium, including those of the uter-
ine cervix, skin, esophagus, and
rectum) have not been developed.
The third general causative en-
vironmental factor for human
cancer is radiation. The control of
sources of ionizing radiation in
our society is relatively stringent,
so that the principal source of
radiation for the majority of our
society is background radiation.
Most of our society is exposed for
varying periods to a major source
of carcinogenic radiation, that of
ultraviolet light. The incidence of
melanomas of the skin has been
on the increase in many Cauca-
sian populations, including the
United States, during the last sev-
eral decades. It is quite likely that
many of these lesions could be
prevented by decreased exposure
to sunlight and by protective mea-
sures taken during such expo-
sures. Although epidermoid carci-
noma of the skin is also related to
exposure to sunlight for many
years, the prognosis of these le-
sions is so excellent that these skin
cancers are not even considered in
most cancer statistical studies. On
the other hand, malignant mela-
noma is potentially fatal in 30%-
50% of affected patients.
The natural history of neoplastic
development in relation to cancer
prevention
The prevention of cancer is med-
ically and sociologically clearly
preferable to the treatment of can-
cer once established. Through our
present knowledge of oncology,
we could prevent more than 50%
of human cancer in our society if
our citizens and their physicians
chose to undertake the needed
preventive measures. That cancer
prevention is not simply a theoret-
ical possibility based on statistical
and epidemiologic findings may
be concluded from modern studies
on the natural history of cancer
development in the living or-
ganism. Today there is substantial
evidence that most, if not all, can-
cers develop through a series of
stages, the most well-defined of
which are termed initiation, pro-
motion, and progression.
The process of initiation alters a
cell in some heritable manner so
that a variety of agents— including
cigarette smoke, diet, and internal
hormones— may promote the de-
velopment of identifiable neo-
plastic lesions within the host,
such as carcinoma in situ, colonic
polyps, mammary adenomas, and
other premalignant lesions. Erom
26
WISCONSIN MEDICAL JOURNAL, DECEMBER I985:VOL. 84
SCIENTIFIC MEDICINE
NEW DISCOVERIES-Pitot
such neoplasms malignant tumors
develop during the stage of pro-
gression. Substantial evidence in-
dicates that both the stages of in-
itiation and progression involve
irreversible genetic changes with-
in the cell. The stage of tumor pro-
motion, on the other hand, is a
reversible process, which is usu-
ally effective in the formation of a
malignant neoplasm from an ini-
tiated cell only when extended
over a long period. Substantial evi-
dence argues that the action of
most, if not all, promoting agents
is reversible; thus, interrupted or
brief exposure to promoting
agents probably represents little if
any carcinogenic risk to the
human. Since the major environ-
mental factors involved in many
human cancers in our society ap-
pear to involve the stage of tumor
promotion {eg, tobacco smoke,
diet, and hormones), cancer pre-
vention by appropriate interrup-
tion of the stage of promotion
could be a reality in the natural
history of the development of
many human cancers.
At the time of diagnosis, most
clinically observed cancers are in
the stage of progression. It is in
this stage that the action of "onco-
genes" appears to predominate.
Oncogenes, first described in
cancer-causing viruses, have
homologues in normal cells which
are termed proto-oncogenes. In
normal tissue, expression of proto-
oncogenes is low and is controlled
by normal cellular function. In
cancer cells not infected by onco-
genic viruses, one or more of these
genes may be expressed at an ex-
tremely high level, and substantial
evidence indicates that this ex-
pression is related directly to the
relatively uncontrolled growth of
the cancer cell. Theoretically pos-
sible techniques now being care-
fully investigated may allow the
specific targeting of agents to the
products of oncogenes in cancer
cells, thereby inhibiting the un-
controlled action of these origi-
nally normal genes.
Newer developments in early
diagnosis and treatment of cancer
Little need be said here about
the revolution in electronic and
computer technology that has led
to sophisticated and refined, albeit
expensive, diagnostic techniques
useful in the detection and man-
agement of cancer in the human.
These include computer-assisted
tomography, nuclear magnetic res-
onance, and other related technol-
ogies. The continued trials of drug
combinations have led to signifi-
cant, even striking, improvements
in the remission and cure of a vari-
ety of human cancers. Some neo-
plasms, such as acute lymphoblas-
tic leukemia in children and Hodg-
kin's disease in both children and
adults, have responded dramat-
ically to multiple drug chemother-
apy with and without radiation
treatment. Although such treat-
ment is not without some small
risk of future cancer, the benefit
to the patient by the elimination of
the fatal disease being treated is
unquestionably great. Unfortu-
nately, major killers such as lung,
breast, prostate, and colon cancer
have not yet responded in a simi-
lar fashion to drug therapy, al-
though combination chemother-
apy has resulted in prolonging the
lives of many patients. Moreover,
several studies indicate that the rig-
orous application of multiple drug
therapeutic regimens by all physi-
cians could result in a marked in-
crease in remission of such neo-
plasms, even leading to cures in a
number of cases.
From the research viewpoint,
an even more exciting avenue of
therapy is still largely in the labo-
ratory. A series of agents have
been shown to induce cancer cells
to differentiate into their essen-
tially normal counterparts; many
times such differentiation is ter-
minal, in that the cells can no
longer divide. Only in the last
couple of years have any of these
agents been tried in patients, al-
though their efficacy in tissue cul-
ture and in a few animal systems
has been known for more than a
decade. Some agents, such as syn-
thetic retinoids, may not only in-
duce such differentiation, but may
actually prevent the formation of
cancers, probably by inhibiting the
stage of tumor promotion. It is
hoped that such agents will be em-
ployed successfully in the clinic
within the next decade.
Cancer; tomorrow and the future
Our knowledge of human can-
cer—its statistics, epidemiologic
characteristics, and pathogenesis—
is increasing at an exponential
rate. Recent knowledge is forcing
consideration and application of
newer methods of prevention and
therapy of this scourge of human-
ity. The physician who treats can-
cer has a responsibility to his or
her patients to keep abreast of de-
velopments in the field of oncol-
ogy that can be applied in prac-
tice. If cancer in our society is
ultimately to be controlled by pre-
vention, early diagnosis, and mod-
ern treatment, it is the physician
and the patient who ultimately
hold the key to such control.
Bibliography
The basis for this short essay is the third
edition of the textbook, "Fundamentals of
Oncology," which will be published in
December 1985 by Marcel Dekker Inc,
New York. The reader interested in more
detailed considerations of the points raised
here may wish to refer to this text.H
Wl.SCONSIN MEDICAL JOl’RNAl., DECEMBER 1985: VOL. 84
27
Serving All Your
Life Insurance Needs.
American Physicians Life's comprehensive and competi-
tively priced line of insurance products is now being
offered exclusively through SMS Services Inc., to State
Medical Society members.
APL is a majority-owned subsidiary of Physicians
Insurance Company of Ohio (PICO) and a sister com-
pany of The Professionals Insurance Company, the
carrier of the SMS-endorsed Professional Liability
Insurance Plan.
APL coverages available to you through SMS Services
Inc., and its authorized insurance representatives
include:
• Innovative Universal Life coverages
• Low Cost Graded Premium Whole Life plan
• Yearly Renewable and Convertible Term Life protection
• Non-cancellable Disability Income programs
• Single and Flexible Premium Annuities
• Comprehensive Office Overhead Expense protection
Why not contact SMS Services Inc., today to find out
how American Physicians Life can solve all your life
insurance needs.
CONTACT:
SMS SERVICES INC.
330 EAST LAKESIDE STREET
P.O. BOX 1109
MADISON, WISCONSIN 53701
(608) 257-6781 OR TOLL FREE
1-800-362-9080
Your time is valuable.
You don’t have time to spend trying to make connections
with the right referral specialist.
So we’ve started a service to make it fast and easy for you
to reach Medical College of Wisconsin (MCW) physicians
and services.
Now you can call PRN, Physician Resource Network.
PRN gives you one-phone-call access, toll-free, to our
physicians and services, 24 hours a day.
One phone call to PRN can:
• Arrange for inpatient or outpatient services from MCW
faculty.
• Connect you by phone with an MCW faculty specialist.
• Obtain patient or medical information from MCW faculty.
Now you can call PRN.
One-phone-call access to
Medical College of Wisconsin physicians.
Toll-Free:
From Milwaukee:
1-800-472-3660
259-3660
PHYSICIAN RESOURCE NETWORK
ORGANIZATIONAL
Membership facts
Whether you're just starting medical school, maintaining a
full-time practice, or retiring, SMS has a membership classi-
fication to fit your individual needs. Election to membership
by the County Medical Society in which your principal place
of practice is located carries with it membership in the State
Medical Society of Wisconsin and, if you wish, the American
Medical Association. If you qualify for resident membership
at the time of your election, your membership dues are
greatly reduced. This may also qualify you for reduced dues
the first two years of your practice. In addition, two-physician
families may be eligible for a $50 discount on total SMS
membership dues. Dues for regular membership in 1986 are
$455 for SMS, $375 for AMA, and county society dues vary.
A more detailed listing of SMS membership classifications
and their corresponding dues follows:
State Medical Society of Wisconsin
DESCRIPTION OF MEMBERSHIP
CLASSIFICATIONS
Regular: Member in active practice. • First year in
practice — physicians elected to SMS membership within six
months of completing residency, fellowship, or fulfillment
of government obligation enjoy a dues reduction of 50 per-
cent for the first year. • Second year in practice — physicians
who quality by meeting the above criteria enjoy a 25 per-
cent dues reduction during their second year of practice.
• Two-physician family — one member (spouse) of a two-
physician family is entitled to a dues reduction of $50 or the
amount of their State Society dues whichever is less.
Resident: Physician who at January 1 of dues year is in an
approved training program as a hospital resident or research
fellow who is licensed to practice medicine and surgery in
Wisconsin.
Military Service: Members who are serving in the U.S.
armed forces (generally not to exceed five years).
Associate: Member whose dues are waived because of fi-
nancial hardship due to illness or disability. This classifica-
tion is temporary and is reviewed on an annual basis.
Life: Member who has held membership in a state medical
society for 50 years or is a Past President of the State Med-
ical Society of Wisconsin.
Honorary: Member who was named by the Board of Direc-
tors in recognition of long and distinguished service to the
cause of medicine.
Retired: Member who has completely retired from practice
(works less than 240 hours per year). All dues are waived
Your membership in organized medicine will help in-
sure the continued "safety" of your practice and quality
care for all patients. Your voice will be heard through par-
ticipation. Membership in the State Medical Society of Wis-
consin also requires membership in the county medical
society (AMA membership is optional but encouraged). For
Regular, Part-time Practice, or Over Age 70 membership
classifications, dues may be paid in one lump sum or in two
equal installments: one-half of the total payable by January
1, the other half not later than May 15, 1986 which is the
removal date for those members who have not completed
payment. You are urged to renew your membership.
unless county society indicates they wish to charge county
dues.
Part-time Practice: Physician, regardless of age, who prac-
tices 1,000 hours or less during the calendar year but does
not qualify for retired membership.
Over Age 70: Member in active practice who is over 70
years of age as of January 1.
Candidate: Member attending a medical school in Wiscon-
sin or fulfilling a postgraduate obligation prior to eligibility
for licensure.
Scientific Fellow: The Board of Directors may by invitation
and unanimous consent confer upon any person engaged in
teaching of or research in one or more of the basic sciences
at an accredited college or university, and not holding the
degree of Doctor of Medicine or Osteopathy, the status of
Scientific Fellow.
Emeritus: Retired members who have chosen not to renew
their license.
1986 DUES AMOUNTS FOR THESE
CLASSIFICATIONS
SMS
AMA
COUNTY
Regular
$455.00
$375.00
Normal County Dues
1st Year in Practice
$227,50
$187.00
Normal County Dues
2nd Year in Practice
$341.25
$281.00
Normal County Dues
Two Physician Family
$405.00
$375.00
Normal County Dues
Part-Time Practice
$227.50
$375.00/-0-*
Normal County Dues
Part-Time— Over Age 70
$227.50
$187.00*
Normal County Dues
Resident
$ 45.50
$ 45.00
Varies
Military Service
-0-
$250.00/$ 45.00 -0-
Associate
-0-
-0-
-0-
Retired
-0-
$375.00/-0-*
-0-
Retired— Over Age 70
-0-
-0-
-0-
Life
-0-
$375.00/-0 *
-0-
Honorary
-0-
$375.00/-0-*
-0-
Over Age 70
$227.50
$375.00/-0 *
Normal County Dues
Candidate-
Freshman Year
Medical Student
-0-
$ 20.00
Varies
Sophomore and
Succeeding Medical
Student Years
$ 10.00
$ 20.00
Varies
Postgraduate— One
$ 10.00
$ 45.00
Varies
Scientific Fellow
-0-
-0-
-0-
Emeritus
-0-
-0-
-0-
•physicians in these categories may be eligible for exemption from paying AMA dues
under the grandfather clause:
AMA dues-exempt members who were granted exemption before 1986 based on pre-
viously established criteria, with the exception of financial hardship or disability, will
automatically be dues-exempt in 1986 and beyond under the grandfather clause.
Under new AMA policy, only the following two categories of physicians will qualify
for new dues exemption;
(1) Financial hardship and/or disability,
(2) 70 years of age or older and fully retired.
State Society dues are prorated on a monthly basis for
those elected to membership July 1 through September 30.
Those elected after September 30 have no dues payable for
the balance of the year in which they are elected. AMA dues
follow the same pattern except prorating is on a semiannual
basis rather than monthly basis.
To begin the membership process, if your practice is or
will be located in Wisconsin, or you have any questions, you
may contact your local county society or call the Member-
ship and Communications Division of the State Medical
Society, if in Wisconsin: 1-800-362-9080 (Madison area num-
ber: 257-6781). ■
30
WISCONSIN MEDICAL JOURNAL, DECEMBER 1985: VOL. 84
ORGANIZATIONAL
SMS membership reaches new high
Record numbers of physicians
have joined SMS and their county
medical societies in 1985. Since
January 1, 1985, nearly 900 new
members have been elected to
membership. By mid-November
total SMS membership had
reached 6,472, an increase of
12.5% over 1984 levels.
The largest single increase was
in the category of full-dues paying
members, which rose 13.2% to an
all-time high of 5,143 physicians.
Other membership classifications
posted lesser gains. Candidate
membership (students and post-
graduate-ls) rose to 452, an in-
crease of 3.2% over 1984 levels,
while the number of dues-exempt
physicians (life member, military
service, retired, etc) increased
11.2%
Two key factors have contrib-
uted to the surge in SMS member-
ship, according to SMS Director of
Membership and Communica-
tions Ron Henrichs.
The first is the availability of
The Professionals Medical Lia-
bility Insurance Plan through SMS
Services, Inc, the for-profit sub-
sidiary of the State Medical Soci-
ety. Offered to SMS member phy-
sicians only, this program offers
competitively-priced professional
liability insurance with a number
of attractive features. As of mid-
November, more than 2,858 Wis-
consin physicians had opted for
coverage through this program.
The second factor mentioned
frequently by new members is the
awareness and recognition of
organized medicine as an out-
spoken advocate for Wisconsin
physicians and their patients. In
1985, SMS and county medical so-
cieties mounted an aggressive
membership development pro-
gram that focused on physician
advocacy and representation as
well as tangible membership ben-
efits.
While state and county society
memberships have shown sub-
stantial gains, AMA membership
has continued to decline. Only
4,498, or slightly less than 70%, of
SMS members currently belong to
the AMA.
Meeting upon conclusion of the
Leadership Conference, October
26, in Appleton, the House of Del-
egates Nominating Committee
selected the following slate of can-
didates for positions to be filled by
House elections at the 1986 An-
nual Meeting in April;
President of the Society for 1986-87:
John P Mullooly, MD, Milwau-
kee
President-elect for 1986-87: Ken-
neth M Viste Jr, MD, Oshkosh
Treasurer for 1986-87: John J
Foley, MD, Menomonee Falls, to
succeed himself
Vice Speaker of the House of Dele-
gates for 1986-88: Vernon M
Griffin, MD, Mauston, to suc-
ceed himself
AMA Delegates for calendar years
1987 and 1988 to succeed them-
selves: John K Scott, MD, Madi-
son; Patricia J Stuff, MD, Bon-
duel; and DeLore Williams, MD,
West Allis
AMA Alternate Delegates for cal-
endar years 1987 and 1988 to
succeed themselves: Cyril M
Hetsko, MD, Madison; John P
Mullooly, MD, Milwaukee; and
SMS President John K Scott, MD
has expressed his serious concern
about the decline. According to
Doctor Scott, "AMA membership
is absolutely essential for every
Wisconsin physician. Continued,
broad-based physician support for
organized medicine at all levels is
critical to meeting medicine's chal-
lenges today and in the future. "■
John D Riesch, MD, Menomonee
Falls.
Biographical sketches of these
candidates, with pictures, will ap-
pear in the January issue. ■
President-elect Landis
will not serve office
Chairman Darold A Treffert,
MD, Fond du Lac, announced at
the October 25 Board of Directors
meeting in Appleton that Charles
W Landis, MD, Milwaukee, will
not serve, for health reasons, as
the Society's president when his
term is scheduled to begin in April.
Doctor Landis will continue to
serve on the management advisory
committee charged with filling the
secretary-general manager's posi-
tion in 1987.
John P Mullooly, MD, Milwau-
kee, was named as an additional
member of the advisory commit-
tee.
Doctor Mullooly, the following
day, was nominated by the First
District as a candidate to fill the of-
fice of president for the 1986-87
year.B
H/D Nominating Committee
selects slate of candidates
WISCONSIN MEDICAL JOURNAL. DECEMBER 1985: VOL. 84
31
ORGANIZATIONAL
John K Scott, MD
1985 Leadership Conference
The future of medicine — prognosis,
perspectives and prescriptions
October 25-26 /Appleton
Program participants:
Anthony S Earl, Governor of Wisconsin. Special guest at
reception.
James S Haney, President, Wisconsin Association of Manu-
facturers and Commerce. Topic: Wisconsin's economic health.
John K Scott, MD, President, State Medical Society of Wis-
consin. Opening remarks.
Jerald R Schenken, MD, Omaha, Trustee, American Medi-
cal Association. Opening remarks.
Uwe E Reinhardt, PhD, Professor, Department of Eco-
nomics, Princeton University. Topic: Health care: An
economist's view. Discussion facilitator: Darold A Treffert,
MD, Fond du Lac, Chairman, SMS Board of Directors.
David Carley, Carley Capital Group, Madison and Wash-
ington, DC. Topic: Health care: A businessman's view. Dis-
cussion facilitator: Timothy T Flaherty, MD, Neenah, SMS
Past President.
Mark Yessian, Deputy Regional Inspector General, US
Department of Health and Human Services, Boston. Topic:
Fraud and abuse: A federal view. Discussion facilitator: Henry
F Twelmeyer, MD, Elm Grove, Chairman, SMS Health Care
Data Task Force.
Susan F Behrens, MD, Beloit, Chairman, Wisconsin Medi-
cal Examining Board. Topic: The State as 'public protector.'
Discussion facilitator: Robert E Johnston, MD, Green Bay,
Chairman, SMS Mediation and Peer Review Commission.
Kenneth J Wagstaff, Executive Director, Board of Medical
Quality Assurance, State of California, Sacramento. Topic:
Review and discipline: A new look. Discussion facilitator:
Roger L von Heimburg, MD, Green Bay, Vice Chairman,
SMS Board of Directors. ■ Photos by Ben Bartel
Jerald R Schenken, MD
Anthony S Earl
Kenneth J Wagstaff
Susan F Behrens, MD
Mark Yessian
David Carley
James S Haney
32
WISCONSIN MEDICAL JOURNAL. DECEMBER 1985 . VOL. 84
ORGANIZATIONAL
Governor Earl addresses SMS Leadership Conference
Sounding a sympathetic note to
the plight of physicians and other
professions and industries experi-
encing escalating insurance pre-
mium costs, Gov Anthony S Earl
opened the State Medical Society
of Wisconsin's 1985 Leadership
Conference October 25 in Apple-
ton.
The Governor noted that while
limits on malpractice awards are
a partial solution, there must be a
greater effort on the part of both
physicians and attorneys to police,
discipline, and review their own
ranks.
Governor Earl's brief remarks
came at the conclusion of a recep-
tion during which several of the
Dr Treffert named to
statewide professional
discipline task force
The State Medical Society's
chairman of the Board of Directors,
Darold A Treffert, MD, Fond du
Lac, in early November was named
to a statewide panel charged with
reviewing the State Department of
Regulation and Licensing's entire
system of professional review and
discipline.
Governor Anthony S Earl estab-
lished by executive order the Gov-
ernor's Task Force on Professional
and Occupational Discipline. Its
charge is to determine whether
the state's disciplinary procedures
of professions and occupations are
adequate.
Chaired by Dane County Dis-
trict Attorney Hal Harlowe, the
task force will report to the Gov-
ernor by next July 31.
Emmanuel Scarbrough, a Uni-
versity of Wisconsin-Madison
medical researcher, also was
named to the panel.
Doctor Treffert also is a past
president of the State Medical So-
ciety.*
125 SMS leadership physicians
and spouses attending the week-
end-long event had the opportu-
nity to speak with him, expressing
their concerns over the current
malpractice "crisis" and other is-
sues in the field of medicine.
His call for more effective disci-
pline was echoed by numerous
speakers throughout the course of
the conference, including the SMS
Board of Directors which earlier
in the day voted unanimously to
report to the State Medical Exam-
ining Board the questionable prac-
tices of a state physician. The de-
cision, only the second one of its
kind in the past five years, was
based on research conducted over
the course of the past 12 months
into the physician's practice.
That type of demonstrable con-
cern for the profession also was
urged later in the conference by
MEB chairman Dr Susan F Behr-
ens, Beloit. Doctor Behrens told
physicians there is a growing need
for concerned, competent mem-
bers of their ranks to step forward
to volunteer to help review the
backlog of cases the MEB cur-
rently faces and the growing num-
ber of cases it expects to receive in
the months ahead. A new peer re-
view mechanism overseen by the
MEB appears to be the most ac-
ceptable answer to the backlog,
she said.
Doctor Behrens' talk was the
subject of a story in the Sunday,
October 27 edition of The Milwau-
kee Journal in which a new series
of potential penalties against mal-
practicing physicians was cata-
logued.
Those include: requiring physi-
cians to take additional training;
levying fines against them; requir-
ing doctors to refund patient fees
and to pay damage costs; and es-
tablishing a conflict resolution
system involving the patient, the
physician in question and the
State Department of Regulation
and Licensing.
The Department invited the
public's comments on those op-
tions during a November tele-
phone survey.
The broader range of discipli-
nary options would be a step to-
ward correcting the current situa-
tion the Board faces in closing
about 87 percent of the cases
brought to it without taking any
action against the physicians.
Doctor Behrens said.
Additions to the MEB's legal
and investigative staffs are ex-
pected to help but not fully allevi-
ate the 386-case backlog.
Transcribed versions of Doctor
Behrens' presentation and of
other conference participants'
talks will be developed within the
next several weeks. A synopsis of
them will appear in a future edi-
tion of Medigram and in the Wis-
consin Medical Journal, m
WISCONSIN MEDICAL JOURNAL, DECEMBER I985:VOL. 84
33
ORGANIZATIONAL
Max Goodwin Physician-Citizen of the Year
Max H Goodwin, MD, Two
Rivers, was honored November 20
as the 1985 Physician-Citizen of
the Year.
It is an award that has been pre-
sented since 1982 by the SMS and
the Wisconsin Chamber of Com-
merce Executives Association.
SMS President John K Scott,
MD, presented the plaque at a
luncheon in Doctor Goodwin's
honor in Manitowoc.
Doctor Goodwin was chosen on
the basis of his civic involvement
in the Manitowoc-Two Rivers
community since his arrival there
in 1978. Among the criteria used
in making the selection were his
contributions to both the com-
munity and the nation, to the pub-
lic understanding of the role of
medicine, and to the better health
and improved quality of life for
Wisconsin patients.
Doctor Goodwin provided three
years of successful leadership for
Senior physicians elect
The Wisconsin Association of
Senior Physicians (WASP), at its
November 9 annual meeting held
in Madison, elected the following
physicians to office for the year
1986;
Stanley W Hollenbeck, MD,*
Appleton— president
Carroll A Bauer, MD,*
Phillips— secretary-treasurer
Palmer R Kundert, MD,*
Madison— president-elect.
Other events of the meeting
were published in the November
issue.*
Left to right: John K Scott, MD, Madison, pres-
ident of the State Medical Society, with the
1985 Physician-citizen of the Year award re-
cipient Max H Goodwin, MD, Two Rivers;
along with his wife, Mrs ljudithi Goodwin;
John C Zeldenrust, MD, president of the Mani-
towoc County Medical Society; and Betty Bul-
lock, executive vice president. Fort Atkinson
Chamber of Commerce, and member of the
Award selection committee. (SMS Staff photo
by Ron Henrichs)
the Fox Valley Family Practice
Residency program that concluded
this past June. He also served as
medical director for the develop-
ment of the "Fit for Life" wellness
program designed for Hamilton
Industries, Two Rivers. The pro-
gram is now available to physi-
cians across the state and country.
As a member of the Two Rivers
Community Hospital's joint ven-
ture committee. Doctor Goodwin
has taken an active role in ensur-
ing the institution's restructuring
would position it as a longstanding
component in the community's
healthcare delivery system.
He also is a member of the exec-
utive board of the Community
Choice Health Maintenance
Organization which is a joint ven-
ture between the Manitowoc and
Marshfield clinics.
Doctor Goodwin's community
involvement also includes a num-
ber of civic organizations: Com-
passionate Friends, board of direc-
tors; Good Shepard Lutheran
Church, financial secretary, di-
recting council and choir; Lake
Shore Chapter, Lutherans for Life,
medical advisor; Two Rivers-
Mishicot United Way, past mem-
ber, board of directors; Two
Rivers Community Hospital, ex-
ecutive committee, vice chief of
staff, medical audit committee
and joint conference on long-
range planning.
John Zeldenrust, MD, President
of the Manitowoc County Medical
Society, was master of ceremonies
for the luncheon honoring Doctor
Goodwin.*
Annual Meeting
resolution deadline
The 1986 House of Delegates
sessions will be held April 18-19 in
Milwaukee. All resolutions must
be submitted in proper form to the
Secretary's office at SMS no later
than February 18, 1986 (two
months prior to the first session of
the House). It is important that
county medical societies, specialty
sections, and members submit
resolutions early to facilitate early
distribution of materials and allow
all delegates to adequately repre-
sent their county medical society
or specialty section. If a resolution
involves expenditures, a "fiscal
note" must accompany the resol-
lution. SMS staff is available to as-
sist in preparation of fiscal notes.
The first session of the House will
convene on April 18 and the sec-
ond and third sessions will be on
April 19, 1986.*
34
WISCONSIN MEDICAL JOURNAL, DECEMBER 1985: VOL. 84
BALANCED
CALCIUM
BI
Low incidence of side effects
CARDIZEM® (diltiazem HCl)
produces an incidence of adverse
reactions not greater than that
reported with placebo therapy,
thus contributing to the patient’s
sense of well-being.
•Cardizem is indicated in the treatment of angina pectoris due to
coronary artery spasm and in the management of chronic stable
angina (classic effort-associated angina) in patients who carmot
tolerate therapy with beta-blockers and/or nitrates or who remain
symptomatic despite adequate doses of these agents.
References:
1. Strauss WE, McIntyre KM, Parisi AF, et al: Safety and efhcaqy
of diltiazem hydrochloride for the treatment of stable angina
pectoris: Report of a cooperative clinical trial. Am J Cardiol
49:560-566, 1982.
2. Pool PE, Seagren SC, Bonanno JA, et al: The treatment of exercise-
inducible chronic stable angina with diltiazem: Effect on treadmill
exercise. Chest 78 ( Jiily suppl):234-238, 1980.
Reduces angina attack frequency*
42% to 46% decrease reported in
multicenter study
Increases exercise tolerance*
In Bruce exercise testf control
patients averaged 8.0 minutes to
onset of pain; Cardizem patients
averaged 9.8 minutes (P<.005).
CARDIZEM
Cdiltiazem HCl)
THE BALANCED
CALCIUM CHANNEL BLOCKER
Please see full prescribing information on following page.
2/84
PROFLSSIONAL USE INFORMATION
cordlzem.
(dilHozem HCI)
AO mg and 60 mg tablets
DESCRIPTION
CARDIZEM’' (diltiazem hydrochloride) is a calcium ion inllux
inhibitor (slow channel blocker or calcium antagonist). Chemically,
dlltiazem hydrochloride is l,5-Benzothiazepln-4(5H)one,3-(acetyloxy)
■5-[2-(dimethylamino)ethyl]-2.3-dihydro-2-(4-methoxyphenyl)-.
monohydrochloride, 1+) -cis-. The chemical structure Is:
Dlltiazem hydrochloride is a white to oil-white crystalline powder
with a bitter taste It is soluble in water, methanol, and chloroform.
It has a molecular weight ol 450,98 Each tablet of CARDIZEM
contains either 30 mg or 60 mg dlltiazem hydrochloride lor oral
administration
CLINICAL PHARMACOLOGY
The therapeutic benefits achieved with CARDIZEM are believed
to be related to Its ability to Inhibit the inllux ol calcium Ions
during membrane depolarization of cardiac and vascular smooth
muscle
Mechanisms of Action. Although precise mechanisms of Its
antianginal actions ate still being delineated, CARDIZEM is believed
to act in the following ways:
1 Angina Due to Coronary Artery Spasm CARDIZEM has been
shown to be a potent dilator ol coronary arteries doth epicardlal
and subendocardial. Spontaneous and ergonovine-induced cor-
onary artery spasm are Inhibited by CARDIZEM
2. Exertional Angina CARDIZEM has been shown to produce
increases in exercise tolerance, probably due to its ability to
reduce myocardial oxygen demand. This is accomplished via
reductions in heart rate and systemic blood pressure at submaximal
and maximal exercise work loads.
In animal models, dlltiazem interleres with the slow inward
(depolarizing) current In excitable tissue. It causes excitation-contraction
uncoupling In various myocardial tissues without changes In the
conllguratlon of the action potential. Dlltiazem produces relaxation
ol coronary vascular smooth muscle and dilation of both large and
small coronary arteries at drug levels which cause little or no
negative Inotropic effect The resultant increases in coronary blood
flow (epicardlal and subendocardial) occur in Ischemic and nonischemic
models and are accompanied by dose-dependent decreases in sys-
temic blood pressure and decreases in peripheral resistance
Hemodynamic and Electrophysiologic Effects. Like other
calcium antagonists, dlltiazem decreases sinoatrial and atrioventricu-
lar conduction In Isolated tissues and has a negative inotropic effect
In Isolated preparations. In the Intact animal, prolongation of fhe AH
interval can be seen at higher doses.
In man. dlltiazem prevents spontaneous and ergonovine-provoked
coronary artery spasm. It causes a decrease In peripheral vascular
resistance and a modest fail in blood pressure and, in exercise
tolerance studies in patients with ischemic heart disease, reduces
the heart rate-blood pressure product for any given work load,
Sfudles to date, primarily in patients with good ventricular function,
have not revealed evidence of a negative inotropic effect; cardiac
output, ejection fraction, and left ventricular end diastolic pressure
have not been affected. There are as yet few data on the interaction
of dlltiazem and beta-blockers. Resting heart rate Is usually unchanged
or slightly reduced by dlltiazem.
Intravenous dlltiazem In doses of 20 mg prolongs AH conduction
time and AV node functional and effective refractory periods approxi-
mately 20% In a study involving single oral doses of 300 mg of
CARDIZEM in six normal volunteers, the average maximum PR
prolongation was 14% with no Instances of greater than first-degree
AV block. Dlltiazem-associated prolongation of the AH Interval is not
mote pronounced in patients with first-degree heart block. In patients
with sick sinus syndrome, dlltiazem significantly prolongs sinus
cycle length (up to 50% in some cases)
Chronic oral administration of CARDIZEM in doses of up to 240
mg/day has resulted In small Increases in PR interval, but has not
usually produced abnormal prolongation. There were, however, three
instances of second-degree AV block and one instance of third-
degree AV block in a group ol 959 chronically treated patients.
Pharmacokinetics and Metabolism. Dlltiazem Is absorbed
from the tablet formulation to about 80% of a reference capsule and
IS subject to an extensive first-pass effect, giving an absolute
bioavallability (compared to intravenous dosing) of about 40%. CARDIZEM
undergoes extensive hepatic metabolism in which 2% to 4% of the
unchanged drug appears In the urine In vitro binding studies show
CARDIZEM Is 70% to 80% bound to plasma proteins. Competitive
ligand binding studies have also shown CARDIZEM binding Is not
altered by therapeutic concentrations ol digoxin, hydrochlorothiazide,
phenylbutazone, propranolol, salicylic acid, or warfarin. Single oral
doses of 30 to 120 mg of CARDIZEM result in detectable plasma
levels within 30 to 60 minutes and peak plasma levels two to three
hours alter drug administration. The plasma elimination half-life
following single or multiple drug administration is approximately 3,5
hours. Desacetyl dlltiazem is also present In the plasma at levels of
10% to 20% ol the parent drug and is 25% to 50% as potent a
coronary vasodilator as dlltiazem Therapeutic blood levels of
CARDIZEM appear to be in the range ol 50 to 200 ng/ml. There is a
departure from dose-llneariiy when single doses above 60 mg are
given; a 120-mg dose gave blood levels three times that of the 60-mg
dose There Is no information about the effect of renal or hepatic
impairment on excretion or metabolism of dlltiazem
INDICATIONS AND USAGE
1 Angina Pectoris Due to Coronary Artery Spasm. CARDIZEM
is indicated in the treatment of angina pecloris due to coronary
artery spasm. CARDIZEM has been shown effective in the
treatment of spontaneous coronary artery spasm presenting as
Prinzmetal's variant angina (resting angina with ST-segment
elevation occurring during attacks)
2 Chronic Stable Angina (Classic Elfoit-Assoclated Angina).
CARDIZEM Is indicated In the management of chronic stable
angina. CARDIZEM has been effective in controlled trials in
reducing angina frequency and Increasing exercise tolerance
There are no controlled studies of the effectiveness of the concomi-
tant use of dlltiazem and beta-blockers or of the safety of this
combination in patients with impaired ventricular function or conduc-
tion abnormalities
CONTRAINDICATIONS
CARDIZEM is contraindicated in (1) patients with sick sinus
syndrome except in the presence of a functioning ventricular pacemaker,
(2) patients with second- or third-degree AV block except in the
presence ol a functioning ventricular pacemaker, and (3) patients
with hypotension (less than 90 mm Hg systolic).
WARNINGS
1 Cardiac Conduction. CARDIZEM prolongs AV node refrac-
tory periods without significantly prolonging sinus node recov-
ery time, except in patients with sick sinus syndrome. This
effect may rarely result In abnomially slow heart rates (particularly
in patients with sick sinus syndrome) or second- or third-degree
AV block (six of 1243 pafients lor 0 48%). Concomitant use of
dlltiazem with beta-blockers or digitalis may result in additive
effects on cardiac conduction. A patient with Prinzmetal's
angina developed periods of asystole (2 to 5 seconds) alter a
single dose of 60 mg of dlltiazem
2 Congestive Heart Failure. Although dlltiazem has a negative
inotropic effect in Isolated animal tissue preparations, hemodynamic
studies in humans with normal ventricular function have not
shown a reduction in cardiac index nor consistent negative
effects on contractility (dp/dt) Experience with the use of
CARDIZEM alone or in combination with beta-blockers in patients
with impaired ventricular function Is very limited. Caution should
be exercised when using the drug In such patients
3 Hypotension. Decreases In blood pressure associated with
CARDIZEM therapy may occasionally result In symptomatic
hypotension,
4 Acute Hepatic Injury. In rare Instances, patients receiving
CARDIZEM have exhibited reversible acute hepatic injury as
evidenced by moderate to extreme elevations of liver enzymes
(See PRECAUTIONS and ADVERSE REACTIONS.)
PRECAUTIONS
General. CARDIZEM (dlltiazem hydrochloride) is extensively metab-
olized by the liver and excreted by the kidneys and In bile. As with any
new drug given over prolonged periods, laboratory parameters should
be monitored at regular intervals The drug should be used with
cautioh in patients with impaired renal or hepatic function. In sub-
acute and chronic dog and rat studies designed to produce toxicity,
high doses of dlltiazem were associated with hepatic damage In
special subacute hepatic studies, oral doses of 125 mg/kg and
higher In rats were associated with histological changes in the liver
which were reversible when the drug was discontinued. In dogs,
doses of 20 mg/kg were also associated with hepatic changes;
however, these chaeges were reversible with continued dosing.
Drug Interaction. Pharmacologic studies Indicate that there
may be additive effects in prolonging AV conduction when using
beta-blockers or digitalis concomitantly with CARDIZEM (See
WARNINGS).
Controlled and uncontrolled domestic studies suggest that con-
comitant use ol CARDIZEM and beta-blockers or digitalis Is usually
well tolerated Available data are not sufficient, however, to predict
the effects of concomitant treatment, particularly in patients with left
ventricular dysfunction or cardiac conduction abnormalities. In healthy
volunteers, dlltiazem has been shown to increase serum digoxin
levels up to 20%.
Carcinogenesis, Mutagenesis, Impairment ol Fertility. A
24-month study in tats and a 21 -month study In mice showed no
evidence of carcinogenicity There was also no mutagenic response
In In vitro bacterial tests No Intrinsic effect on fertility was observed
In rats.
Pregnancy. Category C Reproduction studies have been con-
ducted in mice, rats, and rabbits. Administration ol doses ranging
from five to ten times greater (on a mg/kg basis) than the daily
recommended therapeutic dose has resulted in embryo and fetal
lethality. These doses. In some studies, have been reported to cause
skeletal abnormalities. In the perinatal/postnatal studies, there was
some reduction in early individual pup weights and survival rates
There was an increased incidence ol stillbirths at doses of 20 times
the human dose or greater
There are no well-controlled studies in pregnant women; therefore,
use CARDIZEM in pregnant women only if the potential benefit
justifies the potential risk to the fetus
Nursing Mothers. It is not known whether this drug is excreted
in human milk. Because many drugs are excreted in human milk,
exercise caution when CARDIZEM is administered to a nursing
woman if the drug's benefits are thought to outweigh its potential
risks in this situation.
Pediatric Use. Safety and effectiveness in children have not
been established
ADVERSE REACTIONS
Serious adverse reactions have been rare in studies carried out to
date, but it should be recognized that patients with impaired ventricu-
lar function and cardiac conduction abnormalities have usually been
excluded.
In domestic placebo-controlled trials, the incidence of adverse
reactions reported during CARDIZEM therapy was not greater than
that reported during placebo therapy
The following represenf occurrences observed in clinical studies
which can be at least reasonably associated with the pharmacology
of calcium influx inhibition. In many cases, the relationshh to
CARDIZEM has not been established. The most common occurrences,
as well as their frequency of presentation, are: edema (2.4%),
headache (2.1%), nausea (1.9%), dizziness (1.5%). rash (1.3%),
asthenia (1.2%), AV block (1.1%). In addition, the following events
were reported infrequently (less than 1%) with the order of presenta-
tion corresponding to the relative frequency of occurrence.
Cardiovascular:
Nervous System:
Gastrointestinal:
Dermatologic
Other
Flushing, arrhythmia, hypotension, bradycar-
dia. palpitations, congestive heart failure,
syncope.
Paresthesia, nervousness, somnolence,
tremor, insomnia, hallucinations, and amnesia.
Constipation, dyspepsia, diarrhea, vomiting,
mild elevations of alkaline phosphatase, SGOT,
SGPT, and LDH
Pruritus, petechiae, urticaria, photosensitivity.
Polyuria, nocturia.
The following additional experiences have been noted:
A patient with Prinzmetal's angina experiencing episodes of
vasospastic angina developed periods of transient asymptomatic
asystole approximately five hours after receiving a single 60-mg
dose of CARDIZEM,
The following postmarkefing events have been reported infre-
quently in patients receiving CARDIZEM: erythema multiforme; leu-
kopenia; and extreme elevations ol alkaline phosphatase, SCOT,
SGPT, LDH, and CPK However, a definitive cause and effect between
these events and CARDIZEM therapy is yet to be established
OVERDOSAGE OR EXAGGERATED RESPONSE
Overdosage experience with oral dlltiazem has been limited.
Single oral doses of 300 mg of CARDIZEM have been well tolerated
by healthy volunteers. In the event of overdosage or exaggerated
response, appropriate supportive measures should be employed in
addition to gastric lavage The following measures may be considered;
Bradycardia
High-Degree AV
Block
Cardiac Failure
Hypotension
Administer atropine (0.60 to 1.0 mg). If there
is no response to vagal blockade, administer
isoproterenol cautiously.
Treat as for bradycardia above. Fixed high-
degree AV block should be treated with car-
diac pacing.
Administer inotropic agents (isoproterenol,
dopamine, or dobutamine) and diuretics.
Vasopressors (eg, dopamine or levarterenol
bitartrate).
Actual treatment and dosage should depend on the severity of the
clinical situation and the judgment and experience of the treating
physician
The oral/LDso's in mice and rats range from 415 to 740 mg/kg
and from 560 to 810 mg/kg, respectively. The intravenous LDsn's in
these species were 60 and 38 mg/kg, respectively. The oral lIjso in
dogs is considered to be in excess of 50 mg/kg, while lethality was
seen in monkeys at 360 mg/kg The toxic dose in man is not known,
but blood levels in excess of 800 ng/ml have not been associated
with toxicity
DOSAGE AND ADMINISTRATION
Exertional Angina Pectoris Due to Atherosclerotic Coro-
nary Artery Disease or Angina Pectoris at Rest Due to Coro-
nary Artery Spasm. Dosage must be adjusted to each patient's
needs Starting with 30 mg four times daily, before meals and at
bedtime, dosage should be increased gradually (given in divided
doses three or four times daily) at one- to two-day intervals until
optimum response is obtained Although individual patients may
respond to any dosage level, the average optimum dosage range
appears to be 1 80 to 240 mg/day. There are no available data concern-
ing dosage requirements in patients with impaired renal or hepatic
function. It the drug must be used in such patients, titration should be
carried out with particular caution
Concomitant Use With Other Antianginal Agents:
1 Sublingual NTG may be taken as required to abort acute
anginal attacks during CARDIZEM therapy.
2 Prophylactic Nitrate Therapy -CARDIZEM may be safely
coadministered with short- and long-acting nitrates, but there
have been no controlled studies to evaluate the antianginal
effectiveness of this combination.
3. Beta-blockers. (See VVARNINGS and PRECAUTIONS.)
HOW SUPPLIED
Cardizem 30-mg tablets are supplied in bottles of 100 (NOC
0088-1771-47) and in Unit Dose Identification Paks of 100 (NDC
0088-1771-49) Each green fablet is engraved with MARION on one
side and 1771 engraved on the other. CARDIZEM 60-mg scored
tablets are supplied in bottles of 100 (NDC 0088-1 772-47) and in Unit
Dose Identification Paks of 100 (NDC 0088-1772-49). Each yellow
tablet is engraved with MARION on one side and 1772 on the other.
Issued 4/1/84
Another patient benefit product from
PHARMACEUTICAL DIVISION
MARION
LABORATORIES. INC
KANSAS CITY, MISSOURI 64137
ORGANIZATIONAl.
Membership Directory— Update
The following information is being provided from Membership reports and from individual members for updating the
1985 Membership Directory as published in the July 1985 issue of the Wisconsin Medical Journal. Because of space limi-
tations address changes and phone numbers will not be included in this Update; however, they will be changed in
Membership records. County transfers will be included when processing has been completed by the Membership
Department.
Changes in practice specialties (as used by the AMA)
and changes in Board-certified specialties as listed by
the American Board of Medical Specialties.
(changes only with member's name; practice specialties appear
before the slash {/) and Board-certified specialties appear after
the slash. I
BARRON /WASHBURN/
BURNETT
FP / FP
Allan J Haesemeyer MD
209 4th Ave West
Shell Lake W1 54871
FP
John B Waldron MD
40 West Newton
Rice Lake WI 54868
BROWN
ORS GS
Marc H Anderson MD
704 S Webster Ave
Green Bay Wl 54301
FP
Steven A Halsey MD
704 S Webster Ave
Green Bay WI 54301
EM
Paul C Hodges MD
835 S Van Buren
Green Bay WI 54301
ON IM / ON
James D McGovern MD
835 S Van Buren
Green Bay WI 54305
EM / EM
Michael E Phillips MD
Rt 1 Whisper Lane
De Pere WI 54115
OPH
Kevin P VVienkers MD
417 S Monroe Ave
PO Box 8087
Green Bay WI 54308
DANE
GE IM / IM
David E Adams MD
1912 Atwood Ave
Madison WI 53704
Gerard G Adler
1530 Adams St
Madison WI 5371 1
AN
Richard L Aerts MD
5335 Brody Dr, #104
Madison WI 53705
PM / PM
James C Agre MD
600 Highland Ave
Madison WI 53792
IM
Mark R Albertini MD
4606 Jenewein Rd, #4
Madison WI 5371 1
IM / IM
Gary D Anderson MD
202 S Park St
Madison WI 53715
Felix K Ankel
615 E Gorham St, #2
Madison WI 53703
CHP P
Laurie Robbins Appelbaum MD
17 Dumont Circle
Madison Wl 5371 1
IM / IM
Richard G Armstrong MD
1912 Atwood Ave
Madison WI 53704
Richard M Auchter
1923 Sherman Ave, #10
Madison WI 53704
OBG / OBG
Robert M Baker MD
20 S Park St
Madison WI 53715
GS TS/GS
John F Batson MD
5714 Odana Rd
Madison WI 53719
OBG / OBG
James P Beck MD
1912 Atwood Ave
Madison WI 53704
Judy Becker
1602 Fordem Ave, #302
Madison Wl 53704
Patricia L Esser Bellissimo
234 Randolph Dr, #221D
Madison WI 53717
IM
J Evan Blanchard MD
446 Woodside Terr
Madison WI 53711
IM
Frank C Bonebrake MD
5793 Williamsburg Way
Madison WI 53719
Michelle Bonness
404 W Doty St, #1
Madison Wl 53703
George A Boush
109 Green Lake Pass
Madison Wl 53705
IM
Alan J Bridges MD
13 Oak Glen Court
Madison WI 53717
Ellen Brockish
2102 University Ave, #3E
Madison WI 53705
IM / EM
Timothy W Burke DO
418 Baitinger Court
Sun Prairie WI 53590
Elizabeth S Burlingame
134 W Gorham St, #3
Madison Wl 53703
IM / IM
Thomas \' Caughlan MD
10 Tower Dr
Sun Prairie Wl 53590
Michael R Chun
1518 Jefferson
Madison WI 53711
Elizabeth L Ciurlik
702 Eugenia
Madison WI 53705
PD AI / PD
Marcus Cohen MD
2 W Gorham St
Madison WI 53703
IM / IM
Paul L Davidson MD
2 West Gorham St
Madison WI 53703
FP
Crystal De Graw MD
2569 University Ave, #A
Madison WI 53705
Albert J Deibele HI
1609 Chadbourne Ave
Madison Wl 53705
OBG / OBG
Gordon L Eckert MD
2 W Gorham St
Madison WI 53703
Rainer Effenhauser
PO Box 151
Lake Mills WI 53551
Thomas O Felton
546 W Doty St, #1
Madison WI 53703
IM / IM
Edwin E Ferguson MD
208 S Century Ave
Waunakee WI 53597
Jonathan E Fliegel
2010 University Ave
Madison Wl 53705
Eric Gaenslen
1008 Spring St
Madison WI 53715
Michael J Garren
4929 Chalet Gardens Rd,
#202
Madison WI 53711
Steve J Gerndt
22 Langdon, #218
Madison WI 53703
Steven P Goff
Apt 603-1 Eagle Heights
Madison WI 53705
continued next page
WI.SCONSIN MEmCAI.JOt'RNAL, DECEMBER mS.S: VOE. 84
37
ORGANIZATIONAL
MEMBERSHIP DIRECTORY-UPDATE
DANE continued
PD / PD
Christal A Gordon MD
3713 Milwaukee St
Madison WI 53714
Mary J Gould
2020 University Ave, #304
Madison WI 53705
FP EM / FP
David L Hahn MD
3434 E Washington Ave
Madison WI 53704
Christopher P Harkin
2318 West Lawn Ave
Madison WI 5371 1
ORS / GS
Lewis B Harned MD
1313 Fish Hatchery Rd
Madison WI 53715
FP
William R Heifner MD
70 Sunfish Court
Madison WI 53713
OBG / OBG
C Weir Horswill MD
2630 Amherst Rd
Middleton WI 53562
P / P
Timothy Howell MD
5534 Medical Circle
Madison WI 53719
Jean E Hoyer
305 North Frances St, #702
Madison WI 53703
Steven J Hunter
745 West Washington, #210
Madison WI 53715
IM / IM
Kenneth Israel MD
600 N 8th St
Mount Horeb WI 53572
PD / PD
Charles L Jahn MD
2 West Gorham St
Madison WI 53703
P
Patricia A Jens MD
5329 Brody Dr, #102
Madison WI 53705
IM PUD/IM
Frederick W Kahn MD
321 N Owen Dr
Madison WI 53705
OPH
Sara A Kaltreider MD
401 N Eau Claire Ave
Madison WI 53705
IM / IM
Peter R Kelly MD
2 West Gorham
Madison WI 53703
OBG / OBG
William S Koller Jr MD
20 S Park St
Madison WI 53715
PD / PD
Steven S Koslov MD
2 W Gorham St
Madison WI 53703
FP
Dean G Kresge MD
101 N Baldwin
Madison WI 53703
Randy Krszjzaniek
840 E Gorham St, #102
Madison WI 53703
FP / FP
Robert R Kuritz MD
5714 Odana Rd
Madison WI 53791
ORS
Edward G Lash MD
G5/3 UW CSC
600 Highland Ave
Madison WI 53792
IM ID / IM
James E Leggett Jr MD
D3224 VA Hospital
2500 Overlook Dr
Madison WI 53705
OTO
Jeffrey Lehman MD
210 Nautilus Dr
Madison WI 53705
ORS
Richard A Lemon MD
2215 Middleton Beach Rd
Middleton WI 53562
OBS / OBG
James A Lindblade MD
2 W Gorham St
Madison WI 53703
Steven Lipscomb
1931 University Ave
Madison WI 53705
Jane F Look
305 N Frances St
Madison WI 53703
Kathleen R Maginot
2302 University Ave, #253
Madison WI 53705
OBG /OBG MFM
Chester B Martin Jr MD
H4/654 UW CSC
600 Highland Ave
Madison WI 53792
R / R
Anthony L Merlis MD
20 South Park St
Madison WI 53715
GS CDS/GS
John D Middleton MD
2 W Gorham St
Madison WI 53703
Ronald Minter
422 W Johnson St, #202
Madison WI 53703
IM ON / IM
Nicholas E Mischler MD
2 W Gorham St
Madison WI 53703
GS
Jon T Moen MD
35 Trillium Court
Madison WI 53719
Mimi H Montgomery
21 18 Allen Blvd
Middleton WI 53562
FP / FP
Robert J Moss MD
3007 E Minnehaha Pkwy
Minneapolis MN 55417
GS TS/GS
Gustave C Mueller MD
2 W Gorham St
Madison WI 53703
IM / IM
Paul M Nemovitz MD
2 W Gorham St
Madison WI 53703
William J O'Brien
1315 Spring St, #2302
Madison WI 53715
EM FP / FP
Kevin O'Connell DO
202 S Park St
Madison WI 53715
FP / FP
Dennis A Oeth MD
5714 Odana Rd
Madison WI 53719
IM RHU / IM
James F Porter MD
2910 Bobin Court
Madison WI 53711
TR
Janalyn Prows MD
2475 Maple Hill Lane
Brookfield WI 53005
IM
Randall Rago MD
5002 Sheboygan Ave, #125
Madison WI 53705
FP / FP
Melvin H Rosen MD
208 S Century Ave
Waunakee WI 53597
AN
John E Ross MD
906 Edgewater Court
Madison WI 53715
PD ID / PD
Thomas N Saari MD
2630 Amherst Rd
Middleton WI 53562
PUD IM / IM
John P Schilling MD
2 W Gorham St
Madison WI 53703
Christopher C Schmidt
923 Drake St
Madison WI 53715
Sandra B Schultz
1650 Monroe St, #F
Madison WI 5371 1
IM / IM
James W Sehloff MD
17 Mesa Court, #1
Madison WI 53719
OPH
Michael B Shapiro MD
1025 Regent St
Madison WI 53715
OBG IM/OBG
Gerald W Shay MD
1912 Atwood Ave
Madison WI 53704
GS
Michael J Statz MD
3112 Bluff St, #5
Madison WI 53705
Deborah A Summa
1 124 Emerald St
Madison WI 53706
ORS
Jeffrey R Stitgen MD
601 Blue Ridge Pkwy
Madison WI 53706
IM / IM
Eric M Streicher MD
2630 Amherst Rd
Middleton WI 53562
GS/GS
Glen J Stuesser MD
2 W Gorham St
Madison WI 53703
David Susman
2707 Colgate Rd
Madison WI 53705
continued next page
38
WISCONSIN MEDICAL JOURNAL, DECEMBER 1985: VOL. 84
MEMBERSHIP DIRECTORY-UPDATE
ORGANIZATIONAL
DANE continued
EM PD
James E Svenson MD
202 S Park St
Madison WI 53715
R TR/R
June M D Unger MD
600 Highland Ave
Madison WI 53792
FP
David L Weber MD
10 Tower Dr
Sun Prairie WI 53590
Mark A Weiner
401 Chamberlain Ave, #8
Madison WI 53705
PD / PD
William H Ylitalo MD
2 W Gorham St
Madison WI 53703
FP EM/FP
John C Yost MD
437 Virginia Terr
Madison WI 53705
KENOSHA
Glenn E Vandervort MD
601 60th St
Kenosha WI 53140
LA CROSSE
EM
William E Carskadon MD
3244 Cliffside Dr
La Crosse WI 54601
FP
Stephen G Henke MD
700 W Avenue South
La Crosse WI 54601
FP
Joanne R Mellema MD
700 W Avenue South
La Crosse WI 54601
FP / FP
Dennis D Ohlrogge MD
520 Amy Dr
Holman WI 54636
FP
Nancy A Peltola MD
700 W Avenue South
La Crosse WI 54601
FP
Kristin E Swanson MD
700 W Avenue South
La Crosse WI 54601
MARATHON
DR R/R
Philip R Albert MD
2727 Plaza Dr
Wausau WI 54401
AN
John P Herring MD
333 Pine Ridge Blvd
Wausau WI 54401
FP
Thomas C Hupy MD
4403 Lakeshore Dr
Wausau WI 54401
PD / PD
Jeffrey H Lamont MD
2727 Plaza Dr
Wausau WI 54401
CD IM/IM
Tennyson G Lee MD
425 Pine Ridge Blvd, #205
Wausau WI 54401
IM
David S Me Greaham MD
2727 Plaza Dr
Wausau WI 54401
OTO / OTO
Thomas O Paulson MD
2727 Plaza Dr
Wausau WI 54401
FP
Thomas J Strick MD
144 Chellis St
Wausau WI 54401
ORS
Daniel M Seybold MD
2727 Plaza Dr
Wausau WI 54401
DR R/R
Roger A Styles MD
2727 Plaza Dr
Wausau WI 54401
FP / FP
John F Wehb MD
2801 Westhill Dr
Wausau WI 54401
MILWAUKEE
TR
Paul W Adams MD
8203 S 88th St
Franklin WI 53132
Norbert G Bauch MD
7623 W Burleigh St
Milwaukee WI 53222
IM PD
Kaushalya Beniwal MD
1020 Lafayette Ct
Brookfield WI 53005
EM
Dennis C Birchall MD
2639 N Prospect Ave, #207
Milwaukee WI 53211
CLP AP / PTH
Edward A Birge MD
9622 Harding Blvd
Wauwatosa WI 53226
IM
Carolyn S Blackstone MD
4225 North Prospect
Milwaukee WI 53211
N
Thomas E Bowser MD
2092 S 102nd St, #327A
West Allis WI 53227
IM
James D Buck MD
4824 London Dr
Indianapolis IN 46254
IM
Charles E Bruso MD
3560 N Oakland Ave, #4
Shorewood WI 53211
AN OBG/AN
Anthony A Buechler MD
2825 N Mayfair Rd
Milwaukee WI 53222
DR PD/R
James D Cates MD
5358-B N Lovers Ln, #216
Milwaukee WI 53225
PD
Teik-ee Cheah MD
1700 W Wisconsin Ave, #4
Milwaukee WI 53233
FP
Stephen J Clark MD
8320 Gridley
Wauwatosa WI 53213
Richard M Clifford MD
2400 S 90th St, #308
West Allis WI 53227
NM R / NM
Bert D Collier Jr MD
8700 W Wisconsin Ave
Milwaukee WI 53226
ORS
Mark A Coppes MD
602 N Hawley Rd
Milwaukee WI 53213
PD ADL
Julie M Cottral MD
2400 W Lincoln Ave
Milwaukee WI 53215
AN OBG/AN
Arthur J Davidson MD
2825 N Mayfair Rd
Milwaukee WI 53222
IM
Albert De Rose MD
2603 Wauwatosa Ave, #4
Wauwatosa WI 53213
PD
Barbara Dewitz MD
3519 N 64th St
Milwaukee WI 53216
IM
Ronald R Domescek MD
1702 N Farwell, #2
Milwaukee WI 53202
AN GS/AN
Eugene C Durkin MD
7710 N Links Way
Fox Point WI 53217
AN
Ray R Dzelzkalns MD
4172 Bartlett Ave
Milwaukee WI 53211
Hassan Eghbali MD
2315 North Lake Dr, #820
Milwaukee WI 53211
FP
Sally R Esser MD
2595 N Cramer St
Milwaukee WI 53211
OBG
Wayne Evans MD
1747 N 6th St
Milwaukee WI 53212
IM
Norbert J Fahey Jr MD
8008 W Bocher St, #7
West Allis WI 53219
DR
Robert L Falk MD
12305 Diane Dr
Wauwatosa WI 53226
FP
Thomas J Federico MD
1570 N Prospect Ave, #108
Milwaukee WI 53202
AP CLP / PTH
Mary C Fernandez MD
10425 North Ave
Milwaukee WI 53226
EM
Ivars J Gailans MD
4417 N Frederick
Shorewood WI 53210
FP
Philip Goldfarb MD
4416 W Arthur Ct, #12
Milwaukee WI 53219
FP
Michael Gorezynski DO
9330 W Greenfield Ave
West Allis WI 53214
continued next page
WISCONSIN MEIJICAI, JOURNAL, DECEMBER 1985: VOL. 84
39
ORGANIZATIONAL
MEMBERSHIP DIRECTORY-UPDATE
MILWAUKEE continued
AN
Jose A N Gozar Jr MD
18760 Yorkshire Ln
Brookfield W1 53005
OM GPM / FP
William VV Greaves MD
8701 Watertown Plank Rd
Milwaukee WI 53226
IM
Eddie Greene MD
2515 North Stowell, #26
Milwaukee WI 53211
FP
Betty J Hagle DO
4400 W Oklahoma Ave
Milwaukee WI 53219
N / N
George W Hambrook MD
2015 E Newport Ave
Milwaukee WI 53211
PD
James D Hanna MD
1922 E Belleview PI
Milwaukee WI 53211
ORS
Rolf S Hauck MD
6004 West Wells
Wauwatosa WI 53213
PD
Halim M A Hennes MD
10213 W Fond du Lac, #136
Milwaukee WI 53224
IM
Kerry H Henrickson MD
920 E Mason St
Milwaukee WI 53202
PD GER/PD
Jurgen Herrmann MD
2600 N Mayfair Rd
Wauwatosa WI 53226
AN
Carl A Hess MD
5634 W Oklahoma Ave, #G-6
Milwaukee WI 53219
PD
Ellen Hing MD
2315 N Lake Dr, #909
Milwaukee WI 53211
ORS / GS
John A Iceton MD
3003 W Good Hope Rd
Milwaukee WI 53217
IM / IM
Gerald L Ignace MD
7400 Harwood Ave
Wauwatosa WI 53213
IM
Joseph X Jenkins MD
4141 North Bartlett
Shorewood WI 53211
FP
James T Jerzak MD
8455 North Servite Dr, #102
Milwaukee WI 53223
FP
Gary L Kamer MD
3143 S 39th St
Milwaukee WI 53215
GS CDS/GS
Mark C Kiselow MD
2350 W Villard Ave, #203
Milwaukee WI 53209
OBG / OBG
Michael J Kuhn MD
12011 W North Ave
Wauwatosa WI 53226
EM FP / FP
Michael J Layde MD
1026 E Sylvan Ave
Milwaukee WI 53217
PD ADL
W Craig Leach DO
8409 Jackson Park Blvd
Wauwatosa WI 53226
FP
Margaret H Leonhardt MD
3428 N 46th St
Milwaukee WI 53216
OPH / OPH
Marc R Levin MD
3003 W Good Hope Rd
Milwaukee WI 53217
EM
Randall M Levin MD
201 W Bergin Dr
Fox Point WI 53217
IM
Lori K Liebman MD
920 E Mason St
Milwaukee WI 53202
OBG GS
Emilio M Lontok MD
3245 Town Crier Ct
Brookfield WI 53005
PD EM / PD
Joseph D Losek Jr MD
1700 W Wisconsin Ave
Milwaukee WI 53233
GP
James R Magliocco DO
9900 W Bluemound Rd
Wauwatosa WI 53226
GP / GP
Paul G Malen DO
9330 W Greenfield
West Allis WI 53214
PD
Jose S Martirez MD
1700 W Wisconsin Ave
Milwaukee WI 53201
FP
Michael C Mather MD
101 1 West Howard
Milwaukee WI 53228
IM
James P Me Guire MD
1129 N Jackson #810-C
Milwaukee WI 53202
D PD
Mary K Me Tigue MD
PO Box 17300
Milwaukee WI 53217
FP
Mark A Meier MD
3175 South 28th St
Milwaukee WI 53215
IM / IM
Rita M Hanson Melzer MD
3070 N 51st St, #411
Milwaukee WI 53210
OPH
Larry A Meyer MD
8806 W Morgan Ave, #4
Milwaukee WI 53228
EM FP / FP
Edward C W Miller MD
3405 W Picarey Ct
Mequon WI 53092
AN
Artemio M Montes MD
3540 Shady Brook Ct
Brookfield WI 53005
EM
David H Moss MD
5770 N Shore Dr
Milwaukee WI 53217
PD
Sheryl L Moss MD
9027 W Wisconsin Ave
Milwaukee WI 53226
N / N
Denis C Nathan MD
2002 West Howard Ave
Milwaukee WI 53221
CD / CD
Thomas E Palmer MD
3070 N 51st St, #601
Milwaukee WI 53210
FP
Judith Pauwels MD
2946 N Summit Ave
Milwaukee WI 53211
U
Louis C Remynse MD
3205 N 76th St
Milwaukee WI 53222
FP
Hugh P Renier MD
3003 West Good Hope Rd
Milwaukee WI 53217
IM
John A Roffers MD
10575 West Allwood
Franklin WI 53132
IM
Susan K Russler MD
6849 N Barnett Ln
Milwaukee WI 53217
FP
Paul Schattauer MD
2460 West Juneau
Milwaukee WI 53233
ORS
Todd A Schmidt MD
2509 N 67th St
Wauwatosa WI 53213
EM
Rudolph J Schroeder MD
9161 West Fielding
Milwaukee WI 53217
GS CDS
Anilkumar M Singh MD
2745 West Layton Ave
Milwaukee WI 53221
FP / FP
William J Stastny MD
4915 South Howell Ave
Milwaukee WI 53207
FP
Robert J Stevens MD
5048 N Bay Ridge Ave
Milwaukee WI 53217
EM
Robert W Stuart MD
8455 Knoll Court
Franklin WI 53132
PD
Jean S Tay MD
1810 W Wisconsin Ave, #503
Milwaukee WI 53233
PD
John W Taylor DO
5210 N 54th St
Milwaukee WI 53218
EM
Glenn A Thiel MD
8901 W Lincoln Ave
West Allis WI 53227
ORS
Robert L Thomas MD
1632 E Irving PI, #28
Milwaukee WI 53202
NM DR
Purushotham Veluvolu MD
2000 W Kilbourn Ave
Milwaukee WI 53233
continued next page
40
WISCONSIN .MEDICAL JOURNAL, DECEMBER 1985 :\ OL. 84
MEMBERSHIP DIRECTORY-UPDATE
ORGANIZATIONAL
MILWAUKEE continued
OBG
Benjamin M Victoria Jr MD
740 N Plankinton Ave, Rm 800
Milwaukee WI 53203
FP
Emma Voloshin MD
3003 W Good Hope Rd
Milwaukee WI 53217
NM PTH/NM
John P Whalen MD
2526 N 124th St, #227
Wauwatosa WI 53226
AN
Jaime B Yamat MD
8825 Greenmeadow Ln
Greendale WI 53129
IM END / IM
James S Ziolkowski MD
7400 Harwood Ave
Wauwatosa WI 53213
ONEIDA VILAS
PS OTO/OTO
Martin E Klabacha MD
Maple Street Box 549
Woodruff WI 54568
AN PS
Gurkirpal S Sikka MD
1044 Kabel Ave
Rhinelander WI 54501
GS/GS
James W Zelinski MD
2328 Hwy 17
Phelps WI 54554
POLK
IM / IM
Carl W Hansen MD
208 Adams St South
St Croix Falls WI 54024
FP / FP
GailJ Hanson MD
208 Adams St South
St Croix Falls WI 54024
FP / FP
Martin L Kimestad MD
225 Scholl St
Amery WI 54001
RUSK
OBG
Robert K De Mott MD
906 College Ave West
Ladysmith WI 54848
WINNEBAGO
FP / FP
David E Bcitz MD
1215 Doctor's Dr
Neenah WI 54956
WAUKESHA
PD
Perla P Agpoon MD
S5 W22449 E Moorland
Waukesha WI 53186
GS
Arthur E Angove DO
13700 W National Ave, #126
New Berlin WI 53151
IM EM
Robert J Ballman MD
1717 Paramount Dr
Waukesha WI 53186
FP
Saharyn Barney MD
434 Madison
Waukesha WI 53188
N / PN
James C Barton MD
888 Thackeray Tr
Oconomowoc WI 53066
FP / FP
Robert J Beaumont DO
237 Wisconsin Ave
Waukesha WI 53186
FP EM
Mark D Bruce DO
15300 Watertown Plk Rd
Elm Grove WI 53122
OM GPM / GP
Charles R Buck MD
W228 N683 Westmound
Waukesha WI 53186
IM
Nicholas K Cannella MD
2010 Melody Ln
Brookfield WI 53005
FP
Marc A Carley Olsen MD
N84 W16889 Menomonee
Menomonee Falls WI 53051
OPH
Michael V Darnieder MD
N84 W 16889 Menomonee
Menomonee Falls WI 53051
FP
Arlen R Delp DO
W186 S8055 Racine Ave
Muskego WI 53150
FP
Roy E Fredricks DO
15300 Watertown Plk Rd
Elm Grove WI 53122
FP EM
James M Frisvold DO
W186 S8055 Racine Ave
Muskego WI 53150
OBG / OBG
Alan E Gustin MD
7 Earling Court
Oconomowoc WI 53066
FP EM
Nezih Z Hasanoglu DO
13700 W National Ave
New Berlin WI 53151
GP
Irwin F Hoeft DO
888 Thackeray Tr
Oconomowoc WI 53066
EM GP/EM
Ronald W Horkheimer MD
18980 Glen Kerry Ave
Brookfield WI 53005
FP
Kenneth J Kurt DO
15300 Watertown Plk Rd
Elm Grove WI 53122
IM
Sarita Makhija MD
W180 N7950 Town Hall Rd
Menomonee WI 53051
EM IM
David R Nahin MD
1175 Gray Fox Hollow
Waukesha WI 53186
GP
Moria E O'Brien-Bruce DO
15300 Watertown Plk Rd
Elm Grove WI 53122
PD
David J Pikna MD
1717 Paramount Dr
Waukesha WI 53186
N / PN
John A H Porter MD
888 Thackeray Tr
Oconomowoc WI 53066
DR / DR
Karen Rasmussen MD
2924 N Interlaken
Oconomowoc WI 53066
ORS
Paul D Rasmussen MD
915 E Summit Ave
Oconomowoc WI 53066
IM / IM
Jeffrey W Schenck MD
W145 N7495 Northwood
Menomonee Falls WI 53051
CHP
Mark Siegel MD
2704 Woodridge Ln
Waukesha WI 53186
AN
Thomas A Stekiel MD
2495 Whipple Tree Ln
Brookfield WI 53005
FP / FP
George S Stenger DO
15710 W Greenfield Ave
Brookfield WI 53005
ORS
Gregory N Van Winkle MD
W 180 N7950 Town Hall Rd
Menomonee Falls WI 53051
OPH
William P Verre MD
W180 N7950 Town Hall Rd
Menomonee Falls WI 53051
OBG
Timothy J Zelko DO
N84 W 16889 Menomonee
Menomonee Falls WI 53051
County society transfers
DANE
(from Wood]
Bryon Gaul MD
600 Highland Ave
Madison WI 53792
MARATHON
(from Oneida-Vilas)
James P Binder MD
425 Pine Ridge Blvd, #202
Wausau WI 54401
SAUK
(from Columbia-Marquette-
Adams)
Harold I, Conley MD
820 Bauer St
Wisconsin Dells WI 53965
Renato T Faylona MD
South Vine St
Wisconsin Dells WI 53965
Richard K Westphal MD
PO Box 325
Wisconsin Dells WI 53965H
WISCONSIN MEDICAL JOURNAI., DECEMBER 1985: VOL, 84
4
For professional liability insurance, the stakes are too
high to depend on anyone else.
That's why the State I^edical Society has endorsed a
professional liability plan which has been developed
especially for Wisconsin physicians.
Available only to members of the Sl^S— and offered
through SPIS Services, Inc.— this medical malpractice policy
has superior features including:
• Consent of the physician is required before settlement of
any claim.
• Availability of legal counsel, experienced in defendant
medical liability.
• All members of claims and underwriting committees are
Wisconsin physicians.
• Occurrence coverage provided for claims arising during
the policy period, even if claim is reported at a later
time.
For the best in professional liability coverage, contact
SMS Services, Inc. at (608) 257-6781 or toll-free 1-800-362-9080
We know how vital it is to safeguard the present...
and to protect the future.
Endorsed by the
State Medical Society
of Wisconsin
A respected leader in coverage for preferred markets.
SOCIOECONOMICS
State Medical Society Legislative Status Report
Bills approved by both Houses
Bill
SMS
Position
Status
AB 85 (Hospital Rate-Setting Commission— HRSC): Retains the
HRSC, but exempts from rate-setting those hospitals with annual
revenues less than $10 million if the rate increase is less than the
hospital market basket and consumer price indexes. Sunsets HRSC
July 1, 1987. Requires a Legislative Council Study on rate-setting
with recommendations due January 1, 1987.
Support
repeal of
HRSC
Law, 1985
Wisconsin Act
29
AB 85 (Capital Expenditure Review— CER): Increases the threshold
amount for reviewable projects from $600,000 to $1,000,000
($1,500,000 for hospital conversions and renovation). Reviews for
expansion of services are limited to transplant programs, burn
centers, neonatal intensive care programs, cardiac programs, air
transport services, and the addition of psychiatric or chemical
dependency beds. Places a 3-year moratorium on new hospital beds.
Sunsets CER program July 1, 1989.
Support
repeal of
CER.
Law, 1985
Wisconsin Act
29
AB 85 (Mandated Mental Health Benefit): Increases required insur-
ance coverage for outpatient mental health and AODA treatment
from $500 to $1,000 and requires inpatient coverage to include the
lesser of 30 days or $7,000. Provides that psychiatrists and psy-
chologists are eligible for the insurance reimbursement, thus ex-
empting them from current "certified clinic" standards. Places a
moratorium on new outpatient clinics. Requires a study on the man-
dated coverage.
Mixed
Law, 1985
Wisconsin Act
29
AB 85 (Health Care for Uninsured): Requires DHSS to develop pilot
projects in three geographical areas to provide health coverage to
low-income, uninsured persons and subjects the plans to Joint Com-
mittee on Finance for approval. Provides funding for Primary Care
Program (modeled on the ShareCare Program) to continue health
care services in areas of high unemployment.
Support
Law, 1985
Wisconsin Act
29
AB 85 (Graduate Medical Education— GME): Provides for a study
to develop proposals on funding GME in Wisconsin.
Monitored
Law, 1985
Wisconsin Act
29
AB 85 (Medical Liability Reporting): Effective February 15, 1986,
and thereafter, requires medical malpractice insurers and the
Patients Compensation Fund to report monthly to the Medical Ex-
amining Board on claims paid the previous month for damages aris-
ing out of the rendering of health care services by a provider.
Support
Law, 1985
Wisconsin Act
29
AB 85 (Chiropractic Coverage): Mandates a minimum coverage of
28 chiropractic visits per year in health insurance contracts, HMOs,
and PPOs.
Oppose
Vetoed
AB471 (Capital Expenditure Review— CER): Changes the effective
date of the increased threshold amounts for reviewable projects
enacted by the budget bill (AB 85) from July 1, 1986, to January
1, 1986. Makes minor modifications to laws relating to forfeitures
for project cost overruns, financing for projects, and hospital acqui-
sitions by another hospital.
Support
Law, 1985
Wisconsin Act
72
WISCONSIN MEDICAL JOURNAL. DECEMBER 1985: VOL. 84
43
State Medical Society Legislative Status Report/ continued
Bill
SMS
Position
Status
AB 487 (AIDS): Modifies language enacted by the budget bill (AB
85) to authorize disclosure of HTLV-III antibody test results to the
person's health care provider, their employers or agents involved
in patient care or in handling or processing specimens or bodily
fluids or tissues. Positive test results are reportable to the state
epidemiologist.
Support
Law, 1985
Wisconsin Act
73
SB 134 (FAS Pamphlets): Requires county clerks to distribute pam-
phlets describing the causes and effects of fetal alcohol syndrome
to persons issued marriage licenses.
Support
Law, 1985
Wisconsin Act
19
SB 219 (Pituitary Gland Removal): Authorizes a coroner's physi-
cian or medical examiner to remove the pituitary gland at a law-
fully performed autopsy and transmit to the National Hormone
and Pituitary Program.
Support
Law, 1985
Wisconsin Act
93
AB481 (Minor Bone Marrow Donation): Establishes a consent pro-
cedure under which a minor may donate bone marrow to a brother
or sister.
Support
Law, 1985
Wisconsin Act
50
Pending Legislation
SB 7 (Seat Belts): Requires use of seat belts in motor vehicles re-
quired by law to be so equipped. (Three identical Assembly Bills
are also pending.)
Support
Endorsed by
Transportation
Committee,
available for
floor action
SB 87 (Drug Paraphernalia): Restricts the sale, use, possession, and
advertising of drug paraphernalia.
Support
In Senate Judi-
ciary & Con-
sumer Affairs
Committee
SB 195 (Drinking Age): Increases minimum age for procurement,
possession, and consumption of alcoholic beverages from 19 to 21.
Support
In Labor, Busi-
ness, Veterans
Affairs & Insur-
ance Cmte.
SB 28 1 (Reporting Birth Defects or Disabilities): Creates a Birth and
Developmental Outcome Monitoring Program within DHSS. Physi-
cians are required to report to the Department birth defects or
developmental disability within 30 days of a suspected, confirmed,
or updated diagnosis in children up to age six.
Oppose
Endorsed by
Agriculture,
Health &
Human Ser-
vices Commit-
tee. In Joint
Finance Cmte.
SB 283 (Sickle Cell Disease): Requires infant testing for sickle cell
disease and creates a technical council on biochemical screening.
Oppose
In Agriculture,
Health &
Human Ser-
vices Commit-
tee. (Public
hearing held)
SB 285 (Pharmacy Practice): Authorizes pharmacists to monitor,
initiate, administer, or modify drug therapy in accordance with
written protocols between a pharmacist and practitioner. SB 285
is a repeal and recreation of the pharmacy statutes.
Oppose
Provision
deleted by
amendment; re-
mainder of bill
passed by Sen-
ate. In Assem-
bly Commerce
& Consumer
Affairs Cmte.
44
WISCONSIN MEDICAL JOURNAL, DECEMBER 1985: VOL. 84
LEGISLATIVE STATUS REPORT
SOCIOECONOMICS
State Medical Society Legislative Status Report! continued
BUI
SMS
Position
Status
SB 320 (Smoking-Induced Diseases): Authorizes a family member
of a person who dies as a result of cigarette-induced lung cancer
or emphysema to bring a wrongful death action against a cigarette
producer.
Monitor
In Judiciary &
Consumer Af-
fairs Commit-
tee. (Public
hearing held)
SB 328 (Medical Malpractice Reforms): Makes various changes in
the laws governing medical malpractice proceedings including plac-
ing a $3.3 million limitation on awards. *(SMS has a position to limit
awards for non-medical expenses to $1 million, with no limits on
awards for future medical expenses.)
* Support
In Labor, Busi-
ness, Veterans
Affairs & In-
surance Com-
mittee. (Public
hearing held)
SB 345 (Regulation and Licensing): Makes various changes within
the Department of Regulation and Licensing including requiring
50% public membership on all examining boards, authorizing the
Department to commence or close disciplinary proceedings without
examining board approval, and authorizing the Department to ap-
peal examining board decisions.
Oppose in
part
In Senate
Judiciary &
Consumer Af-
fairs Committee
SB 350 (Involuntary Commitment): Creates additional standards
for involuntary mental commitment.
Support
In Senate
Judiciary &
Consumer Af-
fairs Committee
SB 369 (Midwives): Directs the Department of Regulation and
Licensing to license as a midwife any person who is at least 18 years
old, is a high school graduate or equivalent, meets certain practice
requirements and educational prerequisites, and passes an exami-
nation.
Oppose
In Senate
Health &
Human Ser-
vices Commit-
tee (Public
hearing held)
SB 372 (CME): Eliminates the biennial continuing medical educa-
tion requirements for physicians.
Oppose
In Senate Agri-
culture, Health
& Human Ser-
vices Commit-
tee
SB 388 (Required Request for Organ Donation): Requires hospitals
to establish a system of requesting consent of family members for
organ donation when a deceased patient is a suitable donor.
Support
Passed Senate
In Assembly
Health Com-
mittee
AB 76 (Involuntary Commitment): Makes a number of procedural
modifications to involuntary commitment law.
Support
Passed Assem-
bly
In Agriculture,
Health &
Human Ser-
vices Commit-
tee
AB 196 (Cigarette Sale to Minors): Prohibits the sale of tobacco prod-
ucts to minors.
Support
Endorsed by
Health Com-
mittee
In Joint
Einance Com-
mittee
WISCONSIN MKOICAI. JOCRNAL, DECEMBER 1985: VOL. 84
43
SOCIOECONOMICS
LEGISLATIVE STATUS REPORT
State Medical Society Legislative Status Report! continued
Bill
SMS
Position
Status
AB 246 (Overdue Insurance Claims): Waives insurance company
interest payments on overdue claims if the amount of interest due
is less than $5. Also, extends time limit before a claim is overdue
from 30 days to 30 business days.
Oppose
Defeated in
Financial Insti-
tutions & Insur-
ance Committee
AB 252 (Living Wills): Repeals the standard that death must occur
within 30 days before a living will is effective and replaces it with
a standard that death must be imminent. Modifies the prohibition
against withholding nutritional support and fluid maintenance to
prohibit it only when necessary to maintain the comfort of the dying
patient. (The latter provision was defeated by the Assembly, so the
bill reverts to the strict prohibition in current law.)
Support
Passed Assem-
bly
In Senate Judi-
ciary & Con-
sumer Affairs
Committee
AB 256 (PT Practice): Authorizes physical therapists to evaluate and
treat patients without the referral from a physician, dentist, or
podiatrist. (Companion bill, SB 233, is currently pending in Senate
Agriculture, Health & Human Services Committee.)
Oppose
Endorsed by
Assembly
Health Com-
mittee. Avail-
able for floor
action.
AB 311 (Mental Commitment): Creates an additional standard for
involuntary mental health commitment based on a patient's need
for treatment and, because of the mental illness, inability to reach
an informed decision concerning treatment. All current due pro-
cess is maintained.
Support
In Judiciary
Committee
(Public hearing
held)
AB 344 (Chiropractic Coverage): Mandates chiropractic services in
health insurance contracts, HMOs, and PPOs.
Oppose
In Financial In-
stitutions & In-
surance Com-
mittee
AB 361 (Local Aid for Public Health): Provides funding of up to $3
per resident to local governments to assist public health services.
Support
In Health
Committee
AB 470 (Respiratory Therapists): Provides for the certification of
respiratory care practitioners by the Medical Examining Board and
requires such certification to practice enumerated respiratory care
procedures.
Support
In Commerce &
Consumer Af-
fairs Committee
AIDS bill becomes law
Assembly Bill 487, dealing with
provisions for HTLV-III antibody
testing, was adopted in the fall ses-
sion of the 1985 Legislature.
This legislation was sought by
the State Medical Society, blood
banks, the State Division of
Health, insurers, and others to
correct the provisions on HTLV-III
testing enacted in the biennial
budget.
While the new law retains the
requirement for a specific written
consent form prior to performing
an HTLV-III antibody test in most
cases, it does resolve virtually all
of the other problems identified
with the current law.
For example, HTLV-III test in-
formation will continue to be in-
cluded in a medical record; test re-
sults may be disclosed without the
patient's consent to most (but not
all) of the entities now given ac-
cess without consent to medical
records; and healthcare providers,
including persons involved in pa-
tient care and in handling or pro-
cessing specimens, may be in-
formed of the test results without
the patient's consent. Also, writ-
ten consent is not required when
an HTLV-III antibody test is per-
formed for purposes of determin-
ing the medical suitability of an
organ, blood, or other body part
for donation.
The new law also provides for
reporting of positive test results to
the state epidemiologist.*
46
WISCONSIN MEDICAL JOURNAL, DECEMBER 1985: VOL. 84
It Pays
TO BE A
Member
SMS Services, Inc.
SMS Services ... A wholly owned subsidiary of the State Medical
Society of Wisconsin organized to provide more and better benefits
to its members.
Endorsed Insurance Programs
Group Major Medical
Group Life
Group Insured Medical
Reimbursement
Auto-Homeowners-
Personal Umbrella
Income Replacement
Disability Income
Business Overhead Expense
Total Office Protection
Professional Liability
Universal Life
Worker’s Compensation
And more on the way!
Other Programs
Medical Information
Network (Minet^^)
Debt Collection Services
Furniture Discount
Book Discounts
Computer Purchase
Seminars
for Members
Uniform Claim Forms
Printing
Auto Lease and Rental
Paper Discount
Home /Office Security Systems
Full Line Lease Company
Personal and Business Credit Cards
the way too!
More of these on
To find out more about these . . .
Invite speakers to your county or specialty society meeting
or call SMS Services, Inc. for further details.
P.O. BOX 1109, MADISON, WI 53701 • PHONE 608/257-6781 OR TOLL-FREE 1-800-362-9080
[county societies
•Physician members of the State Medical Society of Wisconsin
Lincoln CMS offers free colorectal cancer screening
LINCOLN: An initiative by the
Lincoln County Medical Society to
provide free colorectal cancer
screening for one month has led to
a resolution that will be brought
before the SMS 1986 Annual Meet-
ing.
M Y Ahmad, MD, president of
the Lincoln medical group, has
drafted the following proposal:
"Resolved, that colorectal can-
cer screening (Hemoccult® test)
be offered for one month on a
yearly basis by all State Medical
Society members to improve colon
cancer awareness and to find and
treat new colorectal cancer pa-
tients."
A specific month has not yet
been selected.
In a letter to SMS Secretary Earl
R Thayer, Doctor Ahmad said.
Discount prices
on typewriters
and copiers
SMS Services, Inc has
negotiated an agreement
with Modern Business Ma-
chines in Madison to pro-
vide SMS members with a
discount on IBM Wheel-
writer 3 Electronic and IBM
Wheelwriter Selectronic
typewriters (7K memory),
with options. Also available
is a discount on the Xerox
Model 1020 and 1025
copiers with options.
For further information con-
tact Noreen Krueger at SMS
Offices in Madison at 608-
257-6781 or 1-800-362-9080,
extension 141.
"President Reagan's recent cancer
surgery has brought colon cancer
to our nation's attention. The Lin-
coln County Medical Society phy-
sicians took this opportunity to
improve colon cancer awareness
in our communities. Free colo-
rectal cancer screening was held
for one month. As a result, new
cases of colon cancer were found
and treated. Because of the tre-
mendous response, the Lincoln
County Medical Society physi-
cians have decided to offer colo-
rectal cancer screening (Hemoc-
cult® test) for one month on a
yearly basis."
"The Lincoln County Medical
Society is to be congratulated on
its colorectal cancer screening
project," Mr Thayer wrote Doctor
Ahmad in advising him the resolu-
tion will be introduced to the
House of Delegates.
MARINETTE-FLORENCE: Twen-
ty-seven members and guests
were present at the Marinette-
Florence County Medical Society.
Frederick Sobieray, DO, a mem-
house of
BIDWELL, inc.
7954 West Harwood
and Watertown Plank Road
Milwaukee, Wisconsin 53213
#ORTHOTlC
AND
PROSTHETIC
SERVICES
1-414-774-6250
ber of the Boren Clinic in
Marinette spoke on "Update Poly-
pectomy Surveillance." New
members accepted to member-
ship are MDs Vernette M Carl-
son,* Sherwood A Cole,* Gerald
W Favret,* Thomas] Knutson,*
and Calvin D Nogler.*
OUTAGAMIE: At the October
meeting of the Outagamie County
Medical Society 21 members and
guests were present. Guest
speaker was Ellen Gruenbaum,
PhD, professor of anthropology at
the University of Wisconsin Cen-
ter-Manitowoc. Her topic was
"Who Are Healers?" Debra Bo-
wen-Wilke, field representative of
the SMS Physicians Alliance, an-
swered questions regarding the
meeting in Madison on the mal-
practice issue. An award was pre-
sented to Henry Chessin, MD,*
for his past service as president of
the County Society.
SHEBOYGAN: At the October
meeting of the Sheboygan County
Medical Society, MDs Robert W
Pointer,* Jan P De Roos,* and
Cynthia P Northrop* spoke on
their recent medical mission ex-
periences in Haiti, The Domini-
can Republic, and Central Amer-
ica. Sixty-nine members and
guests were present at the com-
bined meeting of the Medical So-
ciety and its Auxiliary.
WINNEBAGO: Ninety-four mem-
bers and guests were present at
the October meeting of the Win-
nebago County Medical Society.
Guest speaker was Senator Susan
Engeleiter, Menomonee Falls,
who spoke on various legislative
issues of current interest. A ques-
tion and answer session followed
the formal address of Senator En-
geleiter.■
48
WISCONSIN MEDICAL JOURNAL. DECEMBER 1985: VOL. 84
OBITUARIES
George Colville Owen, MD died in
Milwaukee on July 25, 1985 at the
age of 80. After receiving a BA
degree from the University of
Wisconsin in 1927 and attending
the University of Wisconsin Medi-
cal School for two years, he grad-
uated from Harvard Medical
School in 1931 and served his in-
ternship at Boston City Hospital.
From 1934 to 1942 he practiced
internal medicine in Oshkosh, ob-
taining certification by the Ameri-
can Board of Internal Medicine
and Fellowship in the American
College of Physicians. He left
Oshkosh to serve at Fitzsimmons
Army Hospital and later served as
Chief of Medicine at Bruns Army
Hospital in Santa Fe during World
War II. He returned to Milwaukee
after six months with the Veterans
Administration in Washington,
DC, to practice internal medicine
and chest diseases. He continued
to serve the Veterans Administra-
tion as a consultant in tuberculosis
at Wood Veterans Administration
Medical Center. He also served on
the Board of Directors of the Wis-
consin Lung Association for 21
years. Jointly with Dr John Steele
he served the State of Wisconsin,
annually reviewing practice in
state tuberculosis sanitoria that
led to the establishment of the
Pembine Chest Conference,
which is ongoing. He served as
Chief of Medicine at Columbia
Hospital from 1966 through 1970.
After retirement from office prac-
tice, he served full-time at Colum-
bia Hospital as cost ombudsman.
Director of the Library, liaison
among the staff, board, and ad-
ministration. Surviving are his
wife, Mona V Owen of Milwau-
kee, and three sons: Nicholas L
Owen, MD of Milwaukee; Tobias
Owen of Long Island, New York;
and George C Owen Jr, of Santa
Fe, New Mexico.
Benjamin E Urdan, MD, 82, died
Aug 15, 1985 in Milwaukee. Born
Dec 15, 1902 in Milwaukee,
Doctor Urdan graduated from
Marquette University School of
Medicine in 1927 and served his
internship at Jewish Hospital in
Cincinatti, Ohio. His residency
was completed at Mt Sinai Hospi-
tal, New York, and Chicago Ly-
ing-In Hospital. He was one of the
founders of the Milwaukee Ob-
stetrics and Gynecology Society
and also was an assistant clinical
professor at Marquette Univer-
sity. He was a member of The
Medical Society of Milwaukee
County, the State Medical Society
of Wisconsin, and the American
Medical Association. Surviving
are his widow, Marian; one son,
Samuel (Karen) and two grand-
daughters.
Moktar Najafzadeh, MD, 79, for-
mer Twin Lakes physician, died
Sept 4, 1985 in Miami, Florida.
Born Apr 6, 1906 in Russia, Doc-
tor Najafzadeh graduated from the
Medical School of Lyon in France
and served his internship at Val
De Grace Hospital in Paris and his
residency was completed in Istan-
bul, Turkey. Doctor Najafzadeh
served for 23 years in the Iranian
Army Medical Corps as general
surgeon in Tehran and retired
with the rank of Brigadier General
in 1959. From 1960-1965 he com-
pleted a residency at the Coney Is-
land Hospital, Brooklyn, New
York. In 1966 Doctor Najafzadeh
became the medical director of
the McCoy Job Corps Center in
Sparta. In 1970 he became associ-
ated with the Twin Lakes Medical
Center and retired from medical
practice in 1975. He was a mem-
ber of the Kenosha County Medi-
cal Society, the State Medical So-
ciety of Wisconsin, and the
American Medical Association.
Surviving is his widow, Karin, of
Coconut Creek, Florida.
Gerald J Bergmann, MD, 71,
Greenfield, died Sept 12, 1985 in
Milwaukee. Born Dec 30, 1913 in
Milwaukee, Doctor Bergmann
graduated from Marquette Uni-
versity School of Medicine in 1939
and served his internship and resi-
dency at Milwaukee County Gen-
eral Hospital. He was chief of the
Family Practice Center at St
Luke's Hospital, Milwaukee, from
1961-1964. Doctor Bergmann was
in private medical practice at the
time of his death. He was a mem-
ber of The Medical Society of Mil-
waukee County, the State Medical
Society of Wisconsin, and the
American Medical Association.
Surviving are his widow, Ruth,
and a daughter Christine Van Hef-
ty of De Pere.
James D Zeratsky, MD, 71, Mari-
nette, died Sept 29, 1985 in
Marinette. Born Oct 5, 1914 in
Marinette, Doctor Zeratsky gradu-
ated from Northwestern Univer-
sity School of Medicine and served
his internship at University Hos-
pitals in Madison. Doctor Zeratsky
was associated with the Boren
Clinic. He was a member of the
Marinette-Florence County Medi-
cal Society, the State Medical
Society of Wisconsin, and the
American Medical Association.
Surviving are his widow, Ruth;
one daughter. Merry Jane Lindt,
Marinette; four sons, John, Jeff,
Joseph, and Jeremy, all of Mari-
nette.
Anthony S Kult, MD, 80, Milwau-
kee, died Oct 7, 1985 in Mil-
waukee. Born Nov 24, 1904 in
Budapest, Hungary, Doctor Kult
graduated from Marquette Uni-
versity School of Medicine and
served his internship at St Joseph
Hospital, Milwaukee. He was a
member of the "Fifty Year Club"
of the State Medical Society of
Wisconsin, a member of The
Medical Society of Milwaukee
County, and the American Medi-
cal Association. Surviving is a son,
Dale.H
WISCONSIN MEDICAI, JOURNAL, DECEMBER 1985: VOL. 84
49
BLUE BOOK UPDATE
On page 1 3 1 of the June Blue Book under the head-
ing Officers of Specialty Sections the following
changes have been made:
ANESTHESIOLOGISTS
Chairman Young K Lee, MD
1836 South Ave, La Crosse 54601
INTERNAL MEDICINE
Chairman James R Mattson, MD
501 S Military Ave, Green Bay 54303
Secretary-Treasurer Cyril M Hetsko, MD
1313 Fish Hatchery Rd, Madison 53715
Delegate James R Mattson, MD
501 S Military Ave, Green Bay 54303
Alternate Delegate Charles S Geiger Jr, MD
279 S 17th Ave, West Bend 53095
RADIOLOGY
Alternate Delegate Bruce C Kirkham, MD
3737 Claymore Lane, Eau Claire 54701
On page 133 under the heading of Officers of Spe-
cialty Societies the following changes have been made:
WISCONSIN SOCIETY OF ANESTHESIOLOGISTS
President Young K Lee, MD (Sept 1986)
1836 South Ave, La Crosse 54601
WISCONSIN SOCIETY OF INTERNAL MEDICINE
President James R Mattson, MD (Sept 1986)
501 S Military Ave, Green Bay 54303
Secretary Cyril M Hetsko, MD (Sept 1986)
1313 Fish Hatchery Rd, Madison 53715
WISCONSIN RADIOLOGICAL SOCIETY
President Mary Ellen Peters, MD (Oct 1986)
600 Highland Ave, Madison 53792H
[news highlights
]
‘Physician members of the State Medical Society of Wisconsin
Columbus Community Hospital
recently selected Mr Miles Meyer
as the new administrator for the
hospital. Mr Meyer received a
Master's degree in Hospital and
Health Administration from the
University of Iowa College of
Business. Prior to joining the Co-
lumbus Community Hospital
staff, Mr Meyer was the adminis-
trator of Ipswich Community
Hospital in South Dakota.
Persons interested in the Im-
paired Physician Program
may call 608/257-6781 or
toll-free in Wisconsin: 1-800-
362-9080 and explain their
concern to Mr John LaBis-
soniere or Mr H B Maroney
of the State Medical Society
staff. The caller's identity
will be kept in complete
confidence.
Marshfield Clinic Executive Di-
rector Frederick J Wenzel has re-
ceived the Group Practice Admin-
istrator recognition award from
the American Group Practice As-
sociation. The award, which was
given for the first time, is "re-
served for outstanding group prac-
tice administrators . . . respected
leaders who contribute not only to
the administrative success of their
own medical groups but also to
their profession through creative,
informative, and relevant group
practice administration." Mr.
Wenzel began his career at the
medical center in 1950 as a re-
search assistant at St Joseph's Hos-
pital. In 1953 he became director
of laboratories at the Clinic, and in
1965, executive director of the
Marshfield Medical Foundation.
He has been executive director of
the Clinic since 1977. He was pre-
sented the award by David Ot-
tensmeyer, MD, former president
of Marshfield Clinic and currently
head of Lovelace Medical Founda-
tion, Albuquerque, New Mexico.
St Mary's Medical Center medical
staff, Racine, recently elected of-
ficers. Joseph D Postorino, MD*
was elected to the second half of
a two-year term as chief-of-staff.
Henry E DeGroot, MD* was re-
elected secretary and Edward A
Stika, MD* serves as the immedi-
ate past chief-of-staff. Department
chiefs elected include MDs Robert
D Shaffer,* medical department;
Hark C Chang,* surgical depart-
ment; Louis J Floch,* gynecology
department; Peter DeGroot, pedi-
atric department; Gerald J Sam-
pica,* family practice department;
and William C Harris, * was reap-
pointed as chief of the emergency
committee. Other executive com-
mittee appointments were MDs
Donald F Cohill,* chairman. Utili-
zation Review Committee, and
Huron L Ericson,* chairman.
Medical Audit Committee. ■
50
WISCONSIN MEDICAL JOURNAL, DECEMBER 1985: VOL. 84
'Physician members of the State Medical Society of Wisconsin
PHYSICIAN BRIEFS
Jay F Schamberg, MD, * West Allis,
recently was given an award
for "Distinguished Service to Pub-
lic Health." The award was pre-
sented to Doctor Schamberg at the
Wisconsin Public Health Associa-
tion Annual Conference. Doctor
Schamberg is on the medical staff
at West Allis Memorial and Meno-
monee Falls hospitals, and has
provided countless hours of vol-
unteer service to the Waukesha
County Health Department. This
award is given for significant con-
tribution to public health in the
community or the state and the
recipient is to be a Wisconsin resi-
dent not employed in a public
health agency. Doctor Schamberg
is a pathologist.
Cynthia Jones-Nosacek, MD, re-
cently joined the medical staff at
the Falls Medical Group in Meno-
monee Falls. Doctor Jones-Nosa-
cek graduated from the Loyola
University Stritch School of Med-
icine and completed her residency
in family practice at Resurrection
Hospital in Chicago.
Michael V Darnieder, MD,* has
joined the medical staff at the Falls
Medical Group in Menomonee
Falls. Doctor Darnieder graduated
from the Medical College of Wis-
consin, Milwaukee, and com-
pleted his residency in ophthal-
mology at Henry Ford Hospital in
Detroit. He was chief of residents
at Henry Ford Hospital in 1984
and 1985.
Eugene J Nordby, MD, * Madison,
recently was reelected president
of the Board of Trustees of Vester-
heim, the Norwegian-American
Museum, at the annual meeting of
Vesterheim Trustees held in Balti-
more. Vesterheim, located in
Decorah, Iowa, is considered the
oldest and most comprehensive
immigrant ethnic museum in the
nation; it has been collecting ob-
jects relating to Norwegian immi-
grant history since 1877.
Timothy J Zelko, DO,* a graduate
of the Philadelphia College of
Osteopathic Medicine, recently
joined the medical staff at the Falls
Medical Group in Menomonee
Falls. Doctor Zelko completed his
residency at St Joseph's Hospital
in Milwaukee.
Matthew W Elson, MD,* Brook-
field, recently was named a fellow
of the American College of Radi-
ology. Doctor Elson is associated
with the West Allis Memorial
Hospital and is a graduate of the
Ohio State University College of
Medicine in Columbus, Ohio.
Cesar N Reyes Jr, MD,* Marsh-
field Clinic vice president, re-
cently was elected to a three-year
term on the Board of Trustees of
the American Group Practice As-
sociation. He will represent the
central region of the United States
on the 13-member board. Doctor
Reyes joined the Clinic in 1966
and is presently serving as Direc-
tor of Laboratories. He has been a
member of the Clinic's Executive
Committee for 12 of the past 13
years.
John M Coffey, MD, * Milwaukee,
has been named medical director
of the De Paul Rehabilitation Hos-
pital Impaired Professional Pro-
gram. He replaced MDs August D
Kropp* and Mark D Biehl* who
had been co-medical directors
since October 1984. Doctor Cof-
fey has been serving in the De
Paul Barrows' Fellowship.
Michael M Miller, MD,* Eau
Claire, recently was appointed to
the managing committee of the
State Medical Society Statewide
Impaired Physician Program.
Comprised of six to nine members
of the medical profession from
throughout the state, the commit-
tee was organized to develop a
plan for implementing an effec-
tive program to aid physicians im-
paired by alcohol or drug abuse,
psychiatric disorders or physician
disability. Doctor Miller is on the
medical staff of the Midelfort
Clinic in Eau Claire.
Wayne Peterson, MD, Burlington,
has joined the medical staff of
Medical Consultants in Burling-
ton. Doctor Peterson graduated
from Rush Medical College and
completed his residency program
at Rush-Christ Family Practice in
Chicago.
Gerald W Favret, MD,* Marinette,
recently became associated with
the Boren Clinic. Doctor Favret
graduated from the Medical Col-
lege of Ohio and completed his
residency at Grant Medical Cen-
ter in Toledo. He is a diplomate of
the American Academy of Family
Practice.
Susan R Bernstein, MD,* Shore-
wood, has opened a medical prac-
tice in association with Larry J
Polacheck, MD.* She graduated
from Northwestern University
Medical School and served her
residency training at the Univer-
sity of Chicago Hospitals and
Clinics and Wyler Children's Hos-
pital. She currently is a clinical as-
sistant professor at the Medical
College of Wisconsin in Mil-
waukee.
Timothy J Freeman, MD, * Green
Bay, has joined the medical staff
of the West Side Clinic. He grad-
uated from the University of Wis-
consin Medical School, Madison,
and served his internship at
Mount Sinai Medical Center in
Milwaukee.
WISCONSIN MEniCAl.JOURNAI,, DECEMBER 1985: VOL. 84
51
PHYSICIAN BRIEFS
David Myerowitz, MD, Madison,
head of the heart transplant team
at the University of Wisconsin
Hospital and Clinics, is leaving the
university to direct a new trans-
plant program at Ohio State Uni-
versity. Doctor Myerowitz has
been a UW surgeon for six and
one-half years and chief heart
transplant surgeon since the pro-
gram was revived in 1984. Doctor
Myerowitz will be chief of cardiac
surgery at Ohio State University
effective December 1.
Viktor Gottlieb, MD, Marshfield,
recently became associated with
the Marshfield Clinic. He is a
graduate from the University of Il-
linois Medical Center, Chicago,
24
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Rentals
Stevens Point— 715/344-7310
Green Bay— 414/494-3675
Madison— 608/249-6604
PBBS EQUIPMENT CORP.
5401 N Park Dr
PO Box 365
Butler, WI 53007
Phone: 414/781-9620
and served his internship and resi-
dency at the University of Iowa
Medical Center in Iowa City. He
practiced at General Leonard
Wood Army Hospital at Fort
Leonard Wood, Mo, and then
completed a plastic surgery resi-
dency at Fitzsimons Army Medi-
cal Center in Aurora, Colo.
Leonas P Sulas, MD, * Portage, re-
cently opened his medical prac-
tice in Portage. He graduated from
the University of Vienna in Austria
and served a residency at Mercy
Hospital in Pittsburgh and at the
University of Illinois Hospital in
Chicago.
Gregory C Doelle, MD, Marsh-
field, has joined the medical staff
of the Marshfield Clinic in the De-
partment of Internal Medicine,
Section of Endocrinology. Doctor
Doelle graduated from the Uni-
versity of Minnesota Medical
School where he also completed
his residency. His fellowship in
endocrinology was served at Van-
derbilt University, Nashville,
Tenn. Prior to joining the Clinic,
he was director of internal medi-
cine at Broadlawns Polk County
Medical Center in Des Moines,
Iowa.
Richard W Shropshire, MD, *
Monona, was reelected speaker of
the Congress of Delegates of the
American Academy of Family
Physicians. Doctor Shropshire has
been in medical practice at the
Monona Grove Clinic since 1957.
He also is an associate clinical pro-
SMS Toll-free
number in Wisconsin
1-800-362-9080
fessor of family medicine and
practice at the University of Wis-
consin Medical School in Madi-
son. He was elected to his first
term as AAFP speaker in 1984 and
prior to that, he served two terms
as vice speaker.
Michael C Stark, DO, * Tomah, re-
cently became associated with
MDs James R Deming,* Michael
J Saunders,* and Gustave A Land-
mann* at the Lake Tomah Clinic.
Doctor Stark graduated from the
College of Osteopathic Medicine
and Surgery in Des Moines, Iowa,
and served an internship at North-
west General Hospital in Mil-
waukee. His family practice resi-
dency was completed in the St
Mary's Hospital residency pro-
gram in Milwaukee. Prior to join-
ing the Lake Tomah Clinic, Doc-
tor Stark was in private medical
practice in Cedar Rapids, Iowa.
Gloria M Halverson, MD, * Brook-
field, has won the "Women of
Distinction" award from the
Christoph Memorial YWCA. Doc-
tor Halverson is affiliated with
Women Care of Waukesha, Mil-
waukee County Medical Com-
plex, Waukesha Memorial Hospi-
tal, and Elmbrook Hospital. She is
a member of the American College
of Obstetrics /Gynecology Task
Force on the Advancement of
Women in Obstetrics and Gyne-
cology. She also is a member of
the SMS Committee on Maternal
and Child Health.
William C Crawford III, MD, She-
boygan, has joined the medical
staff of the Sheboygan Clinic. Doc-
tor Crawford has practiced in
Sheboygan since 1979. He grad-
uated from the University of
Maryland School of Medicine,
Baltimore, and completed his res-
idency at the University of Flor-
ida. He is a member of the medi-
cal staffs at St Nicholas and She-
boygan Memorial hospitals. ■
52
WISCONSIN MEDICAL JOURNAL, DECEMBER 1985: VOL. 84
Consider the
causative organisms...
cefaclor
250-mg Pulvules® t.i.d.
offers effectiveness against
the major causes of bacterial bronchitis
H. influenzae, H. influenzae, S. pneumoniae, S. pyogenes
(ampicillin-susceptible) (ampicillin-resistant)
Bhtf Svmmary. Consult the package literature for prescribing
infonnatiON
Indicatkws and Usage; Ceclor* (cefaclor. Lilly) is indicated in itie
treatment of the followino infections when caused by susceptible
strains of the designated microorganisms
Lower respiratory infection^ including pneumonia caused by
Sitepiococcus pneumoniae iOiplococcus pneumoniae}. Haemoph
ilus influenzae and S pyogenes (group A beta-hemolytic
streptococci)
Appropriate culture and susceptibility studies should be
performed to determine susceptibility of the causative organism
to Ceclor
Contraindication' Ceclor is comraindicated in patients with known
allergy to the cephalosporin group of antibiotics
tNanings; IN PENICILLIN SENSITIVE PATIENTS^ CEPHALO-
SPORIN ANTIBIOTICS SHOULD BE AOMINlSTEREb CAUTIOUSLY
THERE IS CLINICAL AND LABORATORY EVIDENCE OF PARTIAL
CROSS-ALLERGENICITY OF THE PENICILLINS AND THE
CEPHALOSPORINS, ANO THERE ARE INSTANCES IN WHICH
PATIENTS HAVE HAD RErtf)TIONS INCLUDING ANAPHYLAXIS
TO BOTH DRUG CLASSES
Antibiotics, including Ceclor, should be administered cautiously
to any patient who has demonstrated some form of allergy,
particularly to drugs
Pseudomembranous colitis has been reported with virtually all
broad-spectrum antibiotics (including macrolides, semisynthetic
penicillins, and cephalosporins), therefore, it is important to
consider its diagnosis in patients who develop diarrhea in
association with the use of antibiotics Such colitis may range in
severity from mild to life-threatening
Treatment with broad-spectrum antibiotics alters the normal
flora of the colon and may permit overgrowth of Clostridia Studies
indicate that a toiin produced by Clostridium difficile is one
primary cause of antibiotic associated colitis
Mild cases of pseudomembranous colitis usually respond to
drug discontinuance alone In moderate to severe cases, manage
ment should include sigmoidoscopy, appropriate bacteriologic
studies, and fluid, electrolyte, and protein supplementation
When the colitis does not improve after the drug has been
discontinued, or when it is severe, oral vancomycin is the drug
of choice for antibiotic-associated pseudomembranous colitis
produced by C difficile Other causes of colitis should be
ruled out
Precautions: General Precautions - It an allergic reaction to
Ceclor* (cefaclor. Lilly) occurs, the drug should be discontinued,
and. if necessary, the patient should be treated with appropriate
agents, eg. pressor amines, antihistamines, or corticosteroids
Prolonged use of Ceclor may result in the overgrowth of
nonsusceplible organisms Careful observation of the patient is
essential If superinfection occurs during therapy, appropriate
measures should be taken
Positive direct Coombs' tests have been reported during treat-
ment with the cephalosporin antibiotics In hematologic studies
or in transfusion cross-matching procedures when antiglobulin
tests are performed on the minor side or in Coombs' testing of
newborns whose mothers have received cephalosporin antibiotics
before parturition, it should be recognized that a positive
Coombs' test may be due to the drug
Ceclor should be administered with caution in the presence of
markedly impaired renal function Under such conditions, careful
clinical observation and laboratory studies should be made
because safe dosage may be lower than that usually recommended
As a result ol administration of Ceclor, a false-positive reaction
tor glucose in the urine may occur This has been observed with
Benedict's and Fehling's solutions and also with Clinitest*
tablets but not with Tes-Tape’ (Glucose Enzymatic Test Strip.
USP. Lilly)
Broad-spectrum antibiotics should be prescribed with caution in
individuals with a history of gastrointestinal disease, particularly
colitis
Usage in Pregnancy - Pregnancy Category B - Reproduction
studies have been performed in mice and rats at doses up to 12
times the human dose and in ferrets given three times the maximum
human dose and have revealed no evidence of impaired fertility
or harm to the fetus due to Ceclor* (cefaclor. Lilly) There are.
however, no adequate and well-controlled studies in pregnant
women Because animal reproduction studies are not always
predictive of human response, this drug should be used during
pregnancy only if clearly needed
Nursing Mothers - Small amounts of Ceclor have been detected
in mother s milk following administration of single 500-mg doses
Average levels were 0 18. 0 20. 0.21. and 0 16 mcg/ml at two.
three, tour, and five hours respectively Trace amounts were
detected at one hour The effect on nursing infants is not known
Caution should be exercised when Ceclor is* administered to a
nursing woman
Usage in Children - Safety and effectiveness of this product for
use in infants less than one month of age have not been established
Adverse Reactions: Adverse effects considered related to therapy
with Ceclor are uncommon and are listed below
Gastrointestinal symptoms occur in about 2.5 percent of
patients and include diarrhea (1 in 70)
Symptoms ol pseudomembranous colitis may appeal either
during or after antibiotic treatment Nausea and vomiting have
been reported rarely
Hypersensitivity reactions have been reported in about 1 5
Mrcent of patients and include morbilitorm eruptions (1 in 100)
Pruritus, urticaria, and positive Coombs' tests each occur in less
than 1 in 200 patients Cases of serum-sickness-like reactions
(erythema multiforme or the above skin manifestations accompanied
by arthritts/arthralgia and. frequently, fever) have been reported
These reactions are apparently due to hypersensitivity and have
usually occurred during or following a second course of therapy
with Ceclor Such reactions have been reported more frequently
in children than in adults Signs and symptoms usually occur a few
days after initiation of therapy and subside within a tew days
after cessation ol therapy No serious sequelae have been reponed
Antihistamines and corticosteroids appear to enhance resolution
of the syndrome
Cases of anaphylaxis have been reported, half of which have
occurred in patients with a history of penicillin allergy
Other effects considered related to therapy included
eostnophilia (1 in 50 patients) and genital pruritus or vaginitis
(less than 1 in 100 patients)
Causal Relationship Uncertain - Transitory abnormalities in
clinical laboratory test results have been reported Although they
were of uncertain etiology, they are listed below to serve as
alerting information tor the physician
Hepatic -SUqM elevations in SGOT. SGPT, or alkaline
phosphatase values (1 in 40)
Hematopoietic Transient fluctuations in leukocyte count,
predominantly lymphocytosis occurring in infants and young
children (1 in 40)
Aena/ - Slight elevations in BUN or serum creatinine (less than
1 in 500) or abnormal urinalysis (less than 1 in 200)
[061782R1
Note Ceclor* (cefaclor. Lilly) is contraindicated in patients
with known allergy to the cephalosporins and should be given
cautiously to pentcillin-allergic patients
F^nicillin is the usual drug or choice in the treatment and
prevention of streptococcal infections, including the prophylaxis
of rheumatic fever See prescribing information
©1984, ELI LILLY AND COMPANY
5^
Additional intormation available to
the profession on reguesi from
Ell Lilly and Company
Indianapolis Indiana 46285
Ell Lilly Industries, Inc
Carolina Puerto Rico 00630
On nitrates,
but angina still
stril^...
Aftera nitrate,
add ISOPTlf^
(verapamil HCl/Knoll)
To protect your patients, as well as their quality of life,
add Isoptin instead of a beta blocker.
First, Isoptin not only reduces myocardial oxygen demand
by reducing peripheral resistance, but also increases coro-
nary perfusion by preventing coronary vasospasm and
dilating coronary arteries — both normal and stenotic.
These are antianginal actions that no beta blocker
can provide.
Second, Isoptin spares patients the
beta-blocker side effects that may
compromise the quality of life.
With Isoptin, fatigue, bradycardia and mental
depression are rare. Unlike beta blockers,
Isoptin can safely be given to patients with
asthma, COPD, diabetes or peripheral
vascular disease. Serious adverse
reactions with Isoptin are rare
at recommended doses; the
single most common side
effect is constipation (6.3%).
Cardiovascular contra-
indications to the use of
Isoptin are similar to those
of beta blockers: severe
left ventricular dysfunction,
hypotension (systolic pres-
sure <90 mm Hg) or cardio-
genic shock, sick sinus syndrome
(if no artificial pacemaker is present)
and second- or third-degree AV block.
So, the next time a nitrate is not enough, add
Isoptin ... for more comprehensive antianginal
protection without side effects which may
cramp an active life style.
ISOPTIN. Added
antianginal protection
without beta-blocker
side effects.
Please see brief summary on following page
ISOPTIN
(verapamil HCI/Knoll)
80 mg and 120 mg scored, film-coated tablets
Contraindications: Severe left ventricular dysfunction (see Warnings), hypo-
tension (systolic pressure < 90 mm Hg) or cardiogenic shock, sick sinus syn-
drome (except in patients with a functioning artificial ventricular pacemaker),
2nd- or 3rd-degree AV block. Warnings: ISOPTIN should be avoided in patients
with severe left ventricular dysfunction (e g., ejection fraction < 30% or
moderate to severe symptoms of cardiac failure) and in patients with any
degree of ventricular dysfunction if they are receiving a beta blocker. (See
Precautions.) Patients with milder ventricular dysfunction should, if possible, be
controlled with optimum doses of digitalis and/or diuretics before ISOPTIN is
used. (Note interactions with digoxin under Precautions.) ISOPTIN may occa-
sionally produce hypotension (usually asymptomatic, orthostatic, mild and con-
trolled by decrease in ISOPTIN dose). Elevations of transaminases with and
without concomitant elevations in alkaline phosphatase and bilirubin have been
reported. Such elevations may disappear even with continued treatment; how-
ever, four cases of hepatocellular injury by verapamil have been proven by re-
challenge. Periodic monitoring of liver function is prudent during verapamil
therapy. Patients with atrial flutter or fibrillation and an accessory AV pathway
(e g. W-P-W or L-G-L syndromes) may develop increased antegrade conduction
across the aberrant pathway bypassing the AV node, producing a very rapid
ventricular response after receiving ISOPTIN (or digitalis). Treatment is usually
D.C. -cardioversion, which has been used safely and effectively after ISOPTIN.
Because of verapamil's effect on AV conduction and the SA node, 1° AV block
and transient bradycardia may occur. High grade block, however, has been
infrequently observed. Marked 1° or progressive 2° or 3° AV block requires a
dosage reduction or, rarely, discontinuation and institution of appropriate
therapy depending upon the clinical situation. Patients with hypertrophic car-
diomyopathy (IHSS) received verapamil in doses up to 720 mg/day. It must be
appreciated that this group of patients had a serious disease with a high mor-
tality rate and that most were refractory or intolerant to propranolol. A variety
of serious adverse effects were seen in this group of patients including sinus
bradycardia, 2° AV block, sinus arrest, pulmonary edema and/or severe hypo-
tension. Most adverse effects responded well to dose reduction and only rarely
was verapamil discontinued. Precautions: ISOPTIN should be given cautiously
to patients with impaired hepatic function (in severe dysfunction use about
30% of the normal dose) or impaired renal function, and patients should be
monitored for abnormal prolongation of the PR interval or other signs of exces-
sive pharmacologic effects. Studies in a small number of patients suggest that
concomitant use of ISOPTIN and beta blockers may be beneficial in patients
with chronic stable angina. Combined therapy can also have adverse effects on
cardiac function. Therefore, until further studies are completed, ISOPTIN should
be used alone, if possible. If combined therapy is used, close surveillance of vital
signs and clinical status should be carried out. Combined therapy with ISOPTIN
and propranolol should usually be avoided in patients with AV conduction
abnormalities and/or depressed left ventricular function. Chronic ISOPTIN treat-
ment increases serum digoxin levels by 50% to 70% during the first week of
therapy, which can result in digitalis toxicity. The digoxin dose should be re-
duced when ISOPTIN is given, and the patients should be carefully monitored to
avoid over- or under-digitalization. ISOPTIN may have an additive effect on
lowering blood pressure in patients receiving oral antihypertensive agents.
Disopyramide should not be given within 48 hours before or 24 hours after
ISOPTIN administration. Until further data are obtained, combined ISOPTIN and
quinidine therapy in patients with hypertrophic cardiomyopathy should prob-
ably be avoided, since significant hypotension may result. Clinical experience
with the concomitant use of ISOPTIN and short- and long-acting nitrates sug-
gest beneficial interaction without undesirable drug interactions. Adequate ani-
mal carcinogenicity studies have not been performed. One study in rats did not
suggest a tumorigenic potential, and verapamil was not mutagenic in the Ames
test. Pregnancy Category C: There are no adequate and well-controlled studies
in pregnant women. This drug should be used during pregnancy, labor and
delivery only if clearly needed. It is not known whether verapamil is excreted in
breast milk; therefore, nursing should be discontinued during ISOPTIN use.
Adverse Reactions: Hypotension (2.9%), peripheral edema (1 .7%), AV block:
3rd degree (0.8%), bradycardia: HR < 50/min (1.1%), CHF or pulmonary
edema (0.9%), dizziness (3.6%), headache (1.8%), fatigue (1.1%), constipa-
tion (6.3%), nausea (1 .6%), elevations of liver enzymes have been reported.
(See Warnings.) The following reactions, reported in less than 0.5%, occurred
under circumstances where a causal relationship is not certain: ecchymosis,
bruising, gynecomastia, psychotic symptoms, confusion, paresthesia, insomnia,
somnolence, equilibrium disorder, blurred vision, syncope, muscle cramp, shaki-
ness, claudication, hair loss, macules, spotty menstruation How Supplied:
ISOPTIN (verapamil HCI) is supplied in round, scored, film-coated tablets con-
taining either 80 mg or 120 mg of verapamil hydrochloride and embossed with
"ISOPTIN 80" or "ISOPTIN 120" on one side and with "KNOLL" on the reverse
side. Revised August, 1984. 2385
KNOLL PHARMACEUTICAL COMPANY
knol 30 NORTH JEFFERSON ROAD, WHIPPANY, NEW JERSEY 07981
2406
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A public service of this publication
STATE MEDICAL SOCIETY OF WISCONSIN
WISCONSIN
MEDICAL JOURNAL
INDEX
VOLUME 84
JANUARY 1985
through
DECEMBER 1985
ISSN 0043-6542
OWNED AND PUBLISHED BY THE
STATE MEDICAL SOCIETY OF WISCONSIN
COPYRIGHT 1985
A monthly journal of
medicine and surgery
KEY TO NUMBERING: First number is the issue
number (eg, January is 1, February is 2, etc) followed
by a hyphen and the page number within the issue.
AUTHORS* OF SCIENTIFIC ARTICLES
Karofsky, Peter S, Madison: 12-19
Katayama, K Paul, Waukesha: 11-9
Kim, Byung (Robert) H, Racine: 9-15
Kirchner, John P, Marshfield: 5-10
Kolts, R Lee, Marshfield: 9-21
Kurtz, Jeff, Wausau: 4-13
Agger, William A, La Crosse: 2-27, 9-18
Abram, Stephen E, Milwaukee: 5-7
Annis, Byron L, La Crosse: 11-15
Avecilla, Constance S, Marshfield: 8-21
Bamrah, Virinderjit, Wood: 3-25
Campbell, Bruce H, Milwaukee: 10-22
Caplan, Robert H, La Crosse: 5-12
Chatton, Thomas B, Milwaukee: 10-22
Chusid, Michael J, Milwaukee: 2-21, 10-22
Clayton, Ellen Wright (JD), Madison: 3-28
Cogbill, Thomas H, La Crosse: 11-15
Craviotto, Don (BS), Milwaukee: 8-11
Dahlberg, Philip J, La Crosse: 5-16, 11-15
Davis, Jeffrey P, Madison: 2-27
Deering, William M, La Crosse: 11-15
De Kraay, Warren H, Kenosha: 2-32
Drinka, Paul, Madison: 4-16
Duthie, Edmund, Wood: 3-25
Falk, Victor S, Edgerton: 5-14
Feins, Robert S, Madison: 10-15
Franson, Timothy R, Milwaukee: 4-19
Funahashi, Akira, Milwaukee: 11-11
Furlano, Frank, La Crosse: 9-18
Garland, Jeffrey S, Milwaukee: 2-21
Gerwood, Joseph B (RN, BS), Washburn: 1-19
Grunert, Brad K (PhD), Milwaukee: 5-7
Gunnarson, Cindy (non-MD), Waukesha: 11-9
Guten, Gary N, Milwaukee: 8-11
Gutmann, Frank D, Milwaukee: 2-31
Gutschenritter, Peter W, La Crosse: 5-16
Halverson, Gloria M, Waukesha: 11-9
Hubert, Bruce C, Marshfield: 8-21
Jefferson, James W, Madison: 2-23
Johnson, Kevin T, Milwaukee: 11-11
*All authors are MDs unless otherwise indicated
Larratt, Kari S (MS), Milwaukee: 4-19
Larson, Jeffrey, Milwaukee: 3-33
Lynch, Timothy, Milwaukee: 5-7
Maloney, Patrick M, Marshfield: 5-10
Maly, Betty Joan, Milwaukee: 3-33
Maurer, William J, Marshfield: 8-13
Melvin, John L, Milwaukee: 5-7
Meyer, Matthew A, Waukesha: 11-9
Mirick, Mark J, Wausau: 4-13
Myers, Bruce (non-MD), Milwaukee: 10-24
Nazer, LeeAnne, Milwaukee: 8-16
Newcomer, Kermit L, La Crosse: 5-16
Parker, Eugenia H, Washburn: 1-19
Pitot, Henry C, Madison: 12-25
Pohlmann, Guenther P, Milwaukee: 2-25
Ptacin, Michael J, Wood: 3-25
Rao, Venkat K, Madison: 10-15
Redmann, Beverly (BS), Madison: 2-23
Reynolds, Norman C Jr, Milwaukee: 10-20
Roesler, Mark (non-MD), Waukesha: 11-9
Rytel, Michael W, Milwaukee: 4-19, 8-16
Sheehy, Greg, Madison: 4-16
Short, Howard H, Racine: 9-15
Songsiridej, Vanee, La Crosse: 2-27
Spiro, Joanna (EdD), Milwaukee: 3-33
Sullivan, Bradley, Marshfield: 3-23
Sutton, Thomas M, Marshfield: 3-23
Tanner, George, Wausau: 4-13
Turner, Paul A, Milwaukee: 4-19
WISCONSIN MEDICAL JOURNAL, DECEMBER 1985: VOL. 84
57
INDEX
AUTHORS OF SCIENTIFIC ARTICLES continued
Vasudevan, Sridhar V, Milwaukee: 5-7, 10-24
White, Lynn Rosen, Madison: 12-19
Wickus, Gary G (PhD), La Crosse: 5-12
Wirtz, Charles E, Marshfield: 5-10
Yale, Russell S, Milwaukee: 10-22
Zilz, Mary Ann (RN), Madison: 2-33
AUTHORS* OF NONSCIENTIFIC ARTICLES
Davis, Frederick], Madison: 12-13
Flemma, Robert J, Milwaukee: 6-33
Glicklich, Lucille B, Milwaukee: 5-23
*AIl authors are MDs unless otherwise indicated
Handy, George H, Madison: 2-16
Locher, Roland A, La Crosse: 3-16
Peters, David A (PhD), Stevens Point: 12-10
Schmidt, Susan M (JD), Chicago, IL: 6-41
SCIENTIFIC ARTICLES / ABSTRACTS / INFORMATION
Acquired Immunodeficiency Syndrome or prodromal syndromes,
clinical and laboratory findings in ten Milwaukee patients with
the (Turner, Larratt, Franson, Rytel): 4-19
Adenocarcinoma of the gallbladder and cystic duct, Clonorchis si-
nensis infection associated with (Drinka, Sheehy): 4-16
Aging, Linguistics offers study tool for: 1-33
AIDS— Acquired Immune Deficiency Syndrome: 6-59
—testing. Statewide network set up for: 8-27
Amyloid cardiomyopathy. Technetium^’™ pyrophosphate scintig-
raphy in (Ptacin, Bamrah, Duthie): 3-25
Aneurysm of the ascending thoracic aorta causing obstruction and
embolism of right pulmonary artery (Kim, Short): 9-15
Anorectal Giant condyloma acuminatum (Kolts, Hubert, Avecilla):
9-21
Antiparkinsonian agents?. Old versus new (Reynolds): 10-20
Asbestos Body; Malignant mesothelioma (De Kraay): 2-32
Blood and blood products: Case report of post-transfusion Hepa-
titis-B, Hazards of (Wirtz, Kirchner, Maloney): 5-10
Blood Cholesterol to prevent heart disease. Lowering: 10-18
Blood Pressure Advisory Committee, Is high too low? A commen-
tary by the Wisconsin State High (Gutmann): 3-31
—Elevated blood pressure (Falk)(editorial): 1-7
Bone scan changes in a marathon runner; case report (Guten, Cra-
viotto): 8-11
Brain Injury, Malignant posttraumatic hypermetabolic syndrome
associated with (Dahlberg, Cogbill, et al): 11-15
Bronchogenic Carcinoma . . . Successful management with staged
bilateral thoracotomy. Severe bullous emphysema and contra-
lateral (Johnson, Funahashi): 11-11
Cancer: See Clinical cancer
Cadaver organs for transplantation; Required request: A practical
proposal for increasing the supply of (Peters): 12-10
Carcinoma of the lower lip. Microscopically controlled surgical
treatment for squamous cell (abstract): 9-24
—of the penis. Microscopically controlled surgery in the treatment
of (abstract): 10-28
Cardiomyopathy, Technetium”™ pyrophosphate scintigraphy in
amyloid (Ptacin, Bamrah, Duthie): 3-28
Carotid Artery procedures. Patient selection and results of simul-
taneous coronary and (abstract): 4-15
Chelation therapy: 1-68
Clinical cancer; New discoveries in oncology: Potential applica-
tions to clinical practice (No. 1 of a series)(Pitot): 12-25
Clonorchis Sinensis infection associated with adenocarcinoma of
the gallbladder and cystic duct (Drinka, Sheehy): 4-16
Condyloma acuminatum. Anorectal giant (Kolts, Hubert, Avecil-
la): 9-21
Corticosteroids; Reflex sympathetic dystrophy syndrome: Impor-
tance of early diagnosis and appropriate management (Vasude-
van, Myers): 10-24
Critical Care: Ethical decision-making in the care of seriously ill
patients (Pohlmann): 2-25
Cyclosporine controls herpes eye infection: 1-14
DES-exposure information. Suggested patient form for obtaining:
3-17
—exposed women. Tissue abnormalities twice as likely for: 1-30
—Forty years of fallout (editorial): 2-8
Dicthylstilbestrol (DES) update', A message from the DESAD Proj-
ect: 2-11
—Forty years of fallout (editorial): 2-8
Disability Programs, Documentation needs of the Social Security
Administration (Handy): 1-16
DPT shortage. Interim recommendation issued on: 1-68
Dystrophy syndrome: Importance of early diagnosis and appropri-
ate management. Reflex sympathetic (Vasudevan, Meyers): 10-
24
Embryo transfer. In vitro fertilization and (Katayama, et al): 11-9
Emphysema and contralateral bronchogenic carcinoma . . . Suc-
cessful management with staged bilateral thoracotomy. Severe
bullous (Johnson, Funahashi): 11-11
Epidemiology; Neisseria meningitidis serogroup Z as a cause of men-
ingitis (Nazer, Rytel); 8-16
Epstein-Barr virus; Review of the clinical manifestations, labora-
tory findings, and complications of infectious mononucleosis
(White, Karofsky): 12-19
Ethical Decision-Making in the care of seriously ill patients (Pohl-
man); 2-25
Farm accidents in children (abstract): 11-14
(Fitz-Hugh- Curtis Syndrome), Perihepatitis (abstract): 4-15
Gallbladder and cystic duct, Clonorchis sinensis infection associated
with adenocarcinoma of (Drinka, Sheehy): 4-16
Genetics in Wisconsin, Legal aspects of (Clayton): 3-28
Genital herpes a trivial disorder. Recurrent: 5-17
Graft patency. Postoperative surveillance: An effective means of
detecting correctable lesions that threaten (abstract): 5-11
Heart disease. Lowering blood cholesterol to prevent: 10-18
Henoch-Schoenlein purpura: Association with unusual vesicular
lesions (Garland, Chusid): 1-21
Hepatitis-B, Hazards of blood and blood products: Case report of
post-transfusion (Wirtz, Kirchner, Maloney): 5-10
58
WISCONSIN MEDICAL JOURNAL, DECEMBER 1985: VOL. 84
INDEX
SCIENTIFIC ARTICLES/ABSTRACTS/INFORMATION conUnued
Herpes a trivial disorder, Recurrent genital: 5-17
—eye infection, Cyclosporine controls: 1-14
Hyphema, The incidence of rebleeding in traumatic (abstract):
11- 14
Hypothyroid man with severe nonthyroidal illnesses, Absent
serum thyroxine in a (Wickus, Caplan): 5-12
Infectious mononucleosis: Review of the clinical manifestations,
laboratory findings, and complications of (White, Karofsky): 12-
19
In vitro fertilization and embryo transfer (Katayama, et al): 1 1-9
Irradiated foods (Falk)(editorial): 10-6
Kawasaki disease in rural Wisconsin, Endemic (Sutton, Sullivan):
3-23
Kerototomy problem. Poor predictability major radial: 1-14
Leptospirosis in Wisconsin: Report of a case associated with direct
contact with raccoon urine (Falk): 5-14
Lesions, Henoch-Schoenlein purpura: Association with unusual
vesicular (Garland, Chusid): 1-21
—that threaten graft patency, Postoperative surveillance: An ef-
fective means of detecting correctable (abstract): 5-11
Listeriosis in Bayfield County, A case (Parker, Gerwood): 1-19
Lithium and Wisconsin— A medicinal trip through history (Red-
mann, Jefferson): 2-23
Long-term care facilities in Wisconsin, A survey showing current
status of medical directors and (Zilz): 2-34
Magnetic resonance imaging (MRI): View of the Wisconsin Radio-
logical Society (Locher): 3-16
—MRI (Falk)(editorial): 4-6
Malignant posttraumatic hypermetabolic syndrome associated
with brain injury (Dahlberg, et al): 11-15
Mannitol-induced renal insufficiency (Gutschenritter, Newcomer,
Dahlberg): 5-16
Medical ethics; Ethical decision-making in the care of seriously ill
patients (Pohlmann): 2-25
Meningitis, Neisseria meningitidis serogroup Z as a cause of (Nazer,
Rytel): 8-16
Mesothelioma, Malignant (De Kraay): 2-32
Metastases, Multiple biopsies linked to: 5-17
Microsurgery; Replantation for ring avulsion injuries (Rao, Feins);
10-15
Milwaukee shoulder (Falk)(editorial): 8-7
Mononucleosis; Review of the clinical manifestations, laboratory
findings, and complications of infectious (White, Karofsky):
12- 19
(MRI): View of the Wisconsin Radiological Society, Magnetic res-
onance imaging (Locher): 3-16
—editorial: 4-6
Neisseria Meningitidis serogroup Z as a cause of meningitis (Nazer,
Rytel): 8-16
Nifedipine offers rapid hypertension treatment: 1-26
Oncology; New discoveries in (Clinical cancer series. No. l)(Pitot):
12-25
Oiomastoiditis, Tuberculous (Campbell, Chatton, Chusid, Yale):
10-22
Penis, Microscopically controlled surgery in the treatment of car-
cinoma of (abstract): 10-28
Perihepatitis (Fitz-Hugh— Curtis syndrome) (abstract); 4-15
Periorbital melanoma: Fixed-tissue and fresh-tissue techniques,
Microscopically controlled surgery for (abstract): 10-19
Physician morbidity: a limited Study (Larson, Maly, Spiro): 3-33
Plasma, Fresh frozen (Falk)(editorial): 3-9
Pleural plaques; Malignant mesothelioma (De Kraay): 2-32
Pneumatic injury from a nailgun (Mirick, Kurtz, Tanner): 4-13
Pneumoconosis radiologic consultation program begins June 1,
Statewide: 5-38
Poison-warning stickers may not work; 1-14
Prodromal Syndromes, Clinical and laboratory findings in ten Mil-
waukee patients with the acquired immunodeficiency syndrome
or (Turner, Larratt, Franson, Rytel): 4-19
Pulmonary artery. Acute dissecting aneurysm of the ascending
thoracic aorta causing obstruction and embolism of right (Kim,
Short): 9-15
Radiation accident victims concerns SMS EOH Committee, Hospi-
tal preparedness in treating: 1-48
Renal insufficiency, Mannitol-induced (Gutschenritter, New-
comer, Dahlberg): 5-16
Replantation for ring avulsion injuries (Rao, Feins): 10-15
Ring avulsion injuries. Replantation for (Rao, Feins): 10-15
Rocky Mountain Fever, Abdominal symptoms one sign of: 1-20
Silo-filler's disease: A historical perspective and report of a case
(Maurer): 8-13
Splenic autotransplantation. Splenic phagocytic function after par-
tial splenectomy and (abstract): 8-13
Sympathetic dystrophy syndrome: Importance of early diagnosis
and appropriate management (Vasudevan, Myers): 10-24
Technetium'*^'" pyrophosphate scintigraphy in amyloid cardio-
myopathy (Ptacin, Bamrah, Duthie): 3-25
Thiabendazole; Visceral larva migrans (Furlano, Agger): 9-18
Thoracic aorta causing obstruction and embolism of right pul-
monary artery. Acute dissecting aneurysm of the ascending (IGm,
Short): 9-15
Thyroxine in a hypothyroid man with severe nonthyroidal ill-
nesses, Absent serum (Wickus, Caplan): 5-12
Tourette syndrome ( Ward)(letter): 6-15
Toxic organic gas; Silo-filler's disease (Maurer): 8-13
Transplantation; Required request: A practical proposal for in-
creasing the supply of cadaver organs for (Peters): 12-10
Tuberculosis treatment. Consensus on: 5-9
Tuberculous otomastoiditis (Campbell, Chatton, Chusid, Yale);
10-22
Typhus acquired in Wisconsin, Epidemic (Agger, Songsiridej):
2-27
—Commentary: Epidemic typhus in Wisconsin (Davis): 2-29
Vegetative Syndromes; Malignant posttraumatic hypermetabolic
syndrome associated with brain injury (Dahlberg, et al): 1 1-15
Visceral larva migrans (Furlano, Agger): 9-18
Weil's syndrome: Leptospirosis in Wisconsin: Report of a case as-
sociated with direct contact with raccoon urine (Falk): 5-14
Pain: long-term results. Outpatient management of chronic (Vasu-
devan, et al): 5-7
Parkinsonism; Old versus new antiparkinsonian agents? (Rey-
nolds): 10-20
WISCONSIN MEDICAI.JOL'RNAL, DECEMBER I985:VOL. 84
59
INDEX
MEDICOLEGAL / SOCIOECONOMIC / ANCILLARY
Abortion: 6-73
Abuse and neglect; Child: 1-11
—Also see Child Abuse
—education in school; Pediatricians establish policy for alcohol:
3-18
-Elderly: 6-76
Administrative code, Wisconsin: 6-82
Adoption agencies, Wisconsin: 6-53
—process in Wisconsin: 6-73
—records law: 6-73
Aging, SMS leaders discuss health issues of the elderly with Coali-
tion of: 1-49
—Linguistics offers study tool for aging: 1-33
—The patient is our first consideration (Flaherty)(President's Page):
1- 4
AIDS testing, Statewide network set up for: 8-27
Alcohol abuse education in school; Pediatricians establish policy
statement for; 3-18
—abuse; Medical Society asks broadcasters to help fight; 3-40
AMA helping states track physician licensing actions: 4-79
—Guide for Hospital Medical Staff Bylaws available: 4-79
—book wins award: 1-33
—Department of Practice Management 1986 workshops: 11-28
Attorney fees; Legislative committee backs cap on: 1-50
Autopsy: 6-73
—Sudden infant death (SID) syndrome: 6-73
Baby Doe rules proposed; New: 2-68
Biomedical ethics conference coming up June 6 and 7: 4-80
Board certification increasing rapidly: 7-128
Budget bill; Governor's: 4-80
—Governor vetoes chiropractic coverage in: 7-128
Care and treatment facilities; Division of: 6-146
Casualty medical report form; Standard: 6-79
Certificate-of-need regs; Health Policy Council to look at: 1-51
Certification; 6-73
—increasing rapidly; Board: 7-128
Chelation therapy: 1-68
Child abuse and neglect: 1-1 1
—Be aware (Fosterj(letter): 1-7
—Abused child law: 6-73
—Physicians must report, and neglect: 1-68
—After the report is made: 3-13
—and neglect: The law— explanation and implication (1983 Wis-
consin Act 172): 2-15
—Save a child— save the world (editorial): 4-2
—Physicians more aware of child sexual abuse: 5-58
Child safety restraint systems: 6-74
Chiropractic coverage in Budget bill; Governor vetoes: 7-128
—veto action commended; Governor's (Scott, Thayer)(letter); 9-12
—Skulduggery in the Senate (Falk)(editorial): 8-6
Chiropractors to draw blood; SMS seeking repeal of rule allowing:
2- 68
Claims rejected; Bill waiving interest on overdue insurance: 10-47
Clearinghouse, Wisconsin: 6-97
Closing of a physician's practice; Some considerations in the: 6-93
Commitment laws; SMS speaks out on mandated benefits, invol-
untary: 4-48
—Too late (Falk)(editorial): 5-5
—SMS physicians testify for additional mental, standard: 10-47
Communicable disease laws; Recently enacted: 6-58
—Communicable diseases: 6-74
Community services. Division of: 6-144
—Regional offices: 6-145
—District offices: 6-145
—Controlled Substances Board: 6-144
CON legs; Health Policy Council to look at; 1-51
—Welcome to Wisconsin Regulation (Flaherty)(President's Page):
3-5
Consent and related forms for physicians; Use of: 6-83
—Consent forms for physicians: 6-83
Contact lenses; Long-wear (Falk)(editorial): 12-6
Controlled Substances Board: 6-144
Costs; Uncompensated care problem looms on horizon, SMS Presi-
dent says: 2-50
—Reform malpractice system to cut. Medical Society tells Legisla-
ture: 2-50
—Brown CMS plan wins acclaim: 9-39
— 1983 Health spending: 3-49
—Governor delivers 1985-87 budget; many healthcare items in-
cluded: 3-49
—Maximum care at minimum cost (Scott)(President's Page): 8-5
Countersuits: 6-25
Death; Determination of: 6-74
"Denial of access" to healthcare records: 6-74
DES-exposure information; Suggested patient form for obtaining:
3- 17
Disability claims: 6-74
—Insurance Program in Wisconsin; Social Security: 1-6
DPT shortage; Interim recommendations issued on: 1-68
Drivers' licenses for epileptics: 6-75
DRGs?; Have you been receiving complaints from patients about:
4- 79
Drug substitution law: 6-75
Drunk drivers in Other countries; How they handle: 1-49
Elderly abuse: 6-76
—SMS leaders discuss health issues of the elderly with Coalition
of Aging: 1-49
Epileptics; Drivers' licenses for: 6-75
Ethical and judicial Affairs, Council on: 12-72
Ethics conference coming up June 6 and 7; Biomedical: 4-80
Expense reimbursement policy and procedure for physicians on
State Medical Society business: 6-109
Fee assessments due; Fund: 8-24
—discrimination (Schwarz)(letter): 6-15
—freeze; Medicare: 9-39
—freeze; Effects of an extended: 11-56
—increases slow; Physician: 3-64
—splitting statute; Wisconsin's: 6-54
—Legislative committee backs cap on attorney fees: 1-50
Guides help you; Let these: 1-67, 6-80
Health and Social Services; Department of: 6-143
Health, Division of: 6-143
—Center for Health Statistics: 6-144
—Map of Regions: 6-144
—problems available; Report on school: 1-49
—related information in Wisconsin; How to get: 6-44
—trends as reported by the National Health Lawyers Association;
5- 57
Health Policy Council to look at CON regs: 1-51
Health prospects 1983/2003 survey reported; 12-72
Health Systems Agencies, Wisconsin: 6-148
— Physician members of Health Systems Agency Boards: 6-148
Healthcare records; "Denial of Access" to: 6-74
—costs: See under Costs
—items included; Governor delivers 1985-87 budget; many: 3-49
00
WISCONSIN MEDtCALJOCRNAL, DECEMBER 1985: VOL. 84
INDEX
MEDICOLEGAL / SOCIOECONOMIC / ANCI LLARY continued
HMO update: 8-50
—Governor delivers 1985-87 budget; many healthcare items in-
cluded: 3-49
—The urge to merge (Scott)(President's Page): 7-4
—It's confusing (Falk)(editorial): 7-5
—Madison medicine (Manhart)(editorial): 7-5
—Let's control our own destiny (Maurer)(letters): 12-8
Hospital emergency rooms and outpatient facilities are aware of
the following federal and state laws which prohibit . . . Wiscon-
sin: 6-72
—staff privileges; Hospitals required to report physician's loss of:
6-72
Impaired Physician Program; Statewide: 6-45
—Legal aspects of peer review (Schmidt): 6-41
—Peer review in Wisconsin: 6-43
Industry, Labor and Human Relations, Department of: 6-146
Injuries; Work-related (letter)(Hargarten); 3-10
Insurance claims rejected; Bill waiving interest on overdue: 10-47
—rates higher for some Michigan physicians: 11-56
JCAH publishes the Hospice Project Report: 9-54
—announces new Quality Review Bulletin: 12-72
Laws; Good Samaritan law: 6-76
—Implied consent law: 6-76
—Optometrist referral law: 6-76
—Charter Law of Medical Societies (Chapter 148): 6-102
—Abused child law: 6-73
—Child abuse and neglect: The law— explanation and implication
(1983 Wisconsin Act 172): 2-15
—Drug substitution: 6-75
—Fee splitting statute; Wisconsin's: 6-54
—SMS speaks out on mandated benefits, involuntary commitment:
4-48
Legal aspects of medical genetics in Wisconsin (Clayton): 3-28
Legislation; SMS testifies on pituitary gland removal; 9-54
Legislative committee backs cap on attorney fees: 1-50
—leadership announced: 2-52
—Status Report: 12-43
Legislators together; Reception brings 800 physicians and 100:
11-21
Legislature; A brief profile of the 1985 Wisconsin State: 4-50
—Reform malpractice system to cut costs, Medical Society tells:
2-50
Letters: 1-7, 3-10, 4-9, 6-14, 9-12, 10-10, 12-7
—Be aware (Foster): 1-7
—Medical staffs and peer review (Sivertson): 3-10
-Work-related injuries (Hargarten): 3-10
-William H Studley, MD: 1903-1985 (Moore): 3-11
—Nicaragua— diversified views (Madiedo; Keane, et al; Dibbell;
Peters): 4-9
—Is your hospital in compliance? (Lindesmith): 4-11
—The public, malpractice, the Wisconsin Patients Compensation
Fund, and us (Boulanger): 6-14
—Fee discrimination (Schwarz); 6-15
— Tourette syndrome (Ward): 6-15
—The urge to reverse (Rengel): 9-12
—Governor's chiropractic veto action commended (Scott, Thayer) :
9-12
—An overview of the Medical Examining Board (Nichols): 10-10
—New drugless healers? (La Joie): 12-7
—Med student offers perspective on physical therapy (Muir): 12-8
—Milwaukee brace (Gaenslen); 12-8
—Let's control our own destiny (Maurer): 12-8
Liability: See Malpractice
Licensure verification procedure; Physician; 6-81
—Physician re-registration: 6-81
Lilly ad discontinued: Farewell (Falk)(editorial): 1-7
Litigation: 8-23
Malpractice; SB 328 and medical (Scott)(President's Page): 11-5
—focus of Milwaukee county society meeting: 1-52
—seizures (Flaherty)(President's Page): 2-5
—panels: Are they the solution? (Boulanger) (editorial): 2-6
—panels: The Society's view (Johnson)(editorial): 2-6
—What's your opinion?: 2-7
—committee backs SMS peer review proposal: 2-51
—system to cut costs, Medical Society tells Legislature; Reform:
2-50
—premiums to rise 106%: 4-49
—problem: SMS asks business leaders’ help on: 4-49
—seminar scheduled for May 11: 4-49
—Some thoughts about "The Fund": 5-5
—Ten statewide press conferences in two days: 11-42
—SMS Liability Task Force chairman testifies: 11-42
—conference tapes; Medical: 11-43
—A dilemma in the search for justice; Medical (Flemma): 6-33
—The public, malpractice, the Wisconsin Patients Compensation
Fund, and us (Sautter)(letter): 6-14
—law is 'significant': AMA says Supreme Court action on Cali-
fornia: 12-72
Magnetic resonance imaging; MRI (Falk)(editorial): 4-6
Medicaid medical audit: 8-23
Medical ethics: 6-111
—American Medical Association— Principles of: 6-108
—Current opinions of the Judicial Council of the American Medical
Association: 6-111
Medical Examining Board; An overview of the (Nichols)(letter):
10-10
—The public, malpractice, the Wisconsin Patients Compensation
Fund, and us (Sautter)(letter): 6-14
Medical genetics in Wisconsin; Legal aspects of (Clayton): 3-28
Medical liability— a physician's rights and responsibilities: 6-31
-8-23
—Reception brings 800 physicians and 100 legislators together:
11-21
—Telling testimony (editorial): 12-6
Medical malpractice: See also Malpractice
Medical marketing; Three thousand surgeries (Falk)(editorial): 1-7
—fee freeze: 9-39
Medical report form; Standard casualty: 6-79
Medical staffs and peer review (Sivertson)(letter): 3-10
Medicare assignment; Patient handouts available on: 1-40
—assignment sign-up reaches 36% of MDs and DOs: 1-51
—participating physicians' directories available: 2-51
—regarding durable medical equipment; Recent changes in: 3-64
—changes due October 1: 8-23
—participating physician issue update: 9-39
—fee freeze: 9-39
—participating physician program clarified: 11-43
—My white hat (Falk)(editorial): 12-7
Medicine; Trade or profession? (Scott)(President's Page): 12-5
Medigap hotline: 1-800/242-1060: 6-147
Mental commitment standard; SMS physicians testify for addi-
tional: 10-47
Milwaukee brace (Gaenslen)(letters): 12-8
Minor's consent: 6-78
MRI; See under Magnetic resonance imaging
WISCONSIN MEDICAL JOt’RNAI., DECEMBER 1983: VOL. 84
61
INDEX
MEDICOLEGAL/SOCIOECONOMIC/ ANCILLARY continued
Narcotics: 6-97
Newborn infant eye drops: 6-78
News you can use: 1-68, 2-84, 3-64, 4-79, 5-57, 7-128, 8-50, 9-54,
10-58, 11-56, 12-72
Nicaragua— diversified views (Madiedo)jletters): 4-9
—Press release (Keane, et al)(letters): 4-9
— (Dibbell)(letters): 4-10
— (Peters)(letters); 4-10
Nuclear war; Health consequences of; 8-23
Opcninga physician's practice: Some considerations before: 6-92
Opportunities; Physician service, overseas: 11-56
Organ procurement system; Committee seeks ways to improve:
1- 48
Organs; Donation of body: 6-75
—Uniform organ donor cards and decals: 6-75
—Donation of eyes: 6-75
—"Living will” on use of measures to sustain life: 6-75
Patient care; The patient is our first consideration (Flaherty)(Presi-
dent's Page) 1-4
—Maximum care at minimum cost (Scott)(President's Page): 8-5
Patients Compensation Fund; WHCLIP Fund rate increases recom-
mended: 2-51
—The public, malpractice, the Wisconsin Patients Compensation
Fund, and us (Sautterj(letter): 6-14
Peer review; Legal aspects of (Schmidt): 6-41
—in Wisconsin: 6-43
—Services; Mediation and: 6-47
—SMS Secretary issues call for tougher: 6-154
—Medical staffs and (Sivertson)(letter): 3-10
—proposal; Malpractice committee backs SMS: 2-51
—SMS testifies on peer review legislation: 4-48
Physical therapy relating to practice: 6-79
—practice without referral; Hearing held on: 10-44
—New drugless healers? (La Joie)(letters): 12-7
—Med student offers perspective on physical therapy (Muir)(let-
ters): 12-8
Physician-patient-hospital relationship; Legal responsibilities of
the: 6-60
Physician reimbursement; DHSS proposes 3.5% increase in: 1-51
Physician service opportunities overseas: 11-56
Physician's assistants (PAs): 6-79
Poison control program network; Wisconsin: 6-53
—warning stickers may not work: 1-14
Policy statement for alcohol abuse education in school; Pediatri-
cians establish: 3-18
PPA census: All physicians! Plan to participate in the; 4-79
Practice; Some considerations before opening a physician's: 6-92
—Some considerations in the closing of a physician's: 6-93
—Closing a physician's office: 6-74
—management study courses offered: 3-64
Premarital examinations: 6-79
Profession?; Medicine: Trade or (Scott)(President's Page): 12-5
Psychiatric conference: 8-23
Public health; New Baby Doe rules proposed: 2-68
—SMS seeking repeal of rule allowing chiropractors to draw blood:
2- 68
—Wisconsin and Soviet physicians meet in Chicago: 4-46
—Statewide network set up for AIDS testing: 8-27
—Traveler's diarrhea: 11-44
Quack cures: 11-56
Radiation accident victims concerns SMS EOH Committee; Hos-
pital preparedness in treating: 1-48
Records; Retention and inspection of patients': 6-62, 6-78
—Consent to release medical information: 6-68
—Patients' right of access to their medical: 6-68, 7-79
—Denial of researcher access to health care: 6-69
—Denial of government access to health care: 6-69
—laws; Questions about medical: 6-70
—under law; Employees allowed to inspect: 6-76
— "Denial of access" to healthcare: 6-74
— DES-exposure information; Suggested patient form for obtain-
ing: 3-17
Regulation; Welcome to Wisconsin (Flaherty)(President's Page):
3-5
—Joint Finance Committee considers healthcare regs: 4-49
—Saving more money in MoTown (Falk)(editorial): 10-6
Regulation and Licensing, Department of: 6-146
—Bureau of Health Professions; 6-146
—Medical Examining Board: 6-146
—Dentistry Examining Board: 6-146
—Pharmacy Examining Board; 6-146
—Bureau of Nursing: 6-146
—Board of Nursing: 6-146
Reimbursement; DHSS proposes 3.5% increase in physician: 1-51
—The case mix index (Boulanger)(editorial): 6-8
Relationship; Physician-patient-hospital, Legal responsibilities of
the: 6-60
Report?: Must a Wisconsin physician: 6-90
Required request; A practical proposal for increasing the supply
of cadaver organs for transplantation (Peters): 12-10
Retarded, developmentally disabled person; Helping the: 6-30
Return-to-work recommendations record; Attending physician's:
6-98
—form: 6-99
Rural health caucus; Senate: 8-50
RX for a busy physician (Scott)(President's Page): 10-5
School health; Pediatricians establish policy statement for alcohol
abuse education in school: 3-18
Screening; Elevated blood pressure (Falk)(editorial): 1-7
Senate Bill 328; Ten statewide press conferences in two days: 11-42
ShareCare; Reform malpractice system to cut costs. Medical Soci-
ety tells Legislature: 2-50
—The patient is our first consideration (Flaherty)(President's Page):
1-4
Smoking; Cigarettes fire-death hazard in hospital: 1-20
—Is your hospital in compliance? (Lindesmith)(letters): 4-11
Social Security Administration disability programs; Documenta-
tion needs of the (Handy): 1-16
Socioeconomic Monitoring System: 12-66
Specialty societies: 1-59, 8-34, 11-49, 6-133
—Wisconsin Chapter of American College of Physicians: 1-59, 8-34
—Wisconsin Academy of Family Physicians: 8-34
—American Society of Surgery of the Hand: 8-34
—Society of Thoracic Radiology: 8-34
—American Academy of Dermatology: 8-34
—American College of Utilization Review Physicians: 8-34
—Presidents and secretaries, Wisconsin Specialty Societies as of
record June 1, 1985: 6-133
—American Congress of Rehabilitation Medicine: 11-49
—American College of Radiology: 11-49
—American College of Physicians: 11-49
—Wisconsin Society of Internal Medicine: 11-49
—Council of the American College of Surgeons, Wisconsin Chap-
ter: 11-49
—Milwaukee Ophthalmological Society: 11-49
Surgical centers; Hospitals, surgeons, and free-standing (Boulan-
ger)(editorial): 9-9
62
WlSCONStN MEDICAI. JOURNAL, DECEMBER 1985: VOL. 84
INDEX
MEDICOLEGAL/ SOCIOECONOMIC /ANCILLARY continued
Tax reform plan; President Reagan's: 10-58
Toxic substances and infectious agents; Important notice to physi-
cians and clinics re: 6-96
Unemployed; Reform malpractice system to cut costs, Medical
Society tells Legislature: 2-50
Uninsured; Uncompensated care problem looms on horizon, SMS
President says: 2-50
Unprofessional conduct defined; Medical Examining Board,
Chapter Med 10: 6-91
—definition; Changes made in: 10-58
Vocational Rehabilitation, Division of: 6-145
—Bureaus: 6-145
—Field offices: 6-145
Volunteer relief activities in Mexico City: 1 1-56
WHCLIP rate may increase 75%: 1-51
—Fund rate increases recommended: 2-51
—Malpractice committee backs SMS peer review proposal: 2-51
(WHO), Wisconsin Homecare Organization: 6-184
Widow/er; Problems of a physician's: 6-94
WiPRO; In search of accuracy (Boulanger)(editoriaI): 1-6
—The computer says (Falk)(editorial|: 4-7
—What next? (Falk)(editorial): 8-6
— Time's-a-wastin' (Falk)(editorial) 6-8
—Wisconsin Peer Review Organization: 6-149
—Board of Directors: 6-149
—Regions: 6-149
WISPAC membership shows 50% increase: 1-51
-What is WISPAC?: 2-53
—A brief profile of the 1985 Wisconsin State Legislature: 4-50
—Some basic rules to follow when writing to your legislator: 5-43
— AMPAC leader reports: 9-40
—Needs your support: 9-54
STATE MEDICAL SOCIETY / ORGANIZATIONAL
Advertising: See Wisconsin Medical Journal
AMA House of Delegates Meeting, Dec 2-5, Highlights: 1-37
—Delegates and alternate delegates, SMS: List of officers and direc-
tors and: 3-44
AMA Physician Recognition Award recipients:
—December 1984: 2-54
-January 1985: 4-29
-February 1985: 4-30
—March 1985: 5-6
-April 1985; May 1985: 8-26
-June 1985; July 1985: 9-46
—August 1985; September 1985: 11-46
—October 1985: 12-15
Annual Meeting; Annual Meeting resolution deadline: 1-40
—SMS Annual Meeting approaching: 2-39
—Nominees for SMS offices; election April 26: 2-40
— H/D 1984-85 Nominating Committee: 2-42
—SMS needs MDs for committees, commissions: 2-43
—resolution deadline: 2-52
—Mark your calendar for SMS Annual Meeting April 25-27 in La
Crosse: 3-40
—SMS of Wisconsin Program Schedule— A/ M Apr 25-26-27, 1985,
La Crosse: 3-42
— H / D: 1985 SMS of Wisconsin (list of delegates and alternates by
district & sections): 3-44
—SMS AIM focuses on critical medical issues: 4-23
—Professional liability, emergency medical services, and govern-
ment regulations are key issues for '85 House of Delegates: 4-24
—Summary report of SMS H/D April 25-26, 1985, La Crosse,
Wisconsin: 6-158
—H/D Nominating Committee 1985-86: 6-163
—Attendance: 1064: 6-163
—Picture, New Fifty-Year Club members, 1985: 6-172
—Nominations sought for SMS offices: 9-32
—SMS Annual Meeting plans underway: 11-21
—resolution deadline: 12-34
AODA scheduled. Citizens' conference on: 8-24
Auxiliary: 1985-1986, SMS: 6-120
Awards; Medical School deans receive Directors Award; 6-166
—Outstanding medical students receive Houghton Award: 6-166
—Interstate Teaching Award goes to Doctor Sandmire: 6-168
—Maryland physician recipient of Beaumont Award: 6-169
—Doctor Jowsey delivers Elvehjem Lecture; 6-169
—Scientific Exhibit Awards: 6-170
—The "Beaumont 500" Club: 6-170
—Joan Pyre receives Presidential Citation: 6-170
— WRRC received Special Recognition Award: 6-168
Beaumont Award, Maryland physician recipient of: 6-169
"Beaumont 500," Club, The: 6-170
"Blue Book" 1985, Wisconsin Medical Journal: 6-23
-Update: 7-121, 8-26, 9-34, 11-44, 12-50
Board of Directors 1985-86: 6-120
—April Meeting highlights: 6-154
—SMS Board encourages negotiation in ER services: 9-27
—SMS Board reaffirms its position: Don't drop CME requirement:
3-39
—SMS June 29 Board meeting results: 8-23
Bookshelf: 1-64, 8-49, 11-55
Charitable, Educational and Scientific Foundation Contributions:
1-54, 2-54, 3-60, 4-42, 5-36, 6-114, 9-34, 10-44, 11-46, 12-66
—Dr Pomainville resigns CESF treasurer post: 4-23
—Annual Board meeting held: 9-32
—program and functions: 6-112
—Officers and Board of Trustees: 6-113
—student loan program. Facts . . . about the: 6-115
— "The Beaumont 500": 6-116, 6-117
Commissions And Committees: 1985-1986: 6-122
Communications, SMS launches campaign to improve; 4-30
Constitution And Bylaws of the State Medical Society of Wisconsin:
6-103
Continuing Medical Education meetings: 1-65, 2-82, 3-62, 4-77,
5-54, 6-188, 7-125, 8-47, 9-51, 10-55, 11-54
—CME credit deadline approaching: 11-56
—Accreditation Program: 6-100
—requirement, SMS Board reaffirms its position: Don't drop: 3-39
County Medical Societies; Presidents, Secretaries, and other of-
ficers: 2-44, 6-128, 7-115
County Societies, 1-53, 2-77, 3-46, 5-38, 8-33, 11-50, 12-48
—Adams/Marquette/Columbia: 11-50
—Brown: 2-77, 2-78, 3-46, 11-50
-Clark: 5-38
—Dane: 3-46
— Eau Claire /Dunn /Pepin: 2-78
—Jefferson: 1-53, 2-78
—Kenosha: 1-53
—Lincoln: 1-53, 12-48
WISCONSIN MEDICAL JOURNAL, DECEMBER 1985: VOL. 84
63
INDEX
STATE MEDICAL SOCIETY/ORGANIZATIONAL continued
—Marinette /Florence: 2-78, 12-48
—Milwaukee: 1-53
—Monroe: 2-78
—Outagamie: 2-78, 8-33, 12-48
-Sauk: 5-38
—Sheboygan: 3-46, 12-48
-Winnebago: 2-78, 5-38, 8-33, 11-50, 12-48
Court halts attempt to get SMS records: 4-31
Directors Award, Medical School deans receive: 6-166
Directors: 1985-1986, Officers and: 6-119
—Pictures: 6-121
—Map of Districts: 6-118
—Committees: 1985-86: 6-120
Dues due by May 15, SMS: 3-46
Editorials: 1-6, 2-6, 3-6, 4-6, 5-5, 6-8, 7-8, 7-5, 8-6, 9-9, 10-6, 11-6
—In search of accuracy (Boulanger): 1-6
—Social Security Disability Insurance Program in Wisconsin (Falk):
1-6
—Three thousand surgeries (Falk): 1-7
—Farewell (Falk): 1-7
—Elevated blood pressure (Falk): 1-7
—Malpractice panels: Are they the solution? (Boulanger): 2-6
—Malpractice panels: The Society's view (Johnson): 2-8
—DES— Forty years of fallout: 2-8
—The spittoon bowl (McCormick): 2-9
—I am sorry. Doctor (Falk): 2-9
—Advertising (Falk): 2-8
—Dying with your "rights on" or . . . killing with your "rights on"
(Sautter): 3-6
—Appropriate disposition (Falk): 3-7
— Product liability laws (Falk): 3-7
—Doctors' draft (Falk): 3-8
—Futility (Falk): 3-8
—Fresh frozen plasma (Falk): 3-9
— $2,500 per day (Falk): 3-9
—Save a child— save the world: 4-6
-MRl (Falk): 4-7
—The computer says (Falk): 4-7
—Too late (Falk): 5-5
—Some thoughts about "The Fund" (Boulanger): 5-5
—The case mix index (Boulanger): 6-8
—Changing of the guard (Falk): 6-8
— Time's-a-wastin' (Falk): 6-9
—It's confusing (Falk): 7-5
—Madison medicine (Manhart): 7-5
—What next? (Falk): 8-6
—Skulduggery in the Senate (Falk): 8-6
— . . . "that made Milwaukee famous" (Falk): 8-7
—Hospitals, surgeons, and free-standing surgical centers (Boulan-
ger): 9-9
—Saving more in MoTown (Falk): 10-6
—Irradiated foods (Falk): 10-6
—Gratifying response (Falk): 11-6
—It made me sick (Falk): 11-6
—Never, never, never (Falk): 11-6
—Noble work recognized: 11-6
-Non-nurse midwives (Falk): 11-6
—Telling testimony: 12-6
—Long-wear contact lenses (Falk): 12-6
—My white hat (Falk): 12-7
Elvehjem Lecture, Doctor Jowsey delivers: 6-169
Expense Reimbursement policy and procedure for physicians on
State Medical Society business: 6-109
Eifty-Year Club members. New: 6-172
Einancial Statements on the State Medical Society of Wisconsin:
6-165
Flaherty, Timothy S; Report to H/D as past president: "Our num-
ber one priority is malpractice reform": 6-177
Foundation: See Charitable, Educational and Scientific
Geneva, Declaration of: 6-110
Goodwin Physician-Citizen of the Year, Max: 12-34
Houghton Award, Outstanding medical students receive: 6-166
House of Delegates; 1985 SMS members. List of: 3-44
—Election results: 6-152
—April 25, 1985 highlights: 6-155
—Summary report of SMS H/D April 25-26, 1985, La Crosse,
Wisconsin: 6-158
—Nominating Committee: 6-163
—Attendance: 1064: 6-163
—Thank you. Reference committees of H/D: 6-163
—Report to H / D as president: A full and promising agenda already
laid out (Scott): 6-174
—Report to H/D as past president: "Our number one priority is
malpractice reform" (Flaherty): 6-177
—Secretary's report to the H / D— ' 'The problem of competence or
incompetence" (Thayer): 6-181
—H/D Nominating Committee selects slate of candidates: 12-31
Interstate Teaching Award goes to Doctor Sandmdre: 6-168
Kane, Mary A, New communications coordinator named: 11-21
Landis nominated for President-elect of SMS, Doctor: 1-44
—elected president-elect. Doctor: 5-28
—President-elect, Doctor Charles Landis, Milwaukee: 6-153
—President-elect Landis will not serve office: 12-31
Leadership Conference October 26 in Appleton, SMS: 9-28
— 1985 Leadership Conference participants: 12-32
—Governor Earl addresses SMS Leadership Conference: 12-33
Medical Care to meet March 22; SMS Task Force on: 3-41
—picture SMS Task Force: 6-173
Medical Museum season began May 1: 6-156
—Doctor Pomainville honored: 8-25
Medical Yellow Pages: 1-61, 2-79, 3-59, 4-74, 5-52, 6-185, 7-123,
8-45, 9-49, 10-53, 11-51, 12-67
Membership; Directory-Update: 1-44, 2-47, 4-32, 5-29, 10-32, 11-
30, 12-37
-facts: 1-52, 4-34, 6-151, 7-118, 9-48, 10-31, 11-26
—State Medical Society of Wisconsin Directory: 1985: 7-17
—Members want greater emphasis on public image of profession:
11-22
—Dues payment options available: 11-24
—Membership encouraged for residents and students: 11-24
—Reduced practice or retired membership classifications: 11-25
—Spouse physicians take note: 11-25
—SMS membership reaches new high: 12-31
News Highlights: 4-54, 5-37, 12-50
64
WISCONSIN MEDICAL JOIIRNAL, DECEMBER 1985: VOL. 84
INDEX
STATE MEDICAL SOCIETY /ORGANIZATIONAL continued
Oath of Hippocrates, The: 6-110
Obituaries: 1-60, 2-54, 4-66, 5-44, 8-35, 9-33, 10-48
—Andrew, Robert B, Madison: 1-60
— Bargholtz, William Ashland: 8-36
— Bergmann, Gerald J, Greenfield: 12-49
— Bidder, Edwin P, Wauwatosa: 5-44
— Biedlingmaier, Gerard J, Wauwatosa: 5-44
— Bonan, Joseph D, Wauwatosa: 5-44
—Burdette, Stella I, Amery: 5-44
—Burnett, Ralph George, Kenosha 2-54
—Callaghan, Desmond H, Hayward: 8-35
—Church, Ruth E, Whitewater (Waukesha): 10-48
— Clasen, Walter E, Wauwatosa: 4-68
—Cohen, Albert M, Fox Point (Milwaukee): 1-60
—Curtis, John Kimberly, Madison: 8-36
—Darby, Russell C, Oshkosh: 4-66
—Demeter, Nicholas D, Wauwatosa: 4-66
—Farnsworth, Richard W, Janesville: 5-44
—Foley, Charles Francis, Sparta: 10-48
— Frawley, Donald D, Sun City, Ariz (Milwaukee): 8-35
— Fruth, Rodney B, Elm Grove: 8-35
— Gehin, Francis E, Stevens Point: 10-48
— Gingrass, Rudolph P (Oconomowoc): 8-35
— Gonlag, Harry, Eau Claire: 4-67
— Gwinn, Rodney P, Sturgeon Bay: 8-35
— Hable, Albert P, Marshfield: 4-66
— Hatleberg, Earl A, Chippewa Falls: 9-33
— Haushalter, Lester E, Brookfield: 10-48
-Hotter, Adolph M Sr, Madison (Fond du Lac): 9-33
—Jarvis, Donald F, Tomahawk: 4-66
—Jensen, Richard E, Green Bay: 4-66
—Kennedy, Richard D, Eau Claire: 1-60
— Kult, Anthony S, Milwaukee: 12-49
— Lagman, Raul M, Cuba City: 2-54
—Ledbetter, Marion K, Tulsa, Okla (Madison): 9-33
— Limberg, Philip W, Glenwood City: 4-67
—Mason, Paul B, Sheboygan: 4-67
—McCaffrey, Maurice H, Denedin, Fla: 8-36
— McRoberts, Jerry W, Sheboygan: 4-68
— Midelfort, Christian Fredrik, La Crosse: 1-60
—Murphy, Raymond J, Green Bay: 10-48
— Najafzadeh, Moktar, Miami, Florida (Twin Lakes): 12-49
—Owen, George Colville, Milwaukee: 12-49
—Patterson, Lawrence G, Sun Lakes, Ariz (Waupaca): 9-33
—Peters, Bruno J, Wauwatosa: 8-36
—Rauch, Alphonsus M, West Bend (Kenosha and Lake Geneva):
1-60
— Ries, Michael F, Brownsville: 8-35
—Rose, Harold D, Wood: 2-54
—Rutledge, Paul E, Washington Island: 8-36
—Smith, Richard B, Brookfield: 9-33
— Stiennon, Oscar A, Green Bay: 2-54
— Studley, William H, Shorewood: 4-66
— Trimborn, Bernard Anthony, Milwaukee: 2-54
— Urdan, Benjamin E, Milwaukee: 12-49
— Vernetti, Lucy A, Phoenix, Ariz (Hurley): 10-48
—Yost, Raymond G, Manitowoc: 9-33
—Young, William N, Milwaukee: 4-66
—Wagner, Harold, Kenosha: 9-33
— Zeratsky, James D, Marinette: 12-49
Past Presidents of the State Medical Society of Wisconsin: 1961-
1985: 6-120
Physician Briefs: 1-54, 4-51, 5-35, 8-29, 9-43, 10-49, 11-45, 12-51
Physician-citizen of the Year, Max Goodwin: 12-34
Physicians Alliance districts and field consultants, 1985: 6-126,
9-41, 10-45
Placement Service aids physicians and communities, SMS: 6-1 18
Pomainville honored at Medical Museum, Doctor: 8-25
President's Page: 1-4, 2-5, 3-5, 4-5, 5-28, 8-5, 9-5, 10-5, 11-5, 12-5
—The patient is our first consideration (Flaherty): 1-4
—Malpractice seizures (Flaherty): 2-5
—Welcome to Wisconsin regulation (Flaherty): 3-5
—What are you going to do for me in the future? (Flaherty): 4-5
—The new president, John K Scott, MD: 5-28
—The urge to merge (Scott): 7-4
—Maximum care at minimum cost (Scott): 8-5
—When the penalty tax comes due (Scott): 9-5
— RX for a busy physician (Scott): 10-5
—SB 328 and medical malpractice (Scott): 11-5
—Medicine: Trade or profession? (Scott): 12-5
Presidential Citation awarded to Joan Pyre: 6-170
Pyre, Joan; Presidential Citation awarded to: 6-170
Scientific Exhibit Awards: 6-170
Scott, MD, The new president— John K: 5-28
—Installed SMS president. Doctor Scott: 6-152
—Report to H / D as president: A full and promising agenda already
laid out: 6-174
Senior physicians met November 9, Wisconsin Association: 11-25
—elect: 12-34
SMS helps sponsor sexual abuse workshop: 9-30
—hosts Soviet physicians at reception: 10-30
SMS Services Inc: 1985: 6-120
—Board highlights: 9-27
—endorses WC program: 9-28
Specialty Sections, Officers of SMS: 6-131
Thayer, Earl R; Secretary's report to the H/D— "The problem of
competence or incompetence": 6-181
Treffert named to statewide professional discipline task force, Dr:
12-33
WASP met November 9: 11-25
Weinshel, Leo R, MD, named 1985 "Physician Citizen of the Year,"
Milwaukee's: 1-39
Wisconsin Medical Journal: index to advertisers: 1-64, 2-83, 3-61,
4-76, 5-56, 6-180, 7-127, 8-49, 9-53, 10-56, 11-55, 12-71
—Publication information: 1-10, 4-56, 5-56, 6-18
—Principles of advertising: 6-18
—New Editorial Board member: 6-154
—Statement of Ownership, Management and Circulation of the
Wisconsin Medical Journal: 11-28
—Index to Volume 84, January 1985 through December 1986: 12-
57
Wisconsin Rural Rehabilitation Corporation (WRRC) received
Special Recognition Award: 6-168
WISPAC: AMPAC leader reports (Treacy): 9-40
— WISPAC Committee: 6-127
—WISPAC needs your support: 9-54
Workshop on Health, More than 1,000 students, teachers attend
SMS: 11-21H
WISCONSIN MEDICAI.JOCRNAL, DECEMBER 1985: VOL. 84
65
ORGANIZATIONAL
PHYSICIANS APPEAR TO BE spending more time with individual patients, the Socioeconomic Monitoring
System of the AMA Center for Health Policy Research reported. The AMA's 1985 core survey found that
physicians are devoting as much time in patient care this year as they were in 1984— about 51 hours per
week— even though they are seeing slightly fewer patients. Last year's 2.5% decline in weekly patient visits
per physician continues an 11-year trend toward smaller patient loads. Patient loads have been decreasing
steadily since 1975 as more physicians enter the medical profession. Today's typical physician reports about
1 17.5 visits with patients each week. The 1985 survey of 4,040 nonfederal patient care physicians also showed
that the average physician spent 7.1% fewer hours on hospital rounds, while hours for office visits increased
only slightly (1.6%) during the first half of 1985 when compared with the first half of 1984. The decrease in
physician hours spent on hospital rounds, coupled with only a slight increase in office visits, implies that
physicians are working more in emergency rooms, outpatient clinics, and other nonoffice settings, a Socioeco-
nomic Monitoring System spokesman said.B
4
C E S
The Charitable, Educational and Scientific Foundation
>
Foundation
of the State Medical Society of Wisconsin recognizes the
generosity of the following individuals and organizations
of the State Medical
who have made contributions during the month ofOcto-
Society of Wisconsin
ber 1985.
Voluntary Contributions
Perla P Agpoon, MD
James D Buck, MD
Gail J Hansen, MD
Ervin F Kuglitsch, MD
Emilio M Lontok, MD
Thomas J Michlowski, MD
Benjamin M Victoria, Jr, MD
Work Week on Health
State Medical Society of
Wisconsin Auxiliary
Brown County Loan Fund
Dr and Mrs Robert Schmidt
Building and Equipment
Henry A Anderson, MD
Fred J Ansfield, MD
EA Bachhuber, MD
GJ Bachhuber, MD
James H Barbour, MD
Ann Bardeen-Henschel, MD
Gordon W Brewer, MD
Frederick Bunkfeldt, Jr, MD
Chris J Buscaglia, MD
E Frank Castaldo, MD
E Stanley Custer, MD
Frederick Jefferson Davis, MD
John C Docter, MD
Anton S Dorn, MD
Dean A Emanuel MD
William A Fischer, MD
John R Fuller, MD
Irwin Gaynon, MD
Gretchen Guernsey, MD
George H Handy, MD
George C Hank, MD
Samuel B Harper, MD
N Alfred Hill, MD
Dayton H Hinke, MD
CL Ingwell, MD
JW Johnson, MD
AJ Jurishica, MD
Dr and Mrs CK Kincaid
Martin H Klein, MD
Francis Kruse, Jr, MD
Joseph F Kuzma, MD
Gustave Landmann, MD
Jay A Larkey, MD
Jules D Levin, MD
Russell F Lewis, MD
John D Lynch, MD
William J Madden, MD
FW Madison, MD
Urquhart L Meeter, MD
A Melamed, MD
Nekoosa Medical Center, SC
James W Nellen, MD
Vincent W Nordholm, MD
GE Oosterhous, MD
Dr and Mrs David W Ovitt
Ewald H Pawsat, MD
Charles J Picard, MD
WH Pollard, MD
Margaret Prouty, MD
Sverre Quisling, MD
Raymond J Rogers, MD
William T Russell, MD
William C Sheehan, MD
John W Temple, MD
Loren L Thompson, MD
Henry Veit, MD
WH Williamson, MD
Robert G Wochos, MD
Edward Zupanc, MD
Memorialized
Gerald Bergmann, MD
Ruth E Church, MD
Mrs Elizabeth Garrow
Mr Daniel Griffen
Lester E Haushalter, MD
Raymond J Murphy, MD
Moktar Najafzadek, MD
Thomas E Schaewe
Richard Surplice
Mrs Marie Tormey
Benjamin E Urdan, MD
Mrs Clara E Watts
Calvin Yoran, MD
James D Zeratsky, MD
Memorials
Dr and Mrs Robin Allin
Anchor Savings and Loan
Geri Anderson
Mrs Mary Azchowski
Doris E Beighley
Mr and Mrs Chet Beyler
Mr and Mrs Walter Bruckner
Dr and Mrs Irwin J Bruhn
Robert C Buehner
Mr and Mrs Henry R Butler
Charlotte Campion
Dr and Mrs RF Collins
Edith L Cripps
Marion T Darbo
Dr and Mrs Frederick J Davis
Mr and Mrs FC Dettloff
Elaine Dietrick
Mr and Mrs Joseph Dwyer
Bernie and Theo Beisst
Dr and Mrs Carl Fosmark
Dr and Mrs Harold Giese
Maxine Gilbert
Mr and Mrs Eugene W Hankel
Dr and Mrs Tom Henney
Mr and Mrs Robert W Higgins
Elizabeth and Norma Kieffer
Grace Kuczmarski
Mr and Mrs Robert Madigan
Madison Gas and Electric
Company
John and Tony Martinelli
Marquette Elementary
Faculty
Josephine K Melson
Dr and Mrs HJ Morrell
Mr and Mrs George H Nelson
Dr and Mrs EJ Nordby
Herbert Olmslead
Rita G Peck
Mr and Mrs Don Pressentin
John Purcell
Margaret Purcell
Paul and Flo Roth
Mr and Mrs George H Schiler
Dr and Mrs Robert Schmidt
Robert C Spoentgen
State Medical Society of
Wisconsin
Mary Stellone
Beatrice B Tormey
Nancy Voelkner
Mary Wachter
Clara Wagner
Nancy Walsh
Beth Ward
Dr and Mrs William G Weber
Arthur W Wellman
Elizabeth Tormey Werner
Dr and Mrs Stephen C Werner
Mildred YoungB
66
WISCONSIN MEDICAL JOURNAL, DECEMBER 1985: VOL. 84
MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
East Range Clinics, Ltd seeks physicians
in the following specialties: Orthopedic
Surgery, Ophthalmology, and Internal
Medicine (with special interest in cardi-
ology, pulmonary medicine, or intensive
care). Opportunity to join established
practice with progressive multispecialty
group of 27 physicians; unlimited oppor-
tunity for outdoor recreation. Contact:
Gary Lishinski, Administrator, East Range
Clinics, Ltd, 910 North Sixth Ave, Vir-
ginia, MN 55792; ph 218/741-0150.
pl2/85;l-5/86
Rheumatologist. Will complete training
in a university rheumatology fellowship
7/86. Am interested in practice opportuni-
ties in Wisconsin or elsewhere in Mid-
west. Contact Dept 572 in care of the Jour-
nal, pl2/85
Wanted. Qualified physician to prac-
tice emergency medicine in Southeastern
Wisconsin beginning July 1986. Ours is a
small group covering two hospital emer-
gency rooms, maintaining secure profes-
sional contracts. Flexible scheduling and
competitive salary guaranteed. Interested
parties should send CV to Associated
Emergency Room Physicians, SC, 1131
Sherwood Lane, Caledonia, WI 53108; ph
414/835-4889. 12/85;l-6/86
Lake Superior. BC / BE internist needed
to join two young, quality -oriented general
internists, in a growing active practice.
Natural beauty, small-town environment
with sophisticated 105-bed hospital on the
south shore of Lake Superior. Excellent
salary and benefits. Contact Dept 573 care
of the Journal. pl2/85
Solo internist desiring general internist
to help in rapidly growing practice. Lo-
cated on shore of Lake Michigan in Michi-
gan's Upper Peninsula. New 107-bed
acute care hospital. Campus for Michigan
State College of Human Medicine. Call or
write Dennis Spender, MD, PC, 218 South
10th St, Escanaba, MI 49829; ph 906/786-
1563. pl2/85;ltfn/86
RATES: 50« per word, with a minimum
charge of $20.00 per ad. BOXED AD
RATES: $25.00 per column inch.
DEADLINE: Copy must be received by the
15th of the month preceding month of issue;
e.g., copy for the August issue is due July 15.
Send copy to: Wisconsin Medical Journal,
Box 1109, Madison, Wisconsin 53701: or
phone (area code 608) 257-6781: or toll-free
in Wisconsin: 800/362-9080.
Family practitioner. Seven-physician
primary care group in Green Bay, Wiscon-
sin needs one or two family practitioners
to join growing practices. Salary commen-
surate with training and experience. Con-
tact Kenneth J Hujet, MD, Dousman Clin-
ic, Green Bay, Wis 54303; ph 414/494-
9661. 12/85;l/86
South Central Minnesota Practice As-
sociation. Group Professional Corporation
has opening for family practice occupa-
tional medicine. Service area of 65,000,
fee for service; considering prepaid avail-
ability. Excellent benefits and earnings.
Profit sharing and 401(K) plans. Fine res-
idential living in outstanding small city of
20,000, ninety minutes from Minneapolis-
St Paul. First class facilities and hospital,
challenging medical practice. Contact: Al-
bert Lea Regional Medical Group, PA, B
J Boss, Associate Administrator or William
Brouwer, Administrator, 1602 Fountain
St, Albert Lea, MN 56007; ph 507/373-
8251. 12/85;l/86
Family practitioner needed to join 11-
physician expanding multispecialty prac-
tice in upper midwest. Board certified or
eligible. Clinic adjoins JCAH hospital.
Rural location with abundant outdoor rec-
reational opportunities, small four-year
college. Excellent salary and benefits. Call
collect 715/532-6651 or send curriculum
vitae with names of references to: Howard
Chatterton, MD, 906 College Ave, West,
Ladysmith, WI 54848. 12/85;l-2/86
Wisconsin, expanding and innovative
group of residency-trained board certified
emergency physicians is seeking ABEM
certified /prepared emergency physicians
for staff and administrative positions at
Columbia Hospital in Milwaukee and
Kenosha Memorial Hospital. Excellent pa-
tient populations, medical and administra-
tive staffs, and medical school affiliation.
Equity positions available. Send CV to:
Thomas A Reminga, MD, Dept of Emer-
gency Medicine, Columbia 2025 East
Newport Ave, Milwaukee, WI 53211; ph
414/961-3508. 12/85;l-2/86
Growing multispecialty clinic is look-
ing for two family practitioners. One to
staff a three-person Walk-In Department
and the other to function in a traditional
family practice setting located in North
Central Wisconsin. New facility situated
across the street from new hospital. Full
partnership in two years. Easy access to
lakes, woods, and mountains. Write in-
cluding CV to D K Aughenbaugh, MD,
Medical Director, Wausau Medical Cen-
ter, 2727 Plaza Dr, Wausau, WI 54401.
pll-12/85;l/86
Family Practitioner. River Valley Medi-
cal Center is seeking two family practice
Board eligible /certified physicians for its
multispecialty group of 16 physicians in
Northwest Wisconsin. Excellent starting
salary and comprehensive fringe benefit
package the first year with full group
membership after one year. Attached to
a progressive 90-bed hospital. We are
within 45 minutes of the St Paul-Minne-
apolis area. Please contact Dr Carl Han-
sen, Recruitment Chairman or Tom Hal-
verson, Clinic Manager, 208 Adams St,
South, St Croix Falls, WI 54024; ph 715/
483-3221. pll/85;12tfn/85
Family Practice. Third family practice
physician needed to join multispecialty
group of 17 in Hartford, WI. Two branch
locations. All facilities modern and well
equipped. Guaranteed first year negoti-
able salary; usual fringe benefits. Contact:
Murlin Bernd, Clinical Manager, 1004 E
Sumner St, Hartford, WI 53027; ph 414/
673-5745. 12/85;l/86
Wisconsin-Urgent Care Positions. Avail-
able on a part-time basis— weekends and
weekdays for BC/BE family practitioners,
internists. For more information contact
Douglas Gremban, MD, St Elizabeth's
First Care North, 1225 W Northland Ave,
Appleton, WI 54914. Either send CV or
telephone 414/738-2005. 12/85
Physician Preceptor in pediatrics. Up-
per Peninsula Health Education Corpora-
tion is accepting applications for a full-
time Physician Preceptor in Pediatrics.
Responsibilities include patient care and
clinical instruction of medical students of
Upper Peninsula branch campus of Michi-
gan State University's College of Human
Medicine. Requirements are board eligi-
bility or certification in pediatrics with a
commitment to medical education. Aca-
demic rank and salary commensurate
with experience. Send inquiries to John
Hickner, MD, Medical Director, Bay de
Noc Family Health Center, Doctors Park,
Escanaba, Mich 49829; ph 906/786-9510.
12/85
Wanted Board Certified Otolaryngol-
ogist. Head and neck surgeon. Join active
one-man practice. General otolaryngol-
ogy, head and neck surgery, facial plastic
surgery, nasal allergy. Computerized of-
fice with x-ray, audiologist, and hearing
aid dispensing. Northern Wisconsin near
Apostle Islands National Lakeshore. Con-
tact James A Hamp, MD, ENT Profes-
sional Associates, SC, 2101 Beaser Ave,
Suite 1, Ashland, WI 54806; ph 715/682-
9311. 10-12/85;l-3/86
WISCONSIN MEDICAL JOURNAL, DECEMBER 1985: VOL. 84
67
MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
continued
Women's OB /GYN Care, SC of Wauke-
sha, Wisconsin, is seeking a BE/BC OB/
GYN, including residents finishing '86-87,
in a private, fee-for-services practice. This
would add a fifth OB /GYN to our call
schedule. Salary is negotiable with first
year guarantee and early partnership. This
50,000 member community has solid sup-
port for patient centered OB /GYN care.
Referrals from area general practitioners
allow the OB /GYN to spend the majority
of time practicing the specialty. Our nurse
practitioner provides excellent patient
education and preventive self-care. Our
hospital is a Level #2 Obstetric facility
with excellent pediatric colleagues, three
of whom have neonatal experience. Wis-
consin provides a myriad of outdoor and
recreational activities and Milwaukee cul-
tural events are only Vz hour away. Send
CV to Dr Anne Riendl, PO Box 1907, Wau-
kesha, WI 53187-1907: ph 414/544-2801.
11-12/85
Family Practitioner wanted to share ex-
isting practice and fully-equipped medical
office in Waushara County. Salary plus in-
centives and opportunity for eventual pur-
chase of practice. Excellent recreational
area, a great place to live and raise a fam-
ily. Send inquiries to Roy Grunwaldt, Ad-
ministrator, Wild Rose Hospital, PO Box
243, Wild Rose, WI 54984: ph 414/622-
3257, ext 212. pll-12/85:l-2/86
Family practice associate desired to join
established Family Practice Group in cen-
tral Indiana community of 50,000. Excel-
lent facilities, comprehensive benefits,
highly competitive earnings. Must be
Board certified or eligible. Send curricu-
lum vitae to: D Rogers, Business Manager,
Kokomo Family Care, Inc, 806 South
Berkley Rd, Kokomo, Ind 46901: ph 317/
457-8341. pl2/85
FAMILY PRACTITIONERS
INTERNISTS, OB/GYN
The UW Office of Rural Health is seek-
ing primary care specialists for more
than 50 communities throughout Wis-
consin. Opportunities are available
throughout Wisconsin for Board certi-
fied physicians trained in US medical
schools and residencies.
CONTACT:
Laurie Glowac or Fred Moskol
New Physicians for Wisconsin
University of Wisconsin
Department of Family Medicine
777 S Mills St, Madison, WI 53715
Phone 608/263-4095 7/85-6/86
Emergency physicians full or part-time.
Positions available in a moderate volume
emergency room in Beloit, Wis. Must
have an active interest in community re-
lations. ACLS required. ATLS desirable. If
interested, contact John Maher, MD, Di-
rector, Emergency Department, Beloit
Memorial Hospital, 1969 W Hart Rd,
Beloit, WI 53511. 11-12/85
Family Practice: Thirty-one physician
multispecialty group conveniently lo-
cated between Chicago and Milwaukee.
Well-equipped clinic offering salary
gaurantee with incentive bonus: excel-
lent fringe benefits and early ownership.
Please send curriculum vitae to: R D
Lacock, Administrator, Racine Medical
Clinic, 5625 Washington Ave, Racine,
WI 53406. 9tfn/85
Fifty-eight-year-old general practitioner
seeking part or full-time work in outpatient
medical practice. Considerable experience
in student health work. Have Wisconsin
license. Available reasonably soon. Inter-
ested in small communities. Contact Dept
571 in care of the Journal. pi 1-12/85
Ophthalmologist, subspecialty pediatrics
or glaucoma helpful but not required.
Board certified /Board eligible, to join one
other Board certified ophthalmologist in
rapidly expanding 40-member multi-
specialty group with high level ophthalmic
pathology. Must be willing to do general
ophthalmology. Immediate drawing area
100,000 with unopposed subspecialty re-
ferral area much higher. Located on Lake
Michigan with excellent recreational ac-
tivities. Optometric support available. First-
year salary. Association after one year with
income based solely on production with
superb benefits package. Contact D K Ay-
mond, MD, The Sheboygan Clinic, 1011
North 8 Street, Sheboygan, WI 53081: ph
414/457-4461. 9tfn/85
Wisconsin: Pediatrician with sub-
specialty interest to join multispecialty
clinic that includes general pediatricians,
pediatric hematologist, oncologist and
neonatologist in city of 150,000. Send
CV to Dept 561 in care of the Journal.
8tfn/85
Progressive Multispecialty Clin-
ic in Milwaukee requires physi-
cians in the following specialties:
Family Practice, Orthopedic con-
sultation and evaluation. Internal
Medicine /Cardiology, Surgery/
Emergency Trauma. Modern self-
contained clinic offers competitive
salary and attractive benefits in-
cluding malpractice insurance.
These staff needs are IMMEDI-
ATE. Please forward CV and ref-
erences to Dept 574 in care of the
Journal. 12/85;l/86
Ophthalmologist. Board certified /Board
eligible, to join one other Board certified
ophthalmologist in rapidly expanding
40-member multispecialty group with high
level ophthalmic pathology. Immediate
drawing area 100,000. Located on Lake
Michigan with excellent recreational activ-
ities. First -year salary. Association after one
year with income based solely on produc-
tion with superb benefits package. Contact
D K Aymond, MD, The Sheboygan Clinic,
101 1 North 8 Street, Sheboygan, WI 53081:
ph 414/457-4461. 9tfn/85
Pediatrics/Neonatology: Thirty-one
physician multispecialty group con-
veniently located between Chicago and
Milwaukee. Well-equipped clinic offer-
ing salary guarantee with incentive
bonus: excellent fringe benefits, and
early ownership. Neonatology skills
needed for Level II Nursery. Please send
curriculum vitae to R D Lacock, Admin-
istrator, Racine Medical Clinic, 5625
Washington Ave, Racine, WI 53406.
9tfn/85
Family practice opportunity— very
busy five-physician practice being cov-
ered by four physicians. Pleasant South
Central Wisconsin community of 15,000:
close to Milwaukee and Madison. Excel-
lent recreational area. First-year guaran-
teed salary. Excellent benefits. Contact:
C Burchardt, Medical Associates, 1200 N
Center, Beaver Dam, WI 53916: ph 414/
887-7101. lOlfn/85
Internist or Family Practitioner to join
two Internists and General Surgeon in
growing, established. Green Bay area
practice. Send CV to John Brusky, MD,
1203 South Military Ave, Green Bay, WI
53404. 7tfn/84
Pediatrician. BC/BE to join busy four-
member Pediatric Department within a
23-member multispecialty group. Excel-
lent benefits and competitive salary. Call
or write: W J Mommaerts, Administrator,
West Side Clinic, sc, 1551 Dousman St,
Green Bay, WI 54303: ph 414/494-5611.
10-12/85:1/86
Physicians needed full or part-time to
perform light physicals. Milwaukee area.
Professional liability provided. Phone
414/344-2100, Ms Jenkins. lOtfn/84
Psychiatrist wanted. Wisconsin li-
censed and Board certified or eli-
gible psychiatrist, part-time (20-35
hours/ week) at the Bureau of
Social Security Disability Insur-
ance in Madison. If interested,
write or telephone Daniel Kahn,
MD, PO Box 7623, Madison, WI
53707: ph 608/266-6608.
12/85:1/86
68
WISCONSIN MEDICAL JOURNAL, DECEMBER 1985: VOL. 84
MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
continued
Excellent opportunity for a Board cer-
tified or eligible internist to practice
in conjunction with an 8-member Inter-
nal Medicine Department of a 26-mem-
ber multispecialty group. The group is
located in southeastern Wisconsin, in a
city of 100,000 between two major
metropolitan areas of greater than one
million. If interested, please send CV to:
Stephen L Wagner, Kurten Medical
Group, 2405 Northwestern Ave, Racine,
WI 53404. All inquiries will be kept
confidential. 6tfn/85
Family Practitioner needed to join two
FPs at the Ellsworth, Wisconsin office
of a progressive eleven-physician group.
Liberal fringes and financial package.
Forty miles from metropolitan Min-
neapolis/St Paul. Contact R M Hammer,
MD, River Falls, WI 54022; ph 715/425-
6701 or 612/436-8809. 4tfn/85
Wanted — Board qualified— board cer-
tified obstetrician-gynecologist as an
associate. Modern well equipped facility.
Excellent starting salary and benefits in-
cluding profit sharing plan. Please contact
Elizabeth Allen Steffen, MD, 734 Lake
Ave, Racine, Wis 54303. 9tfn/83
OB/GYN: BC/BE to join three OB-GYNs
in 31-physician multispecialty group.
Beautiful lakefront community of 90,000
located between Milwaukee and
Chicago offers a wealth of cultural, edu-
cational, and recreational opportunities.
Well-equipped clinic and two local
hospitals: salary guarantee with in-
centive bonus; excellent fringe benefits
and early partnership. Send curriculum
vitae to: R D Lacock, Administrator,
Racine Medical Clinic, 5625 Washington
Ave, Racine, WI 53406. 9tfn/85
Primary care physicians— Family Prac-
tice, General Practice, or ER experience
desirable. To staff clinics for industrial,
walk-in, after hours and satellite medi-
cine. Excellent opportunity— guaranteed
salary, profit-sharing, great fringes.
Send CV to: Administrator, Manitowoc
Clinic, PO Box 3008, Manitowoc, WI
54220. 9-12/85
Family Practitioner needed to join
established Family Practice group in East
Central Wisconsin city of 50,000 on
beautiful Lake Winnebago. Competitive
salary, fringes, excellent recreation area.
Send CV to MS Knier, MD, 555 S Wash-
burn, Oshkosh, Wis 54901; 414/426-0265.
lOtfn/84
Urgent care physician and internist. Op-
portunities available as clinic services ex-
pand. This 35-member multispecialty
group, including 13 internists, is housed
in a modern facility next to the 240-bed
Mercy Hospital and has a drawing area of
100,000. Send CV with inquiry: Ernest C
Deeds, MD, Box 551, Janesville, WI 53547.
12/85
Second Family Practitioner needed to
staff a satellite of a 38-physician multi-
specialty group in Kiel, a beautiful small
community in East Central Wisconsin. At-
tractive income arrangements, association
membership possible after one year, pen-
sion and profit sharing, extensive fringe
benefits. Contact R B Windsor, MD, 1011
North 8 St, Sheboygan, WI 53081; ph 414/
457-4461. c2tfn/85
West Bend, Wisconsin, General Clin-
ic, a (18| physician multispecialty group,
is seeking physicians in the specialties of
Internal Medicine, Family Practice, OB/
GYN, and Pediatrics. First-year salary
guaranteed. Corporate membership pos-
sible after one year. Excellent fringe
benefits. Located in scenic, recreational
area with close proximity to Milwaukee.
Please contact Hans W Schmelzling, Ad-
ministrator, General Clinic, 279 S 17th
Ave, West Bend, WI 53095; ph 414/338-
1123. 6tfn/85
ORTHOPEDIC SURGEON
Mid-Michigan community seeks orthopedic
surgeon for service area of 90,000. Guaranteed first
year income $150,000. Office space available in
medical office building adjacent to the hospital.
214-bed hospital provides excellent diagnostic
capabilities and new surgical facilities. Excellent
opportunity for a physician seeking busy private
practice opportunity with guaranteed success. Con-
tact Vice
723-5211,
President of Professional Service — 517/
ext 1823. pn-12/85;l-2/86
WISCONSIN MEDICAL JOURNAL, DECEMBER 1985: VOL. 84
69
MEDICAL YELLOW PAGES
PHYSICIANS EXCHANGE
continued
Versatile Surgeon wanted to comple-
ment aggressive family practice group in
rural northeastern Minnesota resort com-
munity. Well-equipped 40-bed hospital
with proven surgical practice volume.
Outstanding outdoor recreational op-
portunities with time off to enjoy it.
Reply with CV to E Johnson, Ely Medical
Center, Ltd, 224 East Chapman Street,
Ely, Mn 55731; ph 218/365-3151. 6tfn/85
Family Practice physician, BE/BC, to
share fully equipped medical office in
southeast Wisconsin with busy Board cer-
tified family practitioner. Opportunity for
partnership. Near Milwaukee and Chi-
cago, rural atmosphere. Excellent recrea-
tional, educational, hospital, and civic ad-
vantages. Send curriculum vitae to F M
Zarbock, MD, Box 158, S89 W22915
Maple Ave, Big Bend, WI 53103.
11-12/85:1/86
MEDICAL FACILITIES
General and surgical solo practice for
sale. Gross in excess of $300,000. Grow-
ing desirable midwestern university
city with population 25,000. One very
well-equipped hospital in county of
60,000 a few blocks away. Owner will
remain to introduce. Contact Dept 563 in
care of the Journal. 9tfn/85
MISCELLANEOUS
Physicians Signature Loans to $50,000.
Up to 7 years to repay. Competitive fixed
rate, with no points, fees, or charges of any
kind. No prepayment penalties. Prompt,
courteous service. Physicians Service
Assn, Atlanta, GA. Toll-Free (800)241-
6905. lOeom/83
HOLTER MONITOR
Quality Scanning for reel or cas-
sette type recorders by qualified
technicians and certified cardiolo-
gists' interpretations, scan price
$35.00 with UPS speedy delivery.
Recorders loaned, leased, or pur-
chase new dual-channel Holter re-
corders, $1295.00, with one-year
warranty. For more information call
Advance Medical and Research
Center 1-800/552-6753. lltfn/85
We buy / sell / lease and service new and
reconditioned Holter-Stress-Echo-EKG
and other Medical Electronic Instruments.
Contact Ed Bentolila, New Life Systems,
Inc, PO Box 8767, Coral Springs, FL 33065;
ph 305/972-4600. 12/85;l-2/86
For sale: Going out of business; will sell
Gemstar Chemical Analyzer and Circadi-
an Holter Monitor. Ph 515/484-4953.
12/85
MEDICAL MEETINGS-
CONTINUING MEDICAL
EDUCATION
WISCONSIN
JANUARY 19-22, 1986: New Therapeu-
tics VI: The Results of Recent Advances in
Medicine. Telemark Lodge, Cable, Wis.
Sponsored by University of Wisconsin
School of Medicine and Continuing Medi-
cal Education. AMA Category I credit 14
hours. Family Practice credit pending,
University of Wisconsin CEUs 1.4. Con-
tad: Ann Bailey, Continuing Medical Edu-
cation, 454 WARE Bldg, 610 Walnut St,
Madison, Wis 53705; ph 608/263-2854.
11-12/85
MARCH 6-7, 1986: Symposium on
Chronic Obstructive Pulmonary Disease.
The Sheraton Inn, Madison. Sponsored by
Wisconsin Specialty
Society Meetings 1986
• Wisconsin Urological Society,
Apr 11-12, 1986, Edgewater
Hotel, Madison
• Wisconsin Radiological Society,
May 30-31, 1986, American Club,
Kohler
• Wisconsin Society of
Anesthesiologists, Sept 5-7,
1986, The Abbey,
Lake Geneva
• Wisconsin Academy of Family
Physicians, June 11-14, 1986,
Telemark Lodge, Cable
• Wisconsin Society of Obstetrics
& Gynecology, July 17-19, 1986,
Embassy Suites, Green Bay
• Wisconsin Dermatological
Society, Aug 1-3, 1986, The
Abbey, Lake Geneva
• Wisconsin Society of Internal
Medicine, Sept 11-13, 1986,
The Edgewater Hotel, Madison
• Wisconsin Radiological Society,
Oct 3-4, 1986, The Concourse
Hotel, Madison
Continuing Medical Education, School of
Medicine, University of Wisconsin-Madi-
son; Pulmonary Section, Department of
Medicine, School of Medicine, University
of Wisconsin-Madison; and Departments
of Nursing and Respiratory Therapy, Clin-
ical Science Center, University of Wiscon-
sin-Madison. AMA Category I credit and
University of Wisconsin CEUs— both ap-
proximately 14 hours. Contact: Sarah As-
lakson. Continuing Medical Education,
610 Walnut St, 465B WARE Bldg, Madi-
son, WI 53705; ph 608/263-2856. 12/85
APRIL 11-12, 1986: Wisconsin Urolog-
ical Society, Edgewater Hotel, Madison.
gll-12/85;l-3/86
MAY 30-31, 1986: Wisconsin Radiolog-
ical Society, American Club, Kohler.
gl2/85;l-4/86
JUNE 11-14, 1986: Wisconsin Academy
of Family Physicians, Telemark Lodge,
Cable. gll-12/85;l-5/86
JULY 17-19, 1986: Wisconsin Society of
Obstetrics & Gynecology, Embassy Suites,
Green Bay. gll-12/85;l-6/86
AUGUST 1-3, 1986: Wisconsin Derma-
tological Society, The Abbey, Lake Gene-
va. gll-12/85;l-7/86
SEPTEMBER 5-7, 1986: Wisconsin
Anesthesiologists, The Abbey, Lake Gene-
va. gl2/85;l-8/86
THIS LISTING is compiled by the State
Medical Society of Wisconsin in coopera-
tion with others who wish to maintain a
centralized schedule of meetings and
courses of interest to Wisconsin physicians
and to avoid scheduling programs in conflict
with others. Hospitals, Clinics, Specialty
Societies, and Medical Schools are par-
ticularly invited to utilize this listing service.
There is a nominal charge for listing of Con-
tinuing Medical Education courses at the
following rates: 50t per word, with a mini-
mum charge of $20.00 per listing.
BOXED LISTINGS; $25.00 per column
inch. Listings of other scientific meetings,
will be included at the discretion of the
editors.
COPY DEADLINE tor listings is 15th of the
month preceding the month of publication:
e.g., copy for the August issue is due by July
15. Address communications to: Wisconsin
Medical Journal, Box 1109, Madison, Wis-
consin 53701; or phone (area code 608|
257-6781; or toll-free in Wisconsin: 800/
362-9080.
FOR LISTING of other meetings see the
January 4, 1985 issue of the Journal of the
American Medical Association: Continuing
Education Opportunities for Physicians for
period January 1985 through December
1985.
70
WISCONSIN MEDICAL JOURNAL, DECEMBER 1985: VOL. 84
MEDICAL YELLOW PAGES
MEDICAL MEETINGS-
CONTINUING MEDICAL
EDUCATION
continued
SEPTEMBER 11-13, 1986: Wisconsin
Society of Internal Medicine, The Edge-
water Hotel, Madison. gl2/85, ’1-8/86
OCTOBER 3-4, 1986: Wisconsin Radio-
logical Society, The Concourse Hotel,
Madison. gl2/85;l-9/86
OTHERS
JANUARY-JULY 1986: (Minnesota):
Continuing medical education programs,
University of Minnesota Medical School,
Minneapolis. See details in full-page ad
elsewhere in this issue. glO/85
FEBRUARY 13-14, 1986 (Michigan):
Tenth Annual Winter Pediatric Confer-
ence at Powderhorn Ski Area, Ironwood,
Michigan. Guest speaker is James A
Stockman, III, MD. Info: Marshfield
Medical Education Deparlmenl or H
James Nickerson, MD, Marshfield Clinic,
1000 North Oak Ave, Marshfield, Wis-
consin 54449. 9-12/85; 1-86
1986 CME CRUISE/ CONFERENCES
ON SELECTED MEDICAL TOPICS-
Caribbean, Mexican, Hawaiian, Alaskan,
Mediterranean. 7-12 days year-round.
Approved for 20-24 CME Category 1
credits (AMA/PRA) & AAFP prescribed
credits. Distinguished professors. FLY
ROUND-TRIP FREE ON CARIBBEAN,
MEXICAN, & ALASKAN CRUISES. Ex-
cellent group fares on finest ships. Reg-
istration limited. Prescheduled in com-
pliance with present IRS requirements.
Information; International Conferences,
189 Lodge Ave, Huntington Station, NY
11746; ph 516/549-0869. plO-12/85
WEEKLY SEMINARS
Most major ski areas, Club Med,
Disney World, Cruising aboard
Sailboats in the Virgin Islands or a
Mississippi Paddlewheeler. Topic:
Medical-legal issues. Accredited
Category 2 by AMA.
Current Concept Seminars, Inc
(since 1980). 3301 Johnson St,
Hollywood, FL 33021; ph 800/
428-6069. $175. p9-12/85; 1-2/86
APRIL 10-13, 1986 (California): Amer-
ican College of Physicians 67th Annual
Session, San Francisco Moscone Center,
San Francisco, Calif. gl2/85;l-3/86
APRIL 11-13, 1986 (Illinois): AMA's
Seventh National Conference on the Im-
paired Physician, Hilton Hotel and
Towers, Chicago, (see further details in
this section) gl2/85;l-3/86
AMA
JUNE 21-25, 1987: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 6-9, 1987; Interim AMA
House of Delegates, Atlanta, GA.
JUNE 26-30, 1988: Annual AMA House
of Delegates, Chicago, IL.
DECEMBER 4-7, 1988: Interim House
of Delegates, Dallas, TX. ■
AMA's 7th National Conference
on the Impaired Physician
IMPAIRMENT AND WELL
BEING OF HEALTH
PROFESSIONALS: A FAMILY
AFFAIR
April 11-13, 1986/Hilton
Hotel and Towers, Chicago
Sponsored by AMA in cooperation
with the American Central Associa-
tion, American Medical Veterinary
Association, American Nurses' As-
sociation, American Pharmaceutical
Association, American Podiatric
Medical Association, American
Medical Womens Association and
National Medical Association. The
Illinois State Medical Society is act-
ing as host.
The conference, which will focus
not just on impaired physicians but
also on allied health professionals,
will serve as a forum for those in-
volved with primary and/or secon-
dary prevention and treatment of
impairment. Attendees will be
drawn from hospital administra-
tors, licensing board personnel,
school deans, residency training di-
rectors, spouses, and medical stu-
dent leaders.
Info: Janice Robertson, Media Re-
lations Department, 535 North
Dearborn St, Chicago, IL 60601; ph
312/645-5079. gl2/85;l-3/86
ADVERTISERS
Acme Laboratories 18
Advanced Technology Associates,
Inc / . . 17
Medical Computer Systems
American Motors Health Plan 4
American Physicians Life 28
Army Medicine 9
Dista Products Co (Div of Eli
Lilly & Co) 53
Ceclor®
Gaarder Miller Milwaukee
Ltd 9
House of Bidwell 48
Knoll Pharmaceutical
Company 54, 55, 56
Isoptin®
Marion Laboratories 35, 36
Cardizem®
Medical College of Wisconsin 29
Physician Resource Network
Medical Protective Company 16
PBBS Equipment 52
Peppino's 18
Professionals Insurance
Company, The 42
Roche Laboratories 73, BC
Dalmane®
S&L Signal Company 18
SMS Services, Inc 47 ■
State Medical Society
of Wisconsin
Dates and locations of
ANNUAL MEETINGS
1986-1992
All meetings will be held in Milwau-
kee at the Milwaukee Exposition and
Convention Center and Arena
(MECCA) and the new Hyatt Regency
as the headquarters hotel.
1986- April 17-19
1987- March 26-28
1988- April 28-30
1989- April 13-15
1990- April 26-28
1991- April 18-20
1992- April 23-25
Meeting days will be Thursday and
Friday; the first session of the House
of Delegates will convene on Thurs-
day, the second and third on Friday.
Scientific programming will be on Fri-
day and Saturday.
Further information: Commission on
Continuing Medical Education, State
Medical Society of Wisconsin, Box
1109, Madison, Wis 53701. Local tele-
phone: 257-6781; toll-free in Wiscon-
sin: 1-800/362-9080.
WISCONSIN MEDICAL JOURNAL, DECEMBER 1985: VOL. 84
7
NEWS YOU CAN USE
HEALTH PROSPECTS 1983/2003 SURVEY REPORTED. The State Medical Society was one of 415 health sys-
tem leaders who completed a survey conducted by the Project HOPE Center for Health Affairs to determine
health prospects from 1983 to 2003. A report of the survey shows that respondents expected life-expectancy
to increase 3.7 years by 2002. Health status was also expected to improve in the next 20 years, but less than
it had in the past 20 years. Respondents expected continued growth in health expenditures, although increases
were expected to moderate, especially from 1988-2002. Almost all respondents believed the public's greatest
concern about personal health services had shifted from access in 1962 to cost in 1982. Two out of every five
respondents said "cost" is the most important problem of the US health system today. Half of these respondents
wanted to implement competition or cost -containment, or encourage alternative delivery systems; the remainder
described other changes. Respondents' visions of the most significant change that would occur in the US health
system in the next 20 years included: Improved lifestyles; the corporatization (sic) of healthcare; a national
healthcare system; competition among providers; and advances in technology. Respondents were generally
more optimistic about the system's long-term future (1988-2002) than about the outlook for the next five years.
There appear to be no universally shared assumptions about the best way to improve health status or the ef-
ficiency of healthcare delivery, the report concluded. Physicians wishing a copy of the report may contact:
Allen S Meyerhoff, Senior Policy Analyst, Project HOPE, Center for Health Affairs, Millwood, VA 22646 (ph
703/837-2100) or Peter G Goldschmidt, MD, Director, Policy Research Institute, 2500 Maryland Ave, Balti-
more, MD 21218 (ph 301/889-3000).b
COLINCIL ON ETHICAL AND JUDICIAL AFFAIRS of the AMA is planning a national conference on medical
ethics March 14-16, 1986 in New Orleans. The conference will be cosponsored by the Hastings Center, Hast-
ings-on-Hudson, NY. For further information contact Mary Devlin, Medicolegal Affairs, AMA headquarters,
Chicago. The telephone number is (312) 645-4613. ■
JCAH ANNOUNCES NEW QUALITY REVIEW BULLETIN. The Joint Commission on Accreditation of Hospitals
QCAH) has announced publication of the new Quality Review Bulletin (QRB) special publication. Quality of Care
for the Terminally III: An Examination of the Issues. A collection of articles written by noted authorities, this publi-
cation provides practical information about the various aspects involved in the care of terminally ill patients.
Issues addressed include: quality assurance; law and ethics; financial, risk, and pain management; and psycho-
social, spiritual, and bereavement care. This special publication can be ordered by sending $20 for each copy to:
Cashier: JCAH, 875 North Michigan Ave, Chicago, IL 60611. Foi further information regarding this or any
JCAH publication, telephone Customer Service at JCAH, 312/642-6061. ■
AMA SAYS SUPREME COURT ACTION ON CALIFORNIA MALPRACTICE LAW IS SIGNIFICANT'. The
United States' Supreme Court ruling October 18 to dismiss an appeal challenging the constitutionality of the
1975 California law establishing a $250,000 maximum limitation on noneconomic losses in medical liability
suits is "significant," the AMA said in a national bulletin issued on the heels of the ruling. The 8-1 dismissal
for lack of a "substantial federal question" was greeted as "a strong signal to the state legislatures and courts
that they may place limits on court awards for both economic and noneconomic damages in professional liabil-
ity cases." California and Indiana are the only two states which have upheld the constitutionality of liability
"caps." The Supreme Court's lone dissenter. Justice Byron White, cautioned, however, that "whether due
process requires a legislatively enacted compensation scheme to be a quid pro quo for the common law or
state law remedy it replaces, and if so, how adequate it must be, . . . appears to be an issue unresolved by
this court." Furthermore, White said, the issue is "one which is dividing the appellate and highest courts of
several states. The issue is important, and is deserving of this Court's review. Moreover, given the continued
national concern over the 'malpractice crisis' it is likely that more states will enact similar types of limitations
and that the issue will recur. "■
72
WISCOXSIX .MEDICAL JOCRXAL, DECEMBER 1985 :\ OL. 84
4-'
EXCERPTS FROM A SYMPOSIUM
THE TREATMENT OF SLEEP DISORDERS"®
. . highly effective
for both sleep induction and
sleep maintenance ff
Sleep Laboratory Investigator
Pennsylvania
. . onset of action is
rapid. . .provides sleep with
no rebound effect to agitate the
patient the following day A ^
Psychiatrist
Calitornia
•• . . appears to have
the best safety record of any
of the benzodiazepines ff
Psychiatrist
Calitornia
After 15 years, the experts still concur about the
continuing value ot Dolmone (tlurozepom HCI/
Roche). It provides sleep that satisfies patients. . .
and the wide margin ot safety that satisfies you.
The recommended dose in elderly or debilitated
patients is 15 mg. Contraindicated in pregnancy
DALMANE
flurazepam HCI/Roche ®
sleep that satisfies
15-mg/30-mg
capsules
References: 1. Kales J. etal: Clin Pharmacol T/ie y2 691-
697, Jul-Aug 1971 2. Kales A, etal Clin Pharmach,^heff^
/8 356-363, Sep 1975 3. Kales A, etal Clin Pham it)Col\
Ther /9 576-583, May 1976 4. Kales A, etal: ClinPharmV
col Ther 32:781-788, Dec 1982 5. Frast JD Jr, DeLucchi A
MR J Am Gerlatr Sac 27 5AI-M8, Dec 1979 6. Dement \
WC, etal: BehavMed, pp 25-31, Oct 1978 7. Kales A,
Kales JD; J Clin Psychopharmacol 3:]A0-]50, Apr 1983
8. Tennant FS, etal: Symposium on the Treatment of Sleep
Disorders, Teleconference, Oct 16, 1984 9. Greenblatt DJ,
Allen MD, Shader Rl: Clin Pharmacol Ther 21 385-381,
Mar 1977.
flurazepam HCI/Roche (w
Before prescribing, please consult complete product
information, o summary of which follows:
Indications: Effective in oil types of insomnia characterized
by difficulty in tolling asleep, frequent nocturnal awakenings
and/or early morning awakening, in patients with recurring
insomnia or poor sleeping habits, in acute or chronic medical
situations requiring restful sleep Objective sleep laboratory
data have shown effectiveness for at least 28 consecutive
nights of administration Since insomnia is often transient
and intermittent, prolonged administration is generally not
necessary or recommended Repeated therapy should only
be undertaken with appropriate patient evaluation
Contraindications: Known hypersensitivity to flurazepam HCI,
pregnancy Benzodiazepines may cause fetal damage when
administered during pregnancy Several studies suggest an
increased risk ot congenital malformations associated with
benzodiazepine use during the first trimester Worn patients
of the potential risks to the fetus should the possibility of be-
coming pregnant exist while receiving flurazepam Instruct
patients to discontinue drug prior to becoming pregnant Con-
sider the possibility of pregnancy prior to instituting therapy
Warnings: Caution patients about possible combined effects
with alcohol and other CNS depressants An additive effect
may occur if alcohol is consumed the day following use for
nighttime sedation This potential may exist tor several days
following discontinuation Caution against hazardous occu-
pations requiring complete mental alertness (e g . operating
machinery, driving) Potential impairment of performance of
such activities may occur the day following ingestion Not
recommended tor use in persons under 15 years of age
Withdrawal symptoms rarely reported, abrupt discontinuation
should be avoided with gradual tapering of dosage for those
potients on medication for o prolonged period of time Use
caution in administering to addiction-prone individuals or
those who might increase dosage
Precautions: In elderly and debilitated patients, it is recom-
mended that the dosage be limited to 15 mg to reduce risk of
oversedation, dizziness, confusion and/or otoxia Consider
potential additive effects with other hypnotics or CNS depres-
sants Employ usual precautions in severely depressed
patients, or in those with latent depression or suicidal tenden-
cies, or in those with impaired renal or hepatic function
Adverse Reactions: Dizziness, drowsiness, lightheadedness,
staggering, atoxio and tolling hove occurred, particularly in
elderly or debilitated patients Severe sedation, lethargy, dis-
orientation and coma, probably indicative of drug intolerance
or overdosage, have been reported Also reported headache,
heartburn, upset stomach, nausea, vomiting, diarrhea, con-
stipation, Gl pom, nervousness, talkativeness, apprehension,
irritability, weakness, palpitations, chest pains, body and joint
poms and GU complaints There have also been rare occur-
rences of leukopenia, granulocytopenia, sweating, flushes,
difficulty in focusing, blurred vision, burning eyes, faintness,
hypotension, shortness of breath, pruritus, skin rash, dry
mouth, bitter taste, excessive salivation, anorexia, euphoria,
depression, slurred speech, confusion, restlessness, halluci-
nations, and elevated SGOT, SGPT, total and direct bilirubins,
and alkaline phosphatase, and paradoxical reactions, e g .
excitement, stimulation and hyperactivity
Dosoge: Individualize for maximum beneficial effect Adults
30 mg usual dosage, 15 mg may suffice in some patients
Elderly or debilitated patients. 15 mg recommended initially
until response is determined
Supplied: Capsules containing 15 mg or 30 mg flurazepam
HCI
Roche Products Inc
Manati, Puerto Rico 00701
*i FOR SLEEP
After more than 1 5 years of use, ifs # 1 for sleep that satisfies.
Patients are satisfied because they fall asleep fast and stay
asleep till nnorning. ^ ® And you're satisfied by the exceptionally
wide margin of safety^ ® As always, caution patients about
driving or drinking alcohol.
Please see references and summary of product information on reverse side
DALMANE
flurazepam HCI/Roche <g
sleep that satisfies
Copyright t 1985 by Roche Products Inc^ All rights reserved
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